| 1. |
- Bajraktari, Gani, et al.
(författare)
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Gender related predictors of limited exercise capacity in heart failure
- 2013
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Ingår i: IJC Heart & Vessels. - : Elsevier. - 2214-7632. ; 1, s. 11-16
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Aim The aim of this study was to investigate the impact of gender on the prediction of limited exercise capacity in heart failure (HF) patients assessed by 6 minute walk test (6-MWT).Methods In 147 HF patients (mean age 61 ± 11 years, 50.3% male), a 6-MWT and a Doppler echocardiographic study were performed in the same day. Conventional cardiac measurements were obtained and global LV dyssynchrony was indirectly assessed using total isovolumic time − t-IVT [in s/min; calculated as: 60 − (total ejection time − total filling time)] and Tei index (t-IVT/ejection time). Patients were divided into two groups according to gender, which were again divided into two subgroups based on the 6-MWT distance (Group I: ≤ 300 m, and Group II: > 300 m).Results Female patients were younger (p = 0.02), and had higher left ventricular (LV) ejection fraction — EF (p = 0.007) but with similar 6-MWT distance to male patients (p = 68). Group I male patients had lower hemoglobin level (p = 0.02) and lower EF (p = 0.03), compared with Group II, but none of the clinical or echocardiographic variables differed between groups in female patients. In multivariate analysis, only t-IVT [0.699 (0.552–0.886), p = 0.003], and LV EF [0.908 (0.835–0.987), p = 0.02] in males, and NYHA functional class [4.439 (2.213–16.24), p = 0.02] in females independently predicted poor 6-MWT distance (< 300 m).Conclusion Despite similar limited exercise capacity, gender determines the pattern of underlying cardiac disturbances; ventricular dysfunction in males and subjective NYHA class in female heart failure patients.
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| 2. |
- Barywani, Salim B., 1968, et al.
(författare)
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Predictors of long-term outcome of percutaneous coronary intervention in octogenarians with acute coronary syndrome
- 2014
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Ingår i: IJC Heart and Vessels. - : Elsevier BV. - 2214-7632. ; 4:1, s. 138-144
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Tidskriftsartikel (refereegranskat)abstract
- The majority of patients with acute coronary syndrome (ACS) are elderly. Limited evidence makes decision-making on the use of percutaneous coronary intervention (PCI) mainly empirical. Old age is one risk factor, but other factors than age may have an impact on mortality as well. Therefore, we investigated predictors of long-term all-cause mortality among octogenarians who have undergone PCI due to ACS. A total of 182 patients ≥. 80 years who underwent PCI during 2006-2007 at Sahlgrenska University Hospital were studied consecutively from recorded clinical data. All-cause five-year mortality of follow-up was 46.2%. Mean age was 83.7. ±. 2.8, 62% were male, 76% were in sinus rhythm, and 42% had left ventricular ejection fraction. < 45%. Indications for PCI were STEMI (52%), NSTEMI (36%) and unstable angina (11%). Multivariate analysis in two steps identified atrial fibrillation, moderate tricuspid valve regurgitation, moderate mitral valve regurgitation, dependency in ADL and eGFR. ≤. 30. ml/min at the first step and moderate mitral valve regurgitation, atrial fibrillation and eGFR. ≤. 30 ml/min at the last step, as independent predictors of all-cause mortality. Kaplan Meier analysis of positive parameters from both steps of multivariate analysis showed high significant difference in survival between patients having these parameters and those who were free from these parameters, with worst prognosis in patients with accumulation of these parameters. Accordingly, we have, in an octogenarian patient cohort who suffered from ACS, undergone PCI in daily clinical practice, identified five prognostic predictors for all-cause death after five years' follow-up.
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| 3. |
- Bytyci, Ibadete, et al.
(författare)
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Left atrial emptying fraction predicts limited exercise performance in heart failure patients
- 2014
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Ingår i: IJC Heart and Vessels. - : Elsevier. - 2214-7632. ; 4, s. 203-207
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Tidskriftsartikel (refereegranskat)abstract
- Aim: We aimed in this study to assess the role of left atrial (LA), in addition to left ventricular (LV) indices, in predicting exercise capacity in patients with heart failure (HF). Methods: This study included 88 consecutive patients (60 ± 10 years) with stable HF. LV end-diastolic and end-systolic dimensions, ejection fraction (EF), mitral and tricuspid annulus peak systolic excursion (MAPSE and TAPSE), myocardial velocities (s′, e′ and a′), LA dimensions, LA volume and LA emptying fraction were measured. A 6-min walking test (6-MWT) distance was performed on the same day of the echocardiographic examination. Results: Patients with limited exercise performance (≤ 300 m) were older (p = 0.01), had higher NYHA functional class (p = 0.004), higher LV mass index (p = 0.003), larger LA (p = 0.002), lower LV EF (p = 0.009), larger LV end-systolic dimension (p = 0.007), higher E/A ratio (p = 0.03), reduced septal MAPSE (p < 0.001), larger LA end-systolic volume (p = 0.03), larger LA end-diastolic volume (p = 0.005) and lower LA emptying fraction (p < 0.001) compared with good performance patients. In multivariate analysis, only the LA emptying fraction [0.944 (0.898–0.993), p = 0.025] independently predicted poor exercise performance. An LA emptying fraction < 60% was 68% sensitive and 73% specific (AUC 0.73, p < 0.001) in predicting poor exercise performance. Conclusion: In heart failure patients, the impaired LA emptying function is the best predictor of poor exercise capacity. This finding highlights the need for routine LA size and function monitoring for better optimization of medical therapy in HF.
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| 4. |
- Mirzada, Naqibullah, 1977, et al.
(författare)
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Absence of significant aortic regurgitation seven years after closure of patent foramen ovale
- 2014
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Ingår i: International journal of cardiology. Heart & vessels. - : Elsevier BV. - 2214-7632. ; 4, s. 59-62
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Tidskriftsartikel (refereegranskat)abstract
- Background It has been suggested that there is an increase in aortic regurgitation (AR) in the short and medium term after percutaneous closure of patent foramen ovale (PFO). The aim of this study is to determine the long-term effect of percutaneous closure of PFO on the prevalence of AR. Methods Patients with cryptogenic stroke or transient ischemic attack who had undergone percutaneous closure of PFO more than five years before the study were invited to an echocardiographic examination. Results Out of 83 invited patients, 64 accepted the invitation and were examined with echocardiography. Mild AR was found in one patient (2%), but this was already evident in the patient's echocardiographic result before PFO closure. Trace AR was detected in 11 patients (17%). No case of moderate or severe AR was detected. Patients with AR were more often hypertensive (six out of 12 patients with AR, compared to nine of the 52 without AR, p = 0.025), and the indexed sinus of Valsalva was larger in patients with AR (18.6 mm/m2, SD 1.6, as compared to 17.3 mm/m2, SD 1.6, p = 0.02). Conclusion In this long-term study with a minimum follow-up of 5.6 years and a mean of 7.1 years, we found negligible levels of AR. Where present, AR was associated with hypertension and mild dilatation of the aortic root, but there was no indication that device closure per se increased the risk of developing AR.
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| 5. |
- Mirzada, Naqibullah, 1977, et al.
(författare)
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Seven-year follow-up of percutaneous closure of patent foramen ovale
- 2013
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Ingår i: IJC Heart and Vessels. - : Elsevier BV. - 2214-7632. ; 1, s. 32-36
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Tidskriftsartikel (refereegranskat)abstract
- Background: Observational studies favor percutaneous closure of patent foramen ovale (PFO) over medical treatment to reduce recurrent stroke while randomized trials fail to demonstrate significant superiority of percutaneous PFO closure. Few long-term studies are available post PFO closure. This study reports long-term clinical outcomes after percutaneous PFO closure. Methods: Between 1997 and 2006, 86 consecutive eligible patients with cerebrovascular events, presumably related to PFO, underwent percutaneous PFO closure. All 86 patients were invited to a long-term follow-up, which was carried out during 2011 and 2012. Results: Percutaneous PFO closure was successfully performed in 85 of 86 patients. The follow-up rate was 100%. No cardiovascular or cerebrovascular deaths occurred. Two patients (both women) died from lung cancer during follow-up. Follow-up visits were conducted for 64 patients and the remaining 20 patients were followed up by phone. The mean follow-up time was 7.3. years (5 to 12.4. years). Mean age at PFO closure was 49. years. One patient had a minor stroke one month after PFO closure and a transient ischemic attack (TIA) two years afterwards. One other patient suffered from a TIA six years after closure. No long-term device-related complications were observed. Conclusions: Percutaneous PFO closure was associated with very low risk of recurrent stroke and is suitable in most patients. We observed no mortality and no long-term device-related complications related to PFO closure, indicating that percutaneous PFO closure is a safe and efficient treatment even in the long term. © 2013 Elsevier B.V.
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| 6. |
- Nicoll, Rachel, et al.
(författare)
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The predictive value of arterial and valvular calcification for mortality and cardiovascular events
- 2014
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Ingår i: IJC Heart & Vessels. - : Elsevier. - 2214-7632. ; 3, s. 1-5
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Forskningsöversikt (refereegranskat)abstract
- A review of the predictive ability of arterial and valvular calcification has shown an additive effect of calcification in more than 1 location in predicting mortality and coronary heart disease, with mitral annual calcification being a particularly strong predictor. In individual arteries and valves there is a clear association between calcification presence, extent and progression and future cardiovascular events and mortality in asymptomatic, symptomatic and high risk patients, although adjustment for calcification in other arterial beds generally renders associations non-significant. Furthermore, in acute coronary syndrome, culprit plaque is normally not calcified. This would tend to reduce the validity of calcification as a predictor and suggest that the association with cardiovascular events and mortality may not be causal. The association with stroke is less clear; carotid and intracranial artery calcification show little predictive ability, with symptomatic plaques tending to be uncalcified.
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| 7. |
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| 8. |
- Thylén, Ingela, et al.
(författare)
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Are ICD recipients able to foresee if they want to withdraw therapy or deactivate defibrillator shocks?
- 2013
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Ingår i: IJC Heart & Vessles. - : Elsevier. - 2214-7632. ; 1, s. 22-31
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundExpert consensus statements on management of implantable cardioverter defibrillators (ICDs) emphasize the importance of having discussions about deactivation before and after implantation. These statements were developed with limited patient input. The purpose of this study was to identify the factors associated with patients' experiences of end-of-life discussions, attitudes towards such discussions, and attitudes towards withdrawal of therapy (i.e., generator replacement and deactivation) at end-of-life, in a large national cohort of ICD-recipients.MethodsWe enrolled 3067 ICD-patients, administrating the End-of-Life-ICD-Questionnaire.ResultsMost (86%) had not discussed ICD-deactivation with their physician. Most (69%) thought discussions were best at end-of-life, but 40% stated that they never wanted the physician to initiate a discussion. Those unwilling to discuss deactivation were younger, had experienced battery replacement, had a longer time since implantation, and had better quality-of-life. Those with psychological morbidity were more likely to desire a discussion about deactivation. Many patients (39%) were unable to foresee what to decide about deactivation in an anticipated terminal condition. Women, those without depression, and those with worse ICD-related experiences were more indecisive about withdrawal of therapy. Irrespective of shock experiences, those who could take a stand regarding deactivation chose to keep shock therapies active in many cases (39%).ConclusionsDespite consensus statements recommending discussions about ICD-deactivation at the end-of-life, such discussion usually do not occur. There is substantial ambivalence and indecisiveness on the part of most ICD-patients in this nationwide survey about having these discussions and about expressing desires about deactivation in an anticipated end-of-life situation.
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