| 1. |
- Klingberg, Eva, et al.
(författare)
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Aortic Regurgitation Is Common in Ankylosing Spondylitis : Time for Routine Echocardiography Evaluation?
- 2015
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Ingår i: American Journal of Medicine. - : Elsevier. - 0002-9343 .- 1555-7162. ; 128:11, s. 1244-50
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to assess the prevalence of aortic regurgitation and any relation to disease activity and specific human leukocyte antigen (HLA)-B27 subtypes in patients with ankylosing spondylitis.METHODS: Transthoracic echocardiography was performed in 187 patients (105 men), mean age (SD) 50 (13) years, and mean disease duration 24 (13) years, and was related to demographic, clinical, radiographic, electrocardiographic, and laboratory data.RESULTS: Aortic regurgitation was found in 34 patients (18%; 95% confidence interval [CI], 12%-24%): mild in 24, moderate in 9, and severe in one. The prevalence was significantly higher than expected from population data. Conduction system abnormalities were documented in 25 patients (13%; 95% CI, 8%-18%), and significantly more likely in the presence of aortic regurgitation (P = .005), which was related to increasing age and longstanding disease, and increased from ∼20% in the 50s to 55% in the 70s. It was also independently associated with disease duration, with higher modified Stoke Ankylosing Spondylitis Spine Score, and with a history of anterior uveitis. HLA-B27 was present in similar proportions in the presence vs absence of aortic regurgitation. For comparison, clinically significant coronary artery disease was present in 9 patients (5%; 95% CI, 2%-8%).CONCLUSION: Patients with ankylosing spondylitis frequently have cardiac abnormalities, but they more often consist of disease-related aortic regurgitation or conduction system abnormalities than manifestations of atherosclerotic heart disease. Because aortic regurgitation or conduction abnormalities might cause insidious symptoms not easily interpreted as of cardiac origin, we suggest that both electrocardiography and echocardiography evaluation should be part of the routine management of patients with ankylosing spondylitis.
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| 2. |
- Andersson, Bert, 1952, et al.
(författare)
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Longitudinal myocardial contraction improves early during titration with metoprolol CR/XL in patients with heart failure.
- 2002
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Ingår i: Heart (British Cardiac Society). - 1468-201X. ; 87:1, s. 23-8
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Tidskriftsartikel (refereegranskat)abstract
- To investigate diastolic and systolic left ventricular recovery during titration with metoprolol CR/XL (controlled release/extended release).Placebo run in, followed by an open study.University hospital.14 patients with chronic heart failure.Metoprolol CR/XL titrated from 12.5 mg once daily to 200 mg once daily.M mode recordings of atrioventricular (AV) plane displacement, Doppler measurement of transmitral flow and pulmonary venous flow, two dimensional ejection fraction, and measurement of venous plasma concentration of noradrenaline. Patients were investigated after 2, 4, 6, and 24 weeks of treatment.A reduction of heart rate was observed on the first dose (12.5 mg once daily), from a mean (SD) of 74 (11) to 67 (11) beats/min, p < 0.05. This was accompanied by prominent effects on AV plane filling parameters, including an increase in early diastolic filling period from 87 (28) to 105 (33) ms (p < 0.05), and in the lateral AV plane fractional shortening from 8.7 (2.7)% to 10.2 (2.8)% (p < 0.05). An early trend towards improvement in global systolic left ventricular function was also seen, although this was not significant until six weeks. Ejection fraction increased from 33 (7.5)% to 38 (11)% (p < 0.05).First effects of left ventricular recovery during beta blocker treatment were seen in recordings of longitudinal performance, as expressed by AV plane displacement. Doppler flow dynamics as well as global systolic recovery appeared several weeks later, emphasising the importance of longitudinal performance in evaluating left ventricular function.
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| 3. |
- Borland, Maria, 1967, et al.
(författare)
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Exercise-based cardiac rehabilitation improves physical fitness in patients with permanent atrial fibrillation - A randomized controlled study
- 2020
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Ingår i: Translational Sports Medicine. - : Hindawi Limited. - 2573-8488. ; 3:5, s. 415-425
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this multicenter randomized controlled trial was to compare physiotherapist-led exercise-based cardiac rehabilitation (PT-X) with physical activity on prescription (PAP) with regard to physical fitness, physical activity, health-related quality of life (HR-QoL), and metabolic risk markers in patients with permanent atrial fibrillation. Ninety six patients (28 women), age 74 (5) years, and ejection fraction >= 45% were randomized. An exercise tolerance test (primary outcome measure), muscle endurance tests, HR-QoL, physical activity assessments (questionnaire and accelerometer), and blood sampling were performed. The PT-X consisted of 60-minute group sessions and home-based exercise, both twice a week. The PAP consisted of 40 minutes of active walking, 4 times a week. Eighty seven patients completed the study. Exercise tolerance (maximum exercise capacity) improved significantly after PT-X (n = 40) but not after PAP (n = 47) (16 vs -3 W; P < .0001). Muscle endurance also improved after PT-X: shoulder flexion left arm (7 vs -1 repetition; P < .001), heel-lift right leg (4 vs 1 repetition; P < .05), left leg (4 vs -1 repetition; P < .001), and shoulder abduction (17 vs -4 s; P < .010). PAP significantly increased energy expenditure. Health-related quality of life and lab-tests did not differ. PT-X improved physical fitness in patients with permanent atrial fibrillation.
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| 4. |
- Cider, Åsa, 1960, et al.
(författare)
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Immersion in warm water induces improvement in cardiac function in patients with chronic heart failure
- 2006
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Ingår i: Eur J Heart Fail. - : Wiley. - 1388-9842. ; 8:3, s. 308-13
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The effects of immersion and training of patients with chronic heart failure (CHF) in warm water has not been thoroughly investigated. The aim of this study was to assess the acute hemodynamic response of immersion and peripheral muscle training in elderly patients with CHF. METHODS: Thirteen CHF patients and 13 healthy subjects underwent echocardiography on land and in a temperature-controlled swimming pool (33-34 degrees C). RESULTS: Rest. Heart rate decreased (CHF, p=0.01; control, p=0.001) and stroke volume increased (CHF, p=0.01; control, p=0.001) during water immersion in both groups, with no change in systolic or diastolic blood pressure. Ejection fraction (p<0.05) and transmitral Doppler E/A ratio (p=0.01) increased in the CHF group, with no changes in left ventricular volumes. The healthy subjects had similar responses, but also displayed an increase in cardiac output (p<0.01) and left ventricular volumes (p<0.001). Exercise. Cardiac output and systolic blood pressure increased significantly in water, in both groups. CONCLUSION: A general increase in early diastolic filling was accompanied by a decrease in heart rate, leading to an increase in stroke volume and ejection fraction in most patients with CHF during warm water immersion. These beneficial hemodynamic effects might be the reason for the previously observed good tolerability of this exercise regime.
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| 5. |
- Grüner Sveälv, Bente, 1956, et al.
(författare)
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Benefit of warm water immersion on biventricular function in patients with chronic heart failure
- 2009
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Ingår i: Cardiovasc Ultrasound. - : Springer Science and Business Media LLC. - 1476-7120 .- 1476-7120. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Regular physical activity and exercise are well-known cardiovascular protective factors. Many elderly patients with heart failure find it difficult to exercise on land, and hydrotherapy (training in warm water) could be a more appropriate form of exercise for such patients. However, concerns have been raised about its safety.The aim of this study was to investigate, with echocardiography and Doppler, the acute effect of warm water immersion (WWI) and effect of 8 weeks of hydrotherapy on biventricular function, volumes and systemic vascular resistance. A secondary aim was to observe the effect of hydrotherapy on brain natriuretic peptide (BNP). METHODS: Eighteen patients [age 69 +/- 8 years, left ventricular ejection fraction 31 +/- 9%, peakVO2 14.6 +/- 4.5 mL/kg/min] were examined with echocardiography on land and in warm water (34 degrees C).Twelve of these patients completed 8 weeks of control period followed by 8 weeks of hydrotherapy twice weekly. RESULTS: During acute WWI, cardiac output increased from 3.1 +/- 0.8 to 4.2 +/- 0.9 L/min, LV tissue velocity time integral from 1.2 +/- 0.4 to 1.7 +/- 0.5 cm and right ventricular tissue velocity time integral from 1.6 +/- 0.6 to 2.5 +/- 0.8 cm (land vs WWI, p < 0.0001, respectively). Heart rate decreased from 73 +/- 12 to 66 +/- 11 bpm (p < 0.0001), mean arterial pressure from 92 +/- 14 to 86 +/- 16 mmHg (p < 0.01), and systemic vascular resistance from 31 +/- 7 to 22 +/- 5 resistant units (p < 0.0001).There was no change in the cardiovascular response or BNP after 8 weeks of hydrotherapy. CONCLUSION: Hydrotherapy was well tolerated by all patients. The main observed cardiac effect during acute WWI was a reduction in heart rate, which, together with a decrease in afterload, resulted in increases in systolic and diastolic biventricular function. Although 8 weeks of hydrotherapy did not improve cardiac function, our data support the concept that exercise in warm water is an acceptable regime for patients with heart failure.
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| 6. |
- Grüner Sveälv, Bente, 1956, et al.
(författare)
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Gender and age related differences in left ventricular function and geometry with focus on the long axis
- 2006
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Ingår i: Eur J Echocardiogr. - : Oxford University Press (OUP). - 1525-2167. ; 7:4, s. 298-307
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To study age and gender related alterations in left ventricular (LV) long axis function. METHODS: Eighty-two healthy individuals from the general population in three age groups were investigated. LV long axis and short axis function and dimensions were studied with echocardiographic M-mode and two-dimensional technique. RESULTS: The most prominent age related differences were observed in LV long axis function, whereas only minor alterations in short axis function were noticed. Both systolic and diastolic long axis function decreased with advancing age; maximal systolic velocity (r=0.61, p<0.0001), maximal early diastolic filling velocity (r=0.87, p<0.0001). The length of the long axis decreased with age, while the relative contraction amplitude was maintained. LV global and short axis measurements revealed significant differences between genders, males having generally larger dimensions, even when correcting for body surface area. Females exhibited a more pronounced remodelling process with advancing age. CONCLUSION: Functional age related changes in LV function are more prominent in the long axis, while differences between genders are more pronounced in short axis and in volume measurements. These findings might be of importance when remodelling processes are evaluated, as these appear to be different in men and women and also age related.
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| 7. |
- Grüner Sveälv, Bente, 1956, et al.
(författare)
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Is hydrotherapy an appropriate form of exercise for elderly patients with biventricular systolic heart failure?
- 2012
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Ingår i: Journal of Geriatric Cardiology. - : Tsinghua University Press. - 1671-5411. ; 9:4, s. 408-410
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Tidskriftsartikel (refereegranskat)abstract
- Hydrotherapy (exercise in warm water) is considered to be a safe and beneficial method to use in the rehabilitation of stable heart failure patients, but there is little information on the effect of the increased venous return and enhanced preload in elderly patients with biventricular heart failure. We present a case of an elderly man who was recruited to participate in a hydrotherapy study. We compared echocardiographic data during warm water immersion with land measurements, and observed increases in stroke volume from 32 mL (land) to 42 mL (water), left ventricular ejection fraction from 22% to 24%, left ventricular systolic velocity from 4.8 cm/s to 5.0 cm/s and left atrioventricular plane displacement from 2.1 mm to 2.2 mm. By contrast, right ventricular systolic velocity decreased from 11.2 cm/s to 8.4 cm/s and right atrioventricular plane displacement from 8.1 mm to 4.7 mm. The tricuspid pressure gradient rose from 18 mmHg on land to 50 mmHg during warm water immersion. Thus, although left ventricular systolic function was relatively unaffected during warm water immersion, we observed a decrease in right ventricular function with an augmented right ventricular pressure. We recommend further investigations to observe the cardiac effect of warm water immersion on patients with biventricular systolic heart failure and at risk of elevated right ventricular pressure.
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| 8. |
- Grüner Sveälv, Bente, 1956, et al.
(författare)
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Prevalence of diastolic dysfunction in patients with ankylosing spondylitis: a cross-sectional study.
- 2015
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Ingår i: Scandinavian journal of rheumatology. - : Informa UK Limited. - 1502-7732 .- 0300-9742. ; 44:2, s. 111-117
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To determine the prevalence of diastolic dysfunction (DD) in patients with ankylosing spondylitis (AS) by following recommended criteria from the American Society of Echocardiography (ASE) and using single variables reflecting DD. Method: A total of 187 patients with AS (105 men; mean age 51 ± 13 years; mean duration of disease 15 ± 11 years) fulfilled the inclusion criteria and underwent pulsed-wave and tissue Doppler imaging. Results: By following ASE recommended criteria, we observed that 12% of patients with AS had mild DD. We also compared single standard Doppler values with normal age-stratified reference values and showed a wide variation in the number of patients with AS outside the 95% confidence interval (CI) of normal values depending on the variable chosen (ranging from 1.1% to 30.5%). Conclusions: By following recommended criteria, our cross-sectional study shows that DD was infrequent and mild in patients with AS.
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| 9. |
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| 10. |
- Grüner Sveälv, Bente, 1956, et al.
(författare)
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Pronounced improvement in systolic and diastolic ventricular long axis function after treatment with metoprolol
- 2007
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Ingår i: Eur J Heart Fail. - : Wiley. - 1388-9842. ; 9:6-7, s. 678-83
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although it is well known that left ventricular (LV) function improves after treatment with beta-blockers in heart failure, little attention has been paid to the effects on LV long axis (LAX) function. AIMS: To evaluate LV LAX function after treatment with metoprolol, and to assess whether LV LAX contractile reserve could predict future long-term improvement. METHODS: Twenty-four heart failure patients were randomised to metoprolol or placebo for 6 months, followed by 6 months of open treatment with metoprolol. Rest and dobutamine stress echocardiography (DSE) was performed before and after each treatment period. RESULTS: After treatment with metoprolol, LV LAX function improved significantly, systolic velocity from 29+/-8 to 32+/-15 mm/s, p<0.01 (metoprolol) vs. 28+/-7 to 28+/-11 mm/s, ns (placebo); atrioventricular plane fractional shortening (AVP-FS) from 5.4+/-2.1 to 7.4+/-2.7%, p<0.001 (metoprolol) vs. 5.9+/-2.1 to 5.8+/-2.9%, ns (placebo). The improvement in function was maintained during DSE. LV LAX contractile reserve could not predict treatment response; the treatment effect on LV LAX function was significantly greater than the contractile reserve at baseline. The relative improvement in LV LAX function after metoprolol was 38%, compared with a 20% improvement in LV ejection fraction (EF). CONCLUSION: A significant improvement in LV LAX function was observed after treatment with metoprolol. AVP-FS and systolic velocities increased significantly, and to a greater extent than LVEF.
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| 11. |
- Grüner Sveälv, Bente, 1956
(författare)
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The importance of long axis function -an echocardiographic study with respect to ageing, response to treatment, prediction of survival and effect of warm water immersion
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Echocardiographic M-mode measurement of atrioventricular plane displacement (AVPD) and determination of annular velocity with Tissue Doppler imaging (TDI) is a reliable method to gauge ventricular long axis function for quantification of myocardial contractility and relaxation. The aim of this thesis was to increase the understanding of the importance of long axis function with respect to ageing, response to pharmacological treatment, prediction of survival, and enhanced load condition caused by warm water immersion. In 82 healthy subjects, we observed a decrease in systolic and diastolic long axis function with advancing age, whereas short axes function remained unchanged. A remodelling of the heart towards a more spherical shape was associated with age, and was also shown to be more pronounced in female subjects. In 24 patients with dilated cardiomyopathy, we demonstrated a significant recovery of left ventricular systolic and diastolic long axis function after 6 months of treatment with the ?1-adrenoceptor antagonist metoprolol. The improvement was observed both at rest and during pharmacological stress. The relative improvement at rest in the long axis function was 38%, compared with 20% in left ventricular ejection fraction (biplane Simpson). In a multivariate regression analyse we found, in 228 patients with chronic heart failure, that systolic long axis function was an independent predictor of 10-year survival. Acute immersion in warm water caused favourable hemodynamic effects in 18 patients with chronic heart failure. Despite increased preload, long axis function improved in both chambers, most likely caused by a combination of reduced heart rate and decreased afterload. Further, we observed in 12 of these patients, that repeated exposure to increased preload (8 weeks of hydrotherapy twice times weekly) was well tolerated. In summary, these results emphasise that observation of long axis function give information about cardiac function that is not readily available in conventional measurements. Also, registration of long axis function appears to be superior to detect minor ventricular changes.
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| 12. |
- Grüner Sveälv, Bente, 1956, et al.
(författare)
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Ventricular long-axis function is of major importance for long-term survival in patients with heart failure.
- 2008
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Ingår i: Heart (British Cardiac Society). - : BMJ. - 1468-201X .- 1355-6037. ; 94:3, s. 284-9
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Tidskriftsartikel (refereegranskat)abstract
- To assess the importance of ventricular systolic and diastolic long-axis (LAX) function in comparison with short-axis (SAX) function for prediction of long-term survival in patients with heart failure.Prospective epidemiological study.University and county hospital.Patients with idiopathic heart failure (n = 228), not older than 65 years, mean (SD) ejection fraction 44 (17)%, were investigated with echocardiography in the SAX and in the LAX basal parts of the right and left ventricle. Patients were followed up for 10 years with respect to total survival or heart transplantation.Left ventricular (LV) LAX systolic amplitude was a strong risk predictor of long-term survival (p<0.001). In a multivariate Cox proportional hazard analysis, adjusting for age, gender, heart rate, systolic blood pressure, and SAX fractional shortening, LAX systolic amplitude was the only independent predictor of outcome (hazard ratio = 0.89 (95% CI 0.80 to 0.98), p = 0.02). Survival curves for each quartile of LAX systolic amplitude differentiated between mild, moderate and severe dysfunction in relation to outcome (p<0.001). There was a significant correlation between SAX and LAX ventricular function only in the lower range of LAX systolic amplitude (<6.8 mm).LV LAX systolic amplitude independently predicted survival, after adjustment for clinical variables and LV SAX function. These data further emphasise the importance of the basal parts of the ventricles for ventricular function and thereby long-term outcome.
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| 13. |
- Pereira, T., et al.
(författare)
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Randomized study of the effects of cocoa-rich chocolate on the ventricle–arterial coupling and vascular function of young, healthy adults
- 2019
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Ingår i: Nutrition. - : Elsevier BV. - 0899-9007. ; 63-64, s. 175-183
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to evaluate and explore the benefits of long-term dark chocolate intake in young, healthy adults by measuring cardiovascular function. Methods: A randomized study was conducted with 30 healthy participants ages 18 to 27 y. Half of the participants ingested a 20-g dose of lower cocoa chocolate (LCC; ∼55%; 12.6 ± 1.4 mg equivalent of epicatechin/g) and the others ingested a daily dose of 20 g of higher cocoa chocolate (HCC; ∼90%; 18.2 ± 2.6 mg equivalent of epicatechin/g). A baseline evaluation was performed before the participants started ingesting the assigned chocolate for a 30-d period, after which a final evaluation was performed. Each evaluation included heart ultrasonography, carotid-femoral pulse wave velocity (PWV) and carotid pulse wave analysis, flow-mediated slowing (FMS), and an analysis of the ventricular–arterial coupling (VAC), which reflects the matching between the aorta and the left ventricle (ratio of arterial elastance to left ventricle elastance). Results: The baseline evaluation presented similar values within normal range in both groups. The positive vascular effects were overall more distinct in the group eating the HCC. No structural modifications on the heart were found after the intervention, notwithstanding cardiac function was improved on certain functional parameters in the HCC group only. A statistically significant improvement was depicted over the brachial and central systolic and pulse pressures in the HCC group, and a trend for improvement in the reflected waves component (Aix) and the FMS was also observed in the HCC, but not in the LCC group. VAC parameters were similar at baseline between groups, but showed a significant improvement in the HCC group after intervention, increasing from 0.674 to 0.719 (P = 0.004), so that the post-intervention VAC was significantly higher in the HCC group than in the LCC group (P < 0.05). In addition, significant variation was observed in both groups regarding arterial and left ventricle elastances, stroke work, and potential energy, with greater mean differences identified in the HCC group. Conclusion: This study demonstrated that regular consumption of HCC has beneficial effects on the cardiovascular system in young, healthy adults, improving vascular function by reducing central brachial artery pressures and promoting vascular relaxation, and thus enhancing the matching of the arterial system with the left ventricle. © 2019 Elsevier Inc.
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| 14. |
- Scharin Täng, Margareta, 1962, et al.
(författare)
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Cardiac reserve in the transplanted heart: effect of a graft polymorphism in the beta1-adrenoceptor
- 2007
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Ingår i: The Journal of Heart and Lung Transplantation. - : Elsevier BV. - 1053-2498. ; 26:9, s. 915-20
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Polymorphism of the beta1-adrenoceptor (beta1-AR) affects outcome and beta-blocker efficacy in patients with heart failure. We studied the influence of the beta1-AR Ser49Gly polymorphism on cardiac reserve in transplanted hearts. METHODS: Beta1-AR polymorphism was determined by allelic discrimination analysis. Patients were divided into two groups: either homozygous for Ser49 (n = 15) or with Gly49 in one or both alleles (Gly49; n = 5). Patients underwent a maximal bicycle exercise test and echocardiographic evaluation at rest and during low-dose dobutamine stress. RESULTS: Patients with Gly49 grafts had better physical endurance (144 +/- 26 vs 112 +/- 31 W, p = 0.03), a trend toward better chronotropic reserve (deltaHR 64 +/- 13 vs 47 +/- 16 bpm, p = 0.056) during exercise, and lower resting heart rate (82 +/- 7 vs 90 +/- 7 bpm, p = 0.04) than those homozygous for Ser49. There were no significant differences in left ventricular ejection fraction (LVEF), with the exception of a decrease in cardiac reserve in patients with the Gly49 variants at the lowest dose of dobutamine (deltaLVEF -4.4 +/- 1.5 vs 2.2 +/- 5.8%, p = 0.04). Doppler myocardial tissue velocities of early relaxation were increased in patients with the Gly49 variants compared with patients homozygous for Ser49, both at rest (14.5 +/- 3.2 vs 10.4 +/- 2.0 cm/s, p = 0.03) and during the lowest dose of dobutamine (15.0 +/- 3.7 vs 10.9 +/- 2.5 cm/s, p = 0.04). CONCLUSIONS: Heart transplant patients with the beta1-AR Gly49 variants had a lower heart rate, and better stress endurance and diastolic function compared with patients homozygous for Ser49. They also showed a trend toward better chronotropic reserve. These results provide a possible explanation for differences in cardiac reserve among patients with heart transplants.
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| 15. |
- Varkey, Emma, et al.
(författare)
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Provocation of Migraine after Maximal Exercise: A Test-Retest Study.
- 2017
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Ingår i: European neurology. - : S. Karger AG. - 1421-9913 .- 0014-3022. ; 78:1-2, s. 22-27
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Tidskriftsartikel (refereegranskat)abstract
- Exercise is often recommended in migraine treatment, but strenuous physical activity is also reported as a migraine trigger. The main aim of this study was to evaluate whether migraine can be triggered by a maximal exercise test, using a prospective test-retest method. A secondary aim was to compare the participants who responded to the maximal exercise test with a migraine attack with those who did not suffer a migraine attack after the test.A total of 19 patients reporting exercise as a potential trigger for their migraines were included in the study. After a baseline period of 1 month with measurements of migraine frequency, a cycle ergometer test until exhaustion was used twice on each patient.A total of 14 patients were test-retested, and of these, 3 reported migraine following both tests, 5 after one of the tests, and 6 did not report migraine after either test. We observed a higher risk of migraine after 1 or 2 tests in patients with a higher baseline migraine frequency (p = 0.036).In conclusion, the study showed that although maximal aerobic exercise can trigger migraine attacks, it does not always provoke an attack even in those who report exercise as a migraine trigger.
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