| 1. |
- Beck-Friis, Josefine, et al.
(författare)
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No difference in biomarkers of ischemic heart injury and heart failure in patients with COVID-19 who received treatment with chloroquine phosphate and those who did not.
- 2021
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Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 16:8
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Tidskriftsartikel (refereegranskat)abstract
- Chloroquine was promoted as a COVID-19 therapeutic early in the pandemic. Most countries have since discontinued the use of chloroquine due to lack of evidence of any benefit and the risk of severe adverse events. The primary aim of this study was to examine if administering chloroquine during COVID-19 imposed an increased risk of ischemic heart injury or heart failure.Medical records, laboratory findings, and electrocardiograms of patients with COVID-19 who were treated with 500 mg chloroquine phosphate daily and controls not treated with chloroquine were reviewed retrospectively. Controls were matched in age and severity of disease.We included 20 patients receiving chloroquine (500 mg twice daily) for an average of five days, and 40 controls. The groups were comparable regarding demographics and biochemical analyses including C-reactive protein, thrombocytes, and creatinine. There were no statistically significant differences in cardiac biomarkers or in electrocardiograms. Median troponin T was 10,8 ng/L in the study group and 17.9 ng/L in the control group, whereas median NT-proBNP was 399 ng/L in patients receiving chloroquine and 349 ng/L in the controls.We found no increased risk of ischemic heart injury or heart failure as a result of administering chloroquine. However, the use of chloroquine to treat COVID-19 outside of clinical trials is not recommended, considering the lack of evidence of its effectiveness, as well as the elevated risk of fatal arrythmias.
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| 2. |
- Jha, Sandeep, et al.
(författare)
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Clinical management in the takotsubo syndrome.
- 2019
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Ingår i: Expert review of cardiovascular therapy. - : Informa UK Limited. - 1744-8344 .- 1477-9072. ; 17:2, s. 83-93
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Forskningsöversikt (refereegranskat)abstract
- Takotsubo syndrome (TS) is an increasingly recognized acute heart failure syndrome which is self-limiting in most cases but can result in life-threatening complications. TS is difficult to distinguish from acute myocardial infarction (AMI) early in the disease course and currently lacks evidence-based treatment recommendations. Areas covered: Based on the available literature this systematic review discusses the clinical management of patients with TS during (i) the diagnostic workup; (ii) acutely after establishing the TS diagnosis; and (iii) after recovery of cardiac function. Expert commentary Since TS is self-limiting in most cases it is recommended to refrain from unnecessary treatment (the do no harm principle) when managing patients with TS. The management of patients with TS should focus on careful monitoring of ECG and hemodynamics, and on preventing and treating complications. Because catecholamine-mediated inotropic overstimulation is implicated in the pathogenesis of TS, and because inotropic drugs have been associated with worse outcomes for patients with TS, we recommend the treating physician to avoid these drugs. Instead, mechanical assist devices should be considered early for patients with TS who develop cardiogenic shock with signs of end-organ hypo-perfusion.
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| 3. |
- Jha, Sandeep, et al.
(författare)
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Electrocardiographic predictors of adverse in-hospital outcomes in the Takotsubo syndrome.
- 2020
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Ingår i: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 299, s. 43-48
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Tidskriftsartikel (refereegranskat)abstract
- Takotsubo syndrome (TS) is a life-threatening acute heart failure syndrome. However, little is known about risk factors for worse outcomes in TS and no high-risk ECG criteria have been defined. We sought to identify ECG predictors of life-threatening in-hospital complications in TS.Using the nationwide Swedish Angiography and Angioplasty Registry (SCAAR) we obtained data on all consecutive patients undergoing coronary angiography at Sahlgrenska University Hospital between June 2008 and February 2019. For all patients with TS we conducted in-depth chart reviews to confirm the TS diagnosis. For those with confirmed TS we then evaluated all ECGs obtained during the index hospitalization. The primary endpoint was the occurrence of in-hospital major adverse cardiac event (MACE), defined as the composite of death, ventricular tachycardia or fibrillation (VT/VF), or atrioventricular block ≥2 or asystole ≫10s. We identified 215 patients with TS (mean age 69±13years; 93% women). MACE occurred in 34 patients (16%), of whom 20 had VT/VF (9,3%). Patients with MACE were less likely than those without MACE to have sinus rhythm (85% versus 96%, p=0.025) or T-wave inversion (29% versus 51%, p=0.025). After propensity score adjustment T-wave inversion was independently associated with lower MACE risk (adjusted odds ratio [AdjOR] 0.28, 95% confidence interval [CI] 0.10-0.76, p=0.012) and VT/VF (AdjOR 0.24, 95% CI 0.06-0.94, p=0.041).T-wave inversion is common in TS and is associated with lower risk of MACE, driven by a lower risk of VT/VF.
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| 4. |
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| 5. |
- Poller, Angela, 1988, et al.
(författare)
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Inter- and intra-observer variability in the echocardiographic evaluation of wall motion abnormality in patients with ST-elevation myocardial infarction or takotsubo syndrome - A novel approach
- 2023
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Ingår i: Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques. - 0742-2822. ; 40:7, s. 711-719
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and ObjectivesUsing existing transthoracic echocardiographic indices to quantify left ventricular wall motion abnormalities (WMAs) can be difficult due to the variations in the location of the abnormalities within the left ventricle, the quality of examinations, and the inter-/intra-observer variability of available indices. This study aimed to evaluate a new approach for measuring the extent of WMA by calculating the percentage of abnormal wall motion and comparing it to the wall motion score index (WMSI). The study also sought to assess inter- and intra-observer variability. MethodsThe study included 140 echocardiograms from 54 patients presenting with ST-elevation myocardial infarction or Takotsubo syndrome. All patients underwent an echocardiographic examination according to a standard protocol and the images were used to measure the extent of akinesia (proportion akinesia, PrA), akinesia and hypokinesia (proportion akinesia/hypokinesia, PrAH), and WMSI. The inter-observer variability between the two operators was analyzed. The intra-observer analysis was performed by one observer using the same images at least 1 month after the first measurement. The agreement was analyzed using the Pearson correlation coefficient and Bland-Altman plots. ResultsInter- and intra-observer variability for PrA and PrAH were low and comparable to those for WMSI. ConclusionPrA and PrAH are reliable and reproducible echocardiographic methods for the evaluation of left ventricular wall motion.
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| 6. |
- Shekka Espinosa, Aaron, et al.
(författare)
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Differences between cardiac troponin I vs. T according to the duration of myocardial ischaemia
- 2023
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Ingår i: European Heart Journal-Acute Cardiovascular Care. - : Oxford University Press (OUP). - 2048-8726 .- 2048-8734. ; 12:6, s. 355-363
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Tidskriftsartikel (refereegranskat)abstract
- Aims Cardiac troponin T (cTnT) and troponin I (cTnI) are expressed as an obligate 1:1 complex in the myocardium. However, blood levels of cTnI often rise much higher than that of cTnT in myocardial infarction (MI), whereas cTnT is often higher in patients with stable conditions such as atrial fibrillation. Here we examine high-sensitive (hs) cTnI and hs-cTnT after different durations of experimental cardiac ischaemia. Methods and results hs-cTnI, hs-cTnT, and the hs-cTnT/hs-cTnI ratio were measured in plasma samples from rats before and at 30 and 120 min after 5, 10, 15, and 30 min of myocardial ischaemia. The animals were killed after 120 min of reperfusion, and the infarct volume and volume at risk were measured. hs-cTnI, hs-cTnT, and the hs-cTnT/hs-cTnI ratio were also measured in plasma samples collected from patients with ST-elevation myocardial infarction (STEMI). hs-cTnT and hs-cTnI increased over 10-fold in all rats subjected to ischaemia. The increase of hs-cTnI and hs-cTnT after 30 min was similar, resulting in a hs-cTnI/hs-cTnT ratio around 1. The hs-cTnI/hs-cTnT ratio was also around 1 in blood samples collected at 120 min in rats subjected to 5 or 10 min of ischaemia where no localized necrosis was observed. In contrast, the hs-cTnI/hs-cTnT ratio at 2 h was 3.6-5.5 after longer ischaemia that induced cardiac necrosis. The large hs-cTnI/hs-cTnT ratio was confirmed in patients with anterior STEMI. Conclusion Both hs-cTnI and hs-cTnT increased similarly after brief periods of ischaemia that did not cause overt necrosis, whereas the hs-cTnI/hs-cTnT ratio tended to increase following longer ischaemia that induced substantial necrosis. A low hs-cTnI/hs-cTnT ratio around 1 may signify non-necrotic cTn release.
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| 7. |
- Tubić, Bojan, 1984, et al.
(författare)
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Randomised study of children with obesity showed that whole body vibration reduced sclerostin
- 2019
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Ingår i: Acta Paediatrica. - : WILEY. - 0803-5253 .- 1651-2227. ; 108:3, s. 502-513
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Tidskriftsartikel (refereegranskat)abstract
- Aim New strategies are required to increase physical activity and improve metabolic profiles in children with obesity. We studied the effect of whole body vibration (WBV) on children with obesity on biochemical markers of energy and bone metabolism, anthropometric measurements, muscle parameters and calcaneal bone mineral density (BMD). Methods This was a randomised, prospective, controlled study of 30 children with a median age of 13 years (range 7-17) at Queen Silvia Children s Hospital, Gothenburg, Sweden, from 2013 to 2015. The target for the intervention group was to perform WBV three times a week for 12 weeks, and the study parameters were assessed at baseline and 12 weeks. Results The 16 in the WBV group achieved 51% of the planned activity, mainly at home, and were compared with 14 controls. Sclerostin, bone-specific alkaline phosphatase and carboxy-terminal collagen cross-links decreased in the WBV group (p amp;lt; 0.05) and balance improved (p amp;lt; 0.006), but osteocalcin and insulin remained unchanged. Anthropometric data, muscle strength and calcaneal BMD did not differ between the groups. Conclusion WBV did not affect most of the clinical parameters in children with obesity, but the reduction in sclerostin implies that it had direct effects on osteocytes, which are key players in bone mechanotransduction.
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| 8. |
- Zeijlon, Rickard
(författare)
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Catching broken hearts - Electrocardiography and in-hospital outcome in Takotsubo syndrome versus ST elevation myocardial infarction
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND AND AIMS: Takotsubo syndrome (TS) and acute myocardial infarction (AMI) have similar symptoms, non-invasive test results and complications. Whereas AMI is caused by cardiac ischemia, the pathophysiology of TS is incompletely understood. Because TS and AMI can present with ST elevation, electrocardiography (ECG) in TS is difficult to distinguish from ST elevation myocardial infarction (STEMI). The aim of this thesis was to compare ECG and outcome between TS and STEMI, and to put these observations into perspective of the pathophysiology of TS. METHODS: All TS patients treated at Sahlgrenska University Hospital (Gothenburg, Sweden) and reported in the Swedish Coronary Angiography and Angioplasty Registry (2008 to 2019) were identified (study I) and matched based on age and sex with STEMI patients (studies II and III). Medical charts, angiography, echocardiography, arrhythmia and ECG were analysed. In study I, the association between T wave inversion and in-hospital Major Adverse Cardiac Events (MACE) was investigated. In study II, life-threatening ventricular arrhythmia (LTVA) or death within 72 hours was investigated in TS versus STEMI. In study III, admission ECG, and ECG predictors of LTVA or death, were compared between ST elevation Takotsubo syndrome (STE-TS) and STEMI. In study IV, TS and anterior STEMI patients were prospectively enrolled to validate the results in study III, and to analyse temporal ECG. RESULTS: The risk of LTVA within 72 hours was lower in TS than in STEMI (study II, N=465). ST deviation magnitude predicted higher risk of LTVA or death within 72 hours in STEMI (study III, N=378), whereas T wave inversion predicted lower risk of in-hospital MACE in TS (study I, N=215). In study III, admission ECG was similar in STE-TS and left anterior descending artery (LAD) STEMI. In temporal analysis (study IV, N=130), the similarities between TS and anterior/LAD STEMI from study III were confirmed, and similarities of T wave inversion were emphasized. CONCLUSIONS: The risk of LTVA within 72 hours was lower in TS than in STEMI. Admission/temporal ECG was similar, but ECG predictors of outcome were different, in TS compared with anterior/LAD STEMI. This thesis indicate that ECG cannot safely distinguish TS from STEMI. Lastly, the observations of the present thesis may indicate a “transient ischemic” pathophysiology of TS.
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| 9. |
- Zeijlon, Rickard, et al.
(författare)
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ECG differences and ECG predictors in patients presenting with ST segment elevation due to myocardial infarction versus takotsubo syndrome.
- 2022
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Ingår i: International journal of cardiology. Heart & vasculature. - : Elsevier BV. - 2352-9067. ; 40:June 2022
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies comparing electrocardiogram (ECG) in Takotsubo syndrome (TS) versus ST elevation myocardial infarction (STEMI) included TS patients without ST elevation, did not consider the culprit lesion in STEMI or had groups that were unbalanced regarding sex and age. Accounting for these factors, we sought to conduct a more reliable comparison of ECG in TS with ST-elevation (STE-TS) versus STEMI. The secondary aim was to investigate if ST segment changes, T wave inversion or prolonged QT interval predicted ventricular arrhythmia or death in STE-TS and STEMI.All STE-TS patients who presented at Sahlgrenska University Hospital between 2008 and 2019 were matched by sex and age to STEMI patients. STEMI patients were subcategorized according to whether or not the culprit lesion was located in the left anterior descending artery (LAD). Baseline characteristics, in-hospital outcomes and admission ECGs were analyzed.104 STE-TS patients were sex- and age-matched with 274 STEMI patients (113 LAD-STEMI, 161 non-LAD STEMI). Admission ECG in STE-TS was more similar to LAD STEMI than non-LAD STEMI. Reciprocal ST depression was less common in STE-TS (7/104, 6.7%) compared with STEMI (112/274, 41%; p=<0.001). The sum of all ST elevations and the sum of all ST-deviations predicted life-threatening ventricular arrhythmia (LTVA) or death in LAD STEMI but not in STE-TS.In conclusion, admission ECG in STE-TS was similar to LAD STEMI but reciprocal ST depression was less common in STE-TS compared with STEMI overall. ST segment changes predicted LTVA or death in STEMI but not in STE-TS.
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| 10. |
- Zeijlon, Rickard, et al.
(författare)
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Risk of in-hospital life-threatening ventricular arrhythmia or death after ST-elevation myocardial infarction vs. the Takotsubo syndrome.
- 2021
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Ingår i: ESC heart failure. - : Wiley. - 2055-5822. ; 8:2, s. 1314-1323
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Tidskriftsartikel (refereegranskat)abstract
- The risk of life-threatening ventricular arrhythmias (LTVA) has been reported to be lower in Takotsubo syndrome (TS) compared with ST-elevation myocardial infarction (STEMI). However, the extent to which these differences relate to the fact that most patients with TS are women (who have a lower risk of LTVA) and a relatively larger proportion of patients with STEMI are men is incompletely understood. We aimed to investigate the risk of LTVA or death in sex-matched and age-matched patients with TS, anterior STEMI, and non-anterior STEMI.We systematically reviewed the charts of all patients with TS who were treated at Sahlgrenska University Hospital (Gothenburg, Sweden) between 2008 and 2019. A total of 155 patients with confirmed TS (according to the European Society of Cardiology diagnostic criteria for TS) were sex-matched and age-matched 1:1:1 to patients with anterior and non-anterior STEMI. Baseline characteristics and in-hospital outcomes were recorded directly from the patient charts for all patients, and all admission electrocardiographs were analysed. The primary outcome was the composite of death or LTVA [defined as sustained ventricular tachycardia (>30s) or ventricular fibrillation] within 72h. The risk of LTVA or death within 72h after admission was considerably lower in TS (2.6%) vs. anterior STEMI (14%; P=0.002) and non-anterior STEMI (9.0%; P=0.02), despite similar or greater risks of acute heart failure, and similar risks of cardiogenic shock. Compared with STEMI, TS was associated with a lower risk of sustained and non-sustained ventricular tachycardia and ventricular fibrillation.In a predominantly female age-matched and sex-matched cohort of patients with TS, anterior STEMI, and non-anterior STEMI, the adjusted risk of in-hospital LTVA or death was considerably lower in TS compared with STEMI, despite similar or greater risk of acute heart failure and similar risk of cardiogenic shock.
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