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- Hult, L., et al.
(författare)
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Post systolic shortening by speckle tracking echocardiography as a predictor for cardiovascular events in patients with type 2 diabetes
- 2022
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 43, s. 923-923
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Tidskriftsartikel (refereegranskat)abstract
- Background: Post systolic shortening (PSS), measured by speckle tracking echocardiography has emerged as a novel method to evaluate left ventricular function and has been linked to adverse outcomes. Purpose: Our aim was to assess if the presence of pathological PSS had prognostic value in the prediction of major cardiovascular events in a cohort of patients with type-II diabetes (T2D). Method: Three-hundred-and-sixty-four patients with T2D in the CARDIPP study (Cardiovascular Risk factors in Patients with Diabetes – a Prospective study in Primary care) underwent echocardiography between 2005 and 2009. All patients were evaluated with strain analysis by speckle tracking. PSS was defined as any myocardial contraction occurring after aortic valve closure (Figure 1). Pathological PSS was defined as a post systolic index (PSI) >5% where PSI was calculated as: (peak global longitudinal strain – peak systolic longitudinal strain) / (peak global longitudinal strain) x 100. The composite endpoint of any major cardiovascular event (MACE) was defined as the diagnosis of or death in heart failure, myocardial infarction, or stroke. Cox proportional hazard ratios (HR) with 95% confidence intervals were calculated and were adjusted for sex, age, body mass index, hypertension, smoking, previous cardiovascular events and HbA1c. Results: Mean follow-up time was 11.2±2.3 years. Patients with pathological PSS had an increased unadjusted risk of MACE, (HR 3.73, 95% CI 2.06–6.76), which persisted after adjustment (HR 2.20, 95% CI 1.11–4.37) as compared to subjects without pathological PSS. When adding PSS to a risk prediction model including Global Longitudinal Strain (GLS), the adjusted HR (95% CI) for MACE was 2.94 (1.33–6.52) for subjects with reduced GLS (lower limit of normal −16%) and PSI >5%, compared to those with normal GLS and PSI ≤5%. Adverse events were more common in subjects with the combination of pathological PSS and GLS (Figure 2). Conclusions: Our results suggest that PSS may provide important additional prognostic information in patients with T2D.
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- Kivimäki, Mika, et al.
(författare)
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Long working hours as a risk factor for atrial fibrillation : a multi-cohort study
- 2017
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 38:34, s. 2621-2628
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Tidskriftsartikel (refereegranskat)abstract
- Aims Studies suggest that people who work long hours are at increased risk of stroke, but the association of long working hours with atrial fibrillation, the most common cardiac arrhythmia and a risk factor for stroke, is unknown. We examined the risk of atrial fibrillation in individuals working long hours (>= 55 per week) and those working standard 35-40 h/week. Methods and results In this prospective multi-cohort study from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium, the study population was 85 494 working men and women (mean age 43.4 years) with no recorded atrial fibrillation. Working hours were assessed at study baseline (1991-2004). Mean follow-up for incident atrial fibrillation was 10 years and cases were defined using data on electrocardiograms, hospital records, drug reimbursement registers, and death certificates. We identified 1061 new cases of atrial fibrillation (10-year cumulative incidence 12.4 per 1000). After adjustment for age, sex and socioeconomic status, individuals working long hours had a 1.4-fold increased risk of atrial fibrillation compared with those working standard hours (hazard ratio = 1.42, 95% CI= 1.13-1.80, P= 0.003). There was no significant heterogeneity between the cohort-specific effect estimates (I-2= 0%, P = 0.66) and the finding remained after excluding participants with coronary heart disease or stroke at baseline or during the follow-up (N= 2006, hazard ratio= 1.36, 95% CI= 1.05-1.76, P = 0.0180). Adjustment for potential confounding factors, such as obesity, risky alcohol use and high blood pressure, had little impact on this association. Conclusion Individuals who worked long hours were more likely to develop atrial fibrillation than those working standard hours.
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- Kylhammar, D., et al.
(författare)
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Global longitudinal strain and mechanical dispersion in the general population aged 50-64 years - results from the echocardiography study of the Swedish CArdioPulmonary bioImage Study (SCAPIS)
- 2019
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 40:1, s. 1859-1859
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe Swedish CArdioPulmonary bioImage Study (SCAPIS) was initiated to improve understanding of underlying mechanisms in order to prevent cardiovascular and pulmonary disease. 30 000 individuals aged 50–64 years, randomly selected from the general population, were included in the study. Six-thousand-eight-hundred of the individuals underwent transthoracic echocardiography.Global longitudinal strain (GLS) and mechanical dispersion (MD) are novel echocardiographic measures of left ventricular (LV) systolic function and electrical instability reflecting risk for malignant arrhythmia, respectively. Previous studies suggest that the limit of normal for GLS is −16% and that MD >70 ms may be associated with increased risk for malignant arrhythmias. GLS and MD have, however, not before been investigated in a large population-based study.PurposeThe purpose of this first project within the SCAPIS echocardiography study is to determine the prevalence of impaired GLS and MD in the general population aged 50–64 years.MethodsGLS and MD, defined as mean peak longitudinal strain of the 18 LV segments and standard deviation of time-to-peak strain for the 18 LV segments, respectively, were analysed using a commercially available software. For group comparisons, the independent-samples t-test, the Mann-Whitney U-test or One Way Analysis of Variance with the Bonferroni post hoc test were performed. Values are mean±standard deviation.Results1850 examinations have so far been reviewed, whereof image quality was considered adequate for strain analysis in 1480 individuals (80%). Image quality, assessed as the number of visually assessable LV segments, was better for the second half of the examinations, as compared to the first half (p<0.001). Of the 1480 individuals where GLS and MD were assessed, 51% were women and mean age was 57±4.4 years with no difference in age between the sexes (p=ns). Mean GLS was −20±2% and men had significantly more negative (p<0.001) GLS values than women (−21±2% vs. −19±2%). There was no significant difference (p=ns) in GLS when comparing individuals aged 50–54, 55–59 or 60–64 years, respectively. GLS values were less negative than −16% in 1.9% of the study population. Mean MD was 41±12 ms with no significant difference (p=ns) between the sexes. MD was significantly lower (p<0.001) among individuals aged 50–54 years, as compared to those aged 55–59 or 60–64 years, respectively. MD was >70 ms in 1.6% of the study population.ConclusionsThese preliminary data from the SCAPIS echocardiography study suggest that, in the general population aged 50–64 years, 1.9% have impaired GLS and 1.6% have increased MD, which is possibly associated with a higher risk for malignant arrhythmias. Men had more negative GLS values than women and MD was lower in the lowest age tertile. Further analyses are ongoing.Acknowledgement/FundingThe Swedish Heart and Lung Foundation. Grants from Linkoping University. ALF-grants from the Swedish government (LIO-700841).
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- Steinke, Elaine E., et al.
(författare)
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Sexual counselling for individuals with cardiovascular disease and their partners : A Consensus Document From the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP)
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 34:41, s. 3217-3235
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Tidskriftsartikel (refereegranskat)abstract
- After a cardiovascular event, patients and their families often cope with numerous changes in their lives, including dealing with consequences of the disease or its treatment on their daily lives and functioning. Coping poorly with both physical and psychological challenges may lead to impaired quality of life. Sexuality is one aspect of quality of life that is important for many patients and partners that may be adversely affected by a cardiac event. The World Health Organization defines sexual health as '… a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences ….' The safety and timing of return to sexual activity after a cardiac event have been well addressed in an American Heart Association scientific statement, and decreased sexual activity among cardiac patients is frequently reported. Rates of erectile dysfunction (ED) among men with cardiovascular disease (CVD) are twice as high as those in the general population, with similar rates of sexual dysfunction in females with CVD. ED and vaginal dryness may also be presenting signs of heart disease and may appear 1-3 years before the onset of angina pectoris. Estimates reflect that only a small percentage of those with sexual dysfunction seek medical care; therefore, routine assessment of sexual problems and sexual counselling may be of benefit as part of effective management by physicians, nurses, and other healthcare providers.
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- Wu, E., et al.
(författare)
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Long-term effects of enhanced external counterpulsation treatment on symptom burden, usage of nitrates, physical capacity and health-related quality of life in patients with refractory angina pectoris
- 2019
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 40:1, s. 1634-1634
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPatients with refractory angina pectoris (RAP) suffer from debilitating symptoms with considerable limitation of functional capacity and impaired health-related quality of life (HRQoL) despite optimized medical therapy. Recurrent angina symptoms are strongly associated with psychological distress and cardiac anxiety (i.e., a subtype of anxiety related to cardiac sensations). Enhanced external counterpulsation (EECP) is an alternative non-invasive treatment for these patients. An EECP course includes 35 1-hour sessions over 7 weeks. No previous study has explored long-term EECP effects on cardiac anxiety in patients with RAP.ObjectiveTo evaluate the effects of EECP treatment in patients with RAP regarding usage of nitrates, physical capacity, cardiac anxiety and HRQoL.MethodsA quasi experimental design with long-term follow-up (6 months) involving 50 patients (men=37, 47–91 years) who had finished one course of EECP. Assessment of average use of nitrates, six-minute walk test, functional class with Canadian Cardiovascular Society (CCS) classification and questionnaires for cardiac anxiety and HRQoL were collected pre and post treatment. In addition, the questionnaires were collected 6 months after completion of EECP.ResultsPatients used significantly less nitrates (p<0.001) compared to at the start of treatment. They enhanced the walking distance on average by 46 m after EECP (p<0.001) and CCS class also improved (p<0.001). All subscales except for one in cardiac anxiety were significantly reduced (p<0.05). All dimensions in HRQoL improved significantly (p<0.01). The positive effects in both cardiac anxiety and HRQoL were maintained 6 months after the treatment.ConclusionsPatients with RAP received beneficial effects from EECP. Reduced symptom burden and improved physical capacity enable engagement in physical activities. Furthermore, less cardiac anxiety and improved HRQoL may enhance life satisfaction for these patients. EECP treatment should be considered to a greater extent to improve the life situation for these patients.
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