| 1. |
- Andersson, Jonas, et al.
(författare)
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Left ventricular remodelling changes without concomitant loss of myocardial fat after long-term dietary intervention
- 2016
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 216, s. 92-96
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Tidskriftsartikel (refereegranskat)abstract
- Background: Accumulation of myocardial triglycerides (MTG) is associated with impaired left ventricular (LV) remodelling and function in obese and diabetic subjects. The role of MTG accumulation in development of heart failure in this group of patients is unknown. Short-term studies suggest that diets that lead to weight loss could mobilize MTG, with a favourable effect on cardiac remodelling. In a 24-month, randomized, investigator-blinded study, we assessed the effect of two different diets and subsequent weight loss on cardiac function and MTG in postmenopausal women. Methods: Sixty-eight healthy postmenopausal women with body mass index [BMI] >= 27 kg/m(2) were randomized to an ad libitum Palaeolithic diet (PD) or a Nordic Nutrition Recommendation (NNR) diet for 24 months. Morphology, cardiac function, and MTG levels were measured using magnetic resonance (MR) scanning, including proton spectroscopy at baseline and 6 and 24 months. Results: Despite mean weight losses of 4.9 (1.0) kg (NNR) and 7.8 (1.1) kg (PD), the MTG content did not change over time (p = 0.98 in the NNR and p = 0.11 in the PD group at 24 months). Reduced left ventricular mass was observed in both diet groups over 24 months. Blood pressure was reduced at 6 months, but returned to baseline levels at 24 months. End diastolic volume, stroke volume, and cardiac output decreased over time. No differences between diet groups were observed. Conclusions: Diet intervention and moderate weight loss over 24 months improved LV remodelling but did not alter MTG levels in overweight/obese postmenopausal women. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
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| 2. |
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| 3. |
- Berglund, Elisabeth, et al.
(författare)
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High incidence of infective endocarditis in adults with congenital ventricular septal defect
- 2016
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Ingår i: Heart. - : BMJ. - 1355-6037 .- 1468-201X. ; 102:22, s. 1835-1839
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Ventricular septal defects (VSDs), if haemodynamically important, are closed whereas small shunts are left without intervention. The long-term prognosis in congenital VSD is good but patients are still at risk for long-term complications. The aim of this study was to clarify the incidence of infective endocarditis (IE) in adults with VSD. METHODS: The Swedish registry for congenital heart disease (SWEDCON) was searched for adults with VSD. 779 patients were identified, 531 with small shunts and 248 who had the VSD previously closed. The National Patient Register was then searched for hospitalisations due to IE in adults during a 10-year period. RESULTS: Sixteen (2%) patients were treated for IE, 6 men and 10 women, with a mean age of 46.3+/-12.2 years. The incidence of IE was 1.7-2.7/1000 years in patients without previous intervention, 20-30 times the risk in the general population. Thirteen had small shunts without previous intervention. There was no mortality in these 13 cases. Two patients had undergone repair of their VSD and also aortic valve replacement before the episode of endocarditis and a third patient with repaired VSD had a bicuspid aortic valve, all of these three patients needed reoperation because of their IE and one patient died. No patient with isolated and operated VSD was diagnosed with IE. CONCLUSIONS: A small unoperated VSD in adults carries a substantially increased risk of IE but is associated with a low risk of mortality.
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| 4. |
- Larsson, Lena, et al.
(författare)
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Aerobic capacity in adolescence is associated with time to intervention in adult men with atrial septal defects
- 2019
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Ingår i: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754. ; 280, s. 57-60
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Tidskriftsartikel (refereegranskat)abstract
- Background: Atrial septal defect (ASD) is a congenital heart lesion that often remains undiagnosed until adulthood. The reasons for this may be multifactorial. It is, however, known that closure of a hemodynamically significant ASD improves exercise capacity. This study aimed to explore whether the aerobic capacity in late adolescence is associated with time to diagnosis and intervention in adult men with late diagnosis of an atrial shunt.Methods: The Swedish Military Conscription Service Register contains data on exercise tests performed in late adolescence. By linking these data with the National Patient Register, 254 men with a later intervention for an ASD were identified.Results: Interventions were performed at a mean of 26.5 +/- 7.9 years after the initial exercise tests. The mean absolute workload among those with a later diagnosed ASD was similar to those without a later diagnosed ASD (274 +/- 51W vs. 276 +/- 52 W, p = 0.49). Men with a higher exercise capacity (>= 1 SD) had their intervention earlier (21.9 +/- 8.6 years vs. 27.5 +/- 7.4 years, p < 0.001).Conclusions: The aerobic exercise capacity was similar in adolescent men with later interventions for ASD compared to the reference population. Furthermore, those with high exercise capacity appeared to be diagnosed earlier. Thus, low exercise capacity may not be a feature of ASD during adolescence, but rather develop later in life as a natural progression of the disease.
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| 5. |
- Meidell Blylod, Viktor, et al.
(författare)
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Interventions in Adults With Repaired Coarctation of the Aorta
- 2022
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Ingår i: Journal of the American Heart Association. - : John Wiley & Sons. - 2047-9980 .- 2047-9980. ; 11:14
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Tidskriftsartikel (refereegranskat)abstract
- Background: Coarctation of the aorta coexists with other cardiac anomalies and has long-term complications, including recoarctation, which may require intervention after the primary coarctation repair. This study aims to clarify the prevalence of and risk factors for interventions related to the coarctation complex as well as late mortality in a large contemporary patient population.Methods and Results: The Swedish National Register of Congenital Heart Disease was used, which comprised 683 adults with repaired coarctation of the aorta. Analysis was performed on freedom from intervention thereafter at the coarctation site, aortic valve, left ventricular outflow tract, or ascending aorta. One hundred ninety-six (29%) patients had at least 1 of these interventions. Estimated freedom from either of these interventions was 60% after 50 years. The risk of undergoing such an intervention was higher among men (hazard ratio, 1.6 [95% CI, 1.2-2.2]). Estimated freedom from another intervention at the coarctation site was 75% after 50 years. In women, there was an increase in interventions at the coarctation site after 45 years. Patients who underwent one of the previously mentioned interventions after the primary coarctation repair had poorer left ventricular function. Eighteen patients (3%) died during follow-up in the register. The standardized mortality ratio was 2.9 (95% CI, 1.7-4.3).Conclusions: Interventions are common after coarctation repair. The risk for and time of interventions are affected by sex. Our results have implications for planning follow-up and giving appropriate medical advice to the growing population of adults with repaired coarctation of the aorta.
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| 6. |
- Rinnström, Daniel, 1982-
(författare)
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Coarctation of the aorta : register and imaging studies
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Coarctation of the aorta (CoA) constitutes 5-8 % of all congenital heart disease (CHD) and is associated with long-term complications such as hypertension (HTN) and left ventricular hypertrophy (LVH). Factors associated with HTN, LVH, and diffuse myocardial fibrosis, are not yet fully explored in this population.Methods Papers I-III: The Swedish national register of congenital heart disease (SWEDCON) was used to identify adult patients with repaired CoA.Paper IV: Data on 2,424 adult patients with CHD was extracted from SWEDCON and compared to controls (n = 4,605) regarding height, weight and body mass index (BMI).Paper V: Adults with CoA (n = 21, age 28.5 (19.1-65.1) years, 33.3 % female) referred for CMR were investigated with T1 mapping to determine left ventricular extracellular volume fraction (ECV).Results Papers I-II: Out of 653 patients, 344 (52.7 %) had HTN. In a multivariable model, age (years) (OR 1.07, CI 1.05-1.10), sex (male) (OR 3.35, CI 1.98-5.68) and BMI (kg/m2) (OR 1.09, CI 1.03-1.16) were associated with having HTN, and so was systolic arm-leg blood pressure (BP) gradient where an association was found at the ranges (10, 20] mmHg (OR 3.58, CI 1.70-7.55) and > 20 mmHg (OR 11.38, CI 4.03-32.11), in comparison to the range [0, 10] mmHg.When investigating 243 patients with diagnosed HTN, 127 (52.3 %) had elevated BP (≥ 140/90 mmHg). Age (years) (OR 1.03, CI 1.01-1.06) was associated with elevated BP, and so was systolic arm-leg BP gradient in the ranges (10, 20] mmHg (OR 4.92, CI 1.76-13.79), and > 20 mmHg (OR 9.93, CI 2.99-33.02), in comparison to the reference interval [0, 10] mmHg.Patients with elevated BP had more classes of anti-hypertensive medication classes prescribed (1.9 vs 1.5, p = 0.003).Paper III: Out of 506 patients, 114 (22.5 %) were found to have LVH. Systolic BP (mmHg) (OR 1.02, CI 1.01-1.04), aortic valve disease, (OR 2.17, CI 1.33–3.53), age (years) (OR 1.03, CI 1.01–1.05), and HTN (OR 3.02, CI 1.81-5.02), were associated with LVH, while sex (female) (OR 0.41, CI 0.24-0.72) was negatively associated with LVH.Paper IV: There was no difference in height, weight, or BMI between patients with CoA (n = 414) and the reference population.Paper V: In the population of 21 patients, an increased left ventricular myocardial ECV was found in 6 cases (28.6 %). Of the patients with increased ECV, 5/6 (83.3 %) were female (p = 0.002). Patients with increased ECV did not otherwise differ from the rest of the study population. ivConclusions In adults with repaired CoA, HTN and LVH were common, and many patients with HTN had elevated BP despite treatment. The potentially modifiable factors BMI and systolic arm-leg BP gradient were associated with HTN, and the gradient was also associated with elevated BP among patients with diagnosed HTN. The gradient’s significance remained even within what the current guidelines consider acceptable ranges. Potentially modifiable factors associated with LVH were systolic BP and aortic valve disease. We found no general difference in height, weight, or BMI between patients with CoA and the reference population. While LVH was more common among men, increased myocardial ECV was more common among women.
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| 7. |
- Rinnström, Daniel, et al.
(författare)
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Factors associated with left ventricular hypertrophy in adults with surgically repaired coarctation of the aorta
- 2013
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Ingår i: International Cardiovascular Forum Journal. - : Barcaray International Publishing. - 2410-2636 .- 2409-3424. ; 1:2, s. 79-83
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Most patients with repaired coarctation of the aorta (CoA) live normal lives and have good physical performance. However, even after a successful surgical intervention, long-term cardiovascular risks including left ventricular hypertrophy remain. The aim of the study was to identify factors associated with increased left ventricular mass (LVM) in patients with surgically repaired CoA.Methods: Consecutive cardiovascular magnetic resonance investigations in 51 patients with surgically repaired CoA (age 37+/-15 years, age at intervention 9.7 ± 6.8 years, 45% female) were reviewed. LVM was measured and indexed to body surface area. The association between increased LVM index and clinical, anatomic and functional variables was investigated with logistic regression analysis.Results: In this population, 14/51 (27%) patients had a LVM index above normal limits. Factors associated with an increased LVM index in univariate analysis were higher systolic blood pressure (odds ratio (OR) = 1.04, 95 % confidence interval(CI) 1.00-1.08, p = 0.03), descending aortic diameter (OR = 1.48, CI 1.14-1.90, p = 0.003) and more than mild aortic valve disease or previous aortic valve intervention (OR = 15.1, CI 2.50-48.4, p=0.002), but not diastolic blood pressure, diameter of ascending aorta, diameter or ratio of CoA, velocity in descending aorta, smoking or bicuspid aortic valve (p > 0.05 for all). In multivariate analysis, only systolic blood pressure (p = 0.05) and aortic valve disease (p = 0.006) remained significant, yielding R2 = 0.47, p = 0.002 for the model.Conclusion: Increased LVM is a common late finding after surgically repaired CoA. This study showed that LVM was associated with modifiable factors; systolic blood pressure and aortic valve disease. As most patients are young, and increased LVM will eventually affect ventricular function, close attention to blood pressure optimization may be of particular importance in the surgically repaired CoA population.
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| 8. |
- Rinnström, Daniel, et al.
(författare)
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Factors associated with left ventricular hypertrophy in adults with surgically repaired coarctation of the aorta
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 34:Supplement: 1, s. 322-322
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: Most patients with repaired coarctation of the aorta live normal lives and have good physical performance. However, even after surgical intervention, there are long-term cardiovascular risks including arterial hypertension and left ventricular hypertrophy.Methods: Fifty-one cardiovascular magnetic resonance investigations inadult patients with repaired coarctation of the aorta were reviewed and left ventricular mass was calculated. Using binary logistic regression, factors associated with left ventricular mass index abovethe reference limit were analysed among clinical, anatomic and functional variables.Results: In this population, 14 (27.5%) of the patients had leftventricular mass index above the upper reference limit. Higher systolic blood pressure (OR=1.042, p=0.028), > mild aortic valve disease/previous aortic valve intervention (OR=1.042, p=0.002), and diameter of the descending aorta (OR=1.475, p=0.003) wereindependently associated with left ventricular mass index above theupper reference limit. In a post hoc model where systolic blood pressure was categorised in four levels, only high systolic blood pressure (>160 mmHg) (OR=31.913, p=0.020), together with > mild aortic valve disease or previous aortic valve intervention (OR=25.493, p=0.002) remainedindependently associated with left ventricular mass index above theupper reference limit.Conclusion: Increased left ventricular mass is a common finding late after repair in coarctation of the aorta and is associated with themodifiable factors blood pressure and aortic valve disease. As most patients are young, and increased mass will affect the left ventricle over decades, attention to blood pressure is important in this population.
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| 9. |
- Rinnström, Daniel, 1982-, et al.
(författare)
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High prevalence of ascending aortic dilation in adults with repaired coarctation of the aorta
- 2021
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Ingår i: Cardiology in the Young. - Cambridge, United Kingdom : Cambridge University Press. - 1047-9511 .- 1467-1107. ; 31:6, s. 992-997
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Tidskriftsartikel (refereegranskat)abstract
- Background: Ascending aortic dilation is a feared complication in adults with repaired coarctation of the aorta, as the condition is associated with life-threatening complications such as aortic dissection and rupture. However, the data are currently limited regarding factors associated with ascending aortic dilation in these patients. Methods and results: From the national register of congenital heart disease, 165 adult patients (≥ 18 years old) with repaired coarctation of the aorta, and echocardiographic data on aortic dimensions, were identified (61.2% male, mean age 35.8 ± 14.5 years). Aortic dilation (aortic diameters > 2 SD above reference mean) was found in 55 (33.3%) of the 165 included patients, and was associated with manifest aortic valve disease in univariable logistic regression analysis (OR 2.44, 95% CI [1.23, 4.83]). Conclusions: Aortic dilation is common post-repair of coarctation of the aorta, and is associated with manifest aortic valve disease and thus indirectly with the presence of a bicuspid aortic valve. However, no association was found between aortic dilation and age or blood pressure. © 2021 The Author(s),. Published by Cambridge University Press.
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| 10. |
- Rinnström, Daniel, 1982-, et al.
(författare)
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High prevalence of increased left ventricular myocardial extracellular volume fraction in adult women with coarctation of the aorta
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Left ventricular hypertrophy (LVH) is common among patients with coarctation of the aorta (CoA). Cardiovascular magnetic resonance imaging (CMR) can be used to accurately measure left ventricular mass (LVM), but also the myocardial extracellular volume fraction (ECV), which reflects the degree of diffuse myocardial fibrosis.Aims: This study aimed to investigate the prevalence of increased left ventricular myocardial ECV in adults with CoA, and to assess the relationship between increased ECV and LVH.Material and methods: Adult patients with CoA (n = 21, age 28.5 (19.1-65.1) years, 33% female, 86% with prior CoA repair) referred clinically for CMR were investigated with T1 and ECV mapping. Clinical and echocardiographic data were retrieved from medical records.Results: Median ECV was 29.0 (22.0-35.0) %; 29.0 (22.0-33.0) % for men versus 32.0 (27.0-35.0) % for women, p = 0.026). Median LVM indexed to body surface area (BSA) was 71.5 (44.0-99.6) g/m2, and LVM/BSA did not correlate with ECV (r = -0.184, p = 0.450). An increased myocardial ECV exceeding the upper normal limit (30.6 %) was found in 6/21 (29 %) of the patients. Of the patients with increased ECV, 5/6 (83 %) were female (p = 0.002). Patients with increased ECV did not differ from the rest of the study population in terms of age, age at intervention, blood pressure, or functional parameters such as left ventricular volumes or ejection fraction (p > 0.05 for all).Conclusion: In a clinical population of adults with CoA, increased myocardial ECV was common, and associated with female sex, but not with LVM.
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