| 1. |
- Johnsson, Åse (Allansdotter), 1966, et al.
(författare)
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Incidental findings and their handling in the Swedish CArdioPulmonary bioimage study (SCAPIS)
- 2017
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Ingår i: Incidental Radiological Findings. - Cham : Springer International Publishing. - 2197-4187 .- 0942-5373. - 9783319425795 - 9783319425818 - 9783319826127 ; , s. 91-101
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Bokkapitel (refereegranskat)abstract
- The Swedish CArdioPulmonary bioImage Study (SCAPIS) combines the use of new imaging technologies, large-scale proteomics/metabolomics/genomics, and epidemiological analyses to extensively characterize a Swedish cohort of 30,000 men and women aged between 50 and 64 years. Its main aims are to improve risk prediction and to optimize our ability to study mechanisms of cardiopulmonary diseases. SCAPIS is currently recruiting at six sites in Sweden, and a pilot study was conducted in 2012 to test the feasibility of the comprehensive study protocol. In the planning phase, it was recognized that the detailed phenotyping used in SCAPIS would identify a large number of clinical findings in need of medical attention. This was confirmed by evaluation of results from the pilot study. Here we focus on pulmonary nodules and asymptomatic coronary artery stenosis. These clinical features were observed in a large number of participants, and the clinical handing and prognosis related to these observations are unclear. They thus posed great challenges for the study in their practical and ethical handling. This chapter describes how we developed procedures to handle these findings based on existing evidence and expert consensus as well as deliberations on ethical issues.
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| 2. |
- Persson, H., et al.
(författare)
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No apparent effect of surgery for temporal lobe epilepsy in heart rate variability
- 2006
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Ingår i: Epilepsy Research. - : Elsevier BV. - 0920-1211 .- 1872-6844. ; 70:2-3, s. 127-132
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Tidskriftsartikel (refereegranskat)abstract
- Background: Impaired cardiac autonomic function may contribute to the risk of sudden unexpected death in epilepsy (SUDEP). Clinical observations indicate that successful epilepsy surgery is associated with a reduced risk of SUDEP. However, in a previous study we found impaired cardiac control pre-surgically in patients with poor outcome of surgery, indicating an a priori lower risk in responders to epilepsy surgery. We have now examined the effect of surgery on cardiac autonomic control in the same patients. Methods: We used 24 h EKG recordings to assess heart rate variability (HRV) by spectral analysis in 21 consecutive patients after temporal lobe epilepsy surgery. The HRV was compared with healthy controls, with pre-surgical HRV in the same patients, and analyzed in relation to seizure control 1 year after surgery. Results: The patients with poor outcome after surgery had significantly lower SD of RR-intervals, total power, very low frequency power and low frequency power than matched healthy controls. The patients with favorable outcome did not differ from the controls, and the postoperative HRV was not different from HRV before surgery in any of the patient groups. Conclusion: We could not demonstrate any effect on HRV of temporal lobe epilepsy surgery in these patients. The observed lower HRV in the poor outcome group was present already before epilepsy surgery as previously reported. Although our results need confirmation in a larger study, the observations suggest that the increased risk of SUDEP in patients failing epilepsy surgery may be due to a common factor predisposing to surgical failure, impaired HRV as well as to an increased risk of SUDEP.
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| 3. |
- Persson, H., et al.
(författare)
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Preoperative heart rate variability in relation to surgery outcome in refractory epilepsy
- 2005
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Ingår i: Neurology. - : Ovid Technologies (Wolters Kluwer Health). - 0028-3878 .- 1526-632X. ; 65, s. 1021-1025
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Epilepsy patients may have an impaired autonomic cardiac control, which has been associated with an increased incidence of sudden unexpected death among people with epilepsy (SUDEP). The risk of SUDEP is particularly high among epilepsy surgery candidates with refractory epilepsy. This risk seems to be reduced after successful surgery but whether this is an effect of surgery or reflects pre-existing differences between good and poor responders is under debate. METHODS: We used spectral analysis to analyze prospectively heart rate variability (HRV) preoperatively in 21 consecutive patients with temporal lobe epilepsy who were planned for epilepsy surgery. The presurgical HRV based on ambulatory 24 hours EKG recordings was analyzed in relation to seizure control at 1 year after surgery. RESULTS: Patients had significantly lower SD of RR-intervals, total power, very low frequency power and low frequency power than matched healthy controls. Patients with good outcome of surgery (Engel class I; n = 11) did not differ from their controls while those with poor outcome (Engel class II-IV; n = 10) had significantly lower power in all domains than those with a favorable outcome. CONCLUSIONS: Measurements of heart rate variability preoperatively indicate that patients with a poor outcome of surgery have a more pronounced impairment of sympathetic as well as parasympathetic cardiac control than those with good outcome. Reduced heart rate variability may be associated with an increased risk of sudden unexpected death among people with epilepsy (SUDEP). Good surgery candidates may a priori have a lower risk of SUDEP.
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