| 1. |
- Caidahl, Kenneth, 1949, et al.
(författare)
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IgM-phosphorylcholine autoantibodies and outcome in acute coronary syndromes.
- 2012
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 167:2, s. 464-469
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Tidskriftsartikel (refereegranskat)abstract
- Abstract BACKGROUND: Antibodies against proinflammatory phosphorylcholine (anti-PC) seem to be protective and reduce morbidity. We sought to determine whether low levels of immunoglobulin-M (IgM) autoantibodies against PC add prognostic information in acute coronary syndromes (ACS). METHODS: IgM anti-PC titers were measured in serum obtained within 24h of admission from 1185 ACS patients (median age 66years, 30% women). We evaluated major acute cardiovascular events (MACE) and all-cause mortality short- (6months), intermediate- (18months) and long- (72months) terms. RESULTS: Low anti-PC titers were associated with MACE and all-cause mortality at all follow-up times. After adjusting for clinical variables, plasma troponin-I, proBNP and CRP levels, associations remained at all times with MACE, short and intermediate terms also with all-cause mortality. With anti-PC titers below median, adjusted hazard ratios at 18months were for MACE 1.79 (95% confidence interval [CI]: 1.31 to 2.44; p=0.0002) and for all-cause mortality 2.28 (95% CI: 1.32 to 3.92; p=0.003). Anti-PC and plasma CRP were unrelated and added to risk prediction. CONCLUSIONS: Serum IgM anti-PC titers provide prognostic information above traditional risk factors in ACS. The ease of measurement and potential therapeutic perspective indicate that it may be a valuable novel biomarker in ACS.
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| 2. |
- Hartford, Marianne, 1944, et al.
(författare)
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Interleukin-18 as a Predictor of Future Events in Patients With Acute Coronary Syndromes.
- 2010
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Ingår i: Arteriosclerosis, thrombosis, and vascular biology. - : Lippincott Williams & Wilkins. - 1524-4636 .- 1079-5642. ; 30:10, s. 2039-2046
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to assess the short- and long-term prognostic significance of interleukin-18 (IL-18) levels in patients with acute coronary syndromes (ACS). METHODS AND RESULTS: In patients hospitalized with ACS (median age, 66 years; 30% females), we evaluated associations of serum IL-18 levels from day 1 (n=1261) with the short- (<3 months) and long-term (median, 7.6 years) risk of death, development of congestive heart failure (CHF), and myocardial infarction (MI). IL-18 was not significantly associated with short-term mortality. In the long term, IL-18 levels were significantly related to all-cause mortality, even after adjustment for clinical confounders (hazard ratio [HR], 1.19; 95% confidence interval, 1.07 to 1.33; P=0.002). Long-term, cardiovascular mortality was univariately related to IL-18, and the adjusted relation between noncardiovascular mortality and IL-18 was highly significant (HR, 1.36; 95% confidence interval, 1.11 to 1.67; P=0.003). IL-18 independently predicted CHF, MI, and cardiovascular death/CHF/MI in both the short and long term. Measurements from day 1 of ACS and 3 months after ACS had a similar power to predict late outcome. CONCLUSIONS: The addition of the measurement of IL-18 to clinical variables improved the prediction of risk of all-cause and noncardiovascular mortality. The association between IL-18 and noncardiovascular mortality is intriguing and warrants further study.
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| 3. |
- Herlitz, Johan, 1949, et al.
(författare)
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Symptoms of chest pain and dyspnoea during a period of 15 years after coronary artery bypass grafting.
- 2010
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Ingår i: European journal of cardio-thoracic surgery. - : Elsevier. - 1873-734X .- 1010-7940. ; 37:1, s. 112-118
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe changes in chest pain and dyspnoea during a period of 15 years after coronary artery bypass grafting (CABG) and to define factors at the time of operation that were associated with the occurrence of these symptoms after 15 years. DESIGN: Prospective observational study in western Sweden. SUBJECTS: All patients who underwent first-time CABG, without simultaneous valve surgery, between 1 June 1988 and 1 June 1991. There were no exclusion criteria. FOLLOW-UP: All patients were followed up prospectively for 15 years. The evaluation of symptoms took place through postal questionnaires prior to and 5, 10 and 15 years after the operation. RESULTS: Totally, 2000 patients were included in the survey and 904 (45%) of them survived to 15 years. Among these 904 survivors, the percentage of patients with chest pain increased from 44% to 50% between the 5- and 15-year follow-up (p=0.004). The percentage of patients who reported symptoms of dyspnoea increased from 60% after 5 years to 74% after 15 years (p<0.001). Factors at the time of surgery that independently tended to predict chest pain after 15 years were higher age (p=0.04) and prolonged duration of symptoms prior to surgery (p=0.04). Predictors of dyspnoea after 15 years were higher age (p<0.0001), the use of inotropic drugs at the time of surgery (p=0.001), a history of diabetes (p=0.01) and obesity (p=0.01). CONCLUSION: After CABG, relief from chest pain and dyspnoea is generally maintained over a long period of time. Eventually, however, functional-limiting symptoms tend to recur and about half the patients report symptoms of chest pain, while three-quarters report dyspnoea after 15 years. Even if no clear predictor of chest pain was found at the time of surgery, age, the use of inotropic drugs, diabetes and obesity predicted dyspnoea.
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| 4. |
- Persson, Anita, 1971, et al.
(författare)
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Effect of surgery on cardiac structure and function in mild primary hyperparathyroidism.
- 2011
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Ingår i: Clinical endocrinology. - : Wiley. - 1365-2265 .- 0300-0664. ; 74:2, s. 174-180
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Tidskriftsartikel (refereegranskat)abstract
- Context The cardiovascular (CV) risk profile is worsened in primary hyperparathyroidism (PHPT), and CV mortality is related to serum calcium levels. It is unknown whether CV mortality is increased in the most common form of PHPT and whether the increased CV risk is reversible after surgery. Objective To investigate reversibility of echocardiographic variables in patients with mild PHPT who were randomized to observation without surgery or operation, and followed for 2years. Design/Setting/Patients Forty-nine patients (mean age 63±7years, 8 men) who had performed the 2-year visit in a randomized study on mild PHPT (serum calcium at baseline 2·65±0·09mm) (observation) vs 2·67±0·06mm (surgery) and where echocardiography had been performed, participated in the study. Results Calcium and parathyroid hormone (PTH) levels were normalized following surgery and were stable in the observation group. PTH levels at baseline were highly correlated with ventricular mass. Detailed echocardiography revealed a minor and borderline significant treatment effect of surgery on left ventricular mass index (LVMI) compared to observation (P=0·066) and a significant 11% reduction in diastolic dimension of the interventricular septum (IVSd-mean) in the surgery group (P<0·01), with no alterations in the observation group. Conclusions Based on detailed echocardiographic measures over a 2-year observation period, we found only minor differences between the two groups. However, the potential treatment effect on LVMI and the within-group differences in IVSd-mean suggest that longer follow-up may yield larger and clinically important differences.
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| 5. |
- Persson, Anita, 1971, et al.
(författare)
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Long-term prognostic value of mitral regurgitation in acute coronary syndromes.
- 2010
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Ingår i: Heart (British Cardiac Society). - : BMJ. - 1468-201X .- 1355-6037. ; 96:22, s. 1803-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To determine the additional prognostic value of mitral regurgitation (MR) over B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and clinical characteristics in patients with acute coronary syndromes (ACS). DESIGN: Long-term follow-up in a prospective ACS cohort with Doppler-assessed MR, echocardiographically-determined LVEF and plasma BNP levels by ELISA. SETTING: Single-centre university hospital. PATIENTS: 725 patients with ACS. MAIN OUTCOME MEASURES: Death and readmission for congestive heart failure. RESULTS: During a median follow-up of 98 months, 235 patients (32%) died. Significant MR (grade >1 of 4) was found in 90 patients (12%). In a multivariate model including MR grade >1, LVEF <0.40 and BNP >373 pg/ml (75th percentile), MR was significantly associated with long-term mortality (HR 2.28, 95% CI 1.67 to 3.12; p<0.0001). When also adjusting for conventional risk factors, MR remained significantly associated with mortality (HR 1.53, 95% CI 1.06 to 2.19; p=0.02), as well as with congestive heart failure (HR 2.08, 95% CI 1.29 to 3.35; p=0.003). CONCLUSIONS: MR is common in patients with ACS, provides independent risk information and should be taken into account in the evaluation of the long-term prognosis.
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| 6. |
- Poci, Dritan, 1969, et al.
(författare)
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Role of the CHADS(2) Score in Acute Coronary Syndromes Risk of Subsequent Death or Stroke in Patients With and Without Atrial Fibrillation
- 2012
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Ingår i: Chest. - : Elsevier BV. - 0012-3692 .- 1931-3543. ; 141:6, s. 1431-1440
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Tidskriftsartikel (refereegranskat)abstract
- Background: Atrial fibrillation (AF) is common in patients with acute coronary syndromes (ACS). We aimed to describe the value of the CHADS(2) (congestive heart failure, hypertension, age >= 75 years, diabetes, prior stroke or transient ischemic attack) score as a risk assessment tool for mortality and stroke in patients with ACS, irrespective of the presence or absence of AF. Methods: Consecutive patients with ACS admitted to the coronary care unit were prospectively included in a risk stratification study. We calculated the CHADS(2) scores from the data collected at admission, and all patients were followed until January 1, 2007, or death. Results: Of 2,335 patients with ACS in this study, 442 (age 71 +/- 8 years, 142 women) had AF. Their mean CHADS(2) score was 1.6 +/- 1.4 vs 1.0 +/- 1.1 in patients without AF (P < .0001). The all-cause mortality at 10 years was strongly associated with the CHADS(2) score in patients with AF (hazard ratio [HR] and 95% CI per unit increase in the six-grade CHADS(2) score, 1.21 [1.07-1.36]; P = .002), hut the same association was also present in patients without AF (HR 1.38 [1.28-1.48], P < .0001), after adjustment for potential confounders. The more complicated GRACE (Global Registry Of Acute Coronary Events) risk score provided a better prediction for short- and long-term mortality than the simpler CHADS(2) score (P < .0001). Hospitalization for stroke was significantly associated with the CHADS(2) score in patients without AF (but not in those with AF) after adjustment (HR 1.46 [1.27-1.68], P <.0001). Conclusions: In patients with ACS, AF is associated with poor prognosis. The CHADS(2) score developed for AF has even greater prognostic value in patients who do not have AF, and it may help to identify patients with high risk for subsequent stroke or death and a need for optimization of risk-reducing treatment. CHEST 2012; 141(6):1431-1440
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| 7. |
- Ravn-Fischer, Annica, 1974, et al.
(författare)
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Community-based gender perspectives of triage and treatment in suspected myocardial infarction.
- 2012
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Ingår i: International journal of cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 156:2, s. 139-143
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Tidskriftsartikel (refereegranskat)abstract
- Abstract BACKGROUND: The gender perspectives of the triage of acute coronary syndromes (ACS) in a community are insufficiently explored. METHODS: Patients (n=3224) with symptoms of ACS, in whom ECG was sent by the ambulance crew to a coronary care unit (CCU)/ cath lab, were investigated in the municipality of Göteborg in 2004-2007. Background, triage priority, investigations and treatment were analysed (p-values age adjusted) in relation to gender. Data were compared with three published studies (1995-2002: Surveys 1-3). RESULTS: Women were directly admitted to the CCU significantly less frequently than men (23 versus 35%, p<0.0001). Adjusted for ECG findings, age, symptoms and medical history, odds ratio and 95% confidence limits (for direct admission; men versus women) were 0.61; 0.46-0.82. SURVEY 1: Patients with ACS, aged <80, in CCU at a university hospital (n=1744). Only minor differences between women and men, with regard to investigations and treatment, were found. SURVEY 2: Patients discharged from hospital (dead or alive) with AMI, regardless of type of ward (n=1423). Fewer women than men were admitted to CCU and fewer women underwent coronary angiography (21% versus 40%; p=0.02) and coronary revascularisation (12% versus 27%; p=0.004). SURVEY 3: Patients with symptoms of AMI (n=930) and patients with a confirmed AMI (n=130) from a pre-hospital perspective. Women tended to be given lower priority than men both by the ambulance dispatchers and by the ambulance crew. CONCLUSION: In our practice setting, men are given priority over women in admission to CCU, but no gender differences are seen thereafter.
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| 8. |
- Barres, R., et al.
(författare)
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Acute exercise remodels promoter methylation in human skeletal muscle
- 2012
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Ingår i: Cell Metabolism. - : Elsevier BV. - 1550-4131 .- 1932-7420. ; 15:3, s. 405-11
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Tidskriftsartikel (refereegranskat)abstract
- DNA methylation is a covalent biochemical modification controlling chromatin structure and gene expression. Exercise elicits gene expression changes that trigger structural and metabolic adaptations in skeletal muscle. We determined whether DNA methylation plays a role in exercise-induced gene expression. Whole genome methylation was decreased in skeletal muscle biopsies obtained from healthy sedentary men and women after acute exercise. Exercise induced a dose-dependent expression of PGC-1alpha, PDK4, and PPAR-delta, together with a marked hypomethylation on each respective promoter. Similarly, promoter methylation of PGC-1alpha, PDK4, and PPAR-delta was markedly decreased in mouse soleus muscles 45 min after ex vivo contraction. In L6 myotubes, caffeine exposure induced gene hypomethylation in parallel with an increase in the respective mRNA content. Collectively, our results provide evidence that acute gene activation is associated with a dynamic change in DNA methylation in skeletal muscle and suggest that DNA hypomethylation is an early event in contraction-induced gene activation.
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| 9. |
- Brismar, Torkel B., et al.
(författare)
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Magnetite Nanoparticles Can Be Coupled to Microbubbles to Support Multimodal Imaging
- 2012
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Ingår i: Biomacromolecules. - : American Chemical Society (ACS). - 1525-7797 .- 1526-4602. ; 13:5, s. 1390-1399
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Tidskriftsartikel (refereegranskat)abstract
- Microbubbles (MBs) are commonly used as injectable ultrasound contrast agent (UCA) in modern ultrasonography. Polymer-shelled UCAs present additional potentialities with respect to marketed lipid-shelled UCAs. They are more robust; that is, they have longer shelf and circulation life, and surface modifications are quite easily accomplished to obtain enhanced targeting and local drug delivery. The next generation of UCAs will be required to support not only ultrasound-based imaging methods but also other complementary diagnostic approaches such as magnetic resonance imaging or computer tomography. This work addresses the features of MBs that could function as contrast agents for both ultrasound and magnetic resonance imaging. The results indicate that the introduction of iron oxide nanoparticles (SPIONs) in the poly(vinyl alcohol) shell or on the external surface of the MBs does not greatly decrease the echogenicity of the host MBs compared with the unmodified one. The presence of SPIONs provides enough magnetic susceptibility to the MBs to accomplish good detectability both in vitro and in vivo. The distribution of SPIONs on the shell and their aggregation state seem to be key factors for the optimization of the transverse relaxation rate.
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| 10. |
- Czepluch, F. S., et al.
(författare)
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Strenuous physical exercise adversely affects monocyte chemotaxis
- 2011
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Ingår i: Thrombosis and Haemostasis. - 0340-6245 .- 2567-689X. ; 105:1, s. 122-30
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Tidskriftsartikel (refereegranskat)abstract
- Physical exercise is important for proper cardiovascular function and disease prevention, but it may influence the immune system. We evaluated the effect of strenuous exercise on monocyte chemotaxis. Monocytes were isolated from blood of 13 young, healthy, sedentary individuals participating in a three-week training program which consisted of repeated exercise bouts. Monocyte chemotaxis and serological biomarkers were investigated at baseline, after three weeks training and after four weeks recovery. Chemotaxis towards vascular endothelial growth factor-A (VEGF-A) and transforming growth factor-beta1 (TGF-beta1) was completely inhibited immediately after training (p<0.01), and remained so after four weeks recovery. Likewise, monocyte chemoattractant protein-1 (MCP-1)-induced migration declined after training (p<0.01) and improved only partially during the recovery period. MCP-1 serum levels were significantly reduced after four weeks recovery compared to baseline (p<0.01). Total blood antioxidant capacity was enhanced at this time point (p<0.01). Monocyte chemokinesis, TGF-beta1 and nitric oxide serum levels remained unchanged during the study. Strenuous three-week training consisting of repeated exercise bouts in healthy, sedentary individuals reduces monocyte chemotaxis. It remains to be established, whether this is a sound adaptation to increased stimuli or an untoward reaction to overtraining. Nevertheless, the effect remains for several weeks with no exercise.
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