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Salzinger B, Lundwall K, Evans M, Mörtberg J, Wallén H, Jernberg T, Kahan T, Lundman P, Tornvall P, Erlinge D, Lindahl B, Baron T, Rezeli M, Spaak J, Jacobson SH. Associations between inflammatory and angiogenic proteomic biomarkers, and cardiovascular events and mortality in relation to kidney function. Clin Kidney J 2024; 17:sfae050. [PMID: 38524235 PMCID: PMC10959071 DOI: 10.1093/ckj/sfae050] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Indexed: 03/26/2024] Open
Abstract
Background The links between chronic kidney disease (CKD) and the high burden of cardiovascular disease remain unclear. We aimed to explore the association between selected inflammatory and angiogenic biomarkers, kidney function and long-term outcome in patients with an acute coronary syndrome (ACS) and to test the hypothesis that CKD status modifies this association. Methods A total of 1293 ACS patients hospitalized between 2008 and 2015 were followed until 31 December 2017. Plasma was collected on days 1-3 after admission. A total of 13 biomarkers were a priori identified and analysed with two proteomic methods, proximity extension assay or multiple reaction monitoring mass spectrometry. Boxplots and multiple linear regression models were used to study associations between biomarkers and kidney function and adjusted standardized Cox regression with an interaction term for CKD was used to assess whether CKD modified the association between biomarkers and major adverse cardiovascular events and death (MACE+). Results The concentrations of nine biomarkers-endothelial cell-specific molecule-1 (ESM-1), fibroblast growth factor 23 (FGF-23), fractalkine (CX3CL1), interleukin-1 receptor antagonist (IL-1RA), interleukin-18 (IL-18), monocyte chemotactic protein-1 (MCP-1), placenta growth factor (PlGF), transmembrane immunoglobulin 1 (TIM-1) and vascular endothelial growth factor A (VEGFA)-were inversely associated with kidney function. ESM-1, FGF-23 and TIM-1 showed associations with MACE+. Only FGF23 remained independently associated after adjustment for the other biomarkers (hazard ratio per standard deviation increase 1.34; 95% Bonferroni corrected confidence interval 1.19-1.50). None of the biomarkers showed an interaction with CKD. Conclusions The concentrations of 9 of the 13 prespecified inflammatory and angiogenic proteomic biomarkers increased when kidney function declined. Only FGF-23 demonstrated an independent association with MACE+, and this association was not modified by CKD status. These findings further support FGF-23 as an independent prognostic marker in ACS patients with and without CKD.
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Affiliation(s)
- Barbara Salzinger
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Kristina Lundwall
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Marie Evans
- ME Renal Medicine, Department of Clinical Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Josefin Mörtberg
- Division of Nephrology, Department of Internal Medicine, Centre for Clinical Research, County of Vastmanland and Uppsala University, Uppsala, Sweden
| | - Håkan Wallén
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Tomas Jernberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Pia Lundman
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Tomasz Baron
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Melinda Rezeli
- Clinical Protein Science & Imaging, Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Jonas Spaak
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Stefan H Jacobson
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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Bergstedt J, Pasman JA, Ma Z, Harder A, Yao S, Parker N, Treur JL, Smit DJA, Frei O, Shadrin A, Meijsen JJ, Shen Q, Hägg S, Tornvall P, Buil A, Werge T, Hjerling-Leffler J, Als TD, Børglum AD, Lewis CM, McIntosh AM, Valdimarsdóttir UA, Andreassen OA, Sullivan PF, Lu Y, Fang F. Distinct genomic signatures and modifiable risk factors underly the comorbidity between major depressive disorder and cardiovascular disease. medRxiv 2024:2023.09.01.23294931. [PMID: 37693619 PMCID: PMC10491387 DOI: 10.1101/2023.09.01.23294931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Major depressive disorder (MDD) and cardiovascular disease (CVD) are often comorbid, resulting in excess morbidity and mortality. Using genomic data, this study elucidates biological mechanisms, key risk factors, and causal pathways underlying their comorbidity. We show that CVDs share a large proportion of their genetic risk factors with MDD. Multivariate genome-wide association analysis of the shared genetic liability between MDD and atherosclerotic CVD (ASCVD) revealed seven novel loci and distinct patterns of tissue and brain cell-type enrichments, suggesting a role for the thalamus. Part of the genetic overlap was explained by shared inflammatory, metabolic, and psychosocial/lifestyle risk factors. Finally, we found support for causal effects of genetic liability to MDD on CVD risk, but not from most CVDs to MDD, and demonstrated that the causal effects were partly explained by metabolic and psychosocial/lifestyle factors. The distinct signature of MDD-ASCVD comorbidity aligns with the idea of an immunometabolic sub-type of MDD more strongly associated with CVD than overall MDD. In summary, we identify plausible biological mechanisms underlying MDD-CVD comorbidity, as well as key modifiable risk factors for prevention of CVD in individuals with MDD.
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Affiliation(s)
- Jacob Bergstedt
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joëlle A Pasman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ziyan Ma
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Arvid Harder
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Shuyang Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department Medical Biochemistry and Biophysics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Nadine Parker
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jorien L Treur
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Dirk J A Smit
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Oleksandr Frei
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Alexey Shadrin
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Joeri J Meijsen
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
| | - Qing Shen
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
- Institute for Advanced Study, Tongji University, Shanghai, China
| | - Sara Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Alfonso Buil
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
| | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Copenhagen, Denmark
- Lundbeck Foundation GeoGenetics Centre, GLOBE Institute, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Hjerling-Leffler
- Department Medical Biochemistry and Biophysics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Thomas D Als
- Department of Molecular Medicine (MOMA), Molecular Diagnostic Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Anders D Børglum
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, Aarhus, Denmark
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
- Department of Medical and Molecular Genetics, King's College London, London, UK
| | - Andrew M McIntosh
- Centre for Clinical Brain Sciences, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
- Centre for Genomics and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Unnur A Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Centre for Neurodevelopmental disorders, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Patrick F Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill, NC, USA
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Steffen Johansson R, Tornvall P, Sörensson P, Nickander J. Reduced stress perfusion in myocardial infarction with nonobstructive coronary arteries. Sci Rep 2023; 13:22094. [PMID: 38086910 PMCID: PMC10716406 DOI: 10.1038/s41598-023-49223-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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCA) has several possible underlying causes, including coronary microvascular dysfunction (CMD). Early cardiovascular magnetic resonance imaging (CMR) is recommended, however cannot provide a diagnosis in 25% of cases. Quantitative stress CMR perfusion mapping can identify CMD, however it is unknown if CMD is present during long-term follow-up of MINOCA patients. Therefore, this study aimed to evaluate presence of CMD during long-term follow-up in MINOCA patients with an initial normal CMR scan. MINOCA patients from the second Stockholm myocardial infarction with normal coronaries study (SMINC-2), with a normal CMR scan at median 3 days after hospitalization were investigated with comprehensive CMR including stress perfusion mapping a median of 5 years after the index event, together with age- and sex-matched volunteers without symptomatic ischemic heart disease. Cardiovascular risk factors, medication and symptoms of myocardial ischemia measured by the Seattle Angina Questionnaire 7 (SAQ-7), were registered. In total, 15 patients with MINOCA and an initial normal CMR scan (59 ± 7 years old, 60% female), and 15 age- and sex-matched volunteers, underwent CMR. Patients with MINOCA and an initial normal CMR scan had lower global stress perfusion compared to volunteers (2.83 ± 1.8 vs 3.53 ± 0.7 ml/min/g, p = 0.02). There were no differences in other CMR parameters, hemodynamic parameters, or cardiovascular risk factors, except for more frequent use of statins in the MINOCA patient group compared to volunteers. In conclusion, global stress perfusion is lower in MINOCA patients during follow-up, compared to age- and sex-matched volunteers, suggesting that CMD may be a possible pathophysiological mechanism in MINOCA.Clinical Trial Registration: Clinicaltrials.gov identifier NCT02318498. Registered 2014-12-17.
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Affiliation(s)
- Rebecka Steffen Johansson
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
- Klinisk Fysiologi A8:01, Karolinska University Hospital, Solna, Eugeniavägen 23, 171 76, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Cardiology Unit, Södersjukhuset, Stockholm, Sweden
| | - Peder Sörensson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jannike Nickander
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden.
- Klinisk Fysiologi A8:01, Karolinska University Hospital, Solna, Eugeniavägen 23, 171 76, Stockholm, Sweden.
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4
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Sundqvist MG, Sörensson P, Ekenbäck C, Lundin M, Agewall S, Brolin EB, Cederlund K, Collste O, Daniel M, Jensen J, Y-Hassan S, Henareh L, Hofman-Bang C, Lyngå P, Maret E, Sarkar N, Spaak J, Winnberg O, Caidahl K, Ugander M, Tornvall P. CMR Is Often Abnormal Despite Normal Echocardiography in Suspected Myocardial Infarction With Nonobstructed Coronary Arteries. JACC Cardiovasc Imaging 2023; 16:1626-1628. [PMID: 37498255 DOI: 10.1016/j.jcmg.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 07/28/2023]
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Lenhoff H, Järnbert-Petersson H, Darpo B, Tornvall P, Frick M. Mortality and ventricular arrhythmias in patients on d,l-sotalol for rhythm control of atrial fibrillation: A nationwide cohort study. Heart Rhythm 2023; 20:1473-1480. [PMID: 37598987 DOI: 10.1016/j.hrthm.2023.08.019] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Use of d,l-sotalol for rhythm control in patients with atrial fibrillation (AF) has raised safety concerns. Previous randomized studies are few and not designed for mortality outcome. OBJECTIVE The purpose of this study was to compare the incidences of mortality and ventricular arrhythmias in AF patients treated with d,l-sotalol for rhythm control vs matched control patients treated with cardioselective beta-blockers. METHODS This population-based cohort study included AF patients from the Swedish National Patient Registry (2006-2017) who underwent rhythm control after a second cardioversion. Incidence rates (IRs) and adjusted hazard ratios (aHRs) for mortality and a composite endpoint of cardiac arrest/death and ventricular arrhythmias were calculated for the overall cohort and a 1:1 propensity score matched cohort of d,l-sotalol vs beta-blocker treatment. RESULTS Among patient treated with d,l-sotalol (n = 4987) and beta-blocker (n = 27,078) (mean follow-up 458 days), all-cause mortality was lower in patients treated with d,l-sotalol: IR 1.21; 95% confidence interval 0.95-1.52 vs 2.42 (2.26-2.60) deaths per 100 patient-years; aHR 0.66 (0.52-0.83). The difference in mortality persisted in the propensity score matched comparison (n = 4953 in each group): aHR 0.63 (0.48-0.86). No differences were observed in the composite outcome: IR in propensity cohorts 2.13 (1.78-2.52) vs 2.07 (1.73-2.53) events per 100 years; aHR 1.01 (0.78-1.29). CONCLUSION There was no excess mortality with d,l-sotalol compared with cardioselective beta-blockers in patients undergoing rhythm control treatment for AF after a second cardioversion. Our results indicate that the risk associated with d,l-sotalol treatment for AF can be mitigated by careful patient selection and strict adherence to follow-up protocols.
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Affiliation(s)
- Hanna Lenhoff
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden.
| | - Hans Järnbert-Petersson
- Department of Clinical Science and Education, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | | | - Per Tornvall
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden
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6
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Wärme J, Sundqvist MO, Hjort M, Agewall S, Collste O, Ekenbäck C, Frick M, Henareh L, Hofman-Bang C, Spaak J, Sörensson P, Y-Hassan S, Svensson P, Lindahl B, Hofmann R, Tornvall P. Helicobacter pylori and Pro-Inflammatory Protein Biomarkers in Myocardial Infarction with and without Obstructive Coronary Artery Disease. Int J Mol Sci 2023; 24:14143. [PMID: 37762446 PMCID: PMC10531769 DOI: 10.3390/ijms241814143] [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: 08/10/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Myocardial infarction (MI) with obstructive coronary artery disease (MI-CAD) and MI in the absence of obstructive coronary artery disease (MINOCA) affect different populations and may have separate pathophysiological mechanisms, with greater inflammatory activity in MINOCA compared to MI-CAD. Helicobacter pylori (Hp) can cause systemic inflammation and has been associated with cardiovascular disease (CVD). We aimed to investigate whether Hp infection is associated with concentrations of protein biomarkers of inflammation and CVD. In a case-control study, patients with MINOCA (n = 99) in Sweden were included, complemented by matched subjects with MI-CAD (n = 99) and controls (n = 100). Protein biomarkers were measured with a proximity extension assay in plasma samples collected 3 months after MI. The seroprevalence of Hp and cytotoxin-associated gene A (CagA) was determined using ELISA. The associations between protein levels and Hp status were studied with linear regression. The prevalence of Hp was 20.2%, 19.2%, and 16.0% for MINOCA, MI-CAD, and controls, respectively (p = 0.73). Seven proteins were associated with Hp in an adjusted model: tissue plasminogen activator (tPA), interleukin-6 (IL-6), myeloperoxidase (MPO), TNF-related activation-induced cytokine (TRANCE), pappalysin-1 (PAPPA), soluble urokinase plasminogen activator receptor (suPAR), and P-selectin glycoprotein ligand 1 (PSGL-1). Hp infection was present in one in five patients with MI, irrespective of the presence of obstructive CAD. Inflammatory proteins were elevated in Hp-positive subjects, thus not ruling out that Hp may promote an inflammatory response and potentially contribute to the development of CVD.
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Affiliation(s)
- Jonatan Wärme
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Martin O. Sundqvist
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Marcus Hjort
- Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Stefan Agewall
- Division of Medicine, Institute of Clinical Medicine, University of Oslo, NO-0318 Oslo, Norway
- Department of Cardiology, Oslo University Hospital, NO-0450 Oslo, Norway
| | - Olov Collste
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Christina Ekenbäck
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Loghman Henareh
- Department of Medicine Huddinge, Karolinska Institute, SE-141 86 Huddinge, Sweden
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Claes Hofman-Bang
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden
| | - Jonas Spaak
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden
| | - Peder Sörensson
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Shams Y-Hassan
- Department of Medicine Huddinge, Karolinska Institute, SE-141 86 Huddinge, Sweden
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Per Svensson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Robin Hofmann
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
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Welén Schef K, Tornvall P, Alfredsson J, Hagström E, Ravn-Fischer A, Soderberg S, Yndigegn T, Jernberg T. Prevalence of angina pectoris and association with coronary atherosclerosis in a general population. Heart 2023; 109:1450-1459. [PMID: 37225242 PMCID: PMC10511980 DOI: 10.1136/heartjnl-2023-322345] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 01/03/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE To assess the contemporary prevalence of, and factors associated with angina pectoris symptoms, and to examine the relationship to coronary atherosclerosis in a middle-aged, general population. METHODS Data were based on the Swedish CArdioPulmonary bioImage Study (SCAPIS), in which 30 154 individuals were randomly recruited from the general population between 2013 and 2018. Participants that completed the Rose Angina Questionnaire were included and categorised as angina or no angina. Subjects with a valid coronary CT angiography (CCTA) were categorised by degree of coronary atherosclerosis; ≥50% obstruction (obstructive coronary atherosclerosis), <50% obstruction or any atheromatosis (non-obstructive coronary atherosclerosis) or none (no coronary atherosclerosis). RESULTS The study population consisted of 28 974 questionnaire responders (median age 57.4 years, female 51.6%, hypertension 19.9%, hyperlipidaemia 7.9%, diabetes mellitus 3.7%), of which 1025 (3.5%) fulfilled the criteria of angina. Coronary atherosclerosis was more common in individuals having angina compared with those with no angina (n=24 602, obstructive coronary atherosclerosis 11.8% vs 5.4%, non-obstructive coronary atherosclerosis 38.9% vs 37.0%, no coronary atherosclerosis 49.4% vs 57.7%, all p<0.001). Factors independently associated with angina were birthplace outside of Sweden (OR 2.58 (95% CI 2.10 to 2.92)), low educational level (OR 1.41 (1.10 to 1.79)), unemployment (OR 1.51 (1.27 to 1.81)), poor economic status (OR 1.85 (1.38 to 2.47)), symptoms of depression (OR 1.63 (1.38 to 1.92)) and high degree of stress (OR 2.92 (1.80 to 4.73)). CONCLUSION Angina pectoris symptoms are common (3.5%) among middle-aged individuals of the general population of Sweden, though with low association to obstructive coronary atherosclerosis. Sociodemographic and psychological factors are highly associated with angina symptoms, irrespective of degree of coronary atherosclerosis.
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Affiliation(s)
- Kerstin Welén Schef
- Department of Clinical Sciences, Danderyd Hospital division of Cardiology, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Alfredsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala Universitet, Uppsala, Sweden
| | - Annica Ravn-Fischer
- Department of Cardiology, Sahlgrenska University Hospital Institute of Medicine, Göteborg, Sweden
- Department of Molecular and Clinical Medicine Sahlgrenska, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Stefan Soderberg
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden
| | - Troels Yndigegn
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lunds Universitet, Lund, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital division of Cardiology, Karolinska Institutet, Stockholm, Sweden
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8
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Berg E, Agewall S, Brolin EB, Caidahl K, Cederlund K, Collste O, Daniel M, Ekenbäck C, Jensen J, Y-Hassan S, Henareh L, Maret E, Spaak J, Sörensson P, Tornvall P, Lyngå P. Health-related quality-of-life up to one year after myocardial infarction with non-obstructive coronary arteries. Eur Heart J Qual Care Clin Outcomes 2023; 9:639-644. [PMID: 36328780 PMCID: PMC10495698 DOI: 10.1093/ehjqcco/qcac072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 09/13/2023]
Abstract
AIMS Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) are a heterogenous group and previous studies indicate a decreased Health-related quality-of-life (HRQoL) compared with patients with myocardial infarction with obstructive coronary artery disease and healthy individuals. However, longitudinal data are scarce. Therefore, the aim was to explore HRQoL among patients with MINOCA during a one-year period after the acute event in comparison with a group of healthy individuals and to describe HRQoL in patients with Takotsubo Syndrome (TTS). METHODS AND RESULTS Patients with MINOCA were recruited from five hospitals in the Stockholm region (SMINC-2 study, clinical trials: NCT2318498). Patients responded to the HRQoL questionnaire RAND-36 between days 2-4, after 6 and 12 months respectively. A sample of population-based individuals was used as a comparison group. A total of 142 MINOCA patients, (70% women) mean age of 56 years, responded. A population-based sample of 317 volunteers (66% women) mean age of 57 years. Patients with MINOCA scored lower than the comparison group in the domains role functioning physical, social functioning, and role functioning emotional (P = 0.01-0.02) at 12 months. In these domains of HRQoL there was no improvement in MINOCA patients during 12 months follow-up. In the domains of energy/fatigue vitality and emotional well-being the scores improved and were similar to the comparison group at 12 months. Patients with TTS scored generally lower on RAND-36 than MINOCA patients without TTS. CONCLUSION Physical, social, and emotional functioning did not improve during the first year after MINOCA, indicating a need for increased follow-up including psychological support.
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Affiliation(s)
- Emma Berg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet Danderyd Hospital, Division of Cardiovascular Medicine, 182 57 Stockholm, Sweden
| | - Stefan Agewall
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
| | - Elin B Brolin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Medical Imaging and Technology, Stockholm, Sweden, and Department of Radiology, Capio S:t Görans Hospital, 11219 Stockholm, Sweden
| | - Kenneth Caidahl
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, 17176 Stockholm, Sweden
| | - Kerstin Cederlund
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Medical Imaging and Technology, Stockholm, Sweden, and Department of Radiology, Södertälje Hospital, 15240 Södertälje, Sweden
| | - Olov Collste
- Department of Clinical Science and Education, Cardiology Unit, Södersjukhuset, Karolinska Institutet, 11883 Stockholm, Sweden
| | - Maria Daniel
- Department of Clinical Science and Education, Cardiology Unit, Södersjukhuset, Karolinska Institutet, 11883 Stockholm, Sweden
| | - Christina Ekenbäck
- Department of Clinical Sciences, Karolinska Institutet, Division of Cardiovascular Medicine, Danderyd Hospital, 18257 Stockholm, Sweden
| | - Jens Jensen
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Department of Cardiology, Capio S:t Görans Hospital, 11219 Stockholm, Sweden
| | - Shams Y-Hassan
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institute and Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Loghman Henareh
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institute and Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Eva Maret
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, 17176 Stockholm, Sweden
| | - Jonas Spaak
- Department of Clinical Sciences, Karolinska Institutet, Division of Cardiovascular Medicine, Danderyd Hospital, 18257 Stockholm, Sweden
| | - Peder Sörensson
- Department of Medicine Solna, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Cardiology Unit, Södersjukhuset, Karolinska Institutet, 11883 Stockholm, Sweden
| | - Patrik Lyngå
- Department of Clinical Science and Education, Cardiology Unit, Södersjukhuset, Karolinska Institutet, 11883 Stockholm, Sweden
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9
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Cederström S, Lundman P, Alfredsson J, Hagström E, Ravn-Fischer A, Söderberg S, Yndigegn T, Tornvall P, Jernberg T. Association between high-sensitivity C-reactive protein and coronary atherosclerosis in a general middle-aged population. Sci Rep 2023; 13:12171. [PMID: 37500663 PMCID: PMC10374905 DOI: 10.1038/s41598-023-39051-3] [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: 03/16/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
Despite abundant knowledge about the relationship between inflammation and coronary atherosclerosis, it is still unknown whether systemic inflammation measured as high-sensitivity C-reactive protein (hsCRP) is associated with coronary atherosclerosis in a general population. This study aimed to examine the association between hsCRP and coronary computed tomography angiography (CCTA)-detected coronary atherosclerosis in a population-based cohort. Out of 30,154 randomly invited men and women aged 50 to 64 years in the Swedish Cardiopulmonary Bioimage Study (SCAPIS), 25,408 had a technically acceptable CCTA and analysed hsCRP. Coronary atherosclerosis was defined as presence of plaque of any degree in any of 18 coronary segments. HsCRP values were categorised in four groups. Compared with hsCRP below the detection limit, elevated hsCRP (≥ 2.3 mg/L) was weakly associated with any coronary atherosclerosis (OR 1.15, 95% CI 1.07-1.24), coronary diameter stenosis ≥ 50% (OR 1.27, 95% CI 1.09-1.47), ≥ 4 segments involved (OR 1.13, 95% CI 1.01-1.26 ) and severe atherosclerosis (OR 1.33, 95% CI 1.05-1.69) after adjustment for age, sex and traditional risk factors. The associations were attenuated after further adjustment for body mass index (BMI), although elevated hsCRP still associated with noncalcified plaques (OR 1.16, 95% CI 1.02-1.32), proposed to be more vulnerable. In conclusion, the additional value of hsCRP to traditional risk factors in detection of coronary atherosclerosis is low. The association to high-risk noncalcified plaques, although unlikely through a causal pathway, could explain the relationship between hsCRP and clinical coronary events in numerous studies.
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Affiliation(s)
- Sofia Cederström
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Pia Lundman
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Alfredsson
- Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Annica Ravn-Fischer
- Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden
| | - Troels Yndigegn
- Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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10
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Shen Q, Mikkelsen DH, Luitva LB, Song H, Kasela S, Aspelund T, Bergstedt J, Lu Y, Sullivan PF, Ye W, Fall K, Tornvall P, Pawitan Y, Andreassen OA, Buil A, Milani L, Fang F, Valdimarsdóttir U. Psychiatric disorders and subsequent risk of cardiovascular disease: a longitudinal matched cohort study across three countries. EClinicalMedicine 2023; 61:102063. [PMID: 37425374 PMCID: PMC10329128 DOI: 10.1016/j.eclinm.2023.102063] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023] Open
Abstract
Background Several psychiatric disorders have been associated with increased risk of cardiovascular disease (CVD), however, the role of familial factors and the main disease trajectories remain unknown. Methods In this longitudinal cohort study, we identified a cohort of 900,240 patients newly diagnosed with psychiatric disorders during January 1, 1987 and December 31, 2016, their 1,002,888 unaffected full siblings, and 1:10 age- and sex-matched reference population from nationwide medical records in Sweden, who had no prior diagnosis of CVD at enrolment. We used flexible parametric models to determine the time-varying association between first-onset psychiatric disorders and incident CVD and CVD death, comparing rates of CVD among patients with psychiatric disorders to the rates of unaffected siblings and matched reference population. We also used disease trajectory analysis to identify main disease trajectories linking psychiatric disorders to CVD. Identified associations and disease trajectories of the Swedish cohort were validated in a similar cohort from nationwide medical records in Denmark (N = 875,634 patients, same criteria during January 1, 1969 and December 31, 2016) and in Estonian cohorts from the Estonian Biobank (N = 30,656 patients, same criteria during January 1, 2006 and December 31, 2020), respectively. Findings During up to 30 years of follow-up of the Swedish cohort, the crude incidence rate of CVD was 9.7, 7.4 and 7.0 per 1000 person-years among patients with psychiatric disorders, their unaffected siblings, and the matched reference population. Compared with their siblings, patients with psychiatric disorders experienced higher rates of CVD during the first year after diagnosis (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.79-1.98) and thereafter (1.37; 95% CI, 1.34-1.39). Similar rate increases were noted when comparing with the matched reference population. These results were replicated in the Danish cohort. We identified several disease trajectories linking psychiatric disorders to CVD in the Swedish cohort, with or without mediating medical conditions, including a direct link between psychiatric disorders and hypertensive disorder, ischemic heart disease, venous thromboembolism, angina pectoris, and stroke. These trajectories were validated in the Estonian Biobank cohort. Interpretation Independent of familial factors, patients with psychiatric disorders are at an elevated risk of subsequent CVD, particularly during first year after diagnosis. Increased surveillance and treatment of CVDs and CVD risk factors should be considered as an integral part of clinical management, in order to reduce risk of CVD among patients with psychiatric disorders. Funding This research was supported by EU Horizon 2020 Research and Innovation Action Grant, European Research Council Consolidator grant, Icelandic Research fund, Swedish Research Council, US NIMH, the Outstanding Clinical Discipline Project of Shanghai Pudong, the Fundamental Research Funds for the Central Universities, and the European Union through the European Regional Development Fund; the Research Council of Norway; the South-East Regional Health Authority, the Stiftelsen Kristian Gerhard Jebsen, and the EEA-RO-NO-2018-0535.
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Affiliation(s)
- Qing Shen
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
- Institute for Advanced Study, Tongji University, Shanghai, China
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dorte Helenius Mikkelsen
- Institute of Biological Psychiatry, Mental Health Services Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Laura Birgit Luitva
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Huan Song
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Medical Big Data Center, Sichuan University, Chengdu, China
| | - Silva Kasela
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Jacob Bergstedt
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Patrick F. Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill, United States
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Katja Fall
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Yudi Pawitan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ole A. Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alfonso Buil
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Mental Health Center Sct. Hans, Mental Health Services, Capital Region Denmark, Roskilde, Denmark
| | - Lili Milani
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Unnur Valdimarsdóttir
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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11
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Ekenbäck C, Nickander J, Jokhaji F, Tornvall P, Engblom H, Spaak J, Persson J. Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function. ESC Heart Fail 2023. [PMID: 37218383 PMCID: PMC10375085 DOI: 10.1002/ehf2.14394] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/30/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
AIMS Coronary microvascular dysfunction (CMD) has been proposed as an important pathophysiological mechanism in Takotsubo syndrome (TTS). Our aims were (i) to evaluate and compare levels of CMD in patients with TTS and patients with ischaemia and no obstructive coronary arteries (INOCA) and (ii) to investigate associations between CMD and clinical parameters, left ventricular function, and coronary atherosclerosis in TTS. METHODS AND RESULTS We conducted a prospective study of 27 female TTS patients and an equally sized, age- and gender-matched, cohort of INOCA patients. Coronary microvascular function was quantified invasively using the index of microcirculatory resistance (IMR), coronary flow reserve (CFR), and resistive reserve ratio (RRR). CMD was defined as IMR ≥ 25 and/or CFR ≤ 2. In the TTS patients, left ventricular function was assessed with echocardiography and cardiovascular magnetic resonance (CMR) imaging, and coronary atherosclerosis was visualized with intravascular ultrasound with near-infrared spectroscopy (IVUS-NIRS). The incidence of CMD was higher in the TTS patients than in the INOCA cohort (78% vs. 44%, P = 0.01), with higher IMR (30 vs. 14, P = 0.002), lower CFR (1.8 vs. 2.8, P = 0.009), and lower RRR (2.1 vs. 3.5, P = 0.003). In apical compared with midventricular TTS, IMR was numerically higher (50 vs. 28, P = 0.20), whereas CFR and RRR were lower (1.5 vs. 2.5, P = 0.003 and 1.6 vs. 2.7, P = 0.01, respectively). Global longitudinal strain and global circumferential strain, assessed with CMR imaging, were more impaired in apical than in midventricular TTS (-11 vs. -14, P < 0.001 and -12 vs. -15, P = 0.049, respectively). In the TTS patients, CFR and RRR correlated with echocardiography-derived (R2 = 0.15, P = 0.002 and R2 = 0.18, P = 0.007, respectively) and CMR-derived (R2 = 0.09, P = 0.025 and R2 = 0.10, P = 0.038, respectively) ejection fraction. CFR and RRR correlated inversely with CMR-derived end-diastolic volume index, end-systolic volume index, and left ventricular mass index. IMR, CFR, and RRR were not associated with measures of coronary atherosclerosis derived by IVUS-NIRS. CONCLUSIONS Coronary microvascular dysfunction is common in patients with TTS and more frequent than in patients with INOCA. CMD in TTS is more severe in the apical compared with the midventricular phenotype of the syndrome, is associated with left ventricular function, but is unrelated to coronary atherosclerosis. Our results support the notion of CMD as a key mediator in TTS.
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Affiliation(s)
- Christina Ekenbäck
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
- Department of Cardiology and Physiology, Danderyd Hospital, Stockholm, Sweden
| | - Jannike Nickander
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Fadi Jokhaji
- Department of Cardiology and Physiology, Danderyd Hospital, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Physiology, Skåne University Hospital and Lund University, Lund, Sweden
| | - Jonas Spaak
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
- Department of Cardiology and Physiology, Danderyd Hospital, Stockholm, Sweden
| | - Jonas Persson
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
- Department of Cardiology and Physiology, Danderyd Hospital, Stockholm, Sweden
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12
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Mörtberg J, Salzinger B, Lundwall K, Edfors R, Jacobson SH, Wallén HN, Jernberg T, Baron T, Erlinge D, Andell P, James S, Eggers KM, Hjort M, Kahan T, Lundman P, Tornvall P, Rezeli M, Marko-Varga G, Lindahl B, Spaak J. Prognostic importance of biomarkers associated with haemostatic, vascular and endothelial disturbances in acute coronary syndrome patients in relation to kidney function. Int J Cardiol 2023; 373:64-71. [PMID: 36476672 DOI: 10.1016/j.ijcard.2022.12.005] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with kidney failure have a high risk for cardiovascular events. We aimed to evaluate the prognostic importance of selected biomarkers related to haemostasis, endothelial function, and vascular regulation in patients with acute coronary syndrome (ACS), and to study whether this association differed in patients with renal dysfunction. METHODS Plasma was collected in 1370 ACS patients included between 2008 and 2015. Biomarkers were analysed using a Proximity Extension Assay and a Multiple Reaction Monitoring mass spectrometry assay. To reduce multiplicity, biomarkers correlating with eGFR were selected a priori among 36 plasma biomarkers reflecting endothelial and vascular function, and haemostasis. Adjusted Cox regression were used to study their association with the composite outcome of myocardial infarction, ischemic stroke, heart failure or death. Interaction with eGFR strata above or below 60 ml/min/1.73 m2 was tested. RESULTS Tissue factor, proteinase-activated receptor, soluble urokinase plasminogen activator surface receptor (suPAR), thrombomodulin, adrenomedullin, renin, and angiotensinogen correlated inversely with eGFR and were selected for the Cox regression. Mean follow-up was 5.2 years during which 428 events occurred. Adrenomedullin, suPAR, and renin were independently associated with the composite outcome. Adrenomedullin showed interaction with eGFR strata (p = 0.010) and was associated with increased risk (HR 1.88; CI 1.44-2.45) only in patients with eGFR ≥60 ml/min/ 1.73 m2. CONCLUSIONS Adrenomedullin, suPAR, and renin were associated with the composite outcome in all. Adrenomedullin, involved in endothelial protection, showed a significant interaction with renal function and outcome, and was associated with the composite outcome only in patients with preserved kidney function.
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Affiliation(s)
- Josefin Mörtberg
- Centre for Clinical Research, Vastmanland Hospital Vasteras, Region Vastmanland - Uppsala University, Sweden; Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Barbara Salzinger
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Lundwall
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Robert Edfors
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Stefan H Jacobson
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Håkan N Wallén
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Jernberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Tomasz Baron
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Pontus Andell
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Heart and Vascular Division, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan James
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Kai M Eggers
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Marcus Hjort
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Pia Lundman
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Melinda Rezeli
- Clinical Protein Science & Imaging, Department of Biomedical Engineering, Lund University, BMC D13, Lund SE-221 84, Sweden
| | - György Marko-Varga
- Clinical Protein Science & Imaging, Department of Biomedical Engineering, Lund University, BMC D13, Lund SE-221 84, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Jonas Spaak
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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13
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Nickander J, Ekenbäck C, Agewall S, Bacsovics Brolin E, Caidahl K, Cederlund K, Collste O, Daniel M, Jensen J, Y-Hassan S, Henareh L, Hofman-Bang C, Lyngå P, Maret E, Sarkar N, Spaak J, Winnberg O, Sundqvist M, Ugander M, Tornvall P, Sörensson P. Comprehensive Follow-Up Cardiac Magnetic Resonance of Patients With Myocardial Infarction With Nonobstructive Coronary Arteries. JACC Cardiovasc Imaging 2023; 16:128-129. [PMID: 36599558 DOI: 10.1016/j.jcmg.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022]
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14
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Cederstrom S, Lundman P, Alfredsson J, Hagstrom E, Ravn-Fischer A, Soderberg S, Yndigegn T, Tornvall P, Jernberg T. Association between high sensitivity C-reactive protein and coronary atherosclerosis in a general middle-aged population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/12/2022] Open
Abstract
Abstract
Background
Despite abundant knowledge about the relationship between inflammation and coronary artery disease (CAD), it is still unknown whether high sensitivity C-reactive protein (hsCRP) is associated with coronary atherosclerosis in the general population.
Objectives
The project aimed to study the association between systemic inflammation, measured as hsCRP, and coronary artery atherosclerosis in a large population based cohort.
Methods
30,154 randomly selected men and women aged between 50 and 64 years were included in the SCAPIS (Swedish Cardiopulmonary Bioimage Study). After excluding those not undergoing coronary computed tomography angiography (CCTA), those with proximal segments not technically assessable and those with missing values of hsCRP, 25,408 individuals were analysed. Coronary artery atherosclerosis was defined as presence of plaque of any degree (1–49% or ≥50% diameter stenosis) or segments not assessable due to calcification in any of the 18 coronary segments. Analysis of severe atherosclerosis included participants with ≥50% diameter stenosis in any of the left main coronary artery (LMCA), the proximal left anterior descending artery (LAD) or three vessel disease including ≥50% diameter stenosis in any of the segments in each of the LAD, right coronary artery (RCA) and circumflex artery (CX). Participants with hsCRP above the lowest detection limit (≥0.7mg/L) were divided into tertiles and compared with hsCRP<0.7 mg/L as a reference.
Results
The highest tertile of measurable hsCRP (≥2.3 mg/L) was associated with coronary atherosclerosis in a multivariate analysis adjusted for classical cardiovascular risk factors (Table 1). HsCRP was also related to atherosclerosis with significant coronary artery diameter stenosis ≥50%, ≥4 segments involved, severe atherosclerosis and atherosclerosis with noncalcified plaques. Also, moderately elevated hsCRP (1.2–2.2 mg/L) was significant associated with noncalcified plaques. In a stratified analysis, coronary atherosclerosis was associated with the two highest tertiles of hsCRP (≥1.2 mg/L) in women, but not in men.
Conclusion
Elevated hsCRP was associated with the prevalence of coronary atherosclerosis in a population based cohort of middle-aged men and women. The relationships were more pronounced for atherosclerosis with noncalcified plaques and in women compared to men. This suggests that more attention should be given to hsCRP in risk assessment in middle-aged individuals without known disease, especially in women.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Swedish Heart Lung FoundationKnut and Alice Wallenberg Foundation
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Affiliation(s)
- S Cederstrom
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital (KI DS) , Stockholm , Sweden
| | - P Lundman
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital (KI DS) , Stockholm , Sweden
| | - J Alfredsson
- Linkoping University, Faculty of Health Sciences , Linkoping , Sweden
| | - E Hagstrom
- Uppsala University, Department of Medical Sciences, Cardiology , Uppsala , Sweden
| | - A Ravn-Fischer
- Sahlgrenska University Hospital, Department of Molecular and Clinical Medicine , Gothenburg , Sweden
| | - S Soderberg
- Umea University, Department of Public Health and Clinical Medicine , Umea , Sweden
| | - T Yndigegn
- Lund University, Department of Clinical Sciences , Lund , Sweden
| | - P Tornvall
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset (KI SÖS) , Stockholm , Sweden
| | - T Jernberg
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital (KI DS) , Stockholm , Sweden
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15
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Steffen Johansson R, Tornvall P, Sorensson P, Nickander J. Lower stress perfusion in patients with myocardial infarction with non-obstructive coronary arteries compared to controls in long-term follow-up with quantitative perfusion mapping. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/14/2022] Open
Abstract
Abstract
Introduction
Myocardial infarction with non-obstructive coronary arteries (MINOCA) constitutes a heterogenous condition with different coronary, cardiac and non-cardiac etiologies. Cardiovascular magnetic resonance imaging (CMR) has emerged as an important diagnostic tool in recent years and is now recommended in patients with MINOCA as a working diagnosis. However, despite early CMR following admission for MINOCA, no cause can be found in around 25% of all patients. A pathophysiological mechanism may be diffuse global coronary microvascular dysfunction (CMD) which has emerged as an important cause of myocardial ischemia. Quantitative adenosine stress CMR perfusion mapping allows for absolute quantification of myocardial perfusion, reflecting CMD in the absence of obstructive coronary disease in MINOCA patients.
Purpose
To study the presence of CMD in MINOCA patients with an initial normal CMR scan compared to healthy controls.
Methods
Patients from the multicenter myocardial infarction in our city with normal Coronaries 2 (SMINC-2) study, with a normal CMR scan 2–4 days after hospitalization, and healthy age- and sex-matched controls underwent stress perfusion at 1.5T (MAGNETOM Aera). Native rest T1 and T2 short-axis maps were acquired. Quantitative perfusion maps were acquired during adenosine stress (140 micrograms/kg/min) and at rest following an intravenous contrast bolus (0.05 mmol/kg of gadoteric acid, Gd-DOTA). Post contrast T1 maps were acquired after intravenous contrast (total dose 0.2 mmol/kg) rendering extracellular volume (ECV) maps. Global native T1, T2, ECV and rest and stress perfusion values were acquired by averaging segmental values per patient. Myocardial perfusion reserve (MPR) was calculated as perfusion in stress divided by rest. Values were presented as mean±standard deviation and compared with the independent t-test in normally distributed data, and with the Mann-Whitney U test in non-normally distributed data. Clinical data regarding cardiovascular risk factors, smoking and medications were presented as numbers (percentages) and compared with Fisher's exact test. Rate pressure product (RPP) was calculated as systolic blood pressure multiplied by heart rate in rest and stress.
Results
In total, 15 patients (59±16 years old, 60% female), and 15 healthy age- and sex-matched controls, were included. There was a trend towards higher incidence of hypertension in patients compared to controls, however no difference in other risk factors (Table 1). Compared to controls, MINOCA patients had lower perfusion in stress (Figure 1). There was no difference in global native T1, T2, ECV, rest perfusion, MPR or hemodynamic parameters between the MINOCA patients and the controls (p>0.05 for all, Table 1).
Conclusions
Myocardial stress perfusion is lower in MINOCA patients with a normal initial CMR scan compared to age- and sex-matched controls suggesting CMD as a possible pathophysiological mechanism in MINOCA.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swedish Heart and Lung Foundation
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Affiliation(s)
- R Steffen Johansson
- Karolinska Institute, Department of Molecular Medicine and Surgery , Stockholm , Sweden
| | - P Tornvall
- Karolinska Institute, Department of Clinical Science and Education , Stockholm , Sweden
| | - P Sorensson
- Karolinska Institute, Department of Medicine Solna , Stockholm , Sweden
| | - J Nickander
- Karolinska Institute, Department of Molecular Medicine and Surgery , Stockholm , Sweden
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Welen Schef K, Hagstrom E, Ravn-Fischer A, Soderberg S, Yndigegn T, Tornvall P, Jernberg T. Prevalence and risk factors of angina pectoris and its association with coronary atherosclerosis in a general population, a cross-sectional study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/12/2022] Open
Abstract
Abstract
Background
Angina pectoris (AP) is a common clinical presentation with low association to significant coronary artery disease (CAD) in selected cohorts, though yet associated with an elevated risk of major cardiovascular adverse events. Current knowledge on AP prevalence is not up to date since contemporary cross-sectional population-based studies using symptom evaluation are sparse and epidemiological studies often use administrative data from routine health care. Also, there is a lack of studies in the general population examining the association between AP and presence of coronary atherosclerosis.
Purpose
To assess the prevalence of AP, the relationship to CAD, and risk factors associated to the conditions in a population-based, middle-aged Swedish cohort.
Methods
Data were based on the Swedish CArdioPulmonary bioImage Study (SCAPIS), in which 30,154 men and women aged 50–64 years were recruited from the general population between 2013 and 2018. Exposure variables included information from blood sampling, physiological examinations, coronary computed tomographic angiography (CCTA) and an extensive questionnaire, including WHO Rose questionnaire on AP. Participants that completed the Rose questionnaire were included and categorized as having Rose angina or No angina. Subjects with a valid CCTA were further assessed regarding correlation between having Rose angina and degree of CAD, categorized as obstructive (>50% occlusion, O-CAD), non-obstructive (<50% occlusion, NO-CAD) or normal coronary angiography (Normal CA). Associations between risk factor exposures and outcomes were analysed in both cohorts using bivariate logistic regression.
Results
The main cohort consisted of N=28,974 individuals, of which n=1025 fulfilled the criteria of Rose angina, giving a prevalence of 3.5%. Out of these, N=24,602 subjects constituted the CCTA-cohort. Coronary atherosclerosis was significantly more common in individuals having Rose angina compared with those with No angina, (p≤0.001; O-CAD 11.8% vs 5.4%, NO-CAD 38.9% vs 37.0%, Normal CA 49.4% vs 57.7%). Factors associated with Rose angina were birthplace outside of Sweden, low educational level, unemployment, poor economic status, symptoms of depression, and high degree of general stress (Table). Physical inactivity, and current or previous cardiopulmonary diseases only marginally attenuated the associations. These findings were consistent in the sub-population of Rose angina with NO-CAD or Normal CA.
Conclusion
Rose Questionnaire AP was common in a Swedish general population, with a greater association to coronary atherosclerosis at CCTA compared with asymptomatic individuals. O-CAD was though uncommon. Risk factors associated with AP were sociodemographic and psychological, irrespective of degree of CAD.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): SCAPIS has been funded mainly from the Swedish Heart- and Lung foundation and Knut och Alice Wallenberg foundation.
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Affiliation(s)
- K Welen Schef
- Danderyd University Hospital, Cardiology , Stockholm , Sweden
| | - E Hagstrom
- Uppsala University Hospital, Cardiology , Uppsala , Sweden
| | - A Ravn-Fischer
- Sahlgrenska University Hospital, Cardiology , Gothenburg , Sweden
| | - S Soderberg
- Umea University Hospital, Cardiology , Umea , Sweden
| | - T Yndigegn
- Skane University Hospital, Cardiology , Lund , Sweden
| | - P Tornvall
- South Hospital Stockholm, Cardiology , Stockholm , Sweden
| | - T Jernberg
- Danderyd University Hospital, Cardiology , Stockholm , Sweden
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Olsson EMG, Norlund F, Rondung E, Humphries SM, Held C, Lyngå P, Spaak J, Sundin Ö, Sundelin R, Leissner P, Kövamees L, Tornvall P. The e-mental health treatment in Stockholm myocardial infarction with non-obstructive coronaries or Takotsubo syndrome study (E-SMINC): a study protocol for a randomised controlled trial. Trials 2022; 23:597. [PMID: 35883115 PMCID: PMC9315084 DOI: 10.1186/s13063-022-06530-3] [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: 04/21/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the aftermath of a myocardial infarction with non-obstructive coronary arteries (MINOCA) or Takotsubo syndrome (TS), patients commonly express high levels of stress and anxiety. Current treatment alternatives rarely address these issues. METHODS The study is a randomised controlled trial, where 90 patients with a discharge diagnosis of MINOCA or TS who also report symptoms of stress or anxiety will be randomised 2-6 weeks after their cardiac event. The treatment consists of 10 weeks of Internet-based cognitive behaviour therapy (CBT) and starts immediately after randomisation for the treatment group. The control group receives usual care. Main outcomes are symptoms of anxiety measured with the Hospital Anxiety and Depression scale, anxiety subscale, and perceived stress measured with the Perceived Stress Scale, 14-item version, 10 weeks after randomisation. Secondary measures include cardiac specific anxiety, symptoms of post-traumatic stress, quality of life, cortisol measured in hair and physiological stress responses (heart rate variability, blood pressure and saliva cortisol) during a stress procedure. Ten weeks after randomisation, the control group will also receive treatment. Long-term follow-up in the self-report measures mentioned above will be conducted 20 and 50 weeks after randomisation where the total group's development over time is followed, and the groups receiving intervention early versus late compared. DISCUSSION At present, there are no randomised studies evaluating psychological treatment for patients with MINOCA or TS. There is an urgent need for treatment alternatives aiming at relieving stress and anxiety considering the high mental stress and anxiety levels observed in MINOCA and TS, leading to decreased quality of life. CBT aiming at reducing mental stress has been shown to be effective regarding prognosis in patients with coronary artery disease. The current protocol describes a randomised open-label controlled trial evaluating an Internet-based CBT program for reduction of stress and anxiety in patients with increased mental stress and/or anxiety with a discharge diagnosis of either MINOCA or TS. TRIAL REGISTRATION ClinicalTrials.gov NCT04178434 . Registered on 26 November 2019.
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Affiliation(s)
- Erik M G Olsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Fredrika Norlund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Elisabet Rondung
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Sophia M Humphries
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Patrik Lyngå
- Department of Clinical Science and Education, Karolinska Institutet and Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Örjan Sundin
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Runa Sundelin
- Department of Clinical Science and Education, Karolinska Institutet and Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Philip Leissner
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lena Kövamees
- Swedish Heart and Lung Association, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Karolinska Institutet and Department of Cardiology, Södersjukhuset, Stockholm, Sweden
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Rondung E, Humphries SM, Olsson EMG, Sundelin R, Norlund F, Held C, Spaak J, Tornvall P, Lyngå P. Reducing stress and anxiety in patients with myocardial infarction with non-obstructive coronary arteries or Takotsubo syndrome: A non-randomized feasibility study. Internet Interv 2022; 29:100562. [PMID: 35910688 PMCID: PMC9334337 DOI: 10.1016/j.invent.2022.100562] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND AIM In the aftermath of a myocardial infarction with non-obstructive coronary arteries (MINOCA) or Takotsubo syndrome (TS), patients commonly express high levels of stress and anxiety. Current treatment alternatives rarely address these issues. The planned E-health Treatment of Stress and Anxiety in Stockholm Myocardial Infarction With Non-obstructive Coronaries Study (e-SMINC) aims to evaluate the effects of an internet-based intervention, building on cognitive behavioral therapy (CBT) by comparison with treatment as usual using an RCT approach. This was a small-scale single arm study designed to test the feasibility of the RCT, addressing uncertainties regarding recruitment, data collection, and intervention delivery. METHODS Participant recruitment and screening took place before discharge from the coronary care unit at a large Swedish hospital. Eligible patients were invited to a nine-step psychologist guided, internet-based CBT intervention. The sample size was set in advance to 10 participants completing the intervention. The recruitment and flow of participants were documented and evaluated in relation to seven pre-defined progression criteria. Self-reports of anxiety (HADS-A), stress (PSS-14), cardiac anxiety (CAQ), posttraumatic stress (IES-6) and quality of life (Rand-36), collected at screening, pre-intervention and post-intervention, were analysed descriptively and by effect sizes (Cohen's d). Individual interviews targeting participant experiences were conducted. RESULTS Six out of seven progression criteria yielded no concerns. Out of 49 patients with a working diagnosis of MINOCA or TS, 31 were eligible for screening, 26 consented to participate, and 14 were eligible with regard to symptoms of stress and/or anxiety. Eleven completed the pre-assessment and were given access the intervention, and 9 completed the intervention. Only the number of patients screened prior to eligibility assessment was slightly lower than expected, indicating possible concerns. Self-reports of anxiety, stress, cardiac anxiety, posttraumatic stress, and quality of life all indicated symptom reduction from pre- to post-intervention, generally showing large effect sizes (d = 0.6-2.6). The general consensus among participants was that the programme was helpful and relevant, and that the personal contact with the psychologist was highly valued. Setting aside time to complete assignments was found critical. CONCLUSION Conducting a full scale RCT was found feasible. Inclusion of more study sites and minor amendments to the protocol and intervention were decided to improve feasibility further. TRIAL REGISTRATION Clinicaltrials.govNCT04178434.
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Affiliation(s)
- Elisabet Rondung
- Department of Psychology and Social Work, Mid Sweden University, 831 25 Östersund, Sweden,Corresponding author.
| | | | | | - Runa Sundelin
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Department of Cardiology, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Fredrika Norlund
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, 751 83 Uppsala, Sweden
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Department of Cardiology, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Patrik Lyngå
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Department of Cardiology, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden
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Wilander H, Pagonis C, Venetsanos D, Swahn E, Dworeck C, Johnston N, Jonasson L, Kellerth T, Tornvall P, Yndigegn T, Sederholm Lawesson S. Nationwide observational study of incidence, management and outcome of spontaneous coronary artery dissection: a report from the Swedish Coronary Angiography and Angioplasty register. BMJ Open 2022; 12:e060949. [PMID: 35649586 PMCID: PMC9161068 DOI: 10.1136/bmjopen-2022-060949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The aim of this study was to conduct a nationwide all comer description of incidence, contemporary management and outcome in Swedish spontaneous coronary artery dissection (SCAD) patients. The incidence of SCAD as well as the management and outcome of these patients is not well described. DESIGN A nationwide observational study. PARTICIPANTS AND SETTING All patients with SCAD registered in the Swedish Coronary Angiography and Angioplasty Register from 2015 to 2017 were included. The index angiographies of patients with registered SCAD were re-evaluated at each centre to confirm the diagnosis. Patients with non-SCAD myocardial infarction (MI) (n=32 601) were used for comparison. OUTCOME MEASURES Outcomes included all-cause mortality, reinfarction or acute coronary reangiography. RESULTS This study found 147 SCAD patients, rendering an incidence of 0.74 per 100 000 per year and a prevalence of 0.43% of all MIs. The average age was 52.9 years, 75.5% were women and 47.6% presented with ST-segment elevation MI. Median follow-up time for major adverse cardiac event was 17.3 months. Percutaneous coronary intervention was attempted in 40.1% of SCAD patients and 30.6% received stent. The use of antithrombotic agents was similar between the groups and there was no difference regarding outcomes, 10.9% vs 13.4%, p=0.75. Mortality was lower in SCAD patients, 2.7% vs 8.0%, p=0.03, whereas SCAD patients more often underwent acute reangiography, 9.5% vs 4.6%, p<0.01. CONCLUSION In this nationwide, all comer Swedish study, the overall incidence of SCAD was low, including 25% men which is more and in contrast to previous studies. Compared with non-SCAD MI, SCAD patients were younger, with lower cardiovascular risk burden, yet suffered substantial mortality and morbidity and more frequently underwent acute coronary reangiography.
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Affiliation(s)
- Henrik Wilander
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Christos Pagonis
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Dimitrios Venetsanos
- Division of cardiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Eva Swahn
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Christian Dworeck
- Department of Molecular and Clinical Medicine, Institute of Medicine, SU Sahlgrenska, Göteborg, Sweden
| | - Nina Johnston
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Lena Jonasson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Faculty of Medicine, Linkoping, Sweden
| | - Thomas Kellerth
- Department of acute cardiology, Region Värmland, Karlstad, Sweden
| | - Per Tornvall
- Cardiology Unit, Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | | | - Sofia Sederholm Lawesson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
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Sen A, Gémes K, Stålhammar G, Svensen C, Tornvall P, Jonsson M, Varmdal T, Endreseth BH, Janszky I, Möller J. Risk for Acute Myocardial Infarction After Ophthalmologic Procedures. Ann Intern Med 2022; 175:628-633. [PMID: 35313112 DOI: 10.7326/m20-6618] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/22/2022] Open
Abstract
BACKGROUND Preoperative cardiovascular evaluations are frequently done before ambulatory ophthalmologic procedures. However, whether these procedures can trigger an acute myocardial infarction (AMI) is unknown. OBJECTIVE To assess the short-term risk for AMI associated with ophthalmologic procedures. DESIGN Case-crossover design. SETTING Population-based nationwide study from Norway and Sweden. PARTICIPANTS First-time patients with AMI, aged 40 years and older, identified via inpatient registries and linked to outpatient surgical procedures in Norway (2008 to 2014) and Sweden (2001 to 2014), respectively. MEASUREMENTS Using self-matching, for each participant, exposure to ophthalmologic procedures in the 0 to 7 days before AMI diagnosis (hazard period) was compared with an 8-day period 30 days earlier, that is, days 29 to 36 before AMI (control period) to estimate the relative risk for an AMI the week after an ophthalmologic procedure. The odds ratios (ORs) with 95% CIs were calculated, using conditional logistic regression. Only patients who had a procedure of interest during either the hazard or control period were included. RESULTS For the 806 patients with AMI included in this study, there was a lower likelihood of AMI in the week after an ophthalmologic procedure than during the control week (OR, 0.83; 95% CI, 0.75 to 0.91). Furthermore, there was no evidence of increased risk for AMI when analyses were stratified by surgery subtype, anesthesia (local or general), duration, invasiveness (low, intermediate, or high), patient's age (<65 years or ≥65 years), or comorbidity (none vs. any). LIMITATION Potential bias from time-varying confounders between the hazard and the control periods. CONCLUSION Ophthalmologic procedures done in an outpatient setting did not seem to be associated with an increased risk for AMI. PRIMARY FUNDING SOURCE Central Norway Regional Health Authority and the Swedish Research Council.
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Affiliation(s)
- Abhijit Sen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Center for Oral Health Services and Research (TkMidt), Trondheim, and Clinic of Surgery, St. Olav's University Hospital, Trondheim, Norway (A.S.)
| | - Katalin Gémes
- Department of Global Public Health, Institute of Environmental Medicine, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (K.G.)
| | - Gustav Stålhammar
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, and St. Erik Eye Hospital, Stockholm, Sweden (G.S.)
| | - Christer Svensen
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden (C.S., P.T.)
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden (C.S., P.T.)
| | - Magnus Jonsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden (M.J.)
| | - Torunn Varmdal
- Department of Research and Development, St. Olav's University Hospital, Trondheim, and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway (T.V.)
| | | | - Imre Janszky
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, and Clinic of Surgery and Regional Center for Health Care Improvement, St. Olav's University Hospital, Trondheim, Norway (I.J.)
| | - Jette Möller
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden (J.M.)
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Svenungsson E, Spaak J, Strandberg K, Wallén HN, Agewall S, Brolin EB, Collste O, Daniel M, Ekenbäck C, Frick M, Henareh L, Malmqvist K, Elvin K, Sörensson P, Y-Hassan S, Hofman-Bang C, Tornvall P. Antiphospholipid antibodies in patients with myocardial infarction with and without obstructive coronary arteries. J Intern Med 2022; 291:327-337. [PMID: 34820922 DOI: 10.1111/joim.13409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 01/23/2023]
Abstract
BACKGROUND Recent studies demonstrate that prothrombotic antiphospholipid antibodies (aPL) are overrepresented in patients with myocardial infarction (MI) due to coronary artery disease (MICAD). However, it is not known whether aPL differ between the two subsets of MI: MICAD and MI with nonobstructive coronary arteries (MINOCA). OBJECTIVES To determine whether aPL are associated with MINOCA or MICAD, or with hypercoagulability as assessed by activated protein C-protein C inhibitor (APC-PCI) complex. METHODS Well-characterized patients with MINOCA (n = 98), age- and gender-matched patients with MICAD (n = 99), and healthy controls (n = 100) were included in a cross-sectional case-control study. Autoantibodies (IgA/G/M) targeting cardiolipin and β2 glycoprotein-I and specific nuclear antigens were analyzed by multiplexed bead technology. The concentration of APC-PCI was determined as a measure of hypercoagulability by an immunofluorometric sandwich assay. RESULTS Both prevalence and titers of aPL of the IgG isotype (anti-cardiolipin and/or anti-β2 glycoprotein-I) were higher in patients with MINOCA and MICAD than in controls. aPL IgG positivity was twice as frequent among patients with MICAD than MINOCA (11% vs. 6%, nonsignificant). We observed no group differences regarding aPL IgA/M or antibodies targeting specific nuclear antigens. Levels of APC-PCI were elevated in aPL IgG-positive compared to aPL IgG-negative MICAD patients. CONCLUSIONS aPL IgG, but not IgA/M, are enriched particularly in patients with MICAD but also in patients with MINOCA, as compared to controls. Interestingly, signs of hypercoagulability-measured by increased levels of the APC-PCI complex-were present in aPL IgG-positive MICAD patients, indicating an association with functional disturbances of the coagulation system.
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Affiliation(s)
- Elisabet Svenungsson
- Department of Medicine, Solna, Division of Rheumatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Strandberg
- Department of Clinical Chemistry and Pharmacology, Division of Laboratory Medicine, Coagulation Laboratory Malmö, University and Regional Laboratories, Region Skåne, Sweden
| | - Håkan N Wallén
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital and Institute of Clinical Sciences, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Elin B Brolin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Radiology, Capio S:t Göran's Hospital, Stockholm, Sweden
| | - Olov Collste
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Maria Daniel
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Christina Ekenbäck
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Loghman Henareh
- Department of Medicine, Heart and Vascular Theme, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Karin Malmqvist
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Elvin
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Peder Sörensson
- Department of Medicine, Solna, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Shams Y-Hassan
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Claes Hofman-Bang
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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22
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Tornvall P, Pettersson HJ. Corrigendum: Reproductive History in Takotsubo Syndrome, A Register-Based Cohort Study. Front Cardiovasc Med 2022; 9:867852. [PMID: 35274015 PMCID: PMC8902638 DOI: 10.3389/fcvm.2022.867852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
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Holm M, Tornvall P, Beck O, Fux T, van der Linden J. Impact of morphine dose on ticagrelor uptake and platelet inhibition in patients with ST-segment elevation myocardial infarction – A substudy from the prospective randomized MOVEMENT trial. Thrombosis Update 2021. [DOI: 10.1016/j.tru.2021.100071] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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24
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Klevebro S, Bahram F, Elfström KM, Hellberg U, Hober S, Merid SK, Kull I, Nilsson P, Tornvall P, Wang G, Conneryd Lundgren K, Ponzer S, Dillner J, Melén E. Risk of SARS-CoV-2 exposure among hospital healthcare workers in relation to patient contact and type of care. Scand J Public Health 2021; 49:707-712. [PMID: 34148454 PMCID: PMC8521364 DOI: 10.1177/14034948211022434] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/13/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 02/05/2023]
Abstract
AIM We aimed to assess prevalence of IgG antibodies to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and factors associated with seropositivity in a large cohort of healthcare workers (HCWs). METHODS From 11 May until 11 June 2020, 3981 HCWs at a large Swedish emergency care hospital provided serum samples and questionnaire data. Presence of IgG antibodies to SARS-CoV-2 was measured as an indicator of SARS-CoV-2 exposure. RESULTS The total seroprevalence was 18% and increased during the study period. Among the seropositive HCWs, 11% had been entirely asymptomatic. Participants who worked with COVID-19 patients had higher odds for seropositivity: adjusted odds ratio 1.96 (95% confidence intervals 1.59-2.42). HCWs from three of the departments managing COVID-19 patients had significantly higher seroprevalences, whereas the prevalence among HCWs from the intensive care unit (also managing COVID-19 patients) was significantly lower. CONCLUSIONS HCWs in contact with SARS-CoV-2 infected patients had a variable, but on average higher, likelihood for SARS-CoV-2 infections.
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Affiliation(s)
- Susanna Klevebro
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | - Fuad Bahram
- Clinical Reseach Center, Södersjukhuset, Sweden
| | | | - Ulrika Hellberg
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | - Sophia Hober
- Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Simon Kebede Merid
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | - Peter Nilsson
- Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Gang Wang
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Sichuan, China
| | | | - Sari Ponzer
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | | | - Erik Melén
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Stockholm, Sweden
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25
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Tengbom J, Cederström S, Verouhis D, Böhm F, Eriksson P, Folkersen L, Gabrielsen A, Jernberg T, Lundman P, Persson J, Saleh N, Settergren M, Sörensson P, Tratsiakovich Y, Tornvall P, Jung C, Pernow J. Arginase 1 is upregulated at admission in patients with ST-elevation myocardial infarction. J Intern Med 2021; 290:1061-1070. [PMID: 34237174 DOI: 10.1111/joim.13358] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The mechanisms underlying rupture of a coronary atherosclerotic plaque and development of myocardial ischemia-reperfusion injury in ST-elevation myocardial infarction (STEMI) remain unresolved. Increased arginase 1 activity leads to reduced nitric oxide (NO) production and increased formation of reactive oxygen species due to uncoupling of the NO-producing enzyme endothelial NO synthase (eNOS). This contributes to endothelial dysfunction, plaque instability and increased susceptibility to ischemia-reperfusion injury in acute myocardial infarction. OBJECTIVE The purpose of this study was to test the hypothesis that arginase gene and protein expression are upregulated in patients with STEMI. METHODS Two cohorts of patients with STEMI were included. In the first cohort (n = 51), expression of arginase and NO-synthases as well as arginase 1 protein levels were determined and compared to a healthy control group (n = 45). In a second cohort (n = 68), plasma arginase 1 levels and infarct size were determined using cardiac magnetic resonance imaging. RESULTS Expression of the gene encoding arginase 1 was significantly elevated at admission and 24-48 h after STEMI but not 3 months post STEMI, in comparison with the control group. Expression of the genes encoding arginase 2 and endothelial NO synthase (NOS3) were unaltered. Arginase 1 protein levels were elevated at admission, 24 h post STEMI and remained elevated for up to 6 months. No significant correlation between plasma arginase 1 protein levels and infarct size was observed. CONCLUSION The markedly increased gene and protein expression of arginase 1 already at admission indicates a role of arginase 1 in the development of STEMI.
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Affiliation(s)
- John Tengbom
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Sofia Cederström
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Dinos Verouhis
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Felix Böhm
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Per Eriksson
- Laboratory of Immunobiology, Cardiovascular Medicine Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anders Gabrielsen
- Laboratory of Immunobiology, Cardiovascular Medicine Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Pia Lundman
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Jonas Persson
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Nawzad Saleh
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Settergren
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Peder Sörensson
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Yahor Tratsiakovich
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - John Pernow
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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26
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Y-Hassan S, Sörensson P, Ekenbäck C, Lundin M, Agewall S, Brolin EB, Caidahl K, Cederlund K, Collste O, Daniel M, Jensen J, Hofman-Bang C, Lyngå P, Maret E, Sarkar N, Spaak J, Winnberg O, Ugander M, Tornvall P, Henareh L. Plasma catecholamine levels in the acute and subacute stages of takotsubo syndrome: Results from the Stockholm myocardial infarction with normal coronaries 2 study. Clin Cardiol 2021; 44:1567-1574. [PMID: 34490898 PMCID: PMC8571561 DOI: 10.1002/clc.23723] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/13/2021] [Accepted: 08/27/2021] [Indexed: 12/30/2022] Open
Abstract
AIMS It is well-accepted that takotsubo syndrome (TS) is characterized by a massive surge of plasma catecholamines despite lack of solid evidence. The objective of this study was to examine the hypothesis of a massive catecholamine elevation in TS by studying plasma-free catecholamine metabolites in patients participating in the Stockholm myocardial infarction (MI) with normal coronaries 2 (SMINC-2) study where TS constituted more than one third of the patients. METHODS AND RESULTS The patients included in the SMINC-2 study were classified, according to cardiac magnetic resonance (CMR) imaging findings (148 patients), which was performed at a median of 3 days after hospital admission. Plasma-free catecholamine metabolites; metanephrine, normetanephrine, and methoxy-tyramine were measured on day 2-4 after admission. Catecholamine metabolite levels were available in 125 patients. One hundred and ten (88%) of the 125 patients included in SMINC-2 study, and 38 (86.4%) of the 44 patients with TS had completely normal plasma metanephrine and normetanephrine levels. All patients had normal plasma methoxy-tyramine levels. Fourteen (11.2%) of the 125 patients included in SMINC-2 study, and 5 (11.6%) of the 43 patients with TS had mild elevations (approximately 1.2 times the upper normal limits) of either plasma metanephrine or normetanephrine. One patient with pheochromocytoma-triggered TS had marked elevation of plasma metanephrine and mild elevation of plasma normetanephrine. There were no significant differences between the number or degree of catecholamine metabolite elevations between the different groups of patients with CMR imaging diagnosis included in SMINC-2 study. CONCLUSION There was no evidence of massive catecholamine elevations in the acute and subacute stages of TS apart from one patient with pheochromocytoma-induced TS. Most of the TS patients had normal catecholamine metabolites indicating that blood-borne catecholamines do not play a direct role in the pathogenesis of TS.
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Affiliation(s)
- Shams Y-Hassan
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Peder Sörensson
- Department of Medicine Solna, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Ekenbäck
- Division of Cardiovascular Medicine, Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Magnus Lundin
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Stefan Agewall
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elin Bacsovics Brolin
- Department of Clinical Science, Division of Medical Imaging and Technology, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Capio S:t Görans Hospital, Stockholm, Sweden
| | - Kenneth Caidahl
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Cederlund
- Department of Clinical Science, Division of Medical Imaging and Technology, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Södertälje Hospital, Södertälje, Sweden
| | - Olov Collste
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Cardiology Unit, Södersjukhuset, Stockholm, Sweden
| | - Maria Daniel
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Cardiology Unit, Södersjukhuset, Stockholm, Sweden
| | - Jens Jensen
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Department of Cardiology, Capio St: Görans Hospital, Stockholm, Sweden
| | - Claes Hofman-Bang
- Division of Cardiovascular Medicine, Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Patrik Lyngå
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Cardiology Unit, Södersjukhuset, Stockholm, Sweden
| | - Eva Maret
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Nondita Sarkar
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Spaak
- Division of Cardiovascular Medicine, Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Oscar Winnberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Department of Cardiology, Capio St: Görans Hospital, Stockholm, Sweden
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden.,Kolling Institute, Royal North Shore Hospital, and Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Cardiology Unit, Södersjukhuset, Stockholm, Sweden
| | - Loghman Henareh
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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27
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Redfors B, Jha S, Thorleifsson S, Jernberg T, Angerås O, Frobert O, Petursson P, Tornvall P, Sarno G, Ekenbäck C, Ravn-Fisher A, Y-Hassan S, Lyon AR, James S, Erlinge D, Omerovic E. Short- and Long-Term Clinical Outcomes for Patients With Takotsubo Syndrome and Patients With Myocardial Infarction: A Report From the Swedish Coronary Angiography and Angioplasty Registry. J Am Heart Assoc 2021; 10:e017290. [PMID: 34465127 PMCID: PMC8649294 DOI: 10.1161/jaha.119.017290] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Takotsubo syndrome (TS) is a potentially life‐threatening acute cardiac syndrome with a clinical presentation similar to myocardial infarction and for which the natural history, management, and outcome remain incompletely understood. Our aim was to assess the relative short‐term mortality risk of TS, ST‐segment–elevation myocardial infarction (STEMI), and non‐STEMI (NSTEMI) and to identify predictors of in‐hospital complications and poor prognosis in patients with TS. Methods and Results This is an observational cohort study based on the data from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). We included all patients (n=117 720) who underwent coronary angiography in Sweden attributed to TS (N=2898 [2.5%]), STEMI (N=48 493 [41.2%]), or NSTEMI (N=66 329 [56.3%]) between January 2009 and February 2018. We compared patients with TS to those with NSTEMI or STEMI. The primary end point was all‐cause mortality at 30 days. Secondary outcomes were acute heart failure (Killip Class ≥2) and cardiogenic shock (Killip Class 4) at the time of angiography. Patients with TS were more often women compared with patients with STEMI or NSTEMI. TS was associated with unadjusted and adjusted 30‐day mortality risks lower than STEMI (adjusted hazard ratio [adjHR], 0.60; 95% CI, 0.48–0.76; P<0.001), but higher than NSTEMI (adjHR, 2.70; 95% CI, 2.14–3.41; P<0.001). Compared with STEMI, TS was associated with a similar risk of acute heart failure (adjHR, 1.26; 95% CI, 0.91–1.76; P=0.16) but a lower risk of cardiogenic shock (adjHR, 0.55; 95% CI, 0.34–0.89; P=0.02). The relative 30‐day mortality risk for TS versus STEMI and NSTEMI was higher for smokers than nonsmokers (adjusted P interaction STEMI=0.01 and P interaction NSTEMI=0.01). Conclusions The 30‐day mortality rate in TS was higher than in NSTEMI but lower than STEMI despite a similar risk of acute heart failure in TS and STEMI. Among patients with TS, smoking was an independent predictor of mortality.
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Affiliation(s)
- Björn Redfors
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Sandeep Jha
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | | | - Tomas Jernberg
- Department of Clinical Sciences Danderyd University HospitalKarolinska Institutet Stockholm Sweden
| | - Oskar Angerås
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Ole Frobert
- The Department of Cardiology Faculty of Health Örebro University Örebro Sweden
| | - Petur Petursson
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset Karolinska Institute Stockholm Sweden
| | - Giovanna Sarno
- The Department of Medical Sciences, Cardiology Uppsala University Uppsala Sweden
| | - Christina Ekenbäck
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine Karolinska Institutet Stockholm Sweden
| | - Annika Ravn-Fisher
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Shams Y-Hassan
- The Department of Medicine Karolinska University Hospital Huddinge Stockholm Sweden
| | - Alexander R Lyon
- NIHR Cardiovascular Biomedical Research Unit Royal Brompton Hospital London United Kingdom.,National Heart and Lung InstituteImperial College London United Kingdom
| | - Stefan James
- The Department of Medical Sciences, Cardiology Uppsala University Uppsala Sweden
| | - David Erlinge
- The Department of Cardiology Skåne University Hospital Lund Sweden
| | - Elmir Omerovic
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
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28
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Eggers KM, Baron T, Hjort M, Nordenskjöld AM, Tornvall P, Lindahl B. GRACE 2.0 Score for Risk Prediction in Myocardial Infarction With Nonobstructive Coronary Arteries. J Am Heart Assoc 2021; 10:e021374. [PMID: 34472364 PMCID: PMC8649242 DOI: 10.1161/jaha.121.021374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kai M Eggers
- Department of Medical Sciences and Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Tomasz Baron
- Department of Medical Sciences and Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Marcus Hjort
- Department of Medical Sciences and Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | | | - Per Tornvall
- Department of Clinical Science and Education SödersjukhusetKarolinska Institute Stockholm Sweden
| | - Bertil Lindahl
- Department of Medical Sciences and Uppsala Clinical Research Center Uppsala University Uppsala Sweden
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29
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Eggers KM, Baron T, Hjort M, Nordenskjöld AM, Tornvall P, Lindahl B. Clinical and prognostic implications of C-reactive protein levels in myocardial infarction with nonobstructive coronary arteries. Clin Cardiol 2021; 44:1019-1027. [PMID: 34032303 PMCID: PMC8259160 DOI: 10.1002/clc.23651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/08/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous condition. Recent studies suggest that MINOCA patients may have a proinflammatory disposition. The role of inflammation in MINOCA may thus be distinct to myocardial infarction with significant coronary artery disease (MI-CAD). HYPOTHESIS We hypothesized that inflammation reflected by C-reactive protein (CRP) levels might carry unique clinical information in MINOCA. METHODS This retrospective registry-based cohort study (SWEDEHEART) included 9916 patients with MINOCA and 97 970 MI-CAD patients, used for comparisons. Multivariable-adjusted regressions were applied to investigate the associations of CRP levels with clinical variables, all-cause mortality and major cardiovascular events (MACE) during a median follow-up of up to 5.3 years. RESULTS Median admission CRP levels in patients with MINOCA and MI-CAD were 5.0 (interquartile range 2.0-9.0) mg/dl and 5.0 (interquartile range 2.1-10.0 mg/dl), respectively. CRP levels in MINOCA exhibited independent associations with various cardiovascular risk factors, comorbidities and estimates of myocardial damage. The association of CRP with peripheral artery disease tended to be stronger compared to MI-CAD. The associations with female sex, renal dysfunction and myocardial damage were stronger in MI-CAD. CRP independently predicted all-cause mortality in MINOCA (hazard ratio 1.22 [95% confidence interval 1.17-1.26]), similar to MI-CAD (p interaction = 0.904). CRP also predicted MACE (hazard ratio 1.08 [95% confidence interval 1.04-1.12]) but this association was weaker compared to MI-CAD (p interaction<.001). CONCLUSIONS We found no evidence indicating the presence of a specific inflammatory pattern in acute MINOCA compared to MI-CAD. However, CRP levels were independently, albeit moderately associated with adverse outcome.
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Affiliation(s)
- Kai M Eggers
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tomasz Baron
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Marcus Hjort
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Anna M Nordenskjöld
- Faculty of Health, Department of Cardiology, Örebro University, Örebro, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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30
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Sörensson P, Ekenbäck C, Lundin M, Agewall S, Bacsovics Brolin E, Caidahl K, Cederlund K, Collste O, Daniel M, Jensen J, Y-Hassan S, Henareh L, Hofman-Bang C, Lyngå P, Maret E, Sarkar N, Spaak J, Winnberg O, Ugander M, Tornvall P. Early Comprehensive Cardiovascular Magnetic Resonance Imaging in Patients With Myocardial Infarction With Nonobstructive Coronary Arteries. JACC Cardiovasc Imaging 2021; 14:1774-1783. [PMID: 33865778 DOI: 10.1016/j.jcmg.2021.02.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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: 08/06/2020] [Revised: 02/12/2021] [Accepted: 02/19/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of the SMINC-2 (Stockholm Myocardial Infarction With Normal Coronaries 2) study was to determine if more than 70% of patients with myocardial infarction with nonobstructed coronary arteries (MINOCA), investigated early with comprehensive cardiovascular magnetic resonance (CMR), could receive a diagnosis entirely by imaging. BACKGROUND The etiology of MINOCA is heterogeneous, including coronary, cardiac, and noncardiac causes. Patients with MINOCA, therefore, represent a diagnostic challenge where CMR is increasingly used. METHODS The SMINC-2 study was a prospective study of 148 patients with MINOCA imaged with 1.5-T CMR with T1 and extracellular volume mapping early after hospital admission, compared to 150 patients with MINOCA imaged using 1.5-T CMR without mapping techniques from the SMINC-1 study as historic controls. RESULTS CMR was performed at a median of 3 (SMINC-2) versus 12 (SMINC-1) days after hospital admission. In total, 77% of patients received a diagnosis with CMR imaging in the SMINC-2 study compared to 47% in the SMINC-1 study (p < 0.001). Compared to SMINC-1, CMR in SMINC-2 detected higher proportions of myocarditis (17% vs. 7%; p = 0.01) and takotsubo syndrome (35% vs. 19%; p = 0.002) but similar proportions of myocardial infarction (22% vs. 19%; p = 0.56) and other cardiomyopathies (3% vs. 2%; p = 0.46). CONCLUSIONS The results of the SMINC-2 study show that 77% of all patients with MINOCA received a diagnosis when imaged early with CMR, including advanced tissue characterization, which was a considerable improvement in comparison to the SMINC-1 study. This supports the use of early CMR imaging as a diagnostic tool in the investigation of patients with MINOCA. (Stockholm Myocardial Infarction With Normal Coronaries [SMINC]-2 Study on Diagnosis Made by Cardiac MRI [SCMINC-2]; NCT02318498).
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Affiliation(s)
- Peder Sörensson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
| | - Christina Ekenbäck
- Karolinska Institutet, Department of Clinical Sciences, Stockholm, Sweden; Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
| | - Magnus Lundin
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - Stefan Agewall
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elin Bacsovics Brolin
- Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Division of Medical Imaging and Technology, Stockholm, Sweden; Department of Radiology, Capio St: Görans Hospital, Stockholm, Sweden
| | - Kenneth Caidahl
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - Kerstin Cederlund
- Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Division of Medical Imaging and Technology, Stockholm, Sweden; Department of Radiology, Södertälje Hospital, Södertälje, Sweden
| | - Olov Collste
- Cardiology Unit, Södersjukhuset, Stockholm, Sweden
| | - Maria Daniel
- Cardiology Unit, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet
| | - Jens Jensen
- Department of Radiology, Capio St: Görans Hospital, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet
| | - Shams Y-Hassan
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Loghman Henareh
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Claes Hofman-Bang
- Karolinska Institutet, Department of Clinical Sciences, Stockholm, Sweden; Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
| | - Patrik Lyngå
- Cardiology Unit, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet
| | - Eva Maret
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - Nondita Sarkar
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Spaak
- Karolinska Institutet, Department of Clinical Sciences, Stockholm, Sweden; Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
| | - Oscar Winnberg
- Department of Radiology, Capio St: Görans Hospital, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden; Kolling Institute, Royal North Shore Hospital, Sydney, Australia; Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Per Tornvall
- Cardiology Unit, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet
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31
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Lenhoff H, Darpö B, Page A, Couderc JP, Tornvall P, Frick M. Diurnal QT analysis in patients with sotalol after cardioversion of atrial fibrillation. Ann Noninvasive Electrocardiol 2021; 26:e12834. [PMID: 33629473 PMCID: PMC8293609 DOI: 10.1111/anec.12834] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/18/2022] Open
Abstract
Background The risk of ventricular arrhythmias in patients on QT prolonging drugs is indicated to be increased early after cardioversion (CV) of atrial fibrillation (AF) to sinus rhythm (SR). Sotalol, used to prevent AF relapse, prolongs cardiac repolarization and corrected QT interval (QTc). A pronounced QTc prolongation is an established marker of pro‐arrhythmias. Our objective was to use novel technique to quantify and evaluate the diurnal variation of the QTc interval after elective CV to SR in patients on sotalol or metoprolol. Methods Fifty patients underwent twelve‐lead Holter recording for 24 hr after elective CV for persistent AF. All patients had the highest tolerable stable dose of sotalol (n = 27) or metoprolol (n = 23). Measurements of QT and RR intervals were performed on all valid beats. Results A clear diurnal variation of both HR and QTc was seen in both groups, more pronounced in patients on sotalol, where a high percentage of heartbeats with QTc >500 ms was observed, especially at night. Six patients (22%) on sotalol but none on metoprolol had >20% of all heart beats within the 24‐hour recording with QTc >500 ms. Conclusion Twenty‐four‐hour Holter recordings with QT‐measurement immediately after CV demonstrated that one in five patients on sotalol had >20% of all heart beats with prolonged QTc >500 ms, especially during night‐time. The QTc diurnal variation was retained in patients on β‐blockade or a potent class III anti‐arrhythmic drug with β‐blocking properties.
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Affiliation(s)
- Hanna Lenhoff
- Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | - Börje Darpö
- Department of Clinical Sciences, Karolinska Institutet, Danderyd, Sweden
| | - Alex Page
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Jean Philippe Couderc
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Per Tornvall
- Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | - Mats Frick
- Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, South Hospital, Stockholm, Sweden
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32
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Arnardottir H, Pawelzik SC, Öhlund Wistbacka U, Artiach G, Hofmann R, Reinholdsson I, Braunschweig F, Tornvall P, Religa D, Bäck M. Stimulating the Resolution of Inflammation Through Omega-3 Polyunsaturated Fatty Acids in COVID-19: Rationale for the COVID-Omega-F Trial. Front Physiol 2021; 11:624657. [PMID: 33505321 PMCID: PMC7830247 DOI: 10.3389/fphys.2020.624657] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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: 10/31/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022] Open
Abstract
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19). SARS-CoV-2 triggers an immune response with local inflammation in the lung, which may extend to a systemic hyperinflammatory reaction. Excessive inflammation has been reported in severe cases with respiratory failure and cardiovascular complications. In addition to the release of cytokines, referred to as cytokine release syndrome or "cytokine storm," increased pro-inflammatory lipid mediators derived from the omega-6 polyunsaturated fatty acid (PUFA) arachidonic acid may cause an "eicosanoid storm," which contributes to the uncontrolled systemic inflammation. Specialized pro-resolving mediators, which are derived from omega-3 PUFA, limit inflammatory reactions by an active process called resolution of inflammation. Here, the rationale for omega-3 PUFA supplementation in COVID-19 patients is presented along with a brief overview of the study protocol for the trial "Resolving Inflammatory Storm in COVID-19 Patients by Omega-3 Polyunsaturated Fatty Acids - A single-blind, randomized, placebo-controlled feasibility study" (COVID-Omega-F). EudraCT: 2020-002293-28; clinicaltrials.gov: NCT04647604.
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Affiliation(s)
- Hildur Arnardottir
- Translational Cardiology, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Theme Heart, Vessels, and Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Sven-Christian Pawelzik
- Translational Cardiology, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Theme Heart, Vessels, and Neuro, Karolinska University Hospital, Stockholm, Sweden
| | | | - Gonzalo Artiach
- Translational Cardiology, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Theme Heart, Vessels, and Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Robin Hofmann
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | | | - Frieder Braunschweig
- Department of Cardiology, Theme Heart, Vessels, and Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Dorota Religa
- Theme Ageing, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Bäck
- Translational Cardiology, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Theme Heart, Vessels, and Neuro, Karolinska University Hospital, Stockholm, Sweden
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Abstract
An association between acute myocardial infarction (AMI) and systemic lupus erythematosus (SLE) has been suggested. The cause of AMI is presumed to be atherothrombosis. In the present study, the primary objective was to assess incident AMI cases and the secondary objective was to estimate the proportion of myocardial infarction with nonobstructive coronary arteries (MINOCA) in patients with SLE. All Swedish patients with SLE without AMI before 1996 (n = 4192) were followed for 20 years in the national patient registry. For each SLE patient, 10 age- and sex-matched controls without SLE and AMI before 1996 (n = 41 892) were identified. Data from patients and controls with AMI after 1996 were linked with the Swedish coronary angiography and angioplasty register; 549 (13%) and 3352 (8%) first AMIs occurred in patients with SLE and controls, respectively. The incidence of AMI was 9.6 (95% CI: 8.9-10.5) and 4.9 (95% CI: 4.8-5.1) events/1000 person-years in patients with SLE and controls, respectively. The proportion of MINOCA was 10.8% in patients with SLE and 13.8% in controls (P = .261), respectively. In conclusion, the incidence of AMI is increased in a European population of patients with SLE but there is no indication that the proportion of MINOCA is increased in these patients.
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Affiliation(s)
- Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, 27106Karolinska Institutet, Stockholm, Sweden
| | - Alexandra Göransson
- Department of Clinical Science and Education Södersjukhuset, 27106Karolinska Institutet, Stockholm, Sweden
| | - Julia Ekman
- Department of Clinical Science and Education Södersjukhuset, 27106Karolinska Institutet, Stockholm, Sweden
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education Södersjukhuset, 27106Karolinska Institutet, Stockholm, Sweden
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Nordenskjöld AM, Agewall S, Atar D, Baron T, Beltrame J, Bergström O, Erlinge D, Gale CP, López-Pais J, Jernberg T, Johansson P, Ravn-Fisher A, Reynolds HR, Somaratne JB, Tornvall P, Lindahl B. Randomized evaluation of beta blocker and ACE-inhibitor/angiotensin receptor blocker treatment in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA-BAT): Rationale and design. Am Heart J 2021; 231:96-104. [PMID: 33203618 DOI: 10.1016/j.ahj.2020.10.059] [Citation(s) in RCA: 45] [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] [Received: 05/19/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is common and occurs in 6-8% of all patients fulfilling the diagnostic criteria for acute myocardial infarction (AMI). This paper describes the rationale behind the trial 'Randomized Evaluation of Beta Blocker and ACE-Inhibitor/Angiotensin Receptor Blocker Treatment (ACEI/ARB) of MINOCA patients' (MINOCA-BAT) and the need to improve the secondary preventive treatment of MINOCA patients. METHODS: MINOCA-BAT is a registry-based, randomized, parallel, open-label, multicenter trial with 2:2 factorial design. The primary aim is to determine whether oral beta blockade compared with no oral beta blockade, and ACEI/ARB compared with no ACEI/ARB, reduce the composite endpoint of death of any cause, readmission because of AMI, ischemic stroke or heart failure in patients discharged after MINOCA without clinical signs of heart failure and with left ventricular ejection fraction ≥40%. A total of 3500 patients will be randomized into four groups; e.g. ACEI/ARB and beta blocker, beta blocker only, ACEI/ARB only and neither ACEI/ARB nor beta blocker, and followed for a mean of 4 years. SUMMARY: While patients with MINOCA have an increased risk of serious cardiovascular events and death, whether conventional secondary preventive therapies are beneficial has not been assessed in randomized trials. There is a limited basis for guideline recommendations in MINOCA. Furthermore, studies of routine clinical practice suggest that use of secondary prevention therapies in MINOCA varies considerably. Thus results from this trial may influence future treatment strategies and guidelines specific to MINOCA patients.
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Affiliation(s)
- Anna M Nordenskjöld
- Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Norway, and Institute of Clinical Sciences, University of Oslo, Norway
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Norway, and Institute of Clinical Sciences, University of Oslo, Norway
| | - Tomasz Baron
- Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - John Beltrame
- Discipline of Medicine, University of Adelaide, Basil Hetzel Institute, Central Adelaide Local Health Network, Adelaide, Australia
| | - Olle Bergström
- Department of Medicine/Cardiology, County Hospital of Kronoberg, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Javier López-Pais
- Department of Cardiology, University Hospital Complex of Santiago de Compostela, Spain
| | - Tomas Jernberg
- Department of clinical sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Pelle Johansson
- Senior research manager, The Swedish Heart and Lung Association, Sweden
| | - Annica Ravn-Fisher
- Department of Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Harmony R Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York
| | | | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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Edfors R, Lindhagen L, Spaak J, Evans M, Andell P, Baron T, Mörtberg J, Rezeli M, Salzinger B, Lundman P, Szummer K, Tornvall P, Wallén HN, Jacobson SH, Kahan T, Marko-Varga G, Erlinge D, James S, Lindahl B, Jernberg T. Use of proteomics to identify biomarkers associated with chronic kidney disease and long-term outcomes in patients with myocardial infarction. J Intern Med 2020; 288:581-592. [PMID: 32638487 DOI: 10.1111/joim.13116] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/30/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) have poor outcomes following myocardial infarction (MI). We performed an untargeted examination of 175 biomarkers to identify those with the strongest association with CKD and to examine the association of those biomarkers with long-term outcomes. METHODS A total of 175 different biomarkers from MI patients enrolled in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry were analysed either by a multiple reaction monitoring mass spectrometry assay or by a multiplex assay (proximity extension assay). Random forests statistical models were used to assess the predictor importance of biomarkers, CKD and outcomes. RESULTS A total of 1098 MI patients with a median estimated glomerular filtration rate of 85 mL min-1 /1.73 m2 were followed for a median of 3.2 years. The random forests analyses, without and with adjustment for differences in demography, comorbidities and severity of disease, identified six biomarkers (adrenomedullin, TNF receptor-1, adipocyte fatty acid-binding protein-4, TNF-related apoptosis-inducing ligand receptor 2, growth differentiation factor-15 and TNF receptor-2) to be strongly associated with CKD. All six biomarkers were also amongst the 15 strongest predictors for death, and four of them were amongst the strongest predictors of subsequent MI and heart failure hospitalization. CONCLUSION In patients with MI, a proteomic approach could identify six biomarkers that best predicted CKD. These biomarkers were also amongst the most important predictors of long-term outcomes. Thus, these biomarkers indicate underlying mechanisms that may contribute to the poor prognosis seen in patients with MI and CKD.
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Affiliation(s)
- R Edfors
- From the, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Bayer AB, Solna, Sweden
| | - L Lindhagen
- Uppsala Clinical Research Center, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - J Spaak
- From the, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Evans
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - P Andell
- Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden
| | - T Baron
- Uppsala Clinical Research Center, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - J Mörtberg
- Department of Clinical Sciences, Division of Renal Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Rezeli
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - B Salzinger
- Department of Clinical Sciences, Division of Renal Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - P Lundman
- From the, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - K Szummer
- Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden
| | - P Tornvall
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - H N Wallén
- From the, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - S H Jacobson
- Department of Clinical Sciences, Division of Renal Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - T Kahan
- From the, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - G Marko-Varga
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - D Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - S James
- Uppsala Clinical Research Center, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - B Lindahl
- Uppsala Clinical Research Center, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - T Jernberg
- From the, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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36
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Wilander H, Swahn E, Johnston N, Jonasson L, Pagonis C, Tornvall P, Venetsanos D, Sederholm Lawesson S. Spontaneous coronary artery dissection – contemporary management and outcome of a national cohort. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1658] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/14/2022] Open
Abstract
Abstract
Background
Spontaneous coronary artery dissection (SCAD) is proposed to cause 1–4% of all acute myocardial infarctions (AMI).
The aim of this study was to conduct a first description of Swedish SCAD patients regarding the prevalence of risk factors, treatment and prognosis.
Method
All patients with AMI registered in the Swedish Coronary Angiography and Angioplasty Register (SCAAR) December 2015 until December 2017 were included. The index angiographies of the SCAD patients were reevaluated by an independent angiographer at each center. Patients with non-SCAD AMI (n=31670) were used for comparison.
Results
SCAD was identified in 137 patients with AMI (100 women, 37 men). The SCAD population was younger than the non-SCAD population 53.9 (51.7–56.1) vs 68.5 (68.3–68.6) years, more often women (73.0 vs 30.7%) and presented with less risk factors: diabetes 2.9 vs 20.8%; hypertension 27.0 vs 57.6%; smoking 41.2 vs 58.1%; statin therapy 12.4 vs 36.9% and previous AMI 7.3 vs 19.6% (p<0.001 for all comparisons).
SCAD patients less frequently underwent percutaneous coronary intervention (PCI) 43.1 vs 70.8% (p<0.001) and received less statin treatment, 78.9 vs 91.5% (p<0.001).
There was no significant difference regarding treatment with aspirin or double antiplatelet therapy at discharge: 93 vs 89.7% (p=0.45) and 86.7 vs 84.2%, respectively (p=0,43).
There was no significant difference in one-year mortality 6.6 vs 8.2% (p=0.57).
Conclusions
With a current prevalence of 0.43% of all Swedish AMIs, data supports SCAD being an underdiagnosed condition with a prognosis resembling that of non-SCAD AMI. Furthermore, SCAD patients are younger and harbor less cardiovascular risk factors. While significant differences in management are present, current therapeutic strategies of the two groups are similar, indicating overtreatment of SCAD.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swedish Heart-Lung foundation, ALF funding
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Affiliation(s)
- H Wilander
- Linkoping University Hospital, Linkoping, Sweden
| | - E Swahn
- Linkoping University Hospital, Linkoping, Sweden
| | - N Johnston
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - L Jonasson
- Linkoping University Hospital, Linkoping, Sweden
| | - C Pagonis
- Linkoping University Hospital, Linkoping, Sweden
| | - P Tornvall
- Karolinska Institutet, Stockholm, Sweden
| | - D Venetsanos
- Karolinska University Hospital, Stockholm, Sweden
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Humphries SM, Rondung E, Norlund F, Sundin Ö, Tornvall P, Held C, Spaak J, Lyngå P, Olsson EMG. Designing a Web-Based Psychological Intervention for Patients With Myocardial Infarction With Nonobstructive Coronary Arteries: User-Centered Design Approach. J Med Internet Res 2020; 22:e19066. [PMID: 32940615 PMCID: PMC7530693 DOI: 10.2196/19066] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/01/2020] [Accepted: 07/26/2020] [Indexed: 01/02/2023] Open
Abstract
Background The involvement of patient research partners (PRPs) in research aims to safeguard the needs of patient groups and produce new interventions that are developed based on patient input. Myocardial infarction with nonobstructive coronary arteries (MINOCA), unlike acute myocardial infarction (MI) with obstructive coronary arteries, is presented with no significant obstructive coronary artery disease. Patients with this diagnosis are a subset of those diagnosed with traditional MI and often need more psychological support, something that is presently not established in the current treatment scheme in Swedish health care or elsewhere, to our knowledge. An internet-delivered intervention might offer patients with MINOCA the opportunity to access a psychological treatment that is tailored to their specific needs after MINOCA and could therefore supplement the existing medical care in an easily accessible format. Objective This paper aims to describe the development of a therapist-guided, internet-delivered psychological intervention designed specifically for patients with MINOCA. Methods The study used a participatory design that involved 7 PRPs diagnosed with MINOCA who collaborated with a team consisting of researchers, cardiologists, and psychologists. Intervention content was developed iteratively and presented to the PRPs across several prototypes, each continually adjusted and redesigned according to the feedback received. The intervention and experience of it were discussed by PRPs in a final meeting and then presented to a panel of 2 clinical psychologists and a cardiologist for further input. Results The outcome of the collaboration between PRPs and the research group produced a web-based psychological 9-step program focusing on stress, worry, and valued action. The input from PRPs contributed substantially to the therapy content, homework tasks, interactive activities, multimedia, and design presentation. Conclusions Working with PRPs to develop an intervention for people with MINOCA produced a web-based intervention that can be further evaluated with the goal of offering a new psychological treatment option to a patient group currently without one. Direct contribution from PRPs enabled us to obtain relevant, insightful, and valuable feedback that was put towards the overall design and content of the intervention.
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Affiliation(s)
| | - Elisabet Rondung
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Fredrika Norlund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Örjan Sundin
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Patrik Lyngå
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Erik M G Olsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Abstract
BACKGROUND A relation to stress and stressful triggers is often, but not always, described in patients with Takotsubo syndrome. Few studies have focused on patients' self-rated stress in combination with qualitative experiences of stress in Takotsubo syndrome. AIMS The aim of this study was to describe stress before and after the onset of Takotsubo syndrome. METHODS Twenty patients were recruited from five major hospitals in Stockholm, Sweden between December 2014 and November 2018. A mixed methods design was used containing the validated questionnaire, perceived stress scale (PSS-14) filled in at baseline and at a 6 and 12-month follow-up, respectively. Qualitative interviews were made at the 6-month follow-up. RESULTS Self-rated stress, measured by the perceived stress scale, showed stress levels above the cut-off value of 25, at the onset of Takotsubo syndrome (median 30.5). Stress had decreased significantly at the 12-month follow-up (median 20.5, P = 0.039) but remained high in one third of the patients. Qualitative interviews confirmed a high long-term stress and half of the patients had an acute stress trigger before the onset of Takotsubo syndrome. The qualitative interviews showed that the patients had reflected on and tried to find ways to deal with stress, but for many this was not successful. CONCLUSION Patients with Takotsubo syndrome reported long-term stress sometimes with an acute stress trigger before the onset of Takotsubo syndrome. Stress decreased over time but remained high for a considerable number of patients. Despite reflection over stress and attempts to deal with stress many were still affected after 6 months. New treatment options are needed for patients with Takotsubo syndrome.
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Affiliation(s)
- Runa Sundelin
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
| | - Chatarina Bergsten
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
| | - Per Tornvall
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
| | - Patrik Lyngå
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
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Verouhis D, Sörensson P, Gourine A, Henareh L, Persson J, Saleh N, Settergren M, Sundqvist M, Tengbom J, Tornvall P, Witt N, Böhm F, Pernow J. Long‐term effect of remote ischemic conditioning on infarct size and clinical outcomes in patients with anterior ST‐elevation myocardial infarction. Catheter Cardiovasc Interv 2020; 97:386-392. [DOI: 10.1002/ccd.28760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/21/2019] [Accepted: 01/20/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Dinos Verouhis
- Division of Cardiology, Department of Medicine, Karolinska Institutet Karolinska University Hospital Stockholm Sweden
- Heart and Vascular Theme Karolinska University Hospital Stockholm Sweden
| | - Peder Sörensson
- Division of Cardiology, Department of Medicine, Karolinska Institutet Karolinska University Hospital Stockholm Sweden
- Heart and Vascular Theme Karolinska University Hospital Stockholm Sweden
| | - Andrey Gourine
- Division of Cardiology, Department of Medicine, Karolinska Institutet Karolinska University Hospital Stockholm Sweden
| | - Loghman Henareh
- Division of Cardiology, Department of Medicine, Karolinska Institutet Karolinska University Hospital Stockholm Sweden
- Heart and Vascular Theme Karolinska University Hospital Stockholm Sweden
| | - Jonas Persson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet Danderyd University Hospital
| | - Nawzad Saleh
- Division of Cardiology, Department of Medicine, Karolinska Institutet Karolinska University Hospital Stockholm Sweden
- Heart and Vascular Theme Karolinska University Hospital Stockholm Sweden
| | - Magnus Settergren
- Division of Cardiology, Department of Medicine, Karolinska Institutet Karolinska University Hospital Stockholm Sweden
- Heart and Vascular Theme Karolinska University Hospital Stockholm Sweden
| | - Martin Sundqvist
- Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset Stockholm Sweden
| | - John Tengbom
- Division of Cardiology, Department of Medicine, Karolinska Institutet Karolinska University Hospital Stockholm Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset Stockholm Sweden
| | - Nils Witt
- Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset Stockholm Sweden
| | - Felix Böhm
- Division of Cardiology, Department of Medicine, Karolinska Institutet Karolinska University Hospital Stockholm Sweden
- Heart and Vascular Theme Karolinska University Hospital Stockholm Sweden
| | - John Pernow
- Division of Cardiology, Department of Medicine, Karolinska Institutet Karolinska University Hospital Stockholm Sweden
- Heart and Vascular Theme Karolinska University Hospital Stockholm Sweden
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40
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Holm M, Tornvall P, Henareh L, Jensen U, Golster N, Alström P, Santos-Pardo I, Witt N, Fedchenko N, Venetsanos D, Beck O, van der Linden J. The MOVEMENT Trial. J Am Heart Assoc 2020; 8:e010152. [PMID: 30636504 PMCID: PMC6497337 DOI: 10.1161/jaha.118.010152] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Morphine administration is a strong predictor of delayed onset of action of orally administered ticagrelor in patients with ST‐segment–elevation myocardial infarction, likely because of impaired gastrointestinal motility. The aim of this study was to evaluate whether the peripheral opioid antagonist methylnaltrexone could improve pharmacodynamics and pharmacokinetics of orally administered ticagrelor in patients with ST‐segment–elevation myocardial infarction receiving morphine. Methods and Results The MOVEMENT (Methylnaltrexone to Improve Platelet Inhibition of Ticagrelor in Morphine‐Treated Patients With ST‐Segment Elevation Myocardial Infarction) trial was a multicenter, prospective, randomized, controlled trial in patients with ST‐segment–elevation myocardial infarction treated with morphine and ticagrelor. Upon arrival to the catheterization laboratory, patients were randomized to a blinded intravenous injection of either methylnaltrexone (8 or 12 mg according to weight) or 0.9% sodium chloride. The proportion of patients with high on‐treatment platelet reactivity and plasma concentrations of ticagrelor and AR‐C124910XX were assessed at baseline (arrival in the catheterization laboratory) and 1 and 2 hours later. A total of 82 patients received either methylnaltrexone (n=43) or placebo (n=39). Median (interquartile range) time from ticagrelor administration to randomization was 41 (31–50) versus 45.5 (37–60) minutes (P=0.16). Intravenous methylnaltrexone administration did not significantly affect prevalence of high on‐treatment platelet reactivity at 2 hours after inclusion, the primary end point, when compared with placebo (54% versus 51%, P=0.84). Plasma concentrations of ticagrelor and its active metabolite, the prespecified secondary end points, did not differ significantly between the groups over time. There was no significant difference in patient self‐estimated pain between the groups. Conclusions Methylnaltrexone did not significantly improve platelet reactivity or plasma concentrations of orally administered ticagrelor in patients with ST‐segment–elevation myocardial infarction receiving morphine. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02942550.
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Affiliation(s)
- Manne Holm
- 1 Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.,2 Perioperative Medicine and Intensive Care, B31 Karolinska University Hospital Huddinge, Stockholm Sweden
| | - Per Tornvall
- 3 Unit of Cardiology Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Loghman Henareh
- 4 Coronary Artery and Vascular Disease Heart and Vascular Theme Department of Medicine Karolinska Institute and Karolinska University Hospital Stockholm Sweden
| | - Ulf Jensen
- 3 Unit of Cardiology Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Nanna Golster
- 1 Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | - Patrik Alström
- 3 Unit of Cardiology Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Irene Santos-Pardo
- 3 Unit of Cardiology Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Nils Witt
- 3 Unit of Cardiology Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Nikolai Fedchenko
- 3 Unit of Cardiology Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Dimitrios Venetsanos
- 4 Coronary Artery and Vascular Disease Heart and Vascular Theme Department of Medicine Karolinska Institute and Karolinska University Hospital Stockholm Sweden
| | - Olof Beck
- 5 Department of Laboratory Medicine Karolinska Institutet Stockholm Sweden
| | - Jan van der Linden
- 1 Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
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Cederström S, Lundman P, Folkersen L, Paulsson-Berne G, Karadimou G, Eriksson P, Caidahl K, Gabrielsen A, Jernberg T, Persson J, Tornvall P. New candidate genes for ST-elevation myocardial infarction. J Intern Med 2020; 287:66-77. [PMID: 31589004 DOI: 10.1111/joim.12976] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite extensive research in atherosclerosis, the mechanisms of coronary atherothrombosis in ST-elevation myocardial infarction (STEMI) patients are undetermined. OBJECTIVES Our aim was to find candidate genes involved in STEMI by analysing leucocyte gene expression in STEMI patients, without the influence of secondary inflammation from innate immunity, which was assumed to be a consequence rather than the cause of coronary atherothrombosis. METHODS Fifty-one patients were included at coronary angiography because of STEMI. Arterial blood was sampled in the acute phase (P1), at 24-48 h (P2) and at 3 months (P3). Leucocyte RNA was isolated and gene expression analysis was performed by Affymetrix Human Transcriptome Array 2.0. By omission of up- or downregulated genes at P2, secondary changes from innate immunity were excluded. Genes differentially expressed in P1 when compared to the convalescent sample in P3 were determined as genes involved in STEMI. RESULTS Three genes were upregulated at P1 compared to P3; ABCG1 (P = 5.81 × 10-5 ), RAB20 (P = 3.69 × 10-5 ) and TMEM2 (P = 7.75 × 10-6 ) whilst four were downregulated; ACVR1 (P = 9.01 × 10-5 ), NFATC2IP (P = 8.86 × 10-5 ), SUN1 (P = 3.87 × 10-5 ) and TTC9C (P = 7.18 × 10-6 ). These genes were also highly expressed in carotid atherosclerotic plaques. CONCLUSIONS We found seven genes involved in STEMI. The study is unique regarding the blood sampling in the acute phase and omission of secondary expressed genes from innate immunity. However, the results need to be replicated by future studies.
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Affiliation(s)
- S Cederström
- Division of Cardiovascular medicine, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital (KI DS), Stockholm, Sweden
| | - P Lundman
- Division of Cardiovascular medicine, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital (KI DS), Stockholm, Sweden
| | - L Folkersen
- Sankt Hans Hospital, Capital Region Hospitals, Roskilde, Denmark
| | - G Paulsson-Berne
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden
| | - G Karadimou
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden
| | - P Eriksson
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden
| | - K Caidahl
- Department of Molecular Medicine and Surgery (MMK), Karolinska Institutet, Stockholm, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Gabrielsen
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden
| | - T Jernberg
- Division of Cardiovascular medicine, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital (KI DS), Stockholm, Sweden
| | - J Persson
- Division of Cardiovascular medicine, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital (KI DS), Stockholm, Sweden
| | - P Tornvall
- Division of Cardiovascular medicine, Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institutet, Stockholm, Sweden
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Tornvall P, Collste O, Pettersson H. Prevalence and cumulative incidence of cancer, and mortality in patients with Takotsubo syndrome with focus on the index event. QJM 2019; 112:861-867. [PMID: 31346617 PMCID: PMC6830042 DOI: 10.1093/qjmed/hcz186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/03/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It has been suggested that Takotsubo syndrome (TS) is associated with cancer but previous studies have limitations. AIM To make a comprehensive analysis of prevalence and cumulative incidence of cancer, and mortality among TS patients with focus on the index event. DESIGN A register-based case-control study. METHODS The first new cancer occurrences (International Classification of Diseases C00-C75, C81-C96) were compared between 505 patients with TS without obstructive coronary artery disease (CAD) and four age- and gender-matched controls comprising patients with acute coronary syndrome with obstructive CAD (CAD controls), respectively, with chest-pain without obstructive CAD at coronary angiography (controls without CAD). RESULTS The prevalence of cancer before the index event was non-significantly (P = 0.052) higher in TS patients (15.8%) than in CAD controls (11.5%), respectively, higher (P = 0.028) than in controls without CAD (11.1%). There were no differences between the groups in cumulative incidence of cancer after the index event but a higher mortality in TS patients who developed cancer when compared with controls without CAD that developed cancer after the index event (P = 0.018). CONCLUSIONS There is an increased prevalence of first diagnosed cancer in TS patients before the index event but no increased cumulative incidence of cancer after the index event. The results does not support investigation for the possibility of a malignancy specifically in TS patients but in the event of cancer this patient group might need special care. However, if there is lack of a clear stressor it could be of importance to investigate the possibility of a malignancy.
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Affiliation(s)
- P Tornvall
- From the Department of Clinic Science and Education, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden
- Address correspondence to P. Tornvall, Department of Clinic Science and Education, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
| | - O Collste
- From the Department of Clinic Science and Education, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - H Pettersson
- From the Department of Clinic Science and Education, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden
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43
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Tengbom J, Cederstrom S, Verouhis D, Sorensson P, Bohm F, Saleh N, Jernberg T, Lundman P, Eriksson P, Gabrielsen A, Caidahl K, Persson J, Folkersen L, Tornvall P, Pernow J. P6599Upregulation of protein and gene expression of arginase-1 in patients with ST elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/13/2022] Open
Abstract
Abstract
Background
The mechanisms underlying rupture of a coronary atherosclerotic plaque and development of myocardial ischemia-reperfusion injury in ST-elevation myocardial infarction (STEMI) remain unknown. Increased arginase-1 activity leads to reduced nitric oxide production and increased formation of reactive oxygen species due to uncoupling of the endothelial nitric oxide synthase (eNOS). These events lead to endothelial dysfunction, plaque instability and increased susceptibility to ischemia-reperfusion injury in acute myocardial infarction. Experimental studies have shown that arginase-1 expression and activity are increased in atherosclerosis and during myocardial ischemia-reperfusion. Accordingly, inhibition of arginase-1 reduces atherosclerotic lesion development and limits the extent of infarct size during ischemia-reperfusion via an eNOS-dependent mechanism. Furthermore, arginase-1 inhibition improves endothelial function in patients with coronary artery disease but the potential role of arginase-1 in patients with STEMI is poorly understood.
Purpose
The purpose of the current study was to test the hypothesis that arginase-1 is upregulated and correlate to infarct size in STEMI patients.
Methods and results
Two independent cohorts of STEMI patients were included. In cohort 1, plasma and buffy coat leukocytes were collected from 53 STEMI patients at the time of arterial puncture for percutaneous coronary intervention, at 24–48 hours post STEMI and at 3 months post STEMI. Gene expression in leukocytes was determined in 51 patients with Affymetrix Human Transcriptome Array 2.0. In cohort 2, plasma was collected from 82 STEMI patients at admission and at 6 months for determination of plasma arginase-1. These patients underwent cardiac magnetic resonance imaging performed at day 4–7 and at 6 months post STEMI. Plasma arginase-1 levels were quantified with ELISA. Control blood samples were collected from 56 healthy age matched subjects. In cohort 1, ARG1 gene expression was four-fold higher in STEMI patients at admission compared to controls (Figure A). This expression returned to control levels within 3 months. Plasma arginase-1 levels were two times higher in STEMI patients at admission compared to controls, and remained elevated at 24–48 hours and at 3 months post STEMI (Figure B). The increase in plasma arginase-1 in STEMI patients was confirmed in cohort 2 (Figure C). Arginase-1 levels did not correlate with infarct size.
Conclusions
STEMI patients demonstrate increased gene expression and plasma levels of arginase-1 in the acute setting. In contrast to gene expression plasma arginase-1 levels remain significantly elevated over time. The markedly increased expression of arginase-1 already at admission may suggest a mechanistic role of arginase-1 in the development of STEMI. Further studies are needed to elucidate whether increased expression, induction and activity of arginase-1 are contributing factors for the development of STEMI.
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Affiliation(s)
- J Tengbom
- Karolinska Institute, Division of Cardiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - S Cederstrom
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - D Verouhis
- Karolinska Institute, Division of Cardiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - P Sorensson
- Karolinska Institute, Division of Cardiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - F Bohm
- Karolinska Institute, Division of Cardiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - N Saleh
- Karolinska Institute, Division of Cardiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - T Jernberg
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - P Lundman
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - P Eriksson
- Karolinska Institute, Department of Medicine, Solna (MedS), Karolinska University Hospital, Stockholm, Sweden
| | - A Gabrielsen
- Karolinska Institute, Department of Medicine, Solna (MedS), Karolinska University Hospital, Stockholm, Sweden
| | - K Caidahl
- Karolinska Institute, Department of Molecular Medicine and Surgery (MMK), Stockholm, Sweden
| | - J Persson
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | | | - P Tornvall
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Stockholm, Sweden
| | - J Pernow
- Karolinska Institute, Division of Cardiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
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Hjort M, Eggers KM, Lindhagen L, Agewall S, Brolin EB, Collste O, Daniel M, Ekenbäck C, Frick M, Henareh L, Hofman-Bang C, Malmqvist K, Spaak J, Sörensson P, Y-Hassan S, Tornvall P, Lindahl B. Increased Inflammatory Activity in Patients 3 Months after Myocardial Infarction with Nonobstructive Coronary Arteries. Clin Chem 2019; 65:1023-1030. [PMID: 31072836 DOI: 10.1373/clinchem.2018.301085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/26/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Around 5%-10% of patients with myocardial infarction (MI) present with nonobstructive coronary arteries (MINOCA). We aimed to assess pathophysiological mechanisms in MINOCA by extensively evaluating cardiovascular biomarkers in the stable phase after an event, comparing MINOCA patients with cardiovascular healthy controls and MI patients with obstructive coronary artery disease (MI-CAD). METHODS Ninety-one biomarkers were measured with a proximity extension assay 3 months after MI in 97 MINOCA patients, 97 age- and sex-matched MI-CAD patients, and 98 controls. Lasso analyses (penalized logistic regression models) and adjusted multiple linear regression models were used for statistical analyses. RESULTS In the Lasso analysis (MINOCA vs MI-CAD), 8 biomarkers provided discriminatory value: P-selectin glycoprotein ligand 1, C-X-C motif chemokine 1, TNF-related activation-induced cytokine, and pappalysin-1 (PAPPA) with increasing probabilities of MINOCA, and tissue-type plasminogen activator, B-type natriuretic peptide, myeloperoxidase, and interleukin-1 receptor antagonist protein with increasing probabilities of MI-CAD. Comparing MINOCA vs controls, 7 biomarkers provided discriminatory value: N-terminal pro-B-type natriuretic peptide, renin, NF-κ-B essential modulator, PAPPA, interleukin-6, and soluble urokinase plasminogen activator surface receptor with increasing probabilities of MINOCA, and agouti-related protein with increasing probabilities of controls. Adjusted multiple linear regression analyses showed that group affiliation was associated with the concentrations of 7 of the 8 biomarkers in the comparison MINOCA vs MI-CAD and 5 of the 7 biomarkers in MINOCA vs controls. CONCLUSIONS Three months after the MI, the biomarker concentrations indicated greater inflammatory activity in MINOCA patients than in both MI-CAD patients and healthy controls, and a varying degree of myocardial dysfunction among the 3 cohorts.
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Affiliation(s)
- Marcus Hjort
- Department of Medical Sciences, and .,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - Lars Lindhagen
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Stefan Agewall
- Institute of Clinical Sciences, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Elin B Brolin
- Department of Clinical Science, Intervention and Technology
| | - Olov Collste
- Department of Clinical Sciences and Education, Södersjukhuset
| | - Maria Daniel
- Department of Clinical Sciences and Education, Södersjukhuset
| | - Christina Ekenbäck
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital
| | - Mats Frick
- Department of Clinical Sciences and Education, Södersjukhuset
| | - Loghman Henareh
- Heart and Vascular Theme, Department of Medicine, Karolinska University Hospital, and
| | - Claes Hofman-Bang
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital
| | - Karin Malmqvist
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital
| | - Jonas Spaak
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital
| | - Peder Sörensson
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Shams Y-Hassan
- Heart and Vascular Theme, Department of Medicine, Karolinska University Hospital, and
| | - Per Tornvall
- Department of Clinical Sciences and Education, Södersjukhuset
| | - Bertil Lindahl
- Department of Medical Sciences, and.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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45
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Nyman E, Mattsson E, Tornvall P. Trigger factors in takotsubo syndrome - A systematic review of case reports. Eur J Intern Med 2019; 63:62-68. [PMID: 30833207 DOI: 10.1016/j.ejim.2019.02.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 10/11/2018] [Revised: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Takotsubo syndrome is an acute heart failure syndrome often preceded by a trigger factor of physical or emotional origin, although the proportion is unclear. The aim of the present study was to determine how common different trigger factors are in takotsubo syndrome divided by sex and age in women. MATERIAL AND METHODS The study consisted of a systematic review of all available case reports in PubMed and Web of Science up to March 2018. Trigger factors were categorized into physical and emotional trigger factors. RESULTS Males had to a higher degree experienced a trigger factor (92.6%) compared to females (81.9%, p < .001). Physical trigger factors were most common (67.3%). Males had to a higher degree experienced a physical trigger factor (85.7%) compared to females (63.5%, p < .001). Females ≤50 years of age had to a higher degree experienced a trigger factor (90.8%) compared to females >50 years of age (79.2%, p < .001). Additionally, females ≤50 years of age had to a higher degree experienced a physical trigger factor (75.6%) compared to females >50 years of age (59.3%, p < .01). CONCLUSION A physical trigger factor is more common than an emotional trigger factor in takotsubo syndrome. Physical triggers includes drugs, surgery and central nervous system conditions. Furthermore, females ≤50 years of age and males more often have an evident trigger factor and it is more often physical, compared to the most common patient, a female >50 years of age.
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Affiliation(s)
- Elin Nyman
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Emma Mattsson
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
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46
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Abstract
Takotsubo syndrome is an intriguing condition of often stress induced reversible cardiac dysfunction mimicking myocardial infarction, but without explanatory coronary obstructions. The pathogenesis of the syndrome is not yet fully understood, though altered sympathetic regulation or response to cardiac sympathetic stimuli is likely to be involved. We present a unique and clinically detailed report of identical twin sisters, who both developed Takotsubo syndrome in association to mental stress shortly after menopause, also covering a potential relapse of disease in one of the twins, supporting the theory of a genetic contribution to the development of the syndrome proposed by previous case reports and small genetic studies.
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Affiliation(s)
- Christina Ekenbäck
- Cardiology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Danderyd, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Spaak
- Cardiology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Danderyd, Sweden
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47
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Eggers KM, Hjort M, Baron T, Jernberg T, Nordenskjöld AM, Tornvall P, Lindahl B. Morbidity and cause-specific mortality in first-time myocardial infarction with nonobstructive coronary arteries. J Intern Med 2019; 285:419-428. [PMID: 30474313 DOI: 10.1111/joim.12857] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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] [Indexed: 01/29/2023]
Abstract
BACKGROUND Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is receiving increasing interest as a prognostically adverse entity distinct from myocardial infarction with significant coronary artery disease (MI-CAD). However, data are still limited regarding long-term cardiovascular morbidity and cause-specific mortality in MINOCA. METHODS This is a registry-based cohort study using data from patients admitted to Swedish coronary care units. We investigated various nonfatal outcomes (recurrent MI, hospitalization for heart failure or stroke) and fatal outcomes (cardiovascular, respiratory or cancer-related mortality) in 4069 patients without apparent acute cardiovascular disease, used as non-MI controls, 7266 patients with first-time MINOCA and 69 267 patients with first-time MI-CAD. RESULTS Almost all event rates (median follow-up 3.8 years) increased in a stepwise fashion across the three cohorts [rates of major adverse events (MAE; composite of all-cause mortality, recurrent MI, hospitalization for heart failure or stroke): n = 268 (6.6%), n = 1563 (21.5%), n = 17 777 (25.7%), respectively]. Compared to non-MI controls, MINOCA patients had an adjusted hazard ratio (HR) of 2.12 (95% confidence interval 1.84-2.43) regarding MAE. MINOCA patients had a substantial risk of cardiovascular mortality and the highest numerical risks of respiratory and cancer-related mortality. Male sex, previous heart failure and chronic obstructive pulmonary disease had a stronger prognostic impact in MINOCA than in MI-CAD. Female MINOCA patients with atrial fibrillation were at particular risk. CONCLUSIONS Patients with first-time MINOCA have a considerable risk of adverse events. This stresses the need for a comprehensive search of the cause of MINOCA, thorough treatment of underlying disease triggers and close follow-up.
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Affiliation(s)
- K M Eggers
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - M Hjort
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - T Baron
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - T Jernberg
- Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - A M Nordenskjöld
- Faculty of Health, Department of Cardiology, Örebro University, Örebro, Sweden
| | - P Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - B Lindahl
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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48
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Nordenskjöld AM, Lagerqvist B, Baron T, Jernberg T, Hadziosmanovic N, Reynolds HR, Tornvall P, Lindahl B. Reinfarction in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Coronary Findings and Prognosis. Am J Med 2019; 132:335-346. [PMID: 30367850 DOI: 10.1016/j.amjmed.2018.10.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 09/24/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is common. There are limited data on the mechanisms and prognosis for reinfarction in MINOCA patients. METHODS In this observational study of MINOCA patients hospitalized in Sweden and registered in the SWEDEHEART registry between July 2003 and June 2013 and followed until December 2013, we identified 9092 unique patients with MINOCA of 199,163 MI admissions in total. The 570 (6.3%) MINOCA patients who were hospitalized due to a recurrent MI constituted the study group. RESULTS The mean age was 69.1 years and 59.1% were women. The median time to readmission was 17 months. A total of 340 patients underwent a new coronary angiography and 180 (53%) had no obstructive coronary artery disease (CAD) and 160 (47%) had obstructive CAD; 123 had 1-vessel, 26 had 2-vessel, 9 had 3-vessel disease, and 2 had left main together with 1-vessel disease. Male sex, diabetes, peripheral vascular disease, higher levels of creatinine, and ST elevation at presentation were more common in patients with MI with obstructive CAD than in patients with a recurrent MINOCA. Mortality during a median follow-up of 38 months was similar whether the reinfarction event was MINOCA or MI with obstructive CAD 13.9% vs 11.9% (P = .54). CONCLUSIONS About half of patients with reinfarction after MINOCA who underwent coronary angiography had progression of coronary stenosis. Angiography should be strongly considered in patients with MI after MINOCA. Mortality associated with recurrent events was substantial, though there was no difference in mortality between those with or without significant CAD.
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Affiliation(s)
- Anna M Nordenskjöld
- Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Bo Lagerqvist
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tomasz Baron
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Nermin Hadziosmanovic
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Harmony R Reynolds
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU School of Medicine, New York, NY
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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49
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Nero D, Agewall S, Daniel M, Caidahl K, Collste O, Ekenbäck C, Frick M, Henareh L, Jernberg T, Malmqvist K, Schenck-Gustafsson K, Spaak J, Sörensson P, Sundin Ö, Y-Hassan S, Hofman-Bang C, Tornvall P. Personality Traits in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries. Am J Med 2019; 132:374-381.e1. [PMID: 30503881 DOI: 10.1016/j.amjmed.2018.11.010] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study was to describe type A behavior pattern and trait anger in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) and compare them with patients with coronary heart disease and healthy controls. Type A behavior pattern and anger have been linked to coronary heart disease in previous studies. This is the first study to assess type A behavior pattern and trait anger in MINOCA patients. METHODS One hundred MINOCA patients, consecutively recruited during 2007-2011 at 5 coronary care units in Stockholm, were matched for sex and age to 100 coronary heart disease patients and 100 healthy controls. All participants completed the Bortner Rating Scale to quantify type A behavior pattern and the Spielberger Trait Anger Scale to quantify anger 3 months after the acute event. RESULTS MINOCA patients' Bortner Rating Scale score was 70.9 ± 10.8 (mean ± SD) and Spielberger Trait Anger Scale score was 14 (12-17) (median; interquartile range). Coronary heart disease patients' Bortner Rating Scale score was 70.5 ± 10.2 and Spielberger Trait Anger Scale score was 14 (12-17). Healthy controls' Bortner Rating Scale score was 71.9 ± 9.1 and Spielberger Trait Anger Scale score was 13 (11-16). CONCLUSION We found no significant differences in Bortner Rating Scale score and Spielberger Trait Anger Scale score among MINOCA, coronary heart disease patients, and healthy controls, regardless of whether total scores, subscales, or cutoffs were used to classify type A behavior pattern and trait anger. However, we cannot exclude the existence of an occasional episode of anger or mental stress in relation to the coronary event. This is the first study to assess type A behavior pattern and trait anger in patients with MINOCA, and future studies need to confirm the current findings before any firm conclusions can be made.
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Affiliation(s)
- Daniella Nero
- Departments of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| | - Stefan Agewall
- Institute of Clinical Sciences, University of Oslo and Oslo University Hospital Ullevål, Norway
| | - Maria Daniel
- Departments of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Caidahl
- Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olov Collste
- Departments of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | | | - Mats Frick
- Departments of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Loghman Henareh
- Coronary Artery and Vascular Disease, Heart and Vascular Theme. Department of Medicine, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Karin Malmqvist
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Karin Schenck-Gustafsson
- Centre for Gender Medicine, Karolinska Institute and Karolinska University Hospital Solna, Institutionen för medicin, enhet kardiologi, FOU Tema Hjärta-Kärl. Stockholm, Sweden
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Peder Sörensson
- Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden
| | | | - Shams Y-Hassan
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Claes Hofman-Bang
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Per Tornvall
- Departments of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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50
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Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio ALP, De Caterina R, Zimarino M, Roffi M, Kjeldsen K, Atar D, Kaski JC, Sechtem U, Tornvall P. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J 2019; 38:143-153. [PMID: 28158518 DOI: 10.1093/eurheartj/ehw149] [Citation(s) in RCA: 228] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 01/14/2016] [Accepted: 03/18/2016] [Indexed: 02/06/2023] Open
Affiliation(s)
- Stefan Agewall
- Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - John F Beltrame
- The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Adelaide, Australia
| | - Harmony R Reynolds
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Wien, Austria
| | - Giuseppe Rosano
- Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK.,Abteilung für Kardiologie, Robert-Bosch Krankenhaus Stuttgart, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Alida L P Caforio
- Division of Cardiology, Department of Cardiological Thoracic and Vascular Sciences Padua University Medical School, Policlinico Universitario, Via N Giustiniani, 2, 35128 Padova, Italy
| | | | - Marco Zimarino
- Institute of Cardiology, G. d'Annunzio University, Chieti, Italy
| | - Marco Roffi
- Division of Cardiology, University Hospital, 1211 Geneva 14, Switzerland
| | - Keld Kjeldsen
- Copenhagen University Hospitals (Rigshospitalet and Holbæk Hospital), Copenhagen and Holbæk, and The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Dan Atar
- Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Juan C Kaski
- Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Udo Sechtem
- Abteilung für Kardiologie, Robert-Bosch Krankenhaus Stuttgart, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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