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Sökning: WFRF:(Ivert Torbjörn)

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1.
  • Dahlin, Lars-Göran, 1956- (författare)
  • Perioperative myocardial infarction in cardiac surgery : a diagnostic dilemma
  • 2001
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Perioperative myocardial infarction remains a major cause of morbidity and mortality after cardiac surgery. In spite of this there is no consensus regarding diagnostic criteria and consequently the reported incidence varies widely. In this thesis risk factors for PMI and outcome after PMI were studied in a retrospective case control study on 42 patients fulfilling strict criteria for PM! collected from a cohort of 1147 adult cardiac surgical patients. Traditional diagnostic criteria for PMI, release characteristics of biochemical markers for myocardial injury and VCG were evaluated in a prospective study on 302 consecutive patients undergoing isolated frrst time CABG. PM! was found to be a problem mainly associated with surgery for ischaemic heart disease. Unstable angina and unfavourable conditions for revascularisation were found to be the most important risk factors for PMI. Patients with PM! had an impaired short-term and mid-term outcome compared with controls. In the prospective study a sustained elevation of troponin-T was used as a marker for permanent myocardial damage. It was demonstrated that Q-wave criteria, previously accepted as the gold standard for diagnosis of PM!, correlated poorly with biochemical markers of myocardial injury and clinical outcome. One fourth of the patients with new Q-waves after CABG had no evidence of permanent myocardial injury. The use of biochemical markers for early diagnosis of myocardial injury is interfered by unspecific release unrelated to permanent myocardial damage. However, little is known about the magnitude of this "diagnostic noise". To address this issue a subgroup with no or minimal permanent myocardial damage was identified by use of the unique release characteristics of troponin-T. The time frame of unspecific release and the plasma levels of CKMB and troponin-T caused by unspecific release were assessed. A substantial early release of both CKMB and troponin-T nnrelated to permanent myocardial injury was found. As the unspecific release can be expected to differ depending on type of cardiac intervention this type of knowledge may prevent inappropriate comparisons. Repeated early sampling for CKMB provided additional information of value for early identification of patients who would later show sustained elevation of troponin-T. VCG was found to correlate better with sustained levels oftroponin-T and clinical outcome than scalar ECG. To conclude, diagnostic pitfalls associated with both ECG and enzymatic diagnosis of PM! were addressed and novel approaches to improve detection of permanent myocardial damage are suggested.
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3.
  • Granfeldt, Hans, 1960- (författare)
  • The use of mechanical circulatory support and passive ventricular constraint in patients with acute and chronic heart failure
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Many patients are diagnosed as having chronic heart failure (CHF) and apart from the fact that daily activities are impaired, they are great consumers of health care, and the prognosis is poor. The distinction between acute heart failure (AHF) and CHF may be difficult and is more a question of time rather than severity. The “gold standard” treatment for end‐stage heart failure is heart transplantation. Due to organ shortage this is reserved for selected patients only. Since the introduction of mechanical circulatory support (MCS) more and more patients with progressive CHF have been bridged‐to‐heart‐transplantation. There are MCS systems available for both short‐ and long‐term support. Newer concepts such as ventricular constraint to prevent ventricular remodelling are on the way. We have investigated short‐ (ImpellaTM) and long‐term (HeartMateTM I and II) MCS and ventricular constraint (CorCapTM CSD) as treatment concepts for all forms of heart failure, the aims being: bridge‐to‐decision, bridge‐to‐transplant and extended therapy, called “destination therapy” (DT).Methods and results: In Paper I, the use of HM‐ITM pulsatile MCS in bridge‐to‐transplantation patients in Sweden was retrospectively investigated regarding outcome and risk factors for mortality and morbidity. Fifty‐nine patients were treated between 1993 and 2002. The dominating diagnosis was dilated cardiomyopathy in 61%. Median support time was 99.5 days. 18.6% died before transplantation. Four patients needed RV assist due to right ventricular failure. Haemorrhage was an issue. Six patients (10%) suffered a cerebrovascular thromboembolic lesion. 15% developed driveline infection. 45% of the MCS patients were discharged home while on pump treatment. Massive blood transfusion was a predictor for mortality and morbidity, p<0.001.In Paper II the second generation long‐term MCS, the continuous axial flow pump HM‐IITM, was prospectively evaluated for mortality and morbidity. Eleven patients, from 2005 until 2008, were consecutively included at our institution. One patient received the pump for DT. The median pump time was 155 days. Survival to transplantation was 81.8%. Ten patients could be discharged home before transplantation after a median time of 65 days.Paper III investigated the Swedish experience and outcome of short‐term axial flow MCS, the ImpellaTM, in patients with AHF. Fifty patients were collected between 2003 and 2007 and divided into two groups: 1. Surgical group (n=33) with cardiogenic shock after cardiac surgery; and 2. Non‐surgical group (n=17), patients with AHF due to acute coronary syndromes with cardiogenic shock (53%) and myocarditis (29%). The 1‐year survival was 36% and 70%, respectively. 52% were reoperated because of bleeding. Predictors for survival at 30 days were preoperatively placed IABP (p=0.01), postoperatively cardiac output at 12 hours and Cardiac Power Output at 6 and 12 hours.In Paper IV we evaluated the use and long term outcome of ventricular constraint CorCapTM CSD. Since 2003, 26 consecutive patients with chronic progressive heart failure were operated with CSD via sternotomy (n=25) or left mini‐thoracotomy (n=1). Seven patients were operated with CorCapTM only. Nineteen patients had concomitant cardiac surgery. There were three early and three late deaths. The remaining cohort (n=18) was investigated in a cross‐sectional study regarding QoL with SF‐36. There was no difference in QoL measured with SF‐36 after a mean 3‐years follow up period, when compared to an age‐ and sex‐matched control group from the general population. The one‐year survival was 86%, and after three years 76%. Echocardiographic dimensions had improved significantly after three years.Conclusion: In our unit, a non‐transplanting medium‐sized cardiothoracic department, short‐ and long‐term MCS (ImpellaTM resp. HMTM) in patients with acute or chronic HF have been used with good results. The use of ventricular constraint early in the course of the disease is a good adjunct to other treatment options in progressive chronic HF patients.
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4.
  • Hägg, Sara, 1977-, et al. (författare)
  • Dual-Specificity Phosphatase-1—An Anti-Inflammatory Marker in Blood Independently Predicting Prolonged Postoperative Stay after Coronary Artery Bypass Grafting : DUSP1 – A Preoperative Blood Marker of Postoperative Stay
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Objectives: Perform multi-organ expression profiling to identify gene markers predicting postoperative complications and hospitalization after coronary artery by-pass grafting (CABG) surgery. Background: Identifying patients who are at increased risk of morbidity and prolonged post-operative stay is of interest from both health-economic and individual patient perspectives. Patients with diabetes often present with inflammatory conditions and have prolonged hospitalization after CABG. The recent development of technologies to generate high-dimensional data provides an opportunity to identify preoperative markers that can be used to help optimize preoperative planning to minimize postoperative complications. Methods: We analyzed 198 whole-genome expression profiles of liver, skeletal muscle, and visceral fat isolated from 66 patients undergoing CABG in the Stockholm Atherosclerosis Gene Expression (STAGE) study. The findings were validated in pre-operative blood samples isolated from 181 patients undergoing CABG at Tartu University Hospital. Results: As shown in other studies, diabetic CABG patients in the STAGE cohort also had prolonged hospitalization time (P<0.02). Out of ~50 000 mRNAs measures in the liver, skeletal muscle and visceral fat in 66 STAGE patients, the mRNA levels of anti-inflammatory gene dual specificity phosphatase-1 (DUSP1) correlated independently with post-operative rehabilitation and separated the patients into those with normal (8 days) and prolonged hospitalization (>8 days). In the validation cohort, preoperative blood levels of DUSP1 separated patients with short and long hospitalization stay (P=9x10-10). Conclusions: From genome scans in three separate organs, we identified the anti-inflammatory gene DUSP1 as a pre-operative marker indicating risk for prolonged postoperative stay after CABG.
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5.
  • Hägg, Sara, et al. (författare)
  • Molecular Phenotypes of Coronary Artery Disease : The Stockholm Atherosclerosis Gene Expression (STAGE) Study
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • BACKGROUNDBy offering a comprehensive view of the molecular underpinnings of pathology, high-dimensional data have the potential to revolutionize the diagnosis and management of complex disorders such as coronary artery disease (CAD). To identify molecular phenotypes of CAD, we performed multi organ gene expression profiling of subjects enrolled in the Stockholm Atherosclerosis Gene Expression (STAGE) study.METHODSAtherosclerotic and unaffected arterial wall, liver, skeletal muscle, and mediastinal fat biopsies were obtained during coronary artery bypass grafting from 114 well-characterized CAD patients. RNA samples were isolated, and 278 transcription profiles were obtained using Affymetrix HG-U133_Plus_2 GeneChips.RESULTSThe most prominent molecular phenotype of the CAD patients was represented by 733 genes in mediastinal fat, which were involved in extracellular matrix organization, response to stress and regulation of programmed cell death. Other aspects of this phenotype were shared with liver (e.g., oxidoreductase activity), skeletal muscle (insulin-like growth factor binding), and atherosclerotic arterial wall (cell motility and adhesion, fatty acid metabolism). In addition, the activity of 400 genes exclusively in mediastinal fat was associated with the extent of coronary stenosis and atherosclerosis. Immune-cell activation in mediastinal fat defined CAD patients with poor blood glucose control and prolonged hospitalization.CONCLUSIONSThe molecular phenotype of mediastinal fat appears to be central in CAD and should be useful for early identification of CAD risk.
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6.
  • Hägg, Sara, 1977-, et al. (författare)
  • Multi-Organ Expression Profiling Uncovers a Gene Module in Coronary Artery Disease Involving Transendothelial Migration of Leukocytes and LIM Domain Binding 2 : The Stockholm Atherosclerosis Gene Expression (STAGE) Study
  • 2009
  • Ingår i: PLoS Genetics. - : PLoS Genetics. - 1553-7390 .- 1553-7404. ; 5:12, s. e1000754-
  • Tidskriftsartikel (refereegranskat)abstract
    • Environmental exposures filtered through the genetic make-up of each individual alter the transcriptional repertoire in organs central to metabolic homeostasis, thereby affecting arterial lipid accumulation, inflammation, and the development of coronary artery disease (CAD). The primary aim of the Stockholm Atherosclerosis Gene Expression (STAGE) study was to determine whether there are functionally associated genes (rather than individual genes) important for CAD development. To this end, two-way clustering was used on 278 transcriptional profiles of liver, skeletal muscle, and visceral fat (n=66/tissue) and atherosclerotic and unaffected arterial wall (n=40/tissue) isolated from CAD patients during coronary artery bypass surgery. The first step, across all mRNA signals (n=15,042/12,621 RefSeqs/genes) in each tissue, resulted in a total of 60 tissue clusters (n=3958 genes). In the second step (performed within tissue clusters), one atherosclerotic lesion (n=49/48) and one visceral fat (n=59) cluster segregated the patients into two groups that differed in the extent of coronary stenosis (P=0.008 and P=0.00015). The associations of these clusters with coronary atherosclerosis were validated by analyzing carotid atherosclerosis expression profiles. Remarkably, in one cluster (n=55/54) relating to carotid stenosis (P=0.04), 27 genes in the two clusters relating to coronary stenosis were confirmed (n=16/17, P<10-27and-30). Genes in the transendothelial migration of leukocytes (TEML) pathway were overrepresented in all three clusters, referred to as the atherosclerosis module (A-module). In a second validation step, using three independent cohorts, the A-module was found to be genetically enriched with CAD risk by 1.8-fold (P<0.004). The transcription co-factor LIM domain binding 2 (LDB2) was identified as a potential high-hierarchy regulator of the A-module, a notion supported by subnetwork analysis, cellular and lesion expression of LDB2, and the expression of 13 TEML genes in Ldb2-deficient arterial wall. Thus, the A-module appears to be important for atherosclerosis development and together with LDB2 merits further attention in CAD research.
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7.
  • Ivert, Torbjörn, et al. (författare)
  • Cardiovascular events in patients under age fifty with early findings of elevated lipid and glucose levels - The AMORIS study
  • 2018
  • Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:8
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The long-term trajectories of lipid and glucose levels in subjects who experience a major cardiovascular (CV) event at a young age has not been well studied. Our objective was to investigate lipid, lipoprotein, apolipoprotein (apo), and glucose levels in individuals experiencing a CV event before 50 years of age.METHODS AND FINDINGS: A first CV event [non-fatal myocardial infarction (MI), coronary revascularisation, or CV related death] before age 50 was recorded in 2,939 (cumulative incidence 1.2% in males and 0.3% in females) of 361,353 individuals included in the prospective Swedish AMORIS (Apolipoprotein-related MOrtality RISk) study with health examinations 1985-1996 and follow-up through 2011. In a nested case-control analysis, cases with a CV event were matched to randomly selected controls. Population risk factor trajectories were calculated up to 20 years prior to an event. Total cholesterol (TC), triglyceride (TG), and glucose levels were higher in cases than in controls as early as 20 years prior to the event with differences increasing over time. Low density lipoprotein, apoB, and the apoB/apoA-1 ratio were higher and increased over time, while HDL and apoA-1 were lower in cases compared to controls. The odds ratio was 2.5 (95% confidence interval 1.6-3.7) for TC ≥5 mmol/L and TG ≥1.7 mmol/L in cases versus controls. The adjusted population-attributable fractions including lipids, glucose, diabetes, smoking, hypertension, and obesity indicated that about 50% of CV events before age 50 may be associated with elevated lipid and glucose levels.CONCLUSIONS: Elevated TC, TG, LDL, apoB, and glucose levels and high apoB/apo A-1 ratio documented two decades before a CV event in subjects younger than 50 years may account for about half of CV events before age 50, which calls for early recognition and possibly treatment of modifiable CV risk factors in young individuals.
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8.
  • Ivert, Torbjörn, et al. (författare)
  • Effect of COVID-19 on cardiac surgery volumes in Sweden
  • 2023
  • Ingår i: Scandinavian Cardiovascular Journal. - : Taylor & Francis. - 1401-7431 .- 1651-2006. ; 57:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The coronavirus disease 2019 (COVID-19) pandemic, which commenced in 2020, is known to frequently cause respiratory failure requiring intensive care, with occasional fatal outcomes. In this study, we aimed to conduct a retrospective nationwide observational study on the influence of the pandemic on cardiac surgery volumes in Sweden.Results: In 2020, 9.4% (n = 539) fewer patients underwent open-heart operations in Sweden (n = 5169) than during 2019 (n = 5708), followed by a 5.8% (n = 302) increase during 2021 (n = 5471). The reduction was greater than 15% in three of the eight hospitals in Sweden performing open-heart operations. Compared to 2019, in 2020, the waiting times for surgery were longer, and the patients were slightly younger, had better renal function, and a lower European System for Cardiac Operative Risk Evaluation; moreover, few patients had a history of myocardial infarction. However, more patients had insulin-treated diabetes mellitus, hypertension, peripheral vascular disease, reduced left ventricular function, and elevated pulmonary artery pressure. Urgent procedures were more common, but acute surgery was less common in 2020 than in 2019. Early mortality and postoperative complications were low and did not differ during the three years.Conclusion: The 9.4% decrease in the number of heart surgeries performed in Sweden during the 2020 COVID-19 pandemic, compared to 2019, partially recovered during 2021; however, there was no backlog of patients awaiting heart surgery.
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9.
  • Ivert, Torbjörn, et al. (författare)
  • Similar survival 15 years after coronary artery surgery irrespective of left main stem stenosis
  • 2013
  • Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006 .- 1651-2510. ; 47:1, s. 42-49
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives. To evaluate 15-year survival after coronary artery bypass grafting (CABG) in relation to grade left main stenosis (LMS) and right coronary artery (RCA) obstruction. Design. Coronary angiographic findings were prospectively collected in 977 patients who had CABG for stable angina during 1994-1995 and were included in the Swedish Coronary Revascularization - Swedish Council of Technology Assessment study. Results. Significant LMS was present in one fifth of the patients and significant RCA obstruction was found in 61% of those with LMS and in 68% of patients without LMS. The patients were categorized as no LMS (Group I), LMS without RCA obstruction (Group II) or significant LMS with significant right coronary artery (RCA) obstruction (Group III). Early mortality did not differ in the three groups and was 1.2, 1.2% and 0.8% in group I, II and III, respectively. Corresponding survival at 15 years was similar 51%, 47% and 47%, respectively. In multivariable analysis older age, smoking, severe angina, positive stress test, hypertension, diabetes mellitus and ejection fraction <50% were risk factors for death at 15 years. Conclusions. Death 15 years after CABG correlated to clinical variables but was not predicted from presence of LMS with or without significant associated RCA obstruction.
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10.
  • Malgerud, Linnéa, et al. (författare)
  • Active chest tube clearance after aortic valve surgery did not influence amount residual pericardial fluid after aortic valve replacement in a randomised trial
  • 2020
  • Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 54:3, s. 200-205
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. Evaluate if the use of active clearance of chest tubes after aortic valve surgery influenced bleeding and reduced postoperative residual pericardial effusion. Design. Prospective randomised trial comparing PleuraFlow® 32 F chest tube with FlowGlide™ active clearance to a standard Argyle® 32 F chest tube in 100 patients undergoing aortic valve surgery. Chest tube outputs and pericardial effusion measurements assessed by two-dimensional transthoracic echocardiography were recorded before hospital discharge. Results. Postoperative chest tube outputs per hour did not differ between the two groups. The median chest tube output was 400 mL for patients who had a PleuraFlow® chest tube vs. 490 mL for patients with an Argyle® chest tube (p =.08). Pericardial effusions ≥ 2 mm were detected in 76% vs. 68% of the patients (p =.50) and postoperative atrial fibrillation occurred in 42% vs. 34% (p =.54), respectively. Conclusions. Use of active clearance chest tubes, compared to standard chest tubes after aortic valve surgery did not differ significantly regarding postoperative bleeding or degree of pericardial effusion as measured by echocardiography prior to hospital discharge.
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