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Zwackman S, Häggström J, Hagström E, Jernberg T, Karlsson JE, Lawesson SS, Leosdottir M, Ravn-Fischer A, Eriksson M, Alfredsson J. Management and outcome in foreign-born vs native-born patients with myocardial infarction in Sweden. Eur Heart J Qual Care Clin Outcomes 2024:qcae020. [PMID: 38453451 DOI: 10.1093/ehjqcco/qcae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Previous studies on disparities in healthcare and outcome have shown conflicting results. The aim of this study was to assess differences in baseline characteristics, management, and outcome in myocardial infarction (MI) patients, by country of birth. METHODS In total, 194 259 MI patients (64% male, 15% foreign-born) from the nationwide SWEDEHEART registry were included and compared by geographic region of birth. The primary outcome was one-year major adverse cardiovascular events (MACE) including all-cause death, MI, and stroke. Secondary outcomes were long-term MACE (up to 12 years), the individual components of MACE, 30-day mortality, management, and risk factors. Logistic regression, Cox proportional hazard models and propensity score matching (PSM), accounting for baseline differences, were used. RESULTS Foreign-born patients were younger, often male, and had a higher cardiovascular (CV) risk factor burden, including smoking, diabetes, and hypertension. In PSM analyses, Asia-born patients had higher likelihood of revascularisation (OR 1.16, 95% CI 1.04-1.30), statins and betablocker prescription at discharge and a 34% lower risk of 30-day mortality. Furthermore, no statistically significant differences were found in the primary outcomes except for Asia-born patients having lower risk of one-year MACE (HR 0.85, 95% CI 0.73-0.98), driven by lower mortality (HR 0.72, 95% CI 0.57-0.91). The results persisted over long-term follow-up. CONCLUSIONS This study shows that in a system with universal healthcare coverage in which acute and secondary preventive treatments do not differ by country of birth, foreign-born patients, despite higher CV risk factor burden, will do at least as well as native-born patients.
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Affiliation(s)
- Sammy Zwackman
- Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
| | - Jenny Häggström
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Sweden
- Uppsala Clinical Research Centre, Uppsala University, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm Sweden
| | - Jan-Erik Karlsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
| | - Sofia Sederholm Lawesson
- Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
| | - Margret Leosdottir
- Department of Cardiology, Skane University Hospital and Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Annica Ravn-Fischer
- Institution of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Eriksson
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - Joakim Alfredsson
- Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
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El-Saadi W, Engvall J, Karlsson JE, Maret E. Four- to seven-year follow-up of pharmacological postconditioning with mangafodipir as an adjunct to primary PCI in ST-segment elevation myocardial infarction. Clin Physiol Funct Imaging 2023; 43:413-420. [PMID: 37300475 DOI: 10.1111/cpf.12839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Adverse left ventricular remodelling (AR) develops over time in approximately 30% of patients with a history of coronary artery disease. AR manifests as a structural change in the left ventricle (LV) in terms of increased volumes and reduced left ventricular ejection fraction (LVEF). Manganese dipyridoxyl diphosphate (mangafodipir) has demonstrated interesting cardioprotective features in acute myocardial ischaemia. Pharmacological postconditioning (PP) with mangafodipir as an adjunct to primary percutaneous coronary intervention may possibly reduce the development of AR over time in ST-elevation myocardial infarction (STEMI). The aim of this 4-7-year follow-up study is to investigate the potential benefits of PP with mangafodipir in STEMI patients. METHOD Thirteen out of the initial 20 patients that were included in the primary study of Karlsson et al. were followed up between April and June 2017. The study group underwent review of the hospital records, a clinical examination with ECG and blood sample analysis before cardiac magnetic resonance examination of the patient. LVEF, left ventricular diastolic volume, left ventricular end systolic volume, LV mass and myocardial strain in all directions were computed. RESULTS The PP group showed a decrease in LV volume, mass and higher LVEF at follow-up (p < 0.05) while the individual response of the placebo group showed features that are seen in AR. Although there was no difference in myocardial strain, measurement for the PP-group was higher in absolute terms. CONCLUSION Pharmacological postconditioning with mangafodipir in STEMI demonstrated cardioprotective features compared to the placebo group at follow-up. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Walid El-Saadi
- Department of Internal Medicine, Ryhov County Hospital, Region Jönköping County, Jönköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology, Linköping University, Linköping, Sweden
- Center for Medical Imaging Science and Visualization, Linköping University, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, Ryhov County Hospital, Region Jönköping County, Jönköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Maret
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Faresjö Å, Karlsson JE, Segerberg H, Lebena A, Faresjö T. Cardiovascular and psychosocial risks among patients below age 50 with acute myocardial infarction. BMC Cardiovasc Disord 2023; 23:121. [PMID: 36890430 PMCID: PMC9996997 DOI: 10.1186/s12872-023-03134-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/20/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Despite improvements in the treatment and prevention of cardiovascular disease since the 1960s, the incidence of cardiovascular diseases among young people has remained the same for many years. This study aimed to compare the clinical and psychosocial attributes of young persons affected by myocardial infarction under the age of 50 years compared to middle-aged myocardial infarction patients 51-65 years old. METHODS Data from patients with a documented STEMI or NSTEMI elevated acute myocardial infarction in the age groups up to 65 years, were collected from cardiology clinics at three hospitals in southeast Sweden. The Stressheart study comprised a total of 213 acute myocardial infarction patients, of which n = 33 (15.5%) were under 50 years of age and n = 180 (84.5%) were middle-aged, (51-65 years). These acute myocardial infarction patients filled in a questionnaire at discharge from the hospital and further information through documentation of data in their medical records. RESULTS Blood pressure was significantly higher in young compared to middle-aged patients. For diastolic blood pressure (p = 0.003), systolic blood pressure (p = 0.028), and mean arterial pressure (p = 0.005). Young AMI patients had a higher (p = 0.030) body mass index (BMI) than the middle-aged. Young AMI patients were reported to be more stressed (p = 0.042), had more frequently experienced a serious life event the previous year (p = 0.029), and felt less energetic (p = 0.044) than middle-aged AMI patients. CONCLUSIONS This study revealed that persons under the age of 50 affected by acute myocardial infarction exhibit traditional cardiovascular risk factors like high blood pressure, and higher BMI, and were more exposed to some psychosocial risk factors. The risk profile of young persons under age 50 affected by AMI was in these respects more exaugurated than for middle-aged persons with AMI. This study underlines the importance of the early discovery of those at increased risk and encourages preventative actions to focus on both clinical and psychosocial risk factors.
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Affiliation(s)
- Åshild Faresjö
- Department of Health, Medicine and Care, General Practice, Linköping University, 581 83, Linköping, Sweden
| | - Jan-Erik Karlsson
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Care, Linköping University, 581 83, Linköping, Sweden
| | - Henrik Segerberg
- Department of Health, Medicine and Care, General Practice, Linköping University, 581 83, Linköping, Sweden
| | - Andrea Lebena
- Department of Health, Medicine and Care, General Practice, Linköping University, 581 83, Linköping, Sweden
| | - Tomas Faresjö
- Department of Health, Medicine and Care, General Practice, Linköping University, 581 83, Linköping, Sweden.
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El-Saadi W, Engvall JE, Alfredsson J, Karlsson JE, Martins M, Sederholm S, Faisal Zaman S, Ebbers T, Kihlberg J. Corrigendum: A head-to-head comparison of myocardial strain by fast-strain encoding and feature tracking imaging in acute myocardial infarction. Front Cardiovasc Med 2023; 10:1140214. [PMID: 36818344 PMCID: PMC9933498 DOI: 10.3389/fcvm.2023.1140214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fcvm.2022.949440.].
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Affiliation(s)
- Walid El-Saadi
- Department of Internal Medicine, Ryhov County Hospital, Region Jönköping County, Jönköping, Sweden,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,*Correspondence: Walid El-Saadi ✉
| | - Jan Edvin Engvall
- Department of Clinical Physiology in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Center for Medical Imaging Science and Visualization, Linköping University, Linköping, Sweden
| | - Joakim Alfredsson
- Department of Cardiology in Linköping and Department of Health Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, Ryhov County Hospital, Region Jönköping County, Jönköping, Sweden,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcelo Martins
- Department of Radiology in Linköping and Department of Health Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Sofia Sederholm
- Department of Cardiology in Linköping and Department of Health Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Shaikh Faisal Zaman
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Center for Medical Imaging Science and Visualization, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Center for Medical Imaging Science and Visualization, Linköping University, Linköping, Sweden
| | - Johan Kihlberg
- Center for Medical Imaging Science and Visualization, Linköping University, Linköping, Sweden,Department of Radiology in Linköping and Department of Health Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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El-Saadi W, Engvall JE, Alfredsson J, Karlsson JE, Martins M, Sederholm S, Faisal Zaman S, Ebbers T, Kihlberg J. A head-to-head comparison of myocardial strain by fast-strain encoding and feature tracking imaging in acute myocardial infarction. Front Cardiovasc Med 2022; 9:949440. [PMID: 35966533 PMCID: PMC9366255 DOI: 10.3389/fcvm.2022.949440] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Myocardial infarction (MI) is a major cause of heart failure. Left ventricular adverse remodeling is common post-MI. Several studies have demonstrated a correlation between reduced myocardial strain and the development of adverse remodeling. Cardiac magnetic resonance (CMR) with fast-strain encoding (fast-SENC) or feature tracking (FT) enables rapid assessment of myocardial deformation. The aim of this study was to establish a head-to-head comparison of fast-SENC and FT in post-ST-elevated myocardial infarction (STEMI) patients, with clinical 2D speckle tracking echocardiography (2DEcho) as a reference. Methods Thirty patients treated with primary percutaneous coronary intervention for STEMI were investigated. All participants underwent CMR examination with late gadolinium enhancement, cine-loop steady-state free precession, and fast-SENC imaging using a 1.5T scanner as well as a 2DEcho. Global longitudinal strain (GLS), segmental longitudinal strain (SLS), global circumferential strain (GCS), and segmental circumferential strain (SCS) were assessed along with the MI scar extent. Results The GCS measurements from fast-SENC and FT were nearly identical: the mean difference was 0.01 (2.5)% (95% CI - 0.92 to 0.95). For GLS, fast-SENC values were higher than FT, with a mean difference of 1.8 (1.4)% (95% CI 1.31-2.35). Tests of significance for GLS did not show any differences between the MR methods and 2DEcho. Average strain in the infarct-related artery (IRA) segments compared to the remote myocardium was significantly lower for the left anterior descending artery and right coronary artery culprits but not for the left circumflex artery culprits. Fast-SENC displayed a higher area under the curve for detecting infarcted segments than FT for both SCS and SLS. Conclusion GLS and GCS did not significantly differ between fast-SENC and FT. Both showed acceptable agreement with 2DEcho for longitudinal strain. Segments perfused by the IRA showed significantly reduced strain values compared to the remote myocardium. Fast-SENC presented a higher sensitivity and specificity for detecting infarcted segments than FT.
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Affiliation(s)
- Walid El-Saadi
- Department of Internal Medicine, Ryhov County Hospital, Region Jönköping County, Jönköping, Sweden,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,*Correspondence: Walid El-Saadi
| | - Jan Edvin Engvall
- Department of Clinical Physiology in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Center for Medical Imaging Science and Visualization, Linköping University, Linköping, Sweden
| | - Joakim Alfredsson
- Department of Cardiology in Linköping and Department of Health Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, Ryhov County Hospital, Region Jönköping County, Jönköping, Sweden,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcelo Martins
- Department of Radiology in Linköping and Department of Health Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Sofia Sederholm
- Department of Cardiology in Linköping and Department of Health Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Shaikh Faisal Zaman
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Center for Medical Imaging Science and Visualization, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Center for Medical Imaging Science and Visualization, Linköping University, Linköping, Sweden
| | - Johan Kihlberg
- Center for Medical Imaging Science and Visualization, Linköping University, Linköping, Sweden,Department of Radiology in Linköping and Department of Health Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Korsholm K, Damgaard D, Valentin JB, Packer EJS, Odenstedt J, Sinisalo J, Putaala J, Næss H, Al-Jazi MA, Karlsson JE, Pontoppidan J, Modrau B, Hjort J, Matzen KL, Johnsen SP, Nielsen-Kudsk JE. Left atrial appendage occlusion vs novel oral anticoagulation for stroke prevention in atrial fibrillation: rationale and design of the multicenter randomized occlusion-AF trial. Am Heart J 2022; 243:28-38. [PMID: 34537184 DOI: 10.1016/j.ahj.2021.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/28/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The prevalence of atrial fibrillation (AF) is increasing globally, which is a major clinical and public health concern due to the 5-fold increased risk of stroke. Oral anticoagulation with novel oral anticoagulants (NOACs) is the current primary option for stroke prevention in patients with AF, although it increases the risk of major bleeding. Patients with prior ischemic cerebrovascular events are at particularly high risk of both recurrent ischemic events and major bleeding. Left atrial appendage occlusion (LAAO) provides an alternative option for stroke prevention in high-risk patients, however, with currently limited evidence. Thus, randomized trials comparing LAAO to NOACs are needed. OBJECTIVE The Occlusion-AF trial is designed to assess whether LAAO is non-inferior to NOAC therapy for reduction of the combined endpoint of stroke, systemic embolism, major bleeding (Bleeding Academic Research Consortium ≥ 3) and all-cause mortality in patients with AF and a recent ischemic stroke or transient ischemic attack (TIA). METHODS AND ANALYSIS Investigator-initiated multicenter, multinational, randomized open-label non-inferiority trial with blinded outcome evaluation (PROBE design). Patients with documented AF, and an ischemic stroke or TIA within 6 months will be eligible for enrollment. Major exclusion criteria are modified Rankin Scale > 3 at enrollment, glomerular filtration rate < 15 ml/min, and life-expectancy less than 2 years. A total of 750 patients will be randomized 1:1 to receive either a NOAC or LAAO using the Amplatzer Amulet (Abbott, MN, USA) or Watchman FLX (Boston Scientific, MN, USA) with subsequent life-long aspirin 75 mg daily. Follow-up will be based on in-office and telephone follow-up in combination with long-term follow-up (10 years) through national hospital discharge registries in the individual Nordic countries. The primary outcome will be a composite endpoint of stroke, systemic embolism, major bleeding (BARC ≥ 3) and all-cause mortality at 2-year follow-up. CONCLUSIONS The Occlusion-AF trial is designed to compare LAAO to NOAC therapy for secondary stroke prevention in AF patients with a high risk of recurrent thromboembolic events, i.e. with previous ischemic stroke or TIA, and otherwise eligible for anticoagulation. The results are expected to contribute significantly to the understanding of the effects of LAAO compared to the standard contemporary pharmacological treatment in these patients.
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Affiliation(s)
- Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark; Department of Cardiology, Regional Hospital, West Jutland, Denmark
| | - Dorte Damgaard
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | | | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Juha Sinisalo
- Heart and Lung Center, Helsinki University Central Hospital, and Helsinki University Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Finland
| | - Halvor Næss
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Jan-Erik Karlsson
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jacob Pontoppidan
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Boris Modrau
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Jakob Hjort
- Clinical Trial Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
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7
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Nordanstig A, Curtze S, Gensicke H, Zinkstok SM, Erdur H, Karlsson C, Karlsson JE, Martinez-Majander N, Sibolt G, Lyrer P, Traenka C, Baharoglu MI, Scheitz JF, Bricout N, Hénon H, Leys D, Eskandari A, Michel P, Hametner C, Ringleb PA, Arnold M, Fischer U, Sarikaya H, Seiffge DJ, Pezzini A, Zini A, Padjen V, Jovanovic DR, Luft A, Wegener S, Kellert L, Feil K, Kägi G, Rentzos A, Lappalainen K, Leker RR, Cohen JE, Gomori J, Brehm A, Liman J, Psychogios M, Kastrup A, Papanagiotou P, Gralla J, Magoni M, Majoie CBLM, Bohner G, Vukasinovic I, Cvetic V, Weber J, Kulcsar Z, Bendszus M, Möhlenbruch M, Ntaios G, Kapsalaki E, Jood K, Nolte CH, Nederkoorn PJJ, Engelter S, Strbian D, Tatlisumak T. EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients (EVA-TRISP) registry: basis and methodology of a pan-European prospective ischaemic stroke revascularisation treatment registry. BMJ Open 2021; 11:e042211. [PMID: 34373287 PMCID: PMC8354282 DOI: 10.1136/bmjopen-2020-042211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The Thrombolysis in Ischemic Stroke Patients (TRISP) collaboration was a concerted effort initiated in 2010 with the purpose to address relevant research questions about the effectiveness and safety of intravenous thrombolysis (IVT). The collaboration also aims to prospectively collect data on patients undergoing endovascular treatment (EVT) and hence the name of the collaboration was changed from TRISP to EVA-TRISP. The methodology of the former TRISP registry for patients treated with IVT has already been published. This paper focuses on describing the EVT part of the registry. PARTICIPANTS All centres committed to collecting predefined variables on consecutive patients prospectively. We aim for accuracy and completeness of the data and to adapt local databases to investigate novel research questions. Herein, we introduce the methodology of a recently constructed academic investigator-initiated open collaboration EVT registry built as an extension of an existing IVT registry in patients with acute ischaemic stroke (AIS). FINDINGS TO DATE Currently, the EVA-TRISP network includes 20 stroke centres with considerable expertise in EVT and maintenance of high-quality hospital-based registries. Following several successful randomised controlled trials (RCTs), many important clinical questions remain unanswered in the (EVT) field and some of them will unlikely be investigated in future RCTs. Prospective registries with high-quality data on EVT-treated patients may help answering some of these unanswered issues, especially on safety and efficacy of EVT in specific patient subgroups. FUTURE PLANS This collaborative effort aims at addressing clinically important questions on safety and efficacy of EVT in conditions not covered by RCTs. The TRISP registry generated substantial novel data supporting stroke physicians in their daily decision making considering IVT candidate patients. While providing observational data on EVT in daily clinical practice, our future findings may likewise be hypothesis generating for future research as well as for quality improvement (on EVT). The collaboration welcomes participation of further centres willing to fulfill the commitment and the outlined requirements.
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Affiliation(s)
- Annika Nordanstig
- Department of Clinical Neurosciences Sahlgrenska Academy at University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sami Curtze
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Sanne M Zinkstok
- Department of Neurology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Hebun Erdur
- Department of Neurology and Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Camilla Karlsson
- Department of Clinical Neurosciences Sahlgrenska Academy at University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden
| | - Jan-Erik Karlsson
- Department of Clinical Neurosciences Sahlgrenska Academy at University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Gerli Sibolt
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Christopher Traenka
- Department of Neurology and Stroke Center, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Merih I Baharoglu
- Department of Neurology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Jan F Scheitz
- Department of Neurology and Center for Stroke Research, Charite Universitatsmedizin Berlin Klinik fur Neurologie mit Experimenteller Neurologie, Berlin, Germany
| | | | - Hilde Hénon
- Department of Neurology, University of Lille, Lille, France
| | - Didier Leys
- Department of Neurology, University of Lille, Lille, France
| | - Ashraf Eskandari
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Patrik Michel
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Christian Hametner
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Marcel Arnold
- Department of Neurology, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hakan Sarikaya
- Department of Neurology, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David J Seiffge
- Department of Neurology, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, Maggiore Hospital, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Visnja Padjen
- Neurology Clinic, Clinical Centre of Serbia, Belgrade, Clinical Center of Serbia, Beograd, Serbia
| | - Dejana R Jovanovic
- Neurology Clinic, Clinical Centre of Serbia, Belgrade, Clinical Center of Serbia, Beograd, Serbia,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andreas Luft
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Susanne Wegener
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Lars Kellert
- Department of Neurology, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Katharina Feil
- Neurology and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Georg Kägi
- Department of Neurology, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Alexandros Rentzos
- Department of Radiology, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden,Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kimmo Lappalainen
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Ronen R Leker
- Department of Neurology, Hebrew University Hadassah Medical School, Yerushalayim, Israel
| | - Jose E Cohen
- Department of Neurosurgery, Hebrew University Hadassah Medical School, Yerushalayim, Israel
| | - John Gomori
- Department of Radiology, Hebrew University Hadassah Medical School, Yerushalayim, Israel
| | - Alex Brehm
- Department of Neurology, Georg-August-Universitat Gottingen Universitatsmedizin, Gottingen, Germany
| | - Jan Liman
- Department of Neurology, Georg-August-Universitat Gottingen Universitatsmedizin, Gottingen, Germany
| | - Marios Psychogios
- Department of Neuroradiology, Georg-August-Universitat Gottingen Universitatsmedizin, Gottingen, Germany,Neuroradiology and Stroke Center Basel, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Andreas Kastrup
- Department of Neurology, University Hospitals Bremen-Mitte and Bremen-Ost, Bremen, Germany
| | - Panagiotis Papanagiotou
- Clinic for Diagnostic and Interventional Neuroradiology, University Hospitals Bremen-Mitte and Bremen-Ost, University of Bremen, Bremen, Germany,Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mauro Magoni
- USD Stroke Unit and Vascular Neurology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Charles B L M Majoie
- Department of Neuroradiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Georg Bohner
- Institute of Neuroradiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Ivan Vukasinovic
- Clinic of Neurosurgery, Clinical Center of Serbia, Beograd, Serbia
| | - Vladimir Cvetic
- Faculty of Medicine, University of Belgrade, Beograd, Serbia,Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - Johannes Weber
- Department of Radiology and Nuclear Medicine, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Martin Bendszus
- Department of Neuroradiology, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Volos, Thessaly, Greece
| | - Eftychia Kapsalaki
- Department of Radiology, University Hospital of Larissa, School of Medicine, University of Thessaly, Volos, Thessaly, Greece
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden,Department for Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy, Goteborg, Sweden
| | - Christian H Nolte
- Department of Neurology and Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Paul J J Nederkoorn
- Department of Neurology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Stefan Engelter
- Department of Neurology and Stroke Center, University of Basel, Basel, Switzerland,Deptartment of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athen, Greece
| | - Daniel Strbian
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Clinical Neurosciences, Sahlgrenska University Hospital, Goteborg, Sweden,Department of Neurology, University of Helsinki, Helsinki, Finland
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8
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Huynh J, Barmano N, Karlsson JE, Stomby A. Sex and age differences in the incidence of acute myocardial infarction during the COVID-19 pandemic in a Swedish health-care region without lockdown: a retrospective cohort study. The Lancet Healthy Longevity 2021; 2:e283-e289. [DOI: 10.1016/s2666-7568(21)00085-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/25/2022] Open
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9
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Laytragoon Lewin N, Karlsson JE, Robinsson D, Fagerberg M, Kentsson M, Sayardoust S, Nilsson M, Shamoun L, Andersson BÅ, Löfgren S, Rutqvist LE, Lewin F. Influence of single nucleotide polymorphisms among cigarette smoking and non-smoking patients with coronary artery disease, urinary bladder cancer and lung cancer. PLoS One 2021; 16:e0243084. [PMID: 33507988 PMCID: PMC7842923 DOI: 10.1371/journal.pone.0243084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/13/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Cigarette smoke is suggested to be a risk factor for coronary artery disease (CAD), urinary bladder cancer (UBCa) or lung cancer (LCa). However, not all heavy smokers develop these diseases and elevated cancer risk among first-degree relatives suggests an important role of genetic factor. Methods Three hundred and ten healthy blood donors (controls), 98 CAD, 74 UBCa and 38 LCa patients were included in this pilot study. The influence of 92 single nucleotide polymorphisms (SNPs) and impact of cigarette smoking were analysed. Results Out of 92 SNPs tested, differences in distribution of 14 SNPs were detected between controls and patient groups. Only CTLA4 rs3087243 showed difference in both CAD and UBCa patient group compared to control group. Stratified by smoking status, the impact of smoking was associated to frequencies of 8, 3 and 4 SNPs in CAD, UBCa, LCa patients, respectively. None of these 92 SNPs showed a statistically significant difference to more than one type of disease among smoking patients. In non-smoking patients, 7, 3 and 6 SNPs were associated to CAD, UBCa, LCa, respectively. Out of these 92 SNPs, CTLA4 rs3087243 was associated to both non-smoking CAD and UBCa. The XRCC1 rs25487 was associated to both non-smoking UBCa and LCa. Conclusion SNPs might be important risk factors for CAD, UBCa and LCa. Distribution of the SNPs was specific for each patient group, not a random event. Impact of cigarette smoking on the disease was associated to the specific SNP sequences. Thus, smoking individuals with SNPs associated to risk of these serious diseases is an important target group for smoking cessation programs.
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Affiliation(s)
| | - Jan-Erik Karlsson
- Dept of Internal Medicine, Ryhov Hospital, Jönköping, Sweden
- Dept of Health Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | | | - Magnus Kentsson
- Dept of Internal Medicine, Ryhov Hospital, Jönköping, Sweden
| | | | - Mats Nilsson
- Futurum, Academy of Health and Care, Region Jönköping, Jönköping, Sweden
- Dept Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Levar Shamoun
- Dept Laboratory Medicine, Ryhov Hospital, Jönköping, Sweden
| | | | - Sture Löfgren
- Dept Laboratory Medicine, Ryhov Hospital, Jönköping, Sweden
| | | | - Freddi Lewin
- Dept Oncology, Ryhov Hospital, Jönköping, Sweden
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10
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Fernlund E, Kissopoulou A, Green H, Karlsson JE, Ellegård R, Årstrand HK, Jonasson J, Gunnarsson C. Hereditary Hypertrophic Cardiomyopathy in Children and Young Adults-The Value of Reevaluating and Expanding Gene Panel Analyses. Genes (Basel) 2020; 11:genes11121472. [PMID: 33302605 PMCID: PMC7764692 DOI: 10.3390/genes11121472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction: Sudden cardiac death (SCD) and early onset cardiomyopathy (CM) in the young will always lead to suspicion of an underlying genetic disorder. Incited by the rapid advances in genetic testing for disease we have revisited families, which previously tested “gene-negative” for familial predominantly pediatric CM, in hopes of finding a causative gene variant. Methods: 10 different families with non-syndromic pediatric CM or hypertrophic cardiomyopathy (HCM) with severe disease progression and/or heredity for HCM/CM related SCD with “gene-negative” results were included. The index patient underwent genetic testing with a recently updated gene panel for CM and SCD. In case of failure to detect a pathogenic variant in a relevant gene, the index patient and both parents underwent clinical (i.e., partial) exome sequencing (trio-exome) in order to catch pathogenic variants linked to the disease in genes that were not included in the CM panel. Results: The mean age at clinical presentation of the 10 index cases was 12.5 years (boys 13.4 years, n = 8; girls 9 years, n = 2) and the family history burden was 33 HCM/CM cases including 9 HCM-related SCD and one heart transplantation. In 5 (50%) families we identified a genetic variant classified as pathogenic or likely pathogenic, in accordance with the American College of Medical Genetics and Genomics (ACMG) criteria, in MYH7 (n = 2), RBM20, ALPK3, and PGM1, respectively, and genetic variants of unknown significance (VUS) segregating with the disease in an additional 3 (30%) families, in MYBPC3, ABCC9, and FLNC, respectively. Conclusion: Our results show the importance of renewed thorough clinical assessment and the necessity to challenge previous genetic test results with more comprehensive updated gene panels or exome sequencing if the initial test failed to identify a causative gene for early onset CM or SCD in children. In pediatric cardiomyopathy cases when the gene panel still fails to detect a causative variant, a trio exome sequencing strategy might resolve some unexplained cases, especially if a multisystemic condition is clinically missed.
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Affiliation(s)
- Eva Fernlund
- Crown Princess Victoria Children’s Hospital, and Department of Biomedical and Clinical Sciences, Department of Pediatrics, Linköping University, 581 83 Linköping, Sweden;
- Department of Clinical Sciences Lund, Pediatric Heart Center, Skåne University Hospital, Lund University, 221 00 Lund, Sweden
| | - Antheia Kissopoulou
- Department of Internal Medicine, County Council of Jönköping, Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Sweden;
- Correspondence:
| | - Henrik Green
- Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden;
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, 111 64 Stockholm, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, County Council of Jönköping, Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Sweden;
| | - Rada Ellegård
- Department of Clinical Genetics, and Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; (R.E.); (H.K.Å.); (J.J.); (C.G.)
| | - Hanna Klang Årstrand
- Department of Clinical Genetics, and Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; (R.E.); (H.K.Å.); (J.J.); (C.G.)
| | - Jon Jonasson
- Department of Clinical Genetics, and Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; (R.E.); (H.K.Å.); (J.J.); (C.G.)
| | - Cecilia Gunnarsson
- Department of Clinical Genetics, and Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; (R.E.); (H.K.Å.); (J.J.); (C.G.)
- Centre for Rare Diseases in South East Region of Sweden, Linköping University, 581 83 Linköping, Sweden
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11
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Larsson A, Karlsson C, Rentzos A, Schumacher M, Abrahamson M, Allardt A, Brederlau A, Ceder E, Davidson M, Dunker D, Gunnarsson T, Holmegaard L, Jerndal M, Karlsson JE, Nordanstig A, Redfors P, Rosengren L, Tatlisumak T, Jood K. Do patients with large vessel occlusion ischemic stroke harboring prestroke disability benefit from thrombectomy? J Neurol 2020; 267:2667-2674. [PMID: 32410019 PMCID: PMC7419353 DOI: 10.1007/s00415-020-09882-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Evidence of endovascular treatment (EVT) for acute large vessel occlusion (LVO) ischemic stroke in patients harboring substantial prestroke disability is lacking due to their exclusion from randomized trials. Here, we used routine care observational data to compare outcomes in patients with and without prestroke disability receiving EVT for LVO ischemic stroke. METHODS Consecutive patients undergoing EVT for acute LVO ischemic stroke at the Sahlgrenska University Hospital from January 1st, 2015 to March 31st, 2018 were registered in the Sahlgrenska Stroke Recanalization Registry. Pre- and poststroke functional levels were assessed by the modified Rankin Scale (mRS). Outcomes were recanalization rate (mTICI = 2b/3), symptomatic intracranial hemorrhage [sICH], complications during hospital stay, and return to prestroke functional level and mortality at 3 months. RESULTS Among 591 patients, 90 had prestroke disability (mRS ≥ 3). The latter group were older, more often female, had more comorbidities and higher NIHSS scores before intervention compared to patients without prestroke disability. Recanalization rates (80.0% vs 85.0%, p = 0.211), sICH (2.2% vs 6.3% p = 0.086) and the proportion of patients returning to prestroke functional level (22.7% vs 14.8% p = 0.062) did not significantly differ between those with and without prestroke disability. Patients with prestroke disability had higher complication rates during hospital stay (55.2% vs 40.1% p < 0.01) and mortality at 3 months (48.9% vs 24.3% p < 0.001). CONCLUSION One of five with prestroke disability treated with thrombectomy for a LVO ischemic stroke returned to their prestroke functional level. However, compared to patients without prestroke disability, mortality at 3 months was higher.
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Affiliation(s)
- Alice Larsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Blå stråket 7, plan 3, 413 45, Göteborg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Camilla Karlsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Blå stråket 7, plan 3, 413 45, Göteborg, Sweden
| | - Alexandros Rentzos
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
- Department of Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Marcus Schumacher
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Blå stråket 7, plan 3, 413 45, Göteborg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - Arne Allardt
- Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Anke Brederlau
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Blå stråket 7, plan 3, 413 45, Göteborg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Erik Ceder
- Department of Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Maria Davidson
- Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Dennis Dunker
- Department of Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Thorsteinn Gunnarsson
- Department of Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Lukas Holmegaard
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Blå stråket 7, plan 3, 413 45, Göteborg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Mikael Jerndal
- Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Jan-Erik Karlsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Blå stråket 7, plan 3, 413 45, Göteborg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Annika Nordanstig
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Blå stråket 7, plan 3, 413 45, Göteborg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Petra Redfors
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Blå stråket 7, plan 3, 413 45, Göteborg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Lars Rosengren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Blå stråket 7, plan 3, 413 45, Göteborg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Blå stråket 7, plan 3, 413 45, Göteborg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Blå stråket 7, plan 3, 413 45, Göteborg, Sweden.
- Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden.
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12
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Gawel DR, Serra-Musach J, Lilja S, Aagesen J, Arenas A, Asking B, Bengnér M, Björkander J, Biggs S, Ernerudh J, Hjortswang H, Karlsson JE, Köpsen M, Lee EJ, Lentini A, Li X, Magnusson M, Martínez-Enguita D, Matussek A, Nestor CE, Schäfer S, Seifert O, Sonmez C, Stjernman H, Tjärnberg A, Wu S, Åkesson K, Shalek AK, Stenmarker M, Zhang H, Gustafsson M, Benson M. Correction to: A validated single-cell-based strategy to identify diagnostic and therapeutic targets in complex diseases. Genome Med 2020; 12:37. [PMID: 32345376 PMCID: PMC7189719 DOI: 10.1186/s13073-020-00732-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Danuta R Gawel
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden
| | - Jordi Serra-Musach
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden
| | - Sandra Lilja
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden
| | - Jesper Aagesen
- Department of Internal Medicine, Region Jönköping County, Jönköping, Sweden
| | - Alex Arenas
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Spain
| | - Bengt Asking
- Department of Surgery, Region Jönköping County, Jönköping, Sweden
| | - Malin Bengnér
- Office for Control of Communicable Diseases, Region Jönköping County, Jönköping, Sweden
| | - Janne Björkander
- Department of Internal Medicine, Region Jönköping County, Jönköping, Sweden
| | - Sophie Biggs
- Division of Rheumatology, Autoimmunity, and Immune Regulation, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jan Ernerudh
- Department of Clinical Immunology and Transfusion Medicine, Linköping University, Linköping, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, Region Jönköping County, Jönköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Mattias Köpsen
- Bioinformatics, Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Eun Jung Lee
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden.,Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Antonio Lentini
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Xinxiu Li
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden
| | - Mattias Magnusson
- Division of Rheumatology, Autoimmunity, and Immune Regulation, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - David Martínez-Enguita
- Bioinformatics, Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Andreas Matussek
- Clinical Microbiology, Region Jönköping County, Jönköping, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Karolinska University Laboratory, Karolinska University Hospital, Solna, Sweden
| | - Colm E Nestor
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Samuel Schäfer
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden
| | - Oliver Seifert
- Department of Dermatology and Venereology, Region Jönköping County, Jönköping, Sweden.,Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Ceylan Sonmez
- Bioinformatics, Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Henrik Stjernman
- Department of Internal Medicine, Region Jönköping County, Jönköping, Sweden
| | - Andreas Tjärnberg
- Bioinformatics, Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Simon Wu
- Bioinformatics, Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Karin Åkesson
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Futurum - Academy for Health and Care, Department of Pediatrics, Region Jönköping County, Jönköping, Sweden
| | - Alex K Shalek
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, USA.,Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Margaretha Stenmarker
- Futurum - Academy for Health and Care, Department of Pediatrics, Region Jönköping County, Jönköping, Sweden.,Department of Pediatrics, Institution for Clinical Sciences, Göteborg, Sweden
| | - Huan Zhang
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden.
| | - Mika Gustafsson
- Bioinformatics, Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Mikael Benson
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden.
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13
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Kissopoulou A, Fernlund E, Holmgren C, Isaksson E, Karlsson JE, Green H, Jonasson J, Ellegård R, Årstrand HK, Svensson A, Gunnarsson C. Monozygotic twins with myocarditis and a novel likely pathogenic desmoplakin gene variant. ESC Heart Fail 2020; 7:1210-1216. [PMID: 32301586 PMCID: PMC7261567 DOI: 10.1002/ehf2.12658] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/23/2020] [Accepted: 02/06/2020] [Indexed: 12/26/2022] Open
Abstract
Myocarditis most often affects otherwise healthy athletes and is one of the leading causes of sudden death in children and young adults. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically determined heart muscle disorder with increased risk for paroxysmal ventricular arrhythmias and sudden cardiac death. The clinical picture of myocarditis and ARVC may overlap during the early stages of cardiomyopathy, which may lead to misdiagnosis. In the literature, we found several cases that presented with episodes of myocarditis and ended up with a diagnosis of arrhythmogenic cardiomyopathy, mostly of the left predominant type. The aim of this case presentation is to shed light upon a possible link between myocarditis, a desmoplakin (DSP) gene variant, and ARVC by describing a case of male monozygotic twins who presented with symptoms and signs of myocarditis at 17 and 18 years of age, respectively. One of them also had a recurrent episode of myocarditis. The twins and their family were extensively examined including electrocardiograms (ECG), biochemistry, multimodal cardiac imaging, myocardial biopsy, genetic analysis, repeated cardiac magnetic resonance (CMR) and echocardiography over time. Both twins presented with chest pain, ECG with slight ST-T elevation, and increased troponin T levels. CMR demonstrated an affected left ventricle with comprehensive inflammatory, subepicardial changes consistent with myocarditis. The right ventricle did not appear to have any abnormalities. Genotype analysis revealed a nonsense heterozygous variant in the desmoplakin (DSP) gene [NM_004415.2:c.2521_2522del (p.Gln841Aspfs*9)] that is considered likely pathogenic and presumably ARVC related. There was no previous family history of heart disease. There might be a common pathophysiology of ARVC, associated with desmosomal dysfunction, and myocarditis. In our case, both twins have an affected left ventricle without any right ventricular involvement, and they are carriers of a novel DSP variant that is likely associated with ARVC. The extensive inflammation of the LV that was apparent in the CMR may or may not be the primary event of ARVC. Nevertheless, our data suggest that irrespective of a possible link here to ARVC, genetic testing for arrhythmogenic cardiomyopathy might be advisable for patients with recurrent myocarditis associated with a family history of myocarditis.
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Affiliation(s)
- Antheia Kissopoulou
- Department of Internal Medicine, County Council of Jönköping, Jönköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Fernlund
- Crown Princess Victoria Children's Hospital, Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping University Hospital, Linköping, Sweden.,Department of Clinical Sciences Lund, Pediatric Heart Center, Lund University, Skane University Hospital, Lund, Sweden
| | - Christina Holmgren
- Department of Internal Medicine, County Council of Jönköping, Jönköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eira Isaksson
- Department of Internal Medicine, County Council of Jönköping, Jönköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, County Council of Jönköping, Jönköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Green
- Division of Drug Research, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Jon Jonasson
- Department of Clinical Genetics and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Rada Ellegård
- Department of Clinical Genetics and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Hanna Klang Årstrand
- Department of Clinical Genetics and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anneli Svensson
- Department of Cardiology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Cecilia Gunnarsson
- Department of Clinical Genetics and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Centre for Rare Diseases in South East Region of Sweden, Linköping University, Linköping, Sweden
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14
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Eriksson H, Löwhagen Hendén P, Rentzos A, Pujol-Calderón F, Karlsson JE, Höglund K, Blennow K, Zetterberg H, Rosengren L, Zelano J. Acute symptomatic seizures and epilepsy after mechanical thrombectomy. Epilepsy Behav 2020; 104:106520. [PMID: 31526644 DOI: 10.1016/j.yebeh.2019.106520] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to assess the incidence of acute symptomatic seizures and poststroke epilepsy (PSE) in a well-characterized cohort of patients treated with mechanical thrombectomy. In addition, we aimed to describe the dynamics of blood markers of brain injury in patients that developed PSE. METHODS Participants of the prospective AnStroke Trial of anesthesia method during mechanical thrombectomy were included and acute symptomatic seizures and PSE ascertained by medical records review. Blood markers neurofilament light (NFL), tau, glial fibrillary acidic protein (GFAP), S100 calcium-binding protein B (S100B), and neuron-specific enolase (NSE) were assessed. RESULTS A total of 90 patients with acute anterior ischemic stroke were included. Median National Institutes of Health Stroke Scale (NIHSS) at admission to hospital was 18 (IQR 15-22). Recanalization was achieved in 90%. No patients had epilepsy prior to the ischemic stroke. Four patients (4.4%) had acute symptomatic seizures and four patients (4.4%) developed PSE during the follow-up time (to death or last medical records review) of 0-4.5 years (median follow-up 1070 days IQR 777-1306), resulting in a two-year estimated PSE risk of 5.3% (95%CI: 0.2-10.4%). Blood markers of brain injury (NFL, tau, GFAP, S100B, and NSE) were generally above the cohort median in patients that developed PSE. CONCLUSIONS The incidence of PSE after mechanical thrombectomy was low in our cohort. All blood biomarkers displayed interesting sensitivity and specificity. However, the number of PSE cases was small and more studies are needed on risk factors for PSE after mechanical thrombectomy. The potential of blood markers of brain injury markers to contribute to assessment of PSE risk should be explored further. This article is part of the Special Issue "Seizures & Stroke".
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Affiliation(s)
- Hanna Eriksson
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital, Blå stråket 7, 413 46, Sweden
| | - Pia Löwhagen Hendén
- Sahlgrenska University Hospital, Blå stråket 7, 413 46, Sweden.; Department of Anesthesiology and Intensive Care, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Alexandros Rentzos
- Sahlgrenska University Hospital, Blå stråket 7, 413 46, Sweden.; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Fani Pujol-Calderón
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Jan-Erik Karlsson
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital, Blå stråket 7, 413 46, Sweden
| | - Kina Höglund
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kaj Blennow
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; UK Dementia Research Institute at UCL, London, United Kingdom; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
| | - Lars Rosengren
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital, Blå stråket 7, 413 46, Sweden
| | - Johan Zelano
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital, Blå stråket 7, 413 46, Sweden..
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15
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Gawel DR, Serra-Musach J, Lilja S, Aagesen J, Arenas A, Asking B, Bengnér M, Björkander J, Biggs S, Ernerudh J, Hjortswang H, Karlsson JE, Köpsen M, Lee EJ, Lentini A, Li X, Magnusson M, Martínez-Enguita D, Matussek A, Nestor CE, Schäfer S, Seifert O, Sonmez C, Stjernman H, Tjärnberg A, Wu S, Åkesson K, Shalek AK, Stenmarker M, Zhang H, Gustafsson M, Benson M. A validated single-cell-based strategy to identify diagnostic and therapeutic targets in complex diseases. Genome Med 2019; 11:47. [PMID: 31358043 PMCID: PMC6664760 DOI: 10.1186/s13073-019-0657-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/10/2019] [Indexed: 12/17/2022] Open
Abstract
Background Genomic medicine has paved the way for identifying biomarkers and therapeutically actionable targets for complex diseases, but is complicated by the involvement of thousands of variably expressed genes across multiple cell types. Single-cell RNA-sequencing study (scRNA-seq) allows the characterization of such complex changes in whole organs. Methods The study is based on applying network tools to organize and analyze scRNA-seq data from a mouse model of arthritis and human rheumatoid arthritis, in order to find diagnostic biomarkers and therapeutic targets. Diagnostic validation studies were performed using expression profiling data and potential protein biomarkers from prospective clinical studies of 13 diseases. A candidate drug was examined by a treatment study of a mouse model of arthritis, using phenotypic, immunohistochemical, and cellular analyses as read-outs. Results We performed the first systematic analysis of pathways, potential biomarkers, and drug targets in scRNA-seq data from a complex disease, starting with inflamed joints and lymph nodes from a mouse model of arthritis. We found the involvement of hundreds of pathways, biomarkers, and drug targets that differed greatly between cell types. Analyses of scRNA-seq and GWAS data from human rheumatoid arthritis (RA) supported a similar dispersion of pathogenic mechanisms in different cell types. Thus, systems-level approaches to prioritize biomarkers and drugs are needed. Here, we present a prioritization strategy that is based on constructing network models of disease-associated cell types and interactions using scRNA-seq data from our mouse model of arthritis, as well as human RA, which we term multicellular disease models (MCDMs). We find that the network centrality of MCDM cell types correlates with the enrichment of genes harboring genetic variants associated with RA and thus could potentially be used to prioritize cell types and genes for diagnostics and therapeutics. We validated this hypothesis in a large-scale study of patients with 13 different autoimmune, allergic, infectious, malignant, endocrine, metabolic, and cardiovascular diseases, as well as a therapeutic study of the mouse arthritis model. Conclusions Overall, our results support that our strategy has the potential to help prioritize diagnostic and therapeutic targets in human disease. Electronic supplementary material The online version of this article (10.1186/s13073-019-0657-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danuta R Gawel
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden
| | - Jordi Serra-Musach
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden
| | - Sandra Lilja
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden
| | - Jesper Aagesen
- Department of Internal Medicine, Region Jönköping County, Jönköping, Sweden
| | - Alex Arenas
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Spain
| | - Bengt Asking
- Department of Surgery, Region Jönköping County, Jönköping, Sweden
| | - Malin Bengnér
- Office for Control of Communicable Diseases, Region Jönköping County, Jönköping, Sweden
| | - Janne Björkander
- Department of Internal Medicine, Region Jönköping County, Jönköping, Sweden
| | - Sophie Biggs
- Division of Rheumatology, Autoimmunity, and Immune Regulation, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jan Ernerudh
- Department of Clinical Immunology and Transfusion Medicine, Linköping University, Linköping, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, Region Jönköping County, Jönköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Mattias Köpsen
- Bioinformatics, Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Eun Jung Lee
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden.,Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Antonio Lentini
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Xinxiu Li
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden
| | - Mattias Magnusson
- Division of Rheumatology, Autoimmunity, and Immune Regulation, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - David Martínez-Enguita
- Bioinformatics, Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Andreas Matussek
- Clinical Microbiology, Region Jönköping County, Jönköping, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Karolinska University Laboratory, Karolinska University Hospital, Solna, Sweden
| | - Colm E Nestor
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Samuel Schäfer
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden
| | - Oliver Seifert
- Department of Dermatology and Venereology, Region Jönköping County, Jönköping, Sweden.,Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Ceylan Sonmez
- Bioinformatics, Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Henrik Stjernman
- Department of Internal Medicine, Region Jönköping County, Jönköping, Sweden
| | - Andreas Tjärnberg
- Bioinformatics, Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Simon Wu
- Bioinformatics, Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Karin Åkesson
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Futurum - Academy for Health and Care, Department of Pediatrics, Region Jönköping County, Jönköping, Sweden
| | - Alex K Shalek
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, USA.,Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Margaretha Stenmarker
- Futurum - Academy for Health and Care, Department of Pediatrics, Region Jönköping County, Jönköping, Sweden.,Department of Pediatrics, Institution for Clinical Sciences, Göteborg, Sweden
| | - Huan Zhang
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden.
| | - Mika Gustafsson
- Bioinformatics, Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Mikael Benson
- Centre for Personalized Medicine, Linköping University, Linköping, Sweden.
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16
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Barmano N, Charitakis E, Kronstrand R, Walfridsson U, Karlsson JE, Walfridsson H, Nystrom FH. The association between alcohol consumption, cardiac biomarkers, left atrial size and re-ablation in patients with atrial fibrillation referred for catheter ablation. PLoS One 2019; 14:e0215121. [PMID: 30970005 PMCID: PMC6457637 DOI: 10.1371/journal.pone.0215121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 03/28/2019] [Indexed: 12/14/2022] Open
Abstract
Background Information on alcohol consumption in patients undergoing radiofrequency ablation (RFA) of atrial fibrillation (AF) is often limited by the reliance on self-reports. The aim of this study was to describe the long-term alcohol consumption, measured as ethyl glucuronide in hair (hEtG), in patients undergoing RFA due to AF, and to examine potential associations with cardiac biomarkers, left atrial size and re-ablation within one year after the initial RFA. Methods The amount of hEtG was measured in patients referred for RFA, and a cut-off of 7 pg/mg was used. N-terminal pro B-type natriuretic peptide (NT-proBNP) and the mid-regional fragment of pro atrial natriuretic peptide (MR-proANP) were examined and maximum left atrium volume index (LAVI) was measured. The number of re-ablations was examined up to one year after the initial RFA. Analyses were stratified by gender, and adjusted for age, systolic blood pressure, body mass index, presence of heart failure and heart rhythm for analyses regarding NT-proBNP, MR-proANP and LAVI and heart rhythm being replaced by type of AF for analyses regarding re-ablation. Results In total, 192 patients were included in the study. Median (25th– 75th percentile) NT-proBNP in men with hEtG ≥ 7 vs. < 7 pg/mg was 250 (96–695) vs. 130 (49–346) pg/ml (p = 0.010), and in women it was 230 (125–480) vs. 230 (125–910) pg/ml (p = 0.810). Median MR-proANP in men with hEtG ≥ 7 vs. < 7 pg/mg was 142 (100–224) vs. 117 (83–179) pmol/l (p = 0.120) and in women it was 139 (112–206) vs. 153 (93–249) pmol/l (p = 0.965). The median of maximum LAVI was 30.1 (26.7–33.9) vs. 25.8 (21.4–32.0) ml/m2 (p = 0.017) in men, and 25.0 (18.9–29.6) vs. 25.7 (21.7–34.6) ml/m2 (p = 0.438) in women, with hEtG ≥ 7 vs. < 7 pg/ml, respectively. Adjusted analyses showed similar results, except for MR-proANP turning out significant in men with hEtG ≥ 7 vs. < 7 pg/mg (p = 0.047). The odds ratio of having a re-ablation was 3.5 (95% CI 1.3–9.6, p = 0.017) in men with hEtG ≥ 7 vs. < 7 pg/mg, while there was no significant difference in women. Conclusions In male patients with AF and hEtG ≥ 7 pg/mg, NT-proBNP and MR-proANP were higher, LA volumes larger, and there was a higher rate of re-ablations, as compared to men with hEtG < 7 pg/mg. This implies that men with an alcohol consumption corresponding to an hEtG-value ≥ 7, have a higher risk for LA remodelling that could potentially lead to a deterioration of the AF situation.
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Affiliation(s)
- Neshro Barmano
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
- * E-mail:
| | - Emmanouil Charitakis
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Robert Kronstrand
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- National Board of Forensic Medicine, Linköping, Sweden
| | - Ulla Walfridsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
| | - Håkan Walfridsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Fredrik H. Nystrom
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre Centrum, Norrköping, Sweden
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17
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Löwhagen Hendén P, Rentzos A, Karlsson JE, Rosengren L, Oras J, Ricksten SE. Off-hour admission and impact on neurological outcome in endovascular treatment for acute ischemic stroke. Acta Anaesthesiol Scand 2019; 63:208-214. [PMID: 30117146 DOI: 10.1111/aas.13241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/10/2018] [Accepted: 07/15/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE In the new era of endovascular treatment for acute ischemic stroke, one of the main predictors of good neurological outcome is a short time interval from stroke onset to recanalization of the occluded vessel. In this study, we examined the effect of on-hour vs off-hour admittance on the time intervals from stroke onset to recanalization in patients with acute ischemic stroke (AIS) undergoing endovascular treatment (EVT). METHODS One-hundred-ninety-eight patients receiving EVT for anterior AIS between 2007 and 2016 were included. Time of day and weekday for stroke admittance were recorded as well as several time intervals. Age, sex, co-morbidities, admission National Institutes of Health Stroke Scale (NIHSS), intraprocedural blood pressure, blood glucose, modified Thrombolysis in Cerebral Ischemia score (mTICI) and neurological outcome at 3 months, measured as modified Rankin Scale (mRS), were registered. On-hour was defined as 8 am-4 pm weekdays, and off-hour as weekdays outside these hours and weekends. RESULTS The time interval from CT (computed tomography) to recanalization was longer during off-hours, while no difference was seen in the time interval from stroke onset to CT. No statistically significant difference was seen in neurological outcome between the on- and off-hour groups in a univariate analysis. CONCLUSIONS Stroke admittance during off-hours is associated with longer time interval from CT examination to vessel recanalization. The study highlights the need of logistic improvement and probably more resources off-hour in order to deliver an effective stroke care around the clock.
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Affiliation(s)
- Pia Löwhagen Hendén
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Alexandros Rentzos
- Department of Radiology; Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Jan-Erik Karlsson
- Department of Neurology; Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Lars Rosengren
- Department of Neurology; Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Jonatan Oras
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Sven-Erik Ricksten
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
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18
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Barmano N, Charitakis E, Karlsson JE, Nystrom FH, Walfridsson H, Walfridsson U. Predictors of improvement in arrhythmia-specific symptoms and health-related quality of life after catheter ablation of atrial fibrillation. Clin Cardiol 2018; 42:247-255. [PMID: 30548275 DOI: 10.1002/clc.23134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The primary goal of radiofrequency ablation (RFA) of atrial fibrillation (AF) is to improve symptoms and health-related quality of life (HRQoL). However, most studies have focused on predictors of AF recurrence rather than on predictors of improvement in symptoms and HRQoL. HYPOTHESIS We sought to explore predictors of improvement in arrhythmia-specific symptoms and HRQoL after RFA of AF, and to evaluate the effects on symptoms, HRQoL, anxiety, and depression. METHODS We studied 192 patients undergoing their first RFA of AF. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), arrhythmia-specific questionnaire in tachycardia and arrhythmia (ASTA), and hospital anxiety and depression scale (HADS) questionnaires were filled out at baseline, at 4 months, and at a 1-year follow-up. RESULTS All questionnaire scale scores improved significantly over time. In the ASTA symptom scale score, female gender and > 10 AF episodes the month before RFA were significant positive predictors of improvement, while diabetes and AF recurrence within 12 months after RFA were significant negative predictors (R2 = 0.18; P < 0.001). In the ASTA HRQoL scale score, the presence of heart failure and > 10 AF episodes the month before RFA were significant positive predictors of improvement, while diabetes, maximum left atrial volume and AF recurrence were significant negative predictors (R2 = 0.20; P < 0.001). CONCLUSION Left atrial volume, gender, diabetes, heart failure, the frequency of AF attacks prior to RFA, and recurrence of AF after RFA were significant factors affecting improvement in symptoms and HRQoL after RFA of AF. Future studies are warranted to confirm these findings.
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Affiliation(s)
- Neshro Barmano
- Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Emmanouil Charitakis
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Fredrik H Nystrom
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Primary Health Care Centre Centrum, Norrköping, Sweden
| | - Håkan Walfridsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Ulla Walfridsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University Hospital, Linköping, Sweden
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19
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Andersson PO, Lawesson SS, Karlsson JE, Nilsson S, Thylén I. Characteristics of patients with acute myocardial infarction contacting primary healthcare before hospitalisation: a cross-sectional study. BMC Fam Pract 2018; 19:167. [PMID: 30305077 PMCID: PMC6180517 DOI: 10.1186/s12875-018-0849-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/17/2018] [Indexed: 12/02/2022]
Abstract
Background The characteristics of patients with on-going myocardial infarction (MI) contacting the primary healthcare (PHC) centre before hospitalisation are not well known. Prompt diagnosis is crucial in patients with MI, but many patients delay seeking medical care. The aims of this study was to 1) describe background characteristics, symptoms, actions and delay times in patients contacting the PHC before hospitalisation when falling ill with an acute MI, 2) compare those patients with acute MI patients not contacting the PHC, and 3) explore factors associated with a PHC contact in acute MI patients. Methods This was a cross-sectional multicentre study, enrolling consecutive patients with MI within 24 hours of admission to hospital from Nov 2012 until Feb 2014. Results A total of 688 patients with MI, 519 men and 169 women, were included; the mean age was 66±11 years. One in five people contacted PHC instead of the recommended emergency medical services (EMS), and 94% of these patients experienced cardinal symptoms of an acute MI; i.e., chest pain, and/or radiating pain in the arms, and/or cold sweat. Median delay time from symptom-onset-to-decision-to-seek-care was 2:15 hours in PHC patients and 0:40 hours in non-PHC patients (p<0.01). The probability of utilising the PHC before hospitalisation was associated with fluctuating symptoms (OR 1.74), pain intensity (OR 0.90) symptoms during off-hours (OR 0.42), study hospital (OR 3.49 and 2.52, respectively, for two of the county hospitals) and a final STEMI diagnosis (OR 0.58). Conclusions Ambulance services are still underutilized in acute MI patients. A substantial part of the patients contacts their primary healthcare centre before they are diagnosed with MI, although experiencing cardinal symptoms such as chest pain. There is need for better knowledge in the population about symptoms of MI and adequate pathways to qualified care. Knowledge and awareness amongst primary healthcare professionals on the occurrence of MI patients is imperative.
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Affiliation(s)
- Per O Andersson
- Primary Health Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. .,Ljungsbro Health Care Centre, Evastigen 9, 590 71 Ljungsbro, Ljungsbro, Sweden.
| | - Sofia Sederholm Lawesson
- Department of Cardiology and department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, Region Jönköping County, Jönköping, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Staffan Nilsson
- Primary Health Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ingela Thylén
- Department of Cardiology and department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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20
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Karlsson JE, El-Saadi W, Ali M, Puskar W, Skogvard P, Engvall JE, Andersson RG, Maret E, Jynge P. Mangafodipir as a cardioprotective adjunct to reperfusion therapy: a feasibility study in patients with ST-segment elevation myocardial infarction. Eur Heart J Cardiovasc Pharmacother 2018; 1:39-45. [PMID: 27533964 DOI: 10.1093/ehjcvp/pvu021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 11/19/2014] [Indexed: 12/30/2022]
Abstract
AIMS The aim of the present study was to examine the feasibility of applying the catalytic antioxidant mangafodipir [MnDPDP, manganese (Mn) dipyridoxyl diphosphate] as a cardioprotective adjunct to primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation (STE) myocardial infarction (STEMI). Both MnDPDP and a metabolite (Mn dipyridoxyl ethyldiamine) possess properties as mitochondrial superoxide dismutase mimetics and iron chelators, and combat oxidative stress in various tissues and conditions. METHODS AND RESULTS The study tested MnDPDP (n = 10) vs. saline placebo (n = 10), given as a brief intravenous (i.v.) infusion prior to balloon inflation during pPCI in patients with STEMI. Mangafodipir was well tolerated and did not affect heart rate or blood pressure. Despite longer ischaemic time (205 vs. 144 min, P = 0.019) in the MnDPDP group, plasma biomarker releases were identical for the two groups. With placebo vs. MnDPDP, mean STE resolutions were 69.8 vs. 81.9% (P = 0.224) at 6 h and 73.1 vs. 84.3% (P = 0.077) at 48 h. Cardiac magnetic resonance revealed mean infarct sizes of 32.5 vs. 26.2% (P = 0.406) and mean left ventricular (LV) ejection fractions of 41.8 vs. 47.7% (P = 0.617) with placebo vs. MnDPDP. More LV thrombi were detected in placebo hearts (5 of 8) than MnDPDP-treated hearts (1 of 10; P = 0.011). CONCLUSIONS Mangafodipir is a safe drug for use as an adjunct to reperfusion therapy. A tendency to benefit of MnDPDP needs confirmation in a larger population. The study revealed important information for the design of a Phase II trial.
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Affiliation(s)
- Jan-Erik Karlsson
- Department of Internal Medicine, County Council of Jönköping, Ryhov County Hospital, Jönköping SE-551 85, Sweden Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Walid El-Saadi
- Department of Internal Medicine, County Council of Jönköping, Ryhov County Hospital, Jönköping SE-551 85, Sweden
| | - Mustafa Ali
- Department of Internal Medicine, County Council of Jönköping, Ryhov County Hospital, Jönköping SE-551 85, Sweden Department of Radiology, County Council of Jönköping, Jönköping, Sweden
| | - Werner Puskar
- Department of Radiology, County Council of Jönköping, Jönköping, Sweden
| | - Patrik Skogvard
- Department of Internal Medicine, County Council of Jönköping, Ryhov County Hospital, Jönköping SE-551 85, Sweden
| | - Jan E Engvall
- Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden Department of Clinical Physiology, County Council of Östergötland, Östergötland, Sweden
| | - Rolf G Andersson
- Division of Drug Research, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Maret
- Department of Radiology, County Council of Jönköping, Jönköping, Sweden Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Jynge
- Division of Drug Research, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden PledPharma AB, Stockholm, Sweden
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21
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Kissopoulou A, Trinks C, Green A, Karlsson JE, Jonasson J, Gunnarsson C. Homozygous missense MYBPC3 Pro873His mutation associated with increased risk for heart failure development in hypertrophic cardiomyopathy. ESC Heart Fail 2018; 5:716-723. [PMID: 29663722 PMCID: PMC6073032 DOI: 10.1002/ehf2.12288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/16/2018] [Accepted: 03/10/2018] [Indexed: 12/13/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a primary autosomal‐dominant disorder of the myocardium with variable expressivity and penetrance. Occasionally, homozygous sarcomere genetic variants emerge while genotyping HCM patients. In these cases, a more severe HCM phenotype is generally seen. Here, we report a case of HCM that was diagnosed clinically at 39 years of age. Initial symptoms were shortness of breath during exertion. Successively, he developed a wide array of severe clinical manifestations, which progressed to an ominous end‐stage heart failure that resulted in heart transplantation. Genotype analysis revealed a missense MYBPC3 variant NM_000256.3:c.2618C>A,p.(Pro873His) that presented in the homozygous form. Conflicting interpretations of pathogenicity have been reported for the Pro873His MYBPC3 variant described here. Our patient, presenting with two copies of the variant and devoid of a normal allele, progressed to end‐stage heart failure, which supports the notion of a deleterious effect of this variant in the homozygous form.
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Affiliation(s)
- Antheia Kissopoulou
- Department of Internal Medicine, County Council of Jönköping, Jönköping, Sweden.,Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Cecilia Trinks
- Department of Clinical Genetics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anna Green
- Department of Clinical Genetics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, County Council of Jönköping, Jönköping, Sweden.,Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Jon Jonasson
- Department of Clinical Genetics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Cecilia Gunnarsson
- Department of Clinical Genetics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Centre for Rare Diseases in South East Region of Sweden, Linköping University, Linköping, Sweden
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22
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Rentzos A, Karlsson JE, Lundqvist C, Rosengren L, Hellström M, Wikholm G. Endovascular treatment of acute ischemic stroke in the posterior circulation. Interv Neuroradiol 2018; 24:405-411. [PMID: 29562859 DOI: 10.1177/1591019918762320] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and purpose Recent randomized clinical trials have proved the efficacy of endovascular treatment of acute ischemic stroke in the anterior circulation. However, the benefit of endovascular treatment of ischemic stroke in the posterior circulation remains to be proven since it was excluded from these trials. We evaluate the benefit of endovascular treatment in posterior circulation strokes. Methods A total of 110 consecutive patients with posterior circulation stroke who underwent endovascular treatment in our institute in the period 1991-2015 were included. Recanalization rate according to modified Treatment in Cerebral Ischemia score and neurological outcome at three months according to modified Rankin Scale were the main outcomes. Collateral circulation, procedural complications and radiological outcome were evaluated in the radiological examinations. Results The median National Institutes of Health Stroke Scale was 31 (IQR: 13-31) and median time from symptom onset to groin puncture was 300 (IQR: 175-463) minutes. Successful recanalization was seen in 80 of 110 patients (73%). Favorable outcome (modified Rankin Scale ≤2) was seen in 38 patients (35%) while moderate favorable outcome (≤3) was seen in 48 patients (44%). Symptomatic intracerebral hemorrhage occurred in 10 patients (9%). An association between collateral circulation, recanalization rate and outcome was seen. Conclusion Endovascular treatment for posterior circulation stroke in this single-center cohort is relatively safe and effective with decreased mortality and increased favorable outcome compared to natural history.
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Affiliation(s)
- Alexandros Rentzos
- 1 Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan-Erik Karlsson
- 2 Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christer Lundqvist
- 2 Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Rosengren
- 2 Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Hellström
- 1 Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnar Wikholm
- 1 Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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23
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Barmano N, Walfridsson U, Walfridsson H, Karlsson JE. Structured care of patients with atrial fibrillation improves guideline adherence. J Atr Fibrillation 2017; 9:1498. [PMID: 29250257 DOI: 10.4022/jafib.1498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/19/2016] [Accepted: 12/22/2016] [Indexed: 11/10/2022]
Abstract
Aims There are many reports of lack of guideline adherence in the treatment of patients with atrial fibrillation (AF), and AF affects health-related quality of life (HRQoL) negatively. The aim of this study was to investigate whether structured care compared to standard care of a general AF population could improve guideline adherence and HRQoL, and reduce symptoms,anxiety and depression. Methods In total, 176 patients were recruited to the intervention and 146 patients to the control group.The intervention consisted of a structured follow-up program, while patients serving as controls received standard care. The primary outcome was guideline adherence evaluated through: appropriate use of oral anticoagulants (OAC) and antiarrhythmics, whether echocardiogram and thyroid lab tests were performed, and patient-reported outcome measures (PROMs), assessed with the questionnaires SF-36, EQ-5D, HADS and ASTA at baseline and after one year. Results Guideline adherence was significantly better in the intervention group, 91% vs. 63% (p < 0.01), mainly due to appropriate OAC treatment 94% vs. 74% (p < 0.01). Symptoms assessed with ASTA were less frequent and the negative impact of AF was reduced in the intervention group after one year/ at follow-up. Five scales in SF-36, and the visual analogue scale for current health status in EQ-5D (EQ-VAS), improved significantly in both groups. Conclusion Structured care of patients with AF significantly improved guideline adherence and patients reported fewer symptoms and a reduced negative impact on disease-specific HRQoL compared to standard care at one year follow-up.
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Affiliation(s)
- Neshro Barmano
- Department of Internal Medicine, County hospital Ryhov, Jönköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Jönköping Academy, Jönköping University,Jönköping, Sweden
| | - Ulla Walfridsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Håkan Walfridsson
- Jönköping Academy, Jönköping University,Jönköping, Sweden.,Jönköping Academy, Jönköping University,Jönköping, Sweden
| | - Jan-Erik Karlsson
- Department of Cardiology, University hospital, Linköping, Sweden.,Department of Cardiology, University hospital, Linköping, Sweden.,Department of Cardiology, University hospital, Linköping, Sweden
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24
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Hedberg B, Malm D, Karlsson JE, Årestedt K, Broström A. Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation. Eur J Cardiovasc Nurs 2017; 17:446-455. [DOI: 10.1177/1474515117741891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making. Aim: The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms. Methods: A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale–Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data. Results: Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication. Conclusion: Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.
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Affiliation(s)
- Berith Hedberg
- Jönköping Academy for Health and Welfare, Jönköping University, Sweden
- Region Jönköpings län, Futurum, Jönköping, Sweden
| | - Dan Malm
- Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden
- Ryhov County Hospital, Region Jönköpings län Jönköping, Sweden
| | - Jan-Erik Karlsson
- Jönköping Academy for Health and Welfare, Jönköping University, Sweden
- Department of Internal Medicine, Department of Medical and Health Sciences, Linköping University, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Medicine and Health Sciences, Linköping University, Sweden
| | - Anders Broström
- Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Sweden
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25
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Löwhagen Hendén P, Rentzos A, Karlsson JE, Rosengren L, Leiram B, Sundeman H, Dunker D, Schnabel K, Wikholm G, Hellström M, Ricksten SE. General Anesthesia Versus Conscious Sedation for Endovascular Treatment of Acute Ischemic Stroke. Stroke 2017; 48:1601-1607. [DOI: 10.1161/strokeaha.117.016554] [Citation(s) in RCA: 252] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 02/16/2017] [Accepted: 03/14/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Retrospective studies have found that patients receiving general anesthesia for endovascular treatment in acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. In this prospective randomized single-center study, we investigated the impact of anesthesia technique on neurological outcome in acute ischemic stroke patients.
Methods—
Ninety patients receiving endovascular treatment for acute ischemic stroke in 2013 to 2016 were included and randomized to general anesthesia or conscious sedation. Difference in neurological outcome at 3 months, measured as modified Rankin Scale score, was analyzed (primary outcome) and early neurological improvement of National Institutes of Health Stroke Scale and cerebral infarction volume. Age, sex, comorbidities, admission National Institutes of Health Stroke Scale score, intraprocedural blood pressure, blood glucose, Paco
2
and Pco
2
modified Thrombolysis in Cerebral Ischemia score, and relevant time intervals were recorded.
Results—
In the general anesthesia group 19 of 45 patients (42.2%) and in the conscious sedation group 18 of 45 patients (40.0%) achieved a modified Rankin Scale score ≤2 (
P
=1.00) at 3 months, with no differences in intraoperative blood pressure decline from baseline (
P
=0.57); blood glucose (
P
=0.94); PaCO2 (
P
=0.68); time intervals (
P
=0.78); degree of successful recanalization, 91.1% versus 88.9% (
P
=1.00); National Institutes of Health Stroke Scale score at 24 hours 8 (3–5) versus 9 (2–15;
P
=0.60); infarction volume, 20 (10–100) versus 20(10–54) mL (
P
=0.53); and hospital mortality (13.3% in both groups;
P
=1.00).
Conclusions—
In endovascular treatment for acute ischemic stroke, no difference was found between general anesthesia and conscious sedation in neurological outcome 3 months after stroke.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01872884.
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Affiliation(s)
- Pia Löwhagen Hendén
- From the Department of Anesthesiology and Intensive Care Medicine (P.L.H., H.S., S.-E.R.), Department of Radiology (A.R., B.L., D.D., K.S., G.W., M.H.), and Department of Neurology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden
| | - Alexandros Rentzos
- From the Department of Anesthesiology and Intensive Care Medicine (P.L.H., H.S., S.-E.R.), Department of Radiology (A.R., B.L., D.D., K.S., G.W., M.H.), and Department of Neurology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden
| | - Jan-Erik Karlsson
- From the Department of Anesthesiology and Intensive Care Medicine (P.L.H., H.S., S.-E.R.), Department of Radiology (A.R., B.L., D.D., K.S., G.W., M.H.), and Department of Neurology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden
| | - Lars Rosengren
- From the Department of Anesthesiology and Intensive Care Medicine (P.L.H., H.S., S.-E.R.), Department of Radiology (A.R., B.L., D.D., K.S., G.W., M.H.), and Department of Neurology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden
| | - Birgitta Leiram
- From the Department of Anesthesiology and Intensive Care Medicine (P.L.H., H.S., S.-E.R.), Department of Radiology (A.R., B.L., D.D., K.S., G.W., M.H.), and Department of Neurology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden
| | - Henrik Sundeman
- From the Department of Anesthesiology and Intensive Care Medicine (P.L.H., H.S., S.-E.R.), Department of Radiology (A.R., B.L., D.D., K.S., G.W., M.H.), and Department of Neurology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden
| | - Dennis Dunker
- From the Department of Anesthesiology and Intensive Care Medicine (P.L.H., H.S., S.-E.R.), Department of Radiology (A.R., B.L., D.D., K.S., G.W., M.H.), and Department of Neurology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden
| | - Kunigunde Schnabel
- From the Department of Anesthesiology and Intensive Care Medicine (P.L.H., H.S., S.-E.R.), Department of Radiology (A.R., B.L., D.D., K.S., G.W., M.H.), and Department of Neurology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden
| | - Gunnar Wikholm
- From the Department of Anesthesiology and Intensive Care Medicine (P.L.H., H.S., S.-E.R.), Department of Radiology (A.R., B.L., D.D., K.S., G.W., M.H.), and Department of Neurology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden
| | - Mikael Hellström
- From the Department of Anesthesiology and Intensive Care Medicine (P.L.H., H.S., S.-E.R.), Department of Radiology (A.R., B.L., D.D., K.S., G.W., M.H.), and Department of Neurology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden
| | - Sven-Erik Ricksten
- From the Department of Anesthesiology and Intensive Care Medicine (P.L.H., H.S., S.-E.R.), Department of Radiology (A.R., B.L., D.D., K.S., G.W., M.H.), and Department of Neurology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden
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26
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Johnston N, Bodegard J, Jerström S, Åkesson J, Brorsson H, Alfredsson J, Albertsson PA, Karlsson JE, Varenhorst C. Effects of interactive patient smartphone support app on drug adherence and lifestyle changes in myocardial infarction patients: A randomized study. Am Heart J 2016; 178:85-94. [PMID: 27502855 DOI: 10.1016/j.ahj.2016.05.005] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 05/01/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Patients with myocardial infarction (MI) seldom reach recommended targets for secondary prevention. This study evaluated a smartphone application ("app") aimed at improving treatment adherence and cardiovascular lifestyle in MI patients. DESIGN Multicenter, randomized trial. METHODS A total of 174 ticagrelor-treated MI patients were randomized to either an interactive patient support tool (active group) or a simplified tool (control group) in addition to usual post-MI care. Primary end point was a composite nonadherence score measuring patient-registered ticagrelor adherence, defined as a combination of adherence failure events (2 missed doses registered in 7-day cycles) and treatment gaps (4 consecutive missed doses). Secondary end points included change in cardiovascular risk factors, quality of life (European Quality of Life-5 Dimensions), and patient device satisfaction (System Usability Scale). RESULTS Patient mean age was 58 years, 81% were men, and 21% were current smokers. At 6 months, greater patient-registered drug adherence was achieved in the active vs the control group (nonadherence score: 16.6 vs 22.8 [P = .025]). Numerically, the active group was associated with higher degree of smoking cessation, increased physical activity, and change in quality of life; however, this did not reach statistical significance. Patient satisfaction was significantly higher in the active vs the control group (system usability score: 87.3 vs 78.1 [P = .001]). CONCLUSIONS In MI patients, use of an interactive patient support tool improved patient self-reported drug adherence and may be associated with a trend toward improved cardiovascular lifestyle changes and quality of life. Use of a disease-specific interactive patient support tool may be an appreciated, simple, and promising complement to standard secondary prevention.
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27
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Abstract
We assume that the number of claims occur according to a renewal process and treat the number of claims that occur and are reported in a certain time interval as a renewal process with random displacements. We obtain a renewal equation for the mean value function and an integral equation for the Laplace transform of the distribution of the claims that are reported. We also give asymptotic expressions for the mean value function and calculate the generating function in the case where the renewal process is a Poisson process. This matter is a part of the IBNR-problem in insurance mathematics.
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28
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Panayi G, Wieringa WG, Alfredsson J, Carlsson J, Karlsson JE, Persson A, Engvall J, Pundziute G, Swahn E. Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography. BMC Cardiovasc Disord 2016; 16:78. [PMID: 27142217 PMCID: PMC4855362 DOI: 10.1186/s12872-016-0254-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/22/2016] [Indexed: 11/21/2022] Open
Abstract
Background Three to five percent of patients with acute myocardial infarction (AMI) have normal coronary arteries on invasive coronary angiography (ICA). The aim of this study was to assess the presence and characteristics of atherosclerotic plaques on computed tomography coronary angiography (CTCA) and describe the clinical characteristics of this group of patients. Methods This was a multicentre, prospective, descriptive study on CTCA evaluation in thirty patients fulfilling criteria for AMI and without visible coronary plaques on ICA. CTCA evaluation was performed head to head in consensus by two experienced observers blinded to baseline patient characteristics and ICA results. Analysis of plaque characteristics and plaque effect on the arterial lumen was performed. Coronary segments were visually scored for the presence of plaque. Seventeen segments were differentiated, according to a modified American Heart Association classification. Echocardiography performed according to routine during the initial hospitalisation was retrieved for analysis of wall motion abnormalities and left ventricular systolic function in most patients. Results Twenty-five patients presented with non ST-elevation myocardial infarction (NSTEMI) and five with ST-elevation myocardial infarction (STEMI). Mean age was 60.2 years and 23/30 were women. The prevalence of risk factors of coronary artery disease (CAD) was low. In total, 452 coronary segments were analysed. Eighty percent (24/30) had completely normal coronary arteries and twenty percent (6/30) had coronary atherosclerosis on CTCA. In patients with atherosclerotic plaques, the median number of segments with plaque per patient was one. Echocardiography was normal in 4/22 patients based on normal global longitudinal strain (GLS) and normal wall motion score index (WMSI); 4/22 patients had normal GLS with pathological WMSI; 3/22 patients had pathological GLS and normal WMSI; 11/22 patients had pathological GLS and WMSI and among them we could identify 5 patients with a Takotsubo pattern on echo. Conclusions Despite a diagnosis of AMI, 80 % of patients with normal ICA showed no coronary plaques on CTCA. The remaining 20 % had only minimal non-obstructive atherosclerosis. Patients fulfilling clinical criteria for AMI but with completely normal ICA need further evaluation, suggestively with magnetic resonance imaging (MRI). Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0254-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Georgios Panayi
- Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden.
| | - Wouter G Wieringa
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joakim Alfredsson
- Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Jörg Carlsson
- Department of Cardiology, Kalmar County Hospital and Linnæus University, Faculty of Health and Life Sciences, Kalmar, Sweden
| | - Jan-Erik Karlsson
- Department of Cardiology, County Hospital Ryhov, Jönköping and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Anders Persson
- Center for Medical Image Science and Visualization (CMIV), Linkoping University, Linkoping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Gabija Pundziute
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva Swahn
- Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
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29
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Candefjord S, Persson M, Fhager A, Sjöqvist BA, Karlsson JE, Elam M. Pre-hospital diagnosis for stroke and trauma patients using microwave technology. Scand J Trauma Resusc Emerg Med 2015. [PMCID: PMC4577722 DOI: 10.1186/1757-7241-23-s2-a26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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30
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Löwhagen Hendén P, Rentzos A, Karlsson JE, Rosengren L, Sundeman H, Reinsfelt B, Ricksten SE. Hypotension During Endovascular Treatment of Ischemic Stroke Is a Risk Factor for Poor Neurological Outcome. Stroke 2015; 46:2678-80. [DOI: 10.1161/strokeaha.115.009808] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/16/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
In retrospective studies, patients receiving general anesthesia for endovascular treatment for acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. It has been suggested that this is caused by general anesthesia–associated hypotension. We investigated the effect of intraprocedural hypotension on neurological outcome.
Methods—
One hundred eight patients with acute ischemic stroke, who underwent endovascular treatment in general anesthesia between 2007 and 2012, were included. Analyzed predictors of neurological outcome were age, sex, comorbidities, baseline National Institutes of Health Stroke Scale, intraprocedural relative changes in mean arterial blood pressure from baseline, blood glucose, modified Thrombolysis in Cerebral Infarction score, and elapsed time from stroke to computed tomography, groin puncture, and recanalization/end of procedure.
Results—
A fall in mean arterial blood pressure of >40% was an independent predictor for poor neurological outcome (
P
=0.032), as were higher admission National Institutes of Health Stroke Scale score (
P
=0.008) and lack of recanalization (
P
=0.003).
Conclusions—
Profound intraprocedural hypotension is an independent predictor for poor neurological outcome in patients with acute ischemic stroke undergoing endovascular therapy in general anesthesia.
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Affiliation(s)
- Pia Löwhagen Hendén
- From the Departments of Anaesthesiology and Intensive Care Medicine (P.L.H., H.S., B.R., S.-E.R.), Neuroradiology (A.R.), and Neurorology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alexandros Rentzos
- From the Departments of Anaesthesiology and Intensive Care Medicine (P.L.H., H.S., B.R., S.-E.R.), Neuroradiology (A.R.), and Neurorology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan-Erik Karlsson
- From the Departments of Anaesthesiology and Intensive Care Medicine (P.L.H., H.S., B.R., S.-E.R.), Neuroradiology (A.R.), and Neurorology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Rosengren
- From the Departments of Anaesthesiology and Intensive Care Medicine (P.L.H., H.S., B.R., S.-E.R.), Neuroradiology (A.R.), and Neurorology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Sundeman
- From the Departments of Anaesthesiology and Intensive Care Medicine (P.L.H., H.S., B.R., S.-E.R.), Neuroradiology (A.R.), and Neurorology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Björn Reinsfelt
- From the Departments of Anaesthesiology and Intensive Care Medicine (P.L.H., H.S., B.R., S.-E.R.), Neuroradiology (A.R.), and Neurorology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- From the Departments of Anaesthesiology and Intensive Care Medicine (P.L.H., H.S., B.R., S.-E.R.), Neuroradiology (A.R.), and Neurorology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Andersson PO, Karlsson JE, Landberg E, Festin K, Nilsson S. Consequences of high-sensitivity troponin T testing applied in a primary care population with chest pain compared with a commercially available point-of-care troponin T analysis: an observational prospective study. BMC Res Notes 2015; 8:210. [PMID: 26036786 PMCID: PMC4467613 DOI: 10.1186/s13104-015-1174-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/18/2015] [Indexed: 11/30/2022] Open
Abstract
Background There is a demand for a highly sensitive and specific point-of care test to detect acute myocardial infarction (AMI). It is unclear if a high-sensitivity troponin assay will have enough discriminative power to become a decision support in primary care. The aim of this study was to evaluate a high-sensitivity troponin T assay performed in three primary health care centres in southeast Sweden and to compare the outcome with a point-of-care troponin T test. Methods This study included 115 patients who consulted their general practitioner for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue in the last 7 days. Troponin T was analysed by a point-of-care test and a high-sensitivity method together with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and creatinine. All patients were checked for AMI or unstable angina (UA) within 30 days of study enrolment. Univariate and multivariate logistic regression was carried out to examine possible connections between troponin T ≥ 15 ng/L, clinical variables and laboratory findings at baseline. In addition, 21 patients with troponin T ≥ 15 ng/L and no signs of AMI or UA were followed up for 2–3 years. Results Three patients were diagnosed with AMI and three with UA. At the ≥ 15 ng/L cut-off, the troponin T method had 100% sensitivity, 75% specificity for AMI and a positive predictive value of 10%. The troponin T point-of-care test missed one case of AMI and the detection limit was 50 ng/L. Troponin T ≥ 15 ng/L was correlated to age ≥65 years (odds ratio (OR), 10.9 95% CI 2.28–51.8) and NT-proBNP in accordance with heart failure (OR 8.62 95% CI 1.61–46.1). Fourteen of the 21 patients, without signs of AMI or UA at baseline, still had increased troponin T at follow-up after 2–3 years. Conclusions A high-sensitivity troponin T assay could become useful in primary care as a point-of-care test for patients <65 years. For patients older than 65–70 years, a higher decision limit than ≥15 ng/L should be considered and used in conjunction with clinical parameters and possibly with NT-proBNP.
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Affiliation(s)
- Per O Andersson
- Primary Health Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Jan-Erik Karlsson
- Department of Internal Medicine, County Council of Jönköping, Jönköping, Sweden. .,Department of Medical and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.
| | - Eva Landberg
- Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Karin Festin
- Department of Medical and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.
| | - Staffan Nilsson
- Primary Health Care and Department of Medical and Health Sciences, Linköping University, Norrköping, Sweden.
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Henriksson C, Larsson M, Herlitz J, Karlsson JE, Wernroth L, Lindahl B. Influence of health-related quality of life on time from symptom onset to hospital arrival and the risk of readmission in patients with myocardial infarction. Open Heart 2014; 1:e000051. [PMID: 25525504 PMCID: PMC4267108 DOI: 10.1136/openhrt-2014-000051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/24/2014] [Accepted: 11/21/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite increased awareness of the importance of early treatment in acute myocardial infarction (AMI), the delay from symptom onset to hospital arrival is still too long and rehospitalisations are frequent. Little is known about how health-related quality of life (HRQL) affects delay time and the frequency of readmissions. METHOD We used quality registers to investigate whether patients' HRQL has any impact on delay time with a new AMI, and on the rate of readmissions during the first year. Patients with AMI <75 years, with HRQL assessed with EQ-5D at 1-year follow-up, and who thereafter had a new AMI registered, were evaluated for the correlation between HRQL and delay time (n=454). The association between HRQL and readmissions was evaluated among those who had an additional AMI and a new 1-year follow-up registration (n=216). RESULTS Patients who reported poor total health status (EQ-VAS ≤50), compared to those who reported EQ-VAS 81-100, had tripled risk to delay ≥2 h from symptom onset to hospital arrival (adjusted OR 3.01, 95% CI 1.43 to 6.34). Patients scoring EQ-VAS ≤50 had also a higher risk of readmissions in the univariate analysis (OR 3.08, 95% CI 1.71 to 5.53). However, the correlation did not remain significant after adjustment (OR 1.99, 95% CI 0.90 to 4.38). EQ-index was not independently associated with delay time or readmissions. CONCLUSIONS Aspects of total health status post-AMI were independently associated with delay time to hospital arrival in case of a new AMI. However, the influence of total health status on the risk of readmissions was less clear.
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Affiliation(s)
- Catrin Henriksson
- Department of Medical Sciences , Uppsala Clinical Research Center, Uppsala University , Uppsala , Sweden
| | - Margareta Larsson
- Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Johan Herlitz
- The Center of Prehospital Research in Western Sweden, University of Borås and Sahlgrenska University Hospital , Gothenburg , Sweden
| | | | - Lisa Wernroth
- Uppsala Clinical Research Center, Uppsala University , Uppsala , Sweden
| | - Bertil Lindahl
- Department of Medical Sciences , Uppsala Clinical Research Center, Uppsala University , Uppsala , Sweden
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Abstract
OBJECTIVE To evaluate the safety and cost-effectiveness of point-of-care troponin T testing (POCT-TnT) for the management of patients with chest pain in primary care. DESIGN Prospective observational study with follow-up. SETTING Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in south-east Sweden. PATIENTS All patients ≥ 35 years of age, contacting one of the PHC centres for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue, with no other probable cause than cardiac, were included. Symptoms must have commenced or worsened during the previous seven days. MAIN OUTCOME MEASURES Emergency referral rates, diagnoses of acute myocardial infarction (AMI) or unstable angina (UA), and costs were collected for 30 days after the patient sought care at the PHC centre. RESULTS A total of 196 patients with chest pain were included: 128 in PHC centres with POCT-TnT and 68 in PHC centres without POCT-TnT. Fewer patients from the PHC centres with POCT-TnT (n = 32, 25%) were emergently referred to hospital than from centres without POCT-TnT (n = 29, 43%; p = 0.011). Eight patients (6.2%) from PHC centres with POCT-TnT were diagnosed with AMI or UA compared with six patients (8.8%) from centres without POCT-TnT (p = 0.565). Two patients with AMI or UA were classified as missed cases from PHC centres with POCT-TnT and there were no missed cases from PHC centres without POCT-TnT. SKr290 000 was saved per missed case of AMI or UA. CONCLUSION The use of POCT-TnT in primary care may be cost saving but at the expense of missed cases.
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Affiliation(s)
- Staffan Nilsson
- Primary Health Care and Department of Medicine and Health Sciences, Linköping University, Norrköping, Sweden
| | - Agneta Andersson
- R&D Department of Local Health Care, County Council of Östergötland, Linköping University, SE-581 85 Linköping, Sweden
| | - Magnus Janzon
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, County Hospital Ryhov, SE-551 85 Jönköping, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Lars-Åke Levin
- Division of Health Care Analysis, Linköping University, SE-581 85 Linköping, Sweden
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El-Saadi W, Maret E, Andersson R, Puskar W, Ali M, Skogvard P, Koch A, Karlsson JE. P158Mangafodipir as an adjunct to percutaneous coronary intervention in patients with acute myocardial infarction. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu082.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nilsson S, Andersson PO, Borgquist L, Grodzinsky E, Janzon M, Kvick M, Landberg E, Nilsson H, Karlsson JE. Point-of-Care Troponin T Testing in the Management of Patients with Chest Pain in the Swedish Primary Care. Int J Family Med 2013; 2013:532093. [PMID: 23365746 PMCID: PMC3556440 DOI: 10.1155/2013/532093] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 12/10/2012] [Indexed: 06/01/2023]
Abstract
Objective. To investigate the diagnostic accuracy and clinical benefit of point-of-care Troponin T testing (POCT-TnT) in the management of patients with chest pain. Design. Observational, prospective, cross-sectional study with followup. Setting. Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in the southeast of Sweden. Patients. All patients ≥35 years old, contacting one of the primary health care centres for chest pain, dyspnoea on exertion, unexplained weakness, and/or fatigue with no other probable cause than cardiac, were included. Symptoms should have commenced or worsened during the last seven days. Main Outcome Measures. Emergency referrals, patients with acute myocardial infarctions (AMI), or unstable angina (UA) within 30 days of study enrolment. Results. 25% of the patients from PHC centres with POCT-TnT and 43% from PHC centres without POCT-TnT were emergently referred by the GP (P = 0.011 ). Seven patients (5.5%) from PHC centres with POCT-TnT and six (8.8%) from PHC centres without POCT-TnT were diagnosed as AMI or UA (P = 0.369). Two patients with AMI or UA from PHC centres with POCT-TnT were judged as missed cases in primary health care. Conclusion. The use of POCT-TnT may reduce emergency referrals but probably at the cost of an increased risk to miss patients with AMI or UA.
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Affiliation(s)
- Staffan Nilsson
- Primary Care, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, East County Primary Health Care, County Council of Östergötland, 581 83 Linköping, Sweden
| | - Per O. Andersson
- Central County Primary Health Care, County Council of Östergötland, 581 85 Linköping, Sweden
| | - Lars Borgquist
- Primary Care, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Ewa Grodzinsky
- Division of Biomedical Laboratory Science, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Department of R&D Unit in Local Health Care, County Council of Östergötland, 581 85 Linköping, Sweden
| | - Magnus Janzon
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, 581 85 Linköping, Sweden
- Department of Cardiology UHL, County Council of Östergötland, 581 85 Linköping, Sweden
| | - Magnus Kvick
- East County Primary Health Care, County Council of Östergötland, 601 82 Norrköping, Sweden
| | - Eva Landberg
- Division of Clinical Chemistry, Department of Clinical and Experimental Medicine, Linköping University, County Council of Östergötland, 581 83 Linköping, Sweden
| | - Håkan Nilsson
- Central County Primary Health Care, County Council of Östergötland, 581 85 Linköping, Sweden
| | - Jan-Erik Karlsson
- Division of Cardiology, Department of Internal Medicine, County Hospital Ryhov, 551 85 Jönköping, Sweden
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Bergman E, Årestedt K, Fridlund B, Karlsson JE, Malm D. The impact of comprehensibility and sense of coherence in the recovery of patients with myocardial infarction: a long-term follow-up study. Eur J Cardiovasc Nurs 2012; 11:276-83. [DOI: 10.1177/1474515111435607] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Kristofer Årestedt
- Linköping University, Linköping, Sweden
- Linnaeus University, Kalmar, Sweden
| | | | | | - Dan Malm
- County Hospital Ryhov, Jönköping, Sweden
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Hedlund E, Karlsson JE, Starck SÅ. Automatic and manual image fusion of In-pentetreotide SPECT and diagnostic CT in neuroendocrine tumor imaging - An evaluation. J Med Phys 2011; 35:223-8. [PMID: 21170187 PMCID: PMC2990117 DOI: 10.4103/0971-6203.71766] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 05/06/2010] [Accepted: 06/02/2010] [Indexed: 11/06/2022] Open
Abstract
In the clinical diagnosis of neuroendocrine tumors (NET), the results of examinations, such as high-resolution computed tomography (CT) and single photon computerized tomography (SPECT), have conventionally been interpreted separately. The aim of the present study was to evaluate Hermes Multimodality™ 5.0 H Image Fusion software-based automatic and manual image fusion of SPECT and CT for the localization of NET lesions. Out of 34 NET patients who were examined by means of somatostatin receptor scintigraphy (SRS) with 111In- pentetreotide along with SPECT, 22 patients had a CT examination of the abdomen, which was used in the fusion analysis. SPECT and CT data were fused using software with a registration algorithm based on normalized mutual information. The criteria for acceptable fusion were established at a maximum cranial or caudal dislocation of 25 mm between the images and at a reasonable consensus (in order of less than 1 cm) between outline of the reference organs. The automatic fusion was acceptable in 13 of the 22 examinations, whereas 9 fusions were not. However all the 22 examinations were acceptable at the manual fusion. The result of automatic fusion was better when the slice thickness of 5 mm was applied at CT examination, when the number of slices was below 100 in CT data and when both examinations included uptakes of pathological lesions. Retrospective manual image fusion of SPECT and CT is a relatively inexpensive but reliable method to be used in NET imaging. Automatic image fusion with specified software of SPECT and CT acts better when the number of CT slices is reduced to the SPECT volume and when corresponding pathological lesions appear at both SPECT and CT examinations.
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Affiliation(s)
- Elisabeth Hedlund
- Medical Imaging, School of Health Sciences, Jönköping University, Jönköping, Sweden
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Affiliation(s)
- Eva Bergman
- Department of Internal Medicine, Division of Cardiology, County Hospital Ryhov, Jönköping, Sweden
| | - Dan Malm
- Department of Internal Medicine, Division of Cardiology, County Hospital Ryhov, Jönköping, Sweden
- School of Health Sciences Jönköping University, Jönköping, Sweden
| | | | - Carina Berterö
- Department of Medicine and Health Sciences, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, Division of Cardiology, County Hospital Ryhov, Jönköping, Sweden
- School of Health Sciences Jönköping University, Jönköping, Sweden
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Nilsson S, Mölstad S, Karlberg C, Karlsson JE, Persson LG. No connection between the level of exposition to statins in the population and the incidence/mortality of acute myocardial infarction: an ecological study based on Sweden's municipalities. J Negat Results Biomed 2011; 10:6. [PMID: 21609438 PMCID: PMC3127855 DOI: 10.1186/1477-5751-10-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 05/24/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Randomised controlled trials have shown an excellent preventive effect of statins on ischemic heart disease. Our objective was to investigate if a relation can be detected between acute myocardial infarction- (AMI) mortality or incidence and statin utilisation, for men and women in different age-groups on a population basis. RESULTS The utilisation rate of statins increased almost three times for both men and women between 1998 and 2002. During 1998-2000 the incidence of AMI decreased clearly for men but only slightly for women. Mortality decreased from 1998 to 2002. The change in statin utilisation from 1998 to 2000 showed no correlation to the change in AMI mortality from 2000 to 2002. Statin utilisation and AMI- incidence or mortality showed no correlations when adjusting for socio-economic deprivation, antidiabetic drugs and geographic coordinates. CONCLUSIONS Despite a widespread and increasing utilisation of statins, no correlation to the incidence or mortality of AMI could be detected. Other factors than increased statin treatment should be analysed especially when discussing the allocation of public resources.
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Affiliation(s)
- Staffan Nilsson
- Division of Community Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Bergman E, Malm D, Berterö C, Karlsson JE. Does one's sense of coherence change after an acute myocardial infarction?: A two-year longitudinal study in Sweden. Nurs Health Sci 2011; 13:156-63. [DOI: 10.1111/j.1442-2018.2011.00592.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Henriksson C, Larsson M, Arnetz J, Berglin-Jarlöv M, Herlitz J, Karlsson JE, Svensson L, Thuresson M, Zedigh C, Wernroth L, Lindahl B. Knowledge and attitudes toward seeking medical care for AMI-symptoms. Int J Cardiol 2009; 147:224-7. [PMID: 19853936 DOI: 10.1016/j.ijcard.2009.08.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 07/16/2009] [Accepted: 08/20/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Time is crucial when an acute myocardial infarction (AMI) occurs, but patients often wait before seeking medical care. AIM To investigate and compare patients' and relatives' knowledge of AMI, attitudes toward seeking medical care, and intended behaviour if AMI-symptoms occur. METHODS The present study was a descriptive, multicentre study. Participants were AMI-patients ≤ 75 years (n = 364) and relatives to AMI-patients (n = 319). Questionnaires were used to explore the participants' knowledge of AMI and attitudes toward seeking medical care. RESULTS Both patients and relatives appeared to act more appropriate to someone else's chest pain than to their own. Patients did not have better knowledge of AMI-symptoms than relatives. Women would more often contact someone else before seeking medical care. A greater percentage of elderly (65-75 years), compared to younger individuals, reported that they would call for an ambulance if chest pain occurred. CONCLUSIONS There were only minor differences between patients and relatives, regarding both knowledge and attitudes. It seems easier to act correctly as a bystander than as a patient. Therefore, in order to decrease patients' delay time it is important to educate relatives as well as patients on how to respond to symptoms of an AMI.
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Isaxon C, Pagels J, Gudmundsson A, Asbach C, John AC, Kuhlbusch TAJ, Karlsson JE, Kammer R, Tinnerberg H, Nielsen J, Bohgard M. Characteristics of welding fume aerosol investigated in three Swedish workshops. ACTA ACUST UNITED AC 2009. [DOI: 10.1088/1742-6596/151/1/012059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ahlstrom C, Ask P, Rask P, Karlsson JE, Nylander E, Dahlström U, Hult P. Assessment of suspected aortic stenosis by auto mutual information analysis of murmurs. ACTA ACUST UNITED AC 2007; 2007:1945-8. [PMID: 18002364 DOI: 10.1109/iembs.2007.4352698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mild sclerotic thickening of the aortic valve affects 25% of the population, and the condition causes aortic valve stenosis (AS) in 2% of adults above 65 years. Echocardiography is today the clinical standard for assessing AS. However, a cost effective and uncomplicated technique that can be used for decision support in the primary health care would be of great value. In this study, recorded phonocardiographic signals were analyzed using the first local minimum of the auto mutual information (AMI) function. The AMI method measures the complexity in the sound signal, which is related to the amount of turbulence in the blood flow and thus to the severity of the stenosis. Two previously developed phonocardiographic methods for assessing AS severity were used for comparison, the murmur energy ratio and the sound spectral averaging technique. Twenty-nine patients with suspected AS were examined with Doppler echocardiography. The aortic jet velocity was used as a reference of AS severity, and it was found to correlate with the AMI method, the murmur energy ratio and the sound spectral averaging technique with the correlation coefficient R = 0.82, R = 0.73 and R = 0.76, respectively.
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Affiliation(s)
- Christer Ahlstrom
- Dept. of Biomedical Engineering, Linköping University, 581 85, Linköping, Sweden.
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Karlsson JE, Svensson O. [Apolipoprotein determination was introduced with the contribution of general practitioners!]. Lakartidningen 2007; 104:962, 964. [PMID: 17469312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Malm D, Karlsson JE, Fridlund B. Effects of a self-care program on the health-related quality of life of pacemaker patients: a nursing intervention study. Can J Cardiovasc Nurs 2007; 17:15-26. [PMID: 17378519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
An experimental, multi-centre, randomized study with a nurse-led intervention was conducted with the aim of evaluating the effects on HRQoL of a 10-month self-care program for pacemaker patients. In the present study, there were no significant differences in HRQoL when comparisons were made between the experimental group and the control group. Results show two main findings for patients in the self-care program (n = 97; mean age 71 years): a significantly better HRQoL in terms of experiencing the symptoms that were the reason for pacemaker implantation, as having decreased or disappeared, and a higher level of perceived exertion in a 1 1/2-minute stair test compared with patients who had standard checkups (n = 115; mean age 73 years). It is important to actively include pacemaker patients in a self-care program while still in the acute phase in the hospital. Health care professionals should support the patient in a kind and professional manner by providing clear, relevant information, and planning a self-care program based on the nurse's assessment of the patient's needs. To enable patients to manage their life situations, training and continued education for health care professionals is necessary so that their efforts are based on a holistic approach to nursing care and recognition of the patient perspective, with emphasis on developing education and counselling for women, patients with atrial fibrillation/sick sinus disease, and patients whose pacemakers have ventricular pacing.
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Affiliation(s)
- D Malm
- Department of Cardiology, County Hospital Ryhov, Jönköping, Sweden.
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Ahlstrom C, Hult P, Rask P, Karlsson JE, Nylander E, Dahlström U, Ask P. Feature extraction for systolic heart murmur classification. Ann Biomed Eng 2006; 34:1666-77. [PMID: 17019618 DOI: 10.1007/s10439-006-9187-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 08/22/2006] [Indexed: 10/24/2022]
Abstract
Heart murmurs are often the first signs of pathological changes of the heart valves, and they are usually found during auscultation in the primary health care. Distinguishing a pathological murmur from a physiological murmur is however difficult, why an "intelligent stethoscope" with decision support abilities would be of great value. Phonocardiographic signals were acquired from 36 patients with aortic valve stenosis, mitral insufficiency or physiological murmurs, and the data were analyzed with the aim to find a suitable feature subset for automatic classification of heart murmurs. Techniques such as Shannon energy, wavelets, fractal dimensions and recurrence quantification analysis were used to extract 207 features. 157 of these features have not previously been used in heart murmur classification. A multi-domain subset consisting of 14, both old and new, features was derived using Pudil's sequential floating forward selection (SFFS) method. This subset was compared with several single domain feature sets. Using neural network classification, the selected multi-domain subset gave the best results; 86% correct classifications compared to 68% for the first runner-up. In conclusion, the derived feature set was superior to the comparative sets, and seems rather robust to noisy data.
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Affiliation(s)
- Christer Ahlstrom
- Department of Biomedical Engineering, University Hospital, Linköping University, IMT, SE-581 85, Linköping, Sweden.
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Stenström U, Nilsson AK, Stridh C, Nijm J, Nyrinder I, Jonsson A, Karlsson JE, Jonasson L. Denial in patients with a first-time myocardial infarction: relations to pre-hospital delay and attendance to a cardiac rehabilitation programme. ACTA ACUST UNITED AC 2006; 12:568-71. [PMID: 16319547 DOI: 10.1097/00149831-200512000-00009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Survival of a myocardial infarction and subsequent prognosis are highly dependent on the time between onset of symptoms and medical intervention. DESIGN This cross-sectional study examines whether patients who used the psychological defence mechanism of denial when faced with symptoms of a first-time myocardial infarction tended to also show a prolonged delay in going to the hospital and to be less willing to participate in a cardiac rehabilitation programme. METHODS One hundred and seven patients, 78 men and 29 women, were enrolled in this study. The sample was divided into two groups depending on whether the patients sought medical help within 4 h after they began experiencing myocardial infarction symptoms (non-delayers) or whether they waited longer (delayers). Denial was measured with the Hackett and Cassem semi-structured interview 3-5 days after the patients entered the hospital. Data on participation (attenders) or not (non-attenders) in the rehabilitation programme was also obtained. RESULTS Forty-nine patients exhibited a prolonged delay and 76 patients did not attend the rehabilitation programme. Both prolonged delay and a lesser readiness to attend the rehabilitation programme that was offered were related to a greater use of denial. In addition, the great majority of the patients categorized as being high deniers were found to also be both delayers and non-attenders. CONCLUSIONS The results suggest denial to increase the health risks of persons potentially prone to myocardial infarction. If our knowledge about this psychological defence mechanism is increased, we might be able to reach more patients in alternative and individually based cardiac rehabilitation programmes.
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Affiliation(s)
- Ulf Stenström
- School of Health Sciences, Jönköping University, Jönköping, Sweden.
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Gerhardsson L, Balogh I, Hambert PA, Hjortsberg U, Karlsson JE. Vascular and nerve damage in workers exposed to vibrating tools. The importance of objective measurements of exposure time. Appl Ergon 2005; 36:55-60. [PMID: 15627422 DOI: 10.1016/j.apergo.2004.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2001] [Revised: 01/15/2004] [Accepted: 09/02/2004] [Indexed: 05/24/2023]
Abstract
The aim of the present study was to compare the development of vibration white fingers (VWF) in workers in relation to different ways of exposure estimation, and their relationship to the standard ISO 5349, annex A. Nineteen vibration exposed (grinding machines) male workers completed a questionnaire followed by a structured interview including questions regarding their estimated hand-held vibration exposure. Neurophysiological tests such as fractionated nerve conduction velocity in hands and arms, vibrotactile perception thresholds and temperature thresholds were determined. The subjective estimation of the mean daily exposure-time to vibrating tools was 192 min (range 18-480 min) among the workers. The estimated mean exposure time calculated from the consumption of grinding wheels was 42 min (range 18-60 min), approximately a four-fold overestimation (Wilcoxon's signed ranks test, p<0.001). Thus, objective measurements of the exposure time, related to the standard ISO 5349, which in this case were based on the consumption of grinding wheels, will in most cases give a better basis for adequate risk assessment than self-exposure assessment.
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Affiliation(s)
- Lars Gerhardsson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, St Sigfridsgatan 85, SE-412 66 Göteborg, Sweden.
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Blomstrand P, Maret E, Ohlsson J, Scheike M, Karlsson JE, Säfström K, Swahn E, Engvall J. Pulsed tissue Doppler imaging for the detection of myocardial ischaemia, a comparison with myocardial perfusion SPECT. Clin Physiol Funct Imaging 2004; 24:289-95. [PMID: 15383086 DOI: 10.1111/j.1475-097x.2004.00564.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In order to compare the diagnostic ability of pulsed tissue Doppler and myocardial perfusion Single Photon Emission Computed Tomography (SPECT) in patients with a history of unstable coronary artery disease, CAD, 26 patients, 22 men and four women, age 47-76 years, were investigated in a prospective study, 5-10 day after an episode of unstable angina. Tissue Doppler and two-dimensional echocardiography were performed during dobutamine stress testing and myocardial scintigraphy after bicycle exercise and at rest. Patients with a normal SPECT had higher peak systolic velocity during dobutamine infusion, 18.9 +/- 4.1 cm s(-1), than patients with ischaemia, 12.2 +/- 3.8 cm s(-1) (P<0.001) or scar, 8.8 +/- 3.0 cm s(-1) (P<0.01). In a territorial analysis the difference in peak systolic velocity between areas with a normal and abnormal SPECT was less apparent. Failure to achieve >/=13 cm s(-1) in mean-peak systolic velocity was the most accurate criterion for detection of significant CAD on SPECT. We conclude that pulsed tissue Doppler can be used for objective quantification of left ventricular wall motion during dobutamine stress testing and for identification of patients with CAD on SPECT but not for identification of regional ischaemia.
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Affiliation(s)
- Peter Blomstrand
- Department of Clinical Physiology, County Hospital Ryhov, 551-85 Jönköping, Sweden
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Strömberg A, Mårtensson J, Fridlund B, Levin LA, Karlsson JE, Dahlström U. Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial. Eur Heart J 2003; 24:1014-23. [PMID: 12788301 DOI: 10.1016/s0195-668x(03)00112-x] [Citation(s) in RCA: 314] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIM The aim of this trial was to prospectively evaluate the effect of follow-up at a nurse-led heart failure clinic on mortality, morbidity and self-care behaviour for patients hospitalised due to heart failure for 12 months after discharge. METHODS A total of 106 patients were randomly assigned to either follow-up at a nurse-led heart failure clinic or to usual care. The nurse-led heart failure clinic was staffed by specially educated and experienced cardiac nurses, delegated the responsibility for making protocol-led changes in medications. The first follow-up visit was 2-3 weeks after discharge. During the visit the nurse evaluated the heart failure status and the treatment, gave education about heart failure and social support to the patient and his family. RESULTS There were fewer patients with events (death or admission) after 12 months in the intervention group compared to the control group (29 vs 40, p=0.03) and fewer deaths after 12 months (7 vs 20, p=0.005). The intervention group had fewer admissions (33 vs 56, p=0.047) and days in hospital (350 vs 592, p=0.045) during the first 3 months. After 12 months the intervention was associated with a 55% decrease in admissions/patient/month (0.18 vs 0.40, p=0.06) and fewer days in hospital/patient/month (1.4 vs 3.9, p=0.02). The intervention group had significantly higher self-care scores at 3 and 12 months compared to the control group (p=0.02 and p=0.01). CONCLUSIONS Follow up after hospitalisation at a nurse-led heart failure clinic can improve survival and self-care behaviour in patients with heart failure as well as reduce the number of events, readmissions and days in hospital.
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Affiliation(s)
- A Strömberg
- Department of Cardiology, Heart Centre, Linköping University Hospital, and Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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