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Holmgren A, Giang KW, Fedchenko M, Eriksson P, Dellborg M, Mandalenakis Z. Ischemic Stroke in Patients With Congenital Heart Disease and Atrial Fibrillation. J Am Heart Assoc 2024; 13:e032813. [PMID: 39190565 DOI: 10.1161/jaha.123.032813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/16/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common arrhythmia in patients with congenital heart disease (CHD), but little is known about the risk for ischemic stroke among younger patients with CHD (aged <65 years) with AF. METHODS AND RESULTS Using data from the National Swedish Patient Register and Cause of Death Register, we identified all patients with both CHD and AF born in Sweden between 1970 and 2017. The Swedish total population register was used to identify age- and sex-matched patients without CHD; those with AF were used as controls. Bottos hierarchical classification was used to define CHD as either complex or noncomplex. Controls were followed from the onset of AF until the index ischemic stroke, death, or end of study (December 31, 2017). We identified 951 patients with CHD with AF and 606 controls with AF. Among patients with both CHD and AF, 2.9% of patients (n=28) developed ischemic stroke, compared with 0.5% (n=3) in controls. When adjusted for age, sex, hypertension, and heart failure, a hazard ratio (HR) of 5.16 (95% CI, 1.52-17.46) was acquired. The HR in noncomplex CHD was 3.84 (95% CI, 1.07-13.84), and the HR in complex CHD was 8.34 (95% CI, 2.27-30.57). For patients born in 1970 to 1989, the HR in ischemic stroke was 7.35 (95% CI, 1.70-31.75). No adjusted HR for patients with CHD born in 1990 to 2017 could be acquired due to few events. CONCLUSIONS The risk for ischemic stroke may be 5 times higher in patients with both CHD and AF compared with patients without CHD with AF. However, larger studies may be needed to confirm/refute these results.
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Affiliation(s)
- Arvid Holmgren
- Department of Molecular and Clinical Medicine/Cardiology Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sweden
| | - Kok Wai Giang
- Department of Molecular and Clinical Medicine/Cardiology Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sweden
- Department of Medicine Region Västra Götaland, Sahlgrenska University Hospital/Östra, Geriatrics and Emergency Medicine/Östra Gothenburg Sweden
| | - Maria Fedchenko
- Department of Molecular and Clinical Medicine/Cardiology Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sweden
- Department of Medicine Region Västra Götaland, Sahlgrenska University Hospital/Östra, Geriatrics and Emergency Medicine/Östra Gothenburg Sweden
| | - Peter Eriksson
- Department of Molecular and Clinical Medicine/Cardiology Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sweden
- Adult Congenital Heart Disease Unit Sahlgrenska University Hospital/Östra Gothenburg Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine/Cardiology Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sweden
- Adult Congenital Heart Disease Unit Sahlgrenska University Hospital/Östra Gothenburg Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine/Cardiology Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sweden
- Adult Congenital Heart Disease Unit Sahlgrenska University Hospital/Östra Gothenburg Sweden
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Engsner S, Giang KW, Dellborg M, Fedchenko M, Eriksson P, Mandalenakis Z. Impact of Down Syndrome on Survival Among Patients With Congenital Heart Disease. J Am Heart Assoc 2024; 13:e031392. [PMID: 38214262 PMCID: PMC10926807 DOI: 10.1161/jaha.123.031392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/17/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Increasing survival among patients with congenital heart disease (CHD) has recently been reported. However, the impact of Down syndrome (DS) in patients with CHD is still debated. We aimed to estimate survival in patients with CHD with versus without DS compared with matched controls from the general population without CHD or DS. METHODS AND RESULTS We linked data from Swedish health registries to identify patients with CHD born between 1970 and 2017. Data from the Total Population Register were used to match each patient with CHD by sex and birth year with 8 controls without CHD or DS. A Cox proportional regression model was used to estimate mortality risk, and Kaplan-Meier curves were analyzed for the survival analysis. We identified 3285 patients with CHD-DS, 64 529 patients with CHD without DS, and 26 128 matched controls. The mortality risk was 25.1 times higher (95% CI, 21.3-29.5) in patients with CHD-DS versus controls. The mortality rate was 2 times higher (95% CI, 1.94-2.31) for patients with CHD with versus without DS. Lower mortality was found during the second versus first birth periods in patients with CHD-DS compared with controls; hazard ratio: 46.8 (95% CI, 29.5-74.0) and 17.7 (95% CI, 12.8-24.42) in those born between 1970 and 1989 versus 1990 and 2017, respectively. CONCLUSIONS In this retrospective cohort study, the mortality risk among patients with CHD-DS was 25 times higher compared with matched controls and 2 times higher compared with patients with CHD without DS. Survival was higher in patients with CHD-DS born after versus before 1990, coinciding with the modern era of congenital heart care.
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Affiliation(s)
- Stella Engsner
- Department of Molecular and Clinical MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Kok Wai Giang
- Department of Molecular and Clinical MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
| | - Mikael Dellborg
- Department of Molecular and Clinical MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
| | - Maria Fedchenko
- Department of Molecular and Clinical MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
| | - Peter Eriksson
- Department of Molecular and Clinical MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
- Adult Congenital Heart Unit, Department of MedicineSahlgrenska University Hospital/ÖstraGothenburgSweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra GötalandSahlgrenska University Hospital/ÖstraGothenburgSweden
- Adult Congenital Heart Unit, Department of MedicineSahlgrenska University Hospital/ÖstraGothenburgSweden
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Zylberberg HM, Lebwohl B, Roelstraete B, Söderling J, Stephansson O, Green PHR, Ludvigsson JF. No Increased Risk of Cardiac Birth Defects in Infants of Mothers With Celiac Disease: A Population and Sibling Comparison. Am J Gastroenterol 2023; 118:1419-1427. [PMID: 37040545 DOI: 10.14309/ajg.0000000000002288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/27/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Several earlier studies have indicated an increased risk of cardiac birth defects among infants born to mothers with celiac disease (CeD). Through linking nationwide Swedish health care registries, we aimed to investigate maternal CeD and risk of any or cardiac birth defects in their offspring. METHODS We performed a retrospective cohort study of infants born between 2002 and 2016 to women with biopsy-proven CeD (villous atrophy, Marsh III) matched to infants born to nonceliac women from the general population. Conditional logistic regression with odds ratios (OR) and their 95% confidence intervals (CI) was used to determine the association between maternal CeD and birth defects. To minimize the impact of intrafamilial confounding, we also compared infants born to mothers with CeD with infants born to their nonaffected sisters. RESULTS A total of 6,990 infants were born to mothers with diagnosed CeD compared with 34,643 infants born to reference mothers. Any birth defect was seen in 234 (33 per 1,000 infants) and 1,244 (36/1,000) reference infants corresponding to an OR of 0.93 (95% CI 0.81-1.08). Cardiac birth defects were seen in 113 (16/1,000) vs 569 (16/1,000) infants (OR 0.98, 95% CI 0.80-1.20). Similar OR for any and cardiac birth defects were also seen in sibling comparisons. DISCUSSION We found no statistically significant risk of any or cardiac birth defects in infants born to mothers with diagnosed CeD compared with the general population and to their nonaffected sisters.
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Affiliation(s)
- Haley M Zylberberg
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Benjamin Lebwohl
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
- Celiac Disease Center, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Bjorn Roelstraete
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Division of Obstetrics, Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Peter H R Green
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
- Celiac Disease Center, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Jonas F Ludvigsson
- Celiac Disease Center, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Pediatrics, Orebro University Hospital, Orebro, Sweden
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Karagianni A, Mandalenakis Z, Papadopoulos S, Dellborg M, Eriksson P. Percutaneous atrial shunt closure and the risk of recurrent ischemic stroke: A register-based, nationwide cohort study. J Stroke Cerebrovasc Dis 2023; 32:107084. [PMID: 36965352 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/27/2023] Open
Abstract
OBJECTIVES We aimed to investigate the risk of recurrent stroke in patients with transcatheter closure of an atrial shunt (ASCIos), compared to patients with an atrial shunt and cerebrovascular event (CVE) but only medical treated (ASMed), and to age- and sex-matched control individuals without a previous CVE. METHODS In total, 663 ASCIos patients were identified in the Swedish National Patient Register from 1997 to 2016 and matched by using propensity score with 663 ASMed patients. Nine age- and sex-matched controls to ASCIos patients (n = 6,302) without a diagnosis of atrial shunt or history of CVE were randomly selected from the general population. RESULTS At a mean follow-up of 6.5 years, the incidence rate of recurrent stroke in the ASCIos group vs ASMed group was 0.9 vs 0.7 per 100 patient-years. The hazard ratio of recurrent stroke in the ASCIos group compared with index stroke in the control group was 9.9 (95% confidence interval, 5.5-17.9). The incidence of atrial fibrillation was similar in the ASCIos and the ASMed group, however four times higher in the ASCIos than in the control group. CONCLUSIONS Our large nationwide, register-based cohort study showed that, unexpectedly, the risk of recurrent stroke in the ASCos group was as high as in the ASMed group and almost ten times higher than the risk of an index stroke in matched controls without previous stroke.
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Affiliation(s)
- Alexia Karagianni
- Center for Adults with Congenital Heart Disease (ACHD), Sahlgrenska University Hospital/Östra, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, Gothenburg University, Sweden.
| | - Zacharias Mandalenakis
- Center for Adults with Congenital Heart Disease (ACHD), Sahlgrenska University Hospital/Östra, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, Gothenburg University, Sweden.
| | - Savvas Papadopoulos
- Department of Business Administration, School of Business, Economics and Law, University of Gothenburg.
| | - Mikael Dellborg
- Center for Adults with Congenital Heart Disease (ACHD), Sahlgrenska University Hospital/Östra, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, Gothenburg University, Sweden.
| | - Peter Eriksson
- Center for Adults with Congenital Heart Disease (ACHD), Sahlgrenska University Hospital/Östra, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, Gothenburg University, Sweden.
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Simon TG, Roelstraete B, Alkhouri N, Hagström H, Sundström J, Ludvigsson JF. Cardiovascular disease risk in paediatric and young adult non-alcoholic fatty liver disease. Gut 2023; 72:573-580. [PMID: 36522149 DOI: 10.1136/gutjnl-2022-328105] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/18/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Longitudinal evidence is lacking regarding the long-term risk of major adverse cardiovascular events (MACE) in children and young adults with non-alcoholic fatty liver disease (NAFLD). DESIGN This nationwide cohort study included all Swedish children and young adults ≤25 years old with histologically confirmed NAFLD and without underlying cardiovascular disease (CVD) at baseline (1966-2016; n=699). NAFLD was defined from prospectively recorded histopathology, and further categorised as simple steatosis or non-alcoholic steatohepatitis (NASH). NAFLD patients were matched to ≤5 population controls without NAFLD or CVD (n=3353). Using Cox proportional hazards modelling, we calculated multivariable-adjusted HRs (aHRs) and 95% CIs for incident MACE (ie, ischaemic heart disease, stroke, congestive heart failure or cardiovascular mortality). In secondary analyses, we also explored rates of incident cardiac arrhythmias. RESULTS Over a median follow-up of 16.6 years, incident MACE was confirmed in 33 NAFLD patients and 52 controls. NAFLD patients had significantly higher rates of MACE than controls (3.1 vs 0.9/1000 person-years (PY); difference=2.1/1000 PY; aHR=2.33, 95% CI=1.43 to 3.78), including higher rates of ischaemic heart disease (difference=1.4/1000 PY; aHR=3.07, 95% CI 1.62 to 5.83) and congestive heart failure (difference=0.5/1000 PY; aHR=3.89, 95% CI=1.20 to 12.64). Rates of incident MACE outcomes appeared to be further augmented with NASH (aHR=5.27, 95% CI=1.96 to 14.19). In secondary analyses, NAFLD patients also had significantly higher rates of cardiac arrythmias (aHR=3.16, 95% CI=1.49 to 6.68). CONCLUSION Compared with matched population controls, children and young adults with biopsy-proven NAFLD had significantly higher rates of incident MACE, including ischaemic heart disease and congestive heart failure. Research to better characterise cardiovascular risk in children and young adults with NAFLD should be prioritised.
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Affiliation(s)
- Tracey G Simon
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Naim Alkhouri
- Hepatology, Arizona Liver Health, Chandler, Arizona, USA
| | - Hannes Hagström
- Karolinska Institute, Stockholm, Sweden
- Division of Hepatology, Department of Upper GI Diseases, Karolinska Hospital, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Pediatrics, Örebro University, Örebro, Sweden
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Giang KW, Mandalenakis Z, Fedchenko M, Eriksson P, Rosengren A, Norman M, Hanséus K, Dellborg M. Congenital heart disease: changes in recorded birth prevalence and cardiac interventions over the past half-century in Sweden. Eur J Prev Cardiol 2023; 30:169-176. [PMID: 36198066 DOI: 10.1093/eurjpc/zwac227] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/11/2022] [Accepted: 09/30/2022] [Indexed: 01/27/2023]
Abstract
AIMS Our objective was to assess changes in the birth prevalence of CHD over a half-century in a high-resource, nationwide setting, as well as changes in the prevalence of cardiac interventions in this population. METHODS AND RESULTS The Swedish National Patient and Cause of Death registers were linked to estimate the annual rates of CHD and cardiac interventions among live-born infants from 1970 to 2017. Additionally, separate estimates were obtained by lesion complexity, from mild to the most complex forms of CHD. Overall, the numbers of live-born infants with a CHD identified varied from 624 to 2459 annual cases, with rates increasing steadily from 5.7 to an average of 20 per 1000 live births at the end of the study period, and with a more pronounced increase from 1996 to 2005. The largest increase over time was observed for mild CHD lesions. Overall, the proportion of cardiac interventions among patients with CHD declined from 40.7% in 1970 to below 15.0% after 2014. However, in the most complex CHD lesion groups, overall cardiac interventions increased from 57.1 to 76.8% in patients with conotruncal defects and from 32.8 to 39.5% in those with severe non-conotruncal defects. CONCLUSION The live-birth prevalence of CHD in Sweden more than tripled during the past half-century, most likely resulting from more accurate diagnostic capabilities. The largest increase over time was observed among patients with simple defects. During the same period, overall cardiac interventions decreased whereas interventions for the most complex CHD groups increased.
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Affiliation(s)
- Kok Wai Giang
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, SE-416 50 Gothenburg, Sweden
- Region Västra Götaland, Department of Medicine, Geriatrics and Emergency Medicine/Östra, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 85, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, SE-416 50 Gothenburg, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 85, Gothenburg, Sweden
| | - Maria Fedchenko
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, SE-416 50 Gothenburg, Sweden
| | - Peter Eriksson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, SE-416 50 Gothenburg, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 85, Gothenburg, Sweden
| | - Annika Rosengren
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, SE-416 50 Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 85, Gothenburg, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Blickagången 6A (Novum), SE-141 57, Stockholm and Karolinska University Hospital S3:03, SE-171 76, Stockholm, Sweden
| | - Katarina Hanséus
- Lund University, Faculty of Medicine, Clinical Sciences, Lund Skåne University Hospital, 221 85 Lund, Sweden
| | - Mikael Dellborg
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, SE-416 50 Gothenburg, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 85, Gothenburg, Sweden
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Pardhan S, Mandalenakis Z, Giang KW, Fedchenko M, Eriksson P, Dellborg M. Healthcare consumption in congenital heart disease: A temporal life-course perspective following pediatric cases to adulthood. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2023. [DOI: 10.1016/j.ijcchd.2023.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Karagianni A, Mandalenakis Z, Papadopoulos S, Dellborg M, Eriksson P. Long-term outcome after closure of an atrial shunt in patients aged 60 years or older with ischemic stroke: A nationwide, registry-based, case-control study. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2023. [DOI: 10.1016/j.ijcchd.2022.100438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Fractures in patients with and without congenital heart disease – A nationwide register-based cohort study. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Karazisi C, Dellborg M, Mellgren K, Giang KW, Skoglund K, Eriksson P, Mandalenakis Z. Risk of cancer in young and older patients with congenital heart disease and the excess risk of cancer by syndromes, organ transplantation and cardiac surgery: Swedish health registry study (1930-2017). THE LANCET REGIONAL HEALTH. EUROPE 2022; 18:100407. [PMID: 35663362 PMCID: PMC9156800 DOI: 10.1016/j.lanepe.2022.100407] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Increasing survival of patients with congenital heart disease (CHD) will result in an increased risk of age-dependent acquired diseases later in life. We aimed to investigate the risk of cancer in young and older patients with CHD and to evaluate the excess risk of cancer by syndromes, organ transplantation and cardiac surgery. Methods Patients with CHD born between 1930 and 2017 were identified using Swedish Health Registers. Each patient with CHD (n = 89,542) was matched by sex and birth year with ten controls without CHD (n = 890,472) from the Swedish Total Population Register. Findings 4012 patients with CHD (4·5%) and 35,218 controls (4·0%) developed cancer. The median follow-up time was 58·8 (IQR 42·4-69·0) years. The overall cancer risk was 1·23 times higher (95% confidence interval (CI) 1·19-1·27) in patients with CHD compared with matched controls, and remained significant when patients with syndromes and organ transplant recipients were excluded. The risk of cancer was higher in all CHD age groups, and in patients that underwent cardiac surgery during the first year after birth (Hazard Ratio 1·83; 95% CI 1·32-2·54). The highest risk was found in children (0-17 years), HR 3·21 (95% CI 2·90-3·56). Interpretation The cancer risk in patients with CHD was 23% higher than in matched controls without CHD. The highest risk was found in children and in the latest birth cohort (1990-2017). Funding Funding by the Swedish state (Grant Number: 236611), the Swedish Research Council (Grant Number: 2019-00193), the Swedish Childhood Cancer Fund (Grant Number: SP2017-0012) and the Swedish Heart-Lung Foundation (Grant Number: 20190724).
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Affiliation(s)
- Christina Karazisi
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
| | - Mikael Dellborg
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Mellgren
- Department of Pediatric Oncology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kok Wai Giang
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
| | - Kristofer Skoglund
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Peter Eriksson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
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Rohani C, Jafarpoor H, Mortazavi Y, Esbakian B, Gholinia H. Mortality in patients with myocardial infarction and potential risk factors: A five-year data analysis. ARYA ATHEROSCLEROSIS 2022; 18:1-8. [PMID: 36815954 PMCID: PMC9931944 DOI: 10.48305/arya.v18i0.2427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/27/2021] [Indexed: 02/24/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) is among the most common causes of death in almost all countries across the world. Awareness of risk factors for the management and prevention of the disease can reduce complications and mortality rates. This study was conducted with the aim to investigate the mortality and potential risk factors of myocardial infarction (MI) as well as their relationships in patients who were admitted to one university hospital in the North of Iran from 2014 to 2018. METHODS This study had retrospective descriptive design. Using a checklist, all necessary information was extracted from 5-year medical records data of MI patients in the university hospital from 2014 to 2018 (n = 564). The data analysis was performed in SPSS software using descriptive statistics and two binary logistic regression analyses. RESULTS The results showed that the mean age of the patients was 62.78 ± 13.38 years, and most of them were men (66.3%). The patients' mortality was 18.6% in a 5-year analysis. However, the number of mortalities was higher in the women (P = 0.001). Descriptive analysis showed that the most common risk factors of the disease in both genders were hypertension (46.6%), diabetes mellitus (DM) (38.5%), hyperlipidemia (24.1%), smoking (20%), and family history of CVDs (18.8%), respectively. However, the results of the adjusted regression model showed that the odds ratio (OR) of the patients' mortality increased in diabetic MI patients (OR: 2.33; 95%CI: 1.42-3.81; P = 0.001), but this ratio decreased in MI patients with a history of hyperlipidemia (OR: 0.23; 95%CI: 0.11-0.44; P ˂ 0.001). CONCLUSION Based on the results, individual- and population-based prevention strategies by focusing on hypertension and diabetes are recommended in our health programs. Surprisingly, the mortality rate of MI patients was lower among those with a history of hyperlipidemia. There are different hypotheses for the cause of this. Therefore, laboratory studies with animal models and prospective cohorts are suggested for future studies.
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Affiliation(s)
- Camelia Rohani
- Affiliated Researcher, Department of Health Care Sciences, Palliative Care Center, Marie Cederschiöld Högskola (Ersta Sköndal Bräcke University College), Campus Ersta, Stockholm, Sweden AND Associate Professor, Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasanali Jafarpoor
- Assistant Professor, Department of Anesthesiology and Operating Room, School of Allied Medical Sciences, Babol University of Medical Sciences, Babol, Iran,Address for correspondence: Hasanali Jafarpoor; Assistant Professor, Department of Anesthesiology and Operating Room, School of
Allied Medical Sciences, Babol University of Medical Sciences, Babol, Iran;
| | - Yousef Mortazavi
- Assistant Professor, Department of Anesthesiology and Operating Room, School of Allied Medical Sciences, Babol University of Medical Sciences, Babol, Iran
| | - Behnam Esbakian
- MSc in Nursing, Department of Anesthesiology and Operating Room, School of Allied Medical Sciences, Babol University of Medical Sciences, Babol, Iran
| | - Hemmat Gholinia
- MSc in Biostatistics, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Odom TL, Zheng Y, Kattan G, Tumin D, Strickland DM, Steed RD, Sarno LA. Recognition of congenital heart disease in subsequent hospital visits among children with a prenatal diagnosis. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Giang KW, Fedchenko M, Dellborg M, Eriksson P, Mandalenakis Z. Burden of Ischemic Stroke in Patients With Congenital Heart Disease: A Nationwide, Case-Control Study. J Am Heart Assoc 2021; 10:e020939. [PMID: 34139861 PMCID: PMC8403327 DOI: 10.1161/jaha.120.020939] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Patients with congenital heart disease (CHD) are at increased risk of developing ischemic stroke (IS) compared with controls without CHD. However, the long‐term outcomes after IS, including IS recurrence and mortality risk, remain unclear. Methods and Results We identified all patients with CHD in Sweden who were born between 1930 and 2017 using the Swedish National Patient Register and the Cause of Death Register. Ten controls without CHD were randomly selected from the general population and matched for birth year and sex for each patient with CHD. The follow‐up of the study population was performed between January 1970 and December 2017. In total, 88 700 patients with CHD (50.6% men) and 890 450 matched controls (51.0%) were included in this study. During a mean follow‐up of 25.1±22.0 years, patients with CHD had a 5‐fold higher risk of developing an index IS (hazard ratio [HR], 5.01; 95% CI, 4.81–5.22) compared with controls. However, the risk of developing a recurrent IS was lower in patients with CHD compared with controls (HR, 0.66; 95% CI, 0.56–0.78), an observation that persisted after adjustment for cardiovascular risk factors and comorbidities. Patients with CHD were also at a significantly lower risk of all‐cause mortality after index IS than controls (HR, 0.53; 95% CI, 0.49–0.58). Conclusions Patients with CHD had a 5‐fold higher risk of developing index IS compared with matched controls. However, the risk of recurrent IS stroke and all‐cause mortality were 34% and 47% lower, respectively, in patients with CHD compared with controls.
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Affiliation(s)
- Kok Wai Giang
- Institute of Medicine Department of Molecular and Clinical Medicine Sahlgrenska AcademyUniversity of Gothenburg Sweden
| | - Maria Fedchenko
- Institute of Medicine Department of Molecular and Clinical Medicine Sahlgrenska AcademyUniversity of Gothenburg Sweden
| | - Mikael Dellborg
- Institute of Medicine Department of Molecular and Clinical Medicine Sahlgrenska AcademyUniversity of Gothenburg Sweden.,ACHD (Adult Congenital Heart Disease) UnitSahlgrenska University Hospital/Östra Gothenburg Sweden
| | - Peter Eriksson
- Institute of Medicine Department of Molecular and Clinical Medicine Sahlgrenska AcademyUniversity of Gothenburg Sweden.,ACHD (Adult Congenital Heart Disease) UnitSahlgrenska University Hospital/Östra Gothenburg Sweden
| | - Zacharias Mandalenakis
- Institute of Medicine Department of Molecular and Clinical Medicine Sahlgrenska AcademyUniversity of Gothenburg Sweden.,ACHD (Adult Congenital Heart Disease) UnitSahlgrenska University Hospital/Östra Gothenburg Sweden
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Snygg-Martin U, Giang KW, Dellborg M, Robertson J, Mandalenakis Z. Cumulative incidence of infective endocarditis in patients with congenital heart disease: a nationwide, case-control study over nine decades. Clin Infect Dis 2021; 73:1469-1475. [PMID: 34036324 PMCID: PMC8528398 DOI: 10.1093/cid/ciab478] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Congenital heart disease (CHD) is a lifelong predisposing condition for infective endocarditis (IE). As a consequence of advances in pediatric care, the number of adults with CHD is now exceeding the number of children. The goal of the present study was to determine the cumulative incidence of IE in patients with CHD and detect temporal changes compared with controls. METHODS Nationwide registry-based case-control study of patients with CHD born 1930-2017 matched with 10 random controls. Infective endocarditis episodes were linked using the Swedish 10-digit personal identification number. RESULTS In total, 89,541 patients with CHD and 890,470 matched controls were included. In patients with CHD, 1477 IE episodes were registered and 447 episodes in controls. Patients with CHD had 8.5% cumulative incidence of IE at age 87 years, compared with 0.7% in matched controls. Incidence rate of IE per 100,000 person-years was 65.5 (95% confidence interval [CI] 62.2-68.9) and 1.8 (95% CI 1.7-2.0) in CHD patients and controls, respectively. By age 18 years, patients with CHD had an IE incidence similar to that of 81-year-old controls. Incidence of IE differed by age but not by birth year. Bacterial etiology was registered from 1997 in half of the IE episodes; among CHD IE cases, 43.3% were caused by streptococci, 29.8% by Staphylococcus aureus. CONCLUSIONS Infective endocarditis remains an important complication in patients with CHD. Incidence correlate with age and the number of IE episodes are expected to increase as the CHD population grow older.
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Affiliation(s)
- Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Kok Wai Giang
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; and Adult Congenital Heart Unit, Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Josefina Robertson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; and Adult Congenital Heart Unit, Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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