| 1. |
- Gjertsson, Peter, 1961, et al.
(författare)
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Diagnostic and referral delay in patients with aortic stenosis is common and negatively affects outcome
- 2007
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Ingår i: Scand Cardiovasc J. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 41:1, s. 12-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Aortic stenosis (AS) patients are often severely symptomatic at the time of aortic valve replacement (AVR). We wanted to investigate doctors' delay and its impact on outcome. DESIGN: AS patients undergoing AVR (n = 422) were included. Clinical and echocardiographic data at the time of diagnosis and preoperatively were noted. The risk of death after AVR was estimated using Poisson regression, incorporating age, gender, coronary artery disease, NYHA III/IV and time on the waiting list for AVR. RESULTS: The age (mean+/-SD) was 71+/-8.6 years, 45% were women, and 48% were in NYHA III/IV. 55% underwent AVR within one year of diagnosis, indicating late diagnosis. The time from referral to AVR (median, range) was 112 (1-803) days. NYHA III/IV independently predicted mortality (hazard ratio 1.76, 95% CI 1.28-2.43, p = 0.0005). The time from referral to AVR influenced the risk of death immediately after operation (p = 0.0083). CONCLUSION: Late diagnosis and late referral for AVR are common, and negatively influence outcome in patients with AS. Delay in surgery after referral increase the mortality immediately after AVR.
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| 2. |
- Gjertsson, Peter, 1961, et al.
(författare)
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Left ventricular diastolic dysfunction late after aortic valve replacement in patients with aortic stenosis
- 2005
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Ingår i: Am J Cardiol. - : Elsevier BV. - 0002-9149. ; 96:5, s. 722-7
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Tidskriftsartikel (refereegranskat)abstract
- Patients with severe aortic stenosis (AS) are known to have increased left ventricular (LV) mass and diastolic dysfunction. It has been suggested that LV mass and diastolic function normalize after aortic valve replacement (AVR). In the present study, change in LV mass index and diastolic function 10 years after AVR for AS was evaluated. Patients who underwent AVR from 1991 to 1993 (n = 57; mean age 67 +/- 8.6 years at AVR, 58% men) were investigated with Doppler echocardiography preoperatively and 2 and 10 years postoperatively. Diastolic function was evaluated by integrating mitral and pulmonary venous flow data. Expected values for each patient, taking age into consideration, were defined using a control group (n = 71; age range 18 to 83 years). Patients were classified into 4 types: normal diastolic function (type A), mild diastolic dysfunction (type B), moderate diastolic dysfunction (type C), and severe diastolic dysfunction (type D). There was a reduction in LV mass index between the preoperative (161 +/- 39 g/m2) and 2-year follow-up (114 +/- 28 g/m2) examinations (p <0.0001), but no further reduction was seen at 10 years (119 +/- 49 g/m2). The percentage of patients with increased LV mass index decreased from 83% preoperatively to 29% at 2-year follow-up (p <0.001). The percentage of patients with moderate to severe LV diastolic dysfunction (types C and D) was unchanged between the preoperative (7%) and 2-year follow-up (13%) examinations (p = 0.27). The percentage of patients increased at 10-year follow-up to 61% (p <0.0001). In conclusion, this reveals the development of moderate to severe diastolic dysfunction 10 years after AVR, despite a reduction in the LV mass index.
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| 3. |
- Gjertsson, Peter, 1961, et al.
(författare)
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Preoperative moderate to severe diastolic dysfunction: a novel Doppler echocardiographic long-term prognostic factor in patients with severe aortic stenosis
- 2005
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Ingår i: J Thorac Cardiovasc Surg. - : Elsevier BV. - 0022-5223. ; 129:4, s. 890-6
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We studied long-term outcomes in severe aortic stenosis and the importance of prosthesis type (mechanical vs biologic) and size, preoperative left ventricular ejection fraction, diastolic function, and left ventricular mass. METHODS: Patients undergoing valve replacement from 1991 to 1993 (n = 399, 45% women) were included. The diastolic function was evaluated by integrating mitral and pulmonary venous flow data with Doppler echocardiography. The patients were classified as having either normal diastolic function to mild diastolic dysfunction or moderate to severe diastolic dysfunction. Left ventricular ejection fraction and the diastolic function category were incorporated together with age, sex, and time since operation into a Poisson regression model with death as the end point. Prosthesis type and size and left ventricular mass were also investigated. RESULTS: The age (mean +/- SD) was 71 +/- 9 years, and the overall survival after 12 years was 50%. Although markedly reduced during the initial 6-month period, mortality risk subsequently increased more than could be explained by age (hazard ratio of 1-year difference = 1.12, P = .0005). The moderate to severe diastolic dysfunction pattern independently predicted late mortality (hazard ratio = 1.72, P = .0038), whereas left ventricular ejection fraction did not (hazard ratio = 0.99, P = .18). The prognostic importance of moderate to severe diastolic dysfunction did not diminish with time; on the contrary, it tended to increase. Mortality after 12 years was not predicted by left ventricular mass (P = .66), prosthesis type (P = .57), or prosthesis size (P = .58). CONCLUSION: This study reveals that moderate to severe diastolic dysfunction in patients with aortic stenosis is an independent predictor of late mortality after valve replacement and that its importance does not decrease with time. Our findings may suggest that moderate to severe diastolic dysfunction implies nonreversible myocardial changes that negatively affect survival.
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| 4. |
- Guron, Cecilia Wallentin, 1965, et al.
(författare)
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The E/e filling index and right ventricular pressure in relation to applied international Doppler recommendations of left ventricular filling assessment
- 2005
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Ingår i: Eur J Echocardiogr. - : Oxford University Press (OUP). - 1525-2167. ; 6:6, s. 419-28
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Tidskriftsartikel (refereegranskat)abstract
- AIM: A ratio>15 between the early diastolic pulsed Doppler velocities of the mitral inflow (E) and the basal left ventricular (LV) tissue (e) has been demonstrated to predict an elevated LV filling pressure (FP). An elevated LVFP implies an elevated right ventricular pressure (RVp). In order to investigate the sensitivity of the E/e filling index, we compared E/e and RVp, in their ability to identify a Doppler-assumed elevation of LVFP. METHODS AND RESULTS: Application of pulsed Doppler international recommendations grouped 134 patients with acute coronary syndromes (ACS) and 50 age- and sex-matched controls, according to LV filling: normal; delayed relaxation; an isolated pathological mitral-pulmonary venous-A-wave-duration difference; pseudo normal; or a restrictive filling pattern. An E/e>15 and an RVp>30 mmHg showed the following (%) sensitivity (32/94), specificity (95/76), positive (68/59), and negative (80/97) predictive values of a Doppler-assumed elevation of LVFP, in terms of either a pseudo normal or a restrictive filling pattern. CONCLUSION: The low sensitivity of E/e to detect a Doppler-assumed elevation of LVFP could limit its clinical usefulness as a single variable, in ACS. The high sensitivity and negative predictive value of RVp support its use as an additional LV filling variable in these patients.
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| 5. |
- Hadimeri, Henrik, 1962, et al.
(författare)
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Echocardiographic findings in kidney transplant patients with autosomal dominant polycystic kidney disease
- 2009
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Ingår i: Scand J Urol Nephrol. ; 43:5, s. 416-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Autosomal dominant polycystic kidney disease (ADPKD) is a systemic disorder with a tendency for aneurysm formation which may also affect the heart. ADPKD kidney transplant patients were studied by echocardiography. MATERIAL AND METHODS: The case-control study consisted of 21 kidney transplant recipients and a group of 21 transplant patients with other diagnoses. They were in a stable phase a median of 3 years (range 1-10) after transplantation. M-mode and two-dimensional echocardiography were performed. RESULTS: Age, haemoglobin and renal function were not different between the groups but ADPKD patients had significantly lower systolic blood pressure (p=0.004). There were no abnormalities in the aortic or mitral valve in either group. The diameter of the left ventricular outflow tract, the bulb or the ascending aorta did not differ between the groups. The diameters of the left ventricle or atrium were also similar. The left ventricular mass index was 132+/-36 in ADPKD patients versus 163+/-63 g/m(2) in the controls (p=0.11). The left ventricular ejection fraction was 69+/-9.0 versus 70+/-8.9%. Early and atrial filling waves were equal. CONCLUSION: Valvular anomalies were infrequent. Aneurysm formation in the aorta and signs of dilated cardiomyopathy were not increased in patients with ADPKD.
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