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- Hayashi, Shirley Yumi, et al.
(författare)
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Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging
- 2006
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 21:1, s. 125-132
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Tidskriftsartikel (refereegranskat)abstract
- Background. Cardiovascular disease is the leading cause of death in chronic kidney disease (CKD) patients. Tissue Doppler velocity imaging (TVI) is a new objective method that accurately quantifies myocardial tissue velocities, deformation, time intervals and left ventricular (LV) filling pressure. In this study, TVI was compared with conventional echocardiography for the assessment of left ventricular (LV) function in pre-dialysis patients with different stages of CKD. The results obtained by TVI were used to analyse possible relationships between LV function and clinical factors such as hyperparathyroidism and hypertension that could influence LV function. Methods. Conventional echocardiography and TVI images were recorded in 40 patients (36 men and 4 women, mean age 60 +/- 14 years, range 28-80 years) and in 27 healthy controls (21 men and 6 women, mean age 58 +/- 17 years, range 28-82 years). Twenty-two patients had mild/moderate CKD (CCr > 29 ml/min; Group 1) and 18 patients had severe CKD (CCr <= 29 ml/min; Group 2). Using TVI, the myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVCv), peak systole (PSv), early (E') and late (A') diastolic filling velocities as well as strain rate (SR), mitral annulus displacement, isovolumetric relaxation time (IVRT) and LV filling pressure were estimated using TVI. The average of six LV wall measurements was used to evaluate LV global function. Results. Using TVI, we were able to identify significantly more patients with diastolic dysfunction than using conventional echocardiography (33 vs 26, P < 0.05). There was no difference in the prevalence of diastolic dysfunction between Group 1 and 2. However, using TVI, Group 2 CKD patients had lower E' velocities (6.2 +/- 1.9 vs 8.0 +/- 2.9 cm/s, P < 0.05) and higher IVRT (137.4 +/- 13 vs 88.2 +/- 26 ms, P < 0.001) in comparison with controls, indicating more accentuated diastolic dysfunction. Systolic blood pressure (SBP) was associated with E' velocities (rho = -0.68, P < 0.005) and E'/A' was strongly associated with SBP (rho = -0.60; P < 0.01) and PTH (rho = -0.64, P < 0.005) in Group 2. Using conventional echocardiography, there was no difference in the prevalence of systolic and diastolic dysfunction between patients with and without LVH. However, using TVI, patients with LVH had significantly lower IVCv (2.8 +/- 1.3 vs 3.8 +/- 1.5 and 3.8 +/- 1.5 cm/s, P < 0.05) and PSv (5.5 +/- 1.0 vs 6.3 +/- 1.2 and 6.4 +/- 1.3 cm/s, P < 0.05) compared with patients without LVH and controls, and they also had lower E' velocities (7.1 +/- 2.7 vs 8.0 +/- 2.9 cm/s, P < 0.05) compared with controls, indicating disturbances in systolic and diastolic left ventricular function. Conclusions. TVI provided additional information on left ventricular function in CKD patients. In patients with advanced renal failure, TVI revealed more accentuated diastolic dysfunction associated with increased systolic blood pressure (SBP) and increased levels of PTH. TVI also demonstrated disturbances in contractility and contraction in patients with LVH, which could not be detected by conventional echocardiography.
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| 2. |
- Hendrikx, Tijn, et al.
(författare)
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Atrial fibrillation among patients under investigation for suspected obstructive sleep apnea
- 2017
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:2
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVES: Obstructive sleep apnea is common among patients with atrial fibrillation, but the prevalence and risk factors for atrial fibrillation among patients who are being investigated on suspicion of sleep apnea are not well known. The aim of the study was to estimate the prevalence of atrial fibrillation among patients investigated for suspected obstructive sleep apnea and to identify risk factors for atrial fibrillation among them.METHODS: The prevalence of atrial fibrillation was investigated among 201 patients referred for suspected obstructive sleep apnea. Patients without known atrial fibrillation were investigated with a standard 12-lead ECG at hospital and short intermittent handheld ECG recordings at home, during 14 days.RESULTS: Atrial fibrillation occurred in 13 of 201 subjects (6.5%), and in 12 of 61 men aged 60 years and older (20%). The prevalence of atrial fibrillation increased with sleep apnea severity (p = 0.038). All patients with atrial fibrillation were men and all had sleep apnea. Age 60 or older, the occurrence of central sleep apnea and diabetes mellitus were independent risk factors for atrial fibrillation after adjustments for body mass index, gender, sleep apnea and cardiovascular disease.CONCLUSIONS: Atrial fibrillation is common among subjects referred for sleep apnea investigation and the prevalence of atrial fibrillation increases with sleep apnea severity. Independent risk factors for atrial fibrillation among patients investigated for suspected obstructive sleep apnea include the occurrence of coexisting central sleep apnea, age 60 years or older and diabetes mellitus.
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| 3. |
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| 4. |
- Janszky, Imre, et al.
(författare)
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Heavy snoring is a risk factor for case fatality and poor short-term prognosis after a first acute myocardial infarction
- 2008
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Ingår i: Sleep. - : Oxford University Press (OUP). - 0161-8105 .- 1550-9109. ; 31:6, s. 801-807
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVESSleep disordered breathing has been associated with an increased risk for developing coronary heart disease. Data on the effects of sleep disordered breathing on case fatality and prognosis of a myocardial infarction are sparse. The present study aimed to investigate a possible relationship of snoring and case fatality and mortality after an acute myocardial infarction.DESIGN, SETTINGS, PATIENTS, AND MEASUREMENTSIn this study, we enrolled 1660 first acute myocardial infarction cases and examined the effects of self- or relative-reported heavy snoring on case fatality and prognosis. The average follow-up time was 8 years, SD = 262 days.RESULTSThere was a variation in the association between snoring and mortality with time, with a strong association in the first 28 days after infarction but not later during the follow-up. Occasional and regular heavy snorers, when compared to those never having heavy snoring, had a 2.04 (95% confidence interval, 1.50 to 2.79) and 3.30 (95% confidence interval, 2.37 to 4.58) hazard ratio for mortality within the first 28 days after controlling for age, gender, obesity, history of diabetes and hypertension, physical activity, smoking, and education, respectively. There was no association between snoring and new myocardial infarction, stroke, or hospitalization for heart failure during the follow-up.CONCLUSIONSHeavy snoring is associated with case fatality and short-term mortality in patients with a first acute myocardial infarction.
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| 5. |
- Rohani, Morteza
(författare)
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Studies on arterial endothelial function and intima-media thickness using ultrasound technique
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The development of ultrasonographic arterial imaging, high-resolution B-mode ultrasonography, has created a technical basis for a new diagnostic approach to atherosclerotic disease by offering the possibility of accurate and reproducible quantification of the structural and functional changes in the arterial wall. Flow-mediated dilation (FMD) of the brachial artery and carotid intima-media thickness (IMT) have been shown to be good surrogate markers of atherosclerosis. Atherosclerotic lesions detected in the thoracic aorta by transesophageal echocardiography (TEE) are markers of diffuse atherosclerotic disease, often associated with coronary, carotid and peripheral vascular disease. Aims: The aims of this thesis were to study whether intake of oral moist snuff causes acute endothelial dysfunction in the brachial artery of long-term snuff users; to assess the strength of any relation between walls changes in the thoracic aorta and carotid arteries and the angiographic severity and extent of coronary artery lesions in patients with angiographically verified CAD; to examine the relationship between morphological and functional parameters of the brachial and carotid arteries and the angiographic extent and severity of coronary artery stenosis in patients with severe CAD; and to determine the influence of low-dose prednisolone on atherosclerosis, endothelial function, and risk factors for atherosclerosis in patients with early rheumatoid arthritis (RA). Methods: The acute effect of 1 g oral snuff on endothelial function in 20 healthy, long-term snuff users was measured by FMD. The effect on heart rate and blood pressure was also measured. The strength of any relation between the angiographic severity and extent of coronary artery lesions on the one hand and ultrasonographically measured walls changes in the thoracic aorta (n=37), carotid arteries and brachial artery and endothelial function in the brachial artery on the other hand was investigated by TEE, carotid and brachial B-mode scanning and FMD in 58 patients who had undergone coronary angiography. In a randomized study 67 patients with early, active rheumatoid arthritis (RA) were randomized to either 7.5 mg prednisolone daily (n=34) or no prednisolone (n=33). The effects of the low-dose treatment with prednisolone on the brachial endothelial function and the carotid wall thickness were studied by FMD and B-mode ultrasonography, respectively, after a mean of 5 years treatment. The relation between risk factors for atherosclerosis and the above mentioned ultrasonographic parameters was investigated. Results: FMD values declined significantly after the administration of oral moist snuff. Heart rate, systolic and diastolic blood pressure increased significantly after snuff administration. All parameters remained unchanged after placebo. A significant correlation was seen between the extent of coronary artery stenosis and aortic plaques score. Mean carotid IMT was also significantly correlated with coronary artery stenosis extent score. Moreover, a significant correlation was seen between the aortic plaque score and the mean carotid IMT. A significant correlation was seen between the extent of coronary artery stenosis defined as the coronary angiographic score and both the mean brachial artery IMT and intima media area (IMa). There was no significant correlation between FMD and the extent of coronary artery stenosis. A significant correlation was seen between the mean carotid artery IMT and the mean brachial artery IMT. However, there was no significant correlation between FMD and the mean carotid artery IMT or IMa. Carotid IMT and IMa, prevalence of carotid atherosclerotic plaques and FMD in brachial artery did not differ between RA patients treated with and those not treated with prednisolone. Carotid IMT and IMa, but not brachial FMD, were significantly associated with traditional risk factors for atherosclerosis in patients with RA. Conclusions: Intake of oral moist snuff significantly impaired endothelial function, measured as FMD of the brachial artery, in long-term snuffers. As endothelial dysfunction predicts cardiovascular morbidity, use of oral snuff should be discouraged. Morphological parameters of the carotid arteries and the thoracic aorta were related to severity and extent of coronary artery stenosis in patients with severe CAD. B-mode ultrasonography of the carotid arteries and transesophageal echocardiography of the aorta therefore have a potential for diagnostic evaluation of patients with suspected CAD. Morphological but not functional parameters of the brachial artery were associated with the extent of coronary artery stenosis and atherosclerotic wall changes in the carotid arteries in patients with severe CAD. These findings indicate a potential of B-mode ultrasonography of morphological parameters in the brachial artery in the diagnostic evaluation of patients with suspected CAD. Low-dose prednisolone did not influence endothelial function or subclinical atherosclerosis in patients with RA. The study verifies the relation between risk factors for atherosclerosis and carotid IMT and IMa.
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