| 1. |
- Sjöland, Helen, 1959, et al.
(författare)
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Pulmonary embolism and deep venous thrombosis after COVID-19: long-term risk in a population-based cohort study
- 2023
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Ingår i: Research and Practice in Thrombosis and Haemostasis. - 2475-0379. ; 7:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Venous thromboembolism (VTE) (pulmonary embolism [PE] or deep venous thrombosis [DVT]) is common during acute COVID-19. Long-term excess risk has not yet been established. Objectives: To study long-term VTE risk after COVID-19. Methods: Swedish citizens aged 18 to 84 years hospitalized and/or testing positive for COVID-19 between January 1, 2020, and September 11, 2021 (exposed), stratified by initial hospitalization, were compared to matched (1:5), nonexposed, population-derived subjects without COVID-19. Outcomes were incident VTE, PE, or DVT recorded within 60, 60 to <180, and & GE;180 days. Cox regression was used for evalu-ation, and a model adjusted for age, sex, comorbidities, and socioeconomic markers was developed to control for confounders. Results: Among exposed patients, 48,861 were hospitalized for COVID-19 (mean age, 60.6 years) and 894,121 were without hospitalization (mean age, 41.4 years). Among patients hospitalized for COVID-19, fully adjusted hazard ratios during 60 to <180 days were 6.05 (95% CI, 4.80-7.62) for PE and 3.97 (CI, 2.96-5.33) for DVT compared with that for nonexposed patients with corresponding estimates among those with COVID-19 without hospitalization 1.17 (CI, 1.01-1.35) and 0.99 (CI, 0.86-1.15), based on 475 and 2311 VTE events, respectively. Long-term (& GE;180 days) hazard ratios in patients hospitalized for COVID-19 were 2.01 (CI, 1.51-2.68) for PE and 1.46 (CI, 1.05-2.01) for DVT, while nonhospitalized patients had similar risk as nonexposed patients, based on 467 and 2030 VTE events, respectively. Conclusion: Patients hospitalized for COVID-19 retained an elevated excess risk of VTE, mainly PE, after 180 days, while long-term risk of VTE in individuals with COVID-19 without hospitalization was similar to that in the nonexposed patients.
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| 2. |
- Tian, Fei, 1964, et al.
(författare)
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Protein disulfide isomerase increases in myocardial endothelial cells in mice exposed to chronic hypoxia: a stimulatory role in angiogenesis.
- 2009
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Ingår i: American Journal of Physiology. Heart and Circulatory Physiology. - : American Physiological Society. - 1522-1539 .- 0363-6135. ; 297:3
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies have shown that exposure to chronic hypoxia protects against myocardial infarction, but little is known about the cellular and molecular mechanisms involved. Here we observed that chronic hypoxia for 3 wk resulted in improved survival of mice (from 64% to 83%), reduced infarction size (from 45 +/- 4% to 32 +/- 4%, P < 0.05), increased cardiac ejection fraction (from 19 +/- 4% to 35 +/- 5%, P < 0.05), coronary flow velocity under adenosine-induced hyperemia (from 58 +/- 2 to 75 +/- 5 cm/s, P < 0.05), myocardial capillary density (from 3,772 +/- 162 to 4,760 +/- 197 capillaries/mm(2), P < 0.01), and arteriolar density (from 8.04 +/- 0.76 to 10.34 +/- 0.69 arterioles/mm(2), P < 0.05) 3 wk after myocardial infarction. With two-dimensional gel electrophoresis, we identified that protein disulfide isomerase (PDI) was highly upregulated in hypoxic myocardial capillary endothelial cells. The loss of PDI function in endothelial cells by small interfering RNA significantly increased the number of apoptotic cells (by 3.4-fold at hypoxia, P < 0.01) and reduced migration (by 52% at hypoxia, P < 0.001) and adhesion to collagen I (by 42% at hypoxia, P < 0.01). In addition, the specific inhibition of PDI by PDI small interfering RNA (by 46%, P < 0.01) and bacitracin (by 72%, P < 0.001) reduced the formation of tubular structures by endothelial cells. Our data indicate that chronic hypoxic exposure improves coronary blood flow and protects the myocardium against infarction. These beneficial effects may be partly explained by the increased endothelial expression of PDI, which protects cells against apoptosis and increases cellular migration, adhesion, and tubular formation. The increased PDI expression in endothelial cells may be a novel mechanism to protect the myocardium against myocardial ischemic diseases.
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| 3. |
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| 4. |
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| 5. |
- Herlitz, Johan, 1949, et al.
(författare)
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Cause of death during 13 years after coronary artery bypass grafting with emphasis on cardiac death
- 2004
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Ingår i: Scand Cardiovasc J. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 38:5, s. 283-6
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the cause of death in the long term after coronary artery bypass grafting (CABG) with particular emphasis on cardiac death. PATIENTS AND SETTING: All the patients in western Sweden without simultaneous valve surgery and without previous CABG who underwent CABG in 1988-1991 in Goteborg, Sweden. DESIGN: Prospective, observational study for 10.6-13.6 years (i.e. until the end of 2001). Various factors contributing to death were described, with the emphasis on cardiac death. RESULTS: In all, 2000 patients were included in the survey. The all-cause mortality rate was 39%. Fifty-eight per cent of all deaths were judged as cardiac deaths. The most frequent cause of death was heart failure (65% among patients who died within 30 days after CABG and 36% among those who died >30 days after CABG). The second most common cause of death was myocardial infarction (56 and 29%, respectively), followed by cancer (0 and 24%, respectively), stroke (21 and 18%, respectively) and infection (8 and 11%, respectively). CONCLUSION: The factors most commonly contributing to death in the long term after CABG were, in order of frequency, heart failure, myocardial infarction, cancer, stroke and infection.
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| 6. |
- Herlitz, Johan, 1949, et al.
(författare)
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Determinants for an impaired quality of life 10 years after coronary artery bypass surgery
- 2005
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Ingår i: Int J Cardiol. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 98:3, s. 447-52
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To identify determinants of an inferior quality of life (QoL) 10 years after coronary artery bypass grafting (CABG). SETTING: Sahlgrenska University Hospital, Goteborg, Sweden. PARTICIPANTS: All patients from Western Sweden who underwent CABG between 1988 and 1991 without simultaneous valve surgery and no previous CABG. MAIN OUTCOME MEASURES: Questionnaires for evaluating QoL 10 years after the operation. Three different instruments were used: The Nottingham health profile (NHP), the psychological general wellbeing index (PGWI), and the Physical Activity Score (PAS). RESULTS: 2000 patients underwent CABG, of whom 633 died during 10 years of follow-up. Information on QoL at 10 years was available in 976 patients (71% of survivors). A history of diabetes and chronic obstructive pulmonary disease were the two independent predictors for an inferior QoL with all three instruments. Furthermore, there were three predictors of an inferior QoL with two of the instruments: high age, female sex and a history of hypertension. A number of factors predicted an inferior QoL with one of the instruments. These were the duration of angina pectoris and functional class prior to CABG, renal dysfunction, a history of cerebrovascular disease, obesity, height, duration of respirator treatment and requirement of inotropic drugs postoperatively. In addition, when introducing preoperative QoL into the model a low QoL before surgery was a strong independent predictor also of an inferior QoL 10 years after CABG. CONCLUSION: Variables independently predictive of an impaired QoL 10 years after CABG, irrespective of the instrument used, were an impaired QoL prior to surgery, chronic obstructive pulmonary disease and a history of diabetes. However, other factors reflecting gender, the previous history as well as postoperative complications were also associated with the QoL 10 years later in at least one of these instruments.
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| 7. |
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| 8. |
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| 9. |
- Herlitz, Johan, 1949, et al.
(författare)
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Impact of a history of diabetes on the improvement of symptoms and quality of life during 5 years after coronary artery bypass grafting.
- 2000
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Ingår i: Journal of diabetes and its complications. - : Elsevier Inc.. - 1056-8727 .- 1873-460X. ; 14:6, s. 314-21
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Tidskriftsartikel (refereegranskat)abstract
- To describe the impact of a history of diabetes mellitus on the improvement of symptoms and various aspects of quality of life (QoL) during 5 years after coronary artery bypass grafting (CABG). Patients who underwent CABG between 1988 and 1991 in western Sweden were approached with an inquiry prior to surgery and 5 years after the operation. QoL was estimated with three different instruments: Physical Activity Score (PAS), Nottingham Health Profile (NHP) and Psychological General Well-Being (PGWB) index. 876 patients participated in the evaluation, of whom 87 (10%) had a history of diabetes. Symptoms of dyspnea and chest pain improved both in diabetic and non-diabetic patients. Diabetic patients scored worse than non-diabetic patients both prior to and 5 years after CABG, but without any major difference in improvement between the two groups with all three measures of QoL. PAS tended to improve more in non-diabetic than in diabetic patients, whereas improvement in NHP and PGWB was similar regardless of a history of diabetes. Diabetic patients differ from non-diabetic patients having an inferior QoL both prior to and 5 years after CABG. Both diabetic and non-diabetic patients improve in symptoms and QoL after the operation. In some aspects improvement tended to be less marked in the diabetic patients but on the whole improvement was similar compared to non-diabetic patients.
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| 10. |
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| 11. |
- Herlitz, Johan, 1949, et al.
(författare)
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Impact of age on improvement in health-related quality of life 5 years after coronary artery bypass grafting.
- 2000
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Ingår i: Scandinavian journal of rehabilitation medicine. - : Stiftelsen Rehabiliteringsinformation. - 0036-5505 .- 1650-1977 .- 1651-2081. ; 32:1, s. 41-8
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the relief of symptoms and improvement in other aspects of health-related quality of life 5 years after coronary artery by-pass grafting in relation to age. Patients in western Sweden were approached with an inquiry prior to surgery and 5 years after the operation. Health-related quality of life was estimated with 3 different instruments: Physical Activity Score (PAS), Nottingham Health Profile (NHP), Psychological General Well-Being Index (PGWB). Prior to surgery patients were approached either in the ward or by post and 5 years after surgery they were approached by post. A total of 1719 patients were available for the survey, of whom 876 (51%) responded to the survey both prior to and after 5 years. Among the 876 respondents 287 were <60 years, 331 were 60-67 years and 258 were >67 years. In terms of physical activity, chest pain and dyspnoea, a similar improvement was observed regardless of age. In terms of health-related quality of life questionnaires, there was an inverse association between age and improvement when using PAS and a similar trend was observed with NHP and PGWB. In conclusion, 5 years after coronary artery bypass grafting relief of symptoms and improvement in physical activity was not associated with age, whereas improvement in other aspects of health-related quality of life tended to be less marked in elderly people. Overall age seemed to have a small impact on the improved well-being 5 years after coronary surgery. However, due to the limited response rate the results may not be applicable to a non-selected coronary artery bypass grafting population.
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| 12. |
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| 13. |
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| 14. |
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| 15. |
- Herlitz, Johan, 1949, et al.
(författare)
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Limitation of physical activity, dyspnoea and chest pain before and two years after coronary artery bypass grafting in relation to preoperative ejection fraction.
- 2000
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Ingår i: Scandinavian cardiovascular journal : SCJ. - 1401-7431. ; 34:1, s. 65-72
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the relationships between limitation of physical activity and dyspnoea and chest pain before and 2 years after coronary artery bypass grafting (CABG) and preoperative left ventricular ejection fraction (LVEF), questionnaires were issued to all patients from Western Sweden who underwent CABG during 1988-1991. The analysis comprised 985 patients. Physical activity improved significantly after CABG regardless of the preoperative LVEF. No significant association was found between LVEF and degree of limitation of physical activity before or after surgery. Dyspnoea and chest pain improved markedly, irrespective of LVEF. There was significant association between freedom from dyspnoea and LVEF preoperatively (less dyspnoea with higher LVEF), but not after CABG. The frequency of chest-pain attacks was not related to LVEF, before or after the operation. Thus physical activity, dyspnoea and chest pain improved in the 2 years after CABG irrespective of preoperative LVEF. Absence of dyspnoea was related to LVEF before, but not after surgery, and there was no association between preoperative LVEF and frequency of anginal attacks before or after CABG.
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| 16. |
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| 18. |
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| 19. |
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| 20. |
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| 21. |
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| 22. |
- Herlitz, Johan, 1949, et al.
(författare)
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Predictors of death and other cardiac events within 2 years after coronary artery bypass grafting.
- 1998
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Ingår i: Cardiology. - 0008-6312. ; 90:2, s. 110-4
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Tidskriftsartikel (refereegranskat)abstract
- In 1,841 patients who underwent coronary artery bypass grafting (CABG) we evaluated risk indicators for death and other cardiac events during 2 years of follow-up. Independent predictors of death were: a history of congestive heart failure, diabetes mellitus and renal dysfunction prior to CABG. Independent predictors of death, acute myocardial infarction (AMI), CABG or percutaneous transluminal coronary angioplasty (PTCA) were: a small body surface area, a history of congestive heart failure, diabetes mellitus and smoking prior to CABG. Independent predictors of death, AMI, CABG, PTCA or rehospitalization for a cardiac reason were: angina functional class, previous AMI, a history of congestive heart failure and renal dysfunction prior to CABG.
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| 23. |
- Herlitz, Johan, 1949, et al.
(författare)
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Predictors of death during 10 years after coronary artery bypass grafting with particular emphasis on age
- 2004
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Ingår i: Coron Artery Dis. - : Ovid Technologies (Wolters Kluwer Health). - 0954-6928 .- 1473-5830. ; 15:3, s. 163-70
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To describe predictors of death during 10 years of follow-up after coronary artery bypass grafting (CABG); to evaluate whether age interacts with the influence of various predictors on outcome; and to compare the mortality during 10 years after CABG with the mortality in an age- and sex-matched control population. DESIGN: Prospective, observational study. SETTING: Department of Thoracic and Cardiovascular Surgery at Sahlgrenska University Hospital and Scandinavian Heart Centre in Goteborg, Sweden. PARTICIPANTS: All patients from western Sweden who underwent CABG between 1 June 1988 and 1 June 1991 without simultaneous valve surgery and with no previous CABG. MAIN OUTCOME MEASUREMENTS: All-cause mortality during 10 years but more than 30 days after CABG. RESULTS: In all, 2000 patients participated in the survey. The following factors appeared as independent predictors of death: preoperative factors-age, history of congestive heart failure, cerebrovascular disease, history of intermittent claudication, current smoking, degree of left ventricular impairment, valvular disease and duration of angina pectoris; peroperative factors-ventilator time and neurological complications; postoperative factors-arrhythmia, requirement of digitalis and requirement of antidiabetics. There was an interaction between age and history of cerebrovascular disease with a stronger impact on outcome in younger patients. The late (>30 days after CABG) 10-year mortality in the study cohort was 29.6% compared with 25.9% in the control population (P=0.02). CONCLUSION: Among patients who underwent CABG, 13 independent predictors for mortality were found, mainly among preoperative factors but also among peroperative factors, postoperative complications and medication requirement after CABG.
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| 24. |
- Herlitz, Johan, 1949, et al.
(författare)
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Quality of life 15 years after coronary artery bypass grafting.
- 2009
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Ingår i: Coronary artery disease. - : Lippincott Williams & Wilkins. - 1473-5830 .- 0954-6928. ; 20:6, s. 363-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To describe changes in quality of life (QoL) during 15 years after coronary artery bypass grafting (CABG) and prediction of impaired QoL after 15 years. METHODS: All patients in western Sweden who underwent primary CABG without simultaneous valve surgery between 1988 and 1991 were included. QoL during a period of 15 years after CABG was evaluated with three instruments: the Nottingham Health Profile, the Psychological General Well-Being Index, and the Physical Activity Score. RESULTS: A total of 2000 patients took part in the survey, (none excluded) of whom 808 were still alive after 15 years and 79% answered the inquiry. Despite an ongoing decline in QoL over the years, an improvement in QoL was maintained in most sub-dimensions at the 15-year follow-up compared with that prior to surgery. Seven factors emerged as predictors of impaired QoL 15 years after CABG. They are as follows: (i) high age, (ii) female sex, (iii) history of diabetes, (iv) obesity, (v) prolonged stay in the intensive care unit, (vi) prolonged treatment on a ventilator, (vii) need for inotropic drugs at the time of surgery; of which the latter three might be secondary to left ventricular dysfunction. CONCLUSION: Despite an ongoing decline in QoL over the years, there was still an improvement in most aspects of QoL 15 years after CABG compared with that before surgery. Intensified early treatment of diabetes, obesity, and left ventricular dysfunction in CABG patients might allow an even better long-term QoL.
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| 25. |
- Herlitz, Johan, 1949, et al.
(författare)
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Relief of symptoms and improvement of health-related quality of life five years after coronary artery bypass graft in women and men.
- 2001
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Ingår i: Clinical cardiology. - 0160-9289. ; 24:5, s. 385-92
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Tidskriftsartikel (refereegranskat)abstract
- Severe coronary artery disease can be successfully treated with coronary artery bypass graft (CABG), with considerable improvement in the symptoms of angina pectoris. Approximately three of four patients are free of ischemic events for 5 years; however, increased survival is demonstrated only in selected subgroups with advanced coronary artery disease, and this effect has not been established in elderly patients.
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| 26. |
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| 27. |
- Herlitz, Johan, 1949, et al.
(författare)
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Symptoms of chest pain and dyspnea and factors associated with chest pain after coronary artery bypass grafting.
- 1999
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 91:4, s. 220-6
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Tidskriftsartikel (refereegranskat)abstract
- Patients in western Sweden who underwent CABG from 1988 to 1991 received prior to coronary angiography and 2 and 5 years after CABG a questionnaire, in which they were asked about symptoms of chest pain and dyspnea. In all, 1,226 patients answered the inquiry prior to CABG, 1,531 patients 2 years and 1,359 patients 5 years after surgery. Both in terms of chest pain and dyspnea there was a marked improvement 2 and 5 years after CABG as compared with prior to surgery. However, between 2 and 5 years after surgery there was a minor deterioration, both regarding chest pain and dyspnea. The most statistically significant preoperative predictors for the occurrence of chest pain more than twice a week 5 years after surgery were concomitant valvular heart disease and obesity.
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| 28. |
- Herlitz, Johan, 1949, et al.
(författare)
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Symptoms of chest pain and dyspnea and factors associated with chest pain and dyspnea 10 years after coronary artery bypass grafting.
- 2008
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Ingår i: American heart journal. - : Elsevier BV. - 1097-6744 .- 0002-8703. ; 156:3, s. 580-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The purpose of the study is to describe (a) changes in physical activity and symptoms of chest pain and dyspnea during 10 years after coronary artery bypass grafting (CABG) and (b) risk indicators for chest pain and dyspnea 10 years after CABG. METHODS: This is a prospective observational study in Western Sweden. The study includes all patients who underwent CABG without simultaneous valve surgery and with no previous CABG between June 1, 1988, and June 1, 1991. All patients were prospectively followed up for 10 years. Evaluation of symptoms took place via postal inquiries before, 5, and 10 years after the operation. RESULTS: In all, 2,000 patients participated in a survey evaluating chest pain and dyspnea during 10 years after CABG. The overall 10-year mortality was 32%. The proportion of patients with no chest pain increased from 3% before surgery to 56% 5 years after the operation and 54% after 10 years. There was only one predictor for chest pain after 10 years and that was the duration of angina pectoris before surgery. The proportion of patients with no dyspnea increased from 12% before surgery to 40% after 5 years but decreased to 31% after 10 years. The most significant predictors for dyspnea after 10 years were female sex, obesity, diabetes mellitus, high age, duration of angina pectoris, functional class before CABG, and number of days in intensive care unit after CABG. CONCLUSION: During 10 years after CABG, one third died. After 10 years, 54% of the survivors were free from chest pain and 31% were free from dyspnea. Predictors for chest pain and dyspnea could be defined and reflected age, history, sex, obesity, preoperative complications, and symptom severity.
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| 29. |
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| 30. |
- Klint, Kjell, et al.
(författare)
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Revealed by degrees: Patients' experience of receiving information after in-hospital cardiac arrest.
- 2019
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Ingår i: Journal of clinical nursing. - : Wiley. - 1365-2702 .- 0962-1067. ; 28:9-10, s. 1517-1527
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Tidskriftsartikel (refereegranskat)abstract
- To describe patients' experience of receiving information about the event after having a cardiac arrest in hospital.In Sweden, approximately 2,600 people per year experience cardiac arrest in hospital. After a cardiac arrest, the patient is entitled to receive information about what has occurred. This information must be provided in a way that does not do the patient more harm than good. In order to provide information to patients in a satisfactory manner for them, knowledge about how patients react to information in this situation is valuable.We used a qualitative approach with interviews and content analysis.Twenty patients participated in face-to-face interviews analysed by content analysis. Consolidated criteria for reporting qualitative studies were used.The analysis resulted in three categories: Getting the information gradually, Understanding information received and Seeking clarity. The subcategories that emerged were as follows: Indirect information, Short and direct information, Explanatory information, Lack of information, Unsatisfactory information, Hard-to-understand information, Insight, Unanswered questions, Hard-to-formulate questions, Requesting information and Searching independently for knowledge.The patients needed gradual and repeated information during their hospitalisation, and repeated information was continually required after their discharge from hospital. Whether or how the information was given varied. The patients' experience was that they sometimes lacked opportunities for conversation and asking questions, while they also found it hard to formulate questions. Patients who have a cardiac arrest in hospital appear to have similar information needs to patients whose cardiac arrest takes place outside the hospital context.Information on the patient's cardiac arrest should be given in gradual stages, according to the patient's needs. The information needs to be repeated during the hospital stay and after discharge. Healthcare professional should gain insight into patients' responses and create information that is adapted to the individual.
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| 31. |
- Lindgren, Martin, et al.
(författare)
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BMI, sex and outcomes in hospitalised patients in western Sweden during the COVID-19 pandemic
- 2022
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- High body mass index (BMI) is associated with severe COVID-19 but findings regarding the need of intensive care (IC) and mortality are mixed. Using electronic health records, we identified all patients in western Sweden hospitalised with COVID-19 to evaluate 30-day mortality or assignment to IC. Adjusted logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for outcomes. Of totally 9761 patients, BMI was available in 7325 (75%), included in the study. There was a marked inverse association between BMI and age (underweight and normal weight patients were on average 78 and 75 years, whereas overweight and obese were 68 and 62 years). While older age, male sex and several comorbidities associated with higher mortality after multivariable adjustment, BMI did not. However, BMI >= 30 kg/m(2) (OR 1.46, 95% CI 1.21-1.75) was associated with need of IC; this association was restricted to women (BMI >= 30; OR 1.96 (95% CI 1.41-2.73), and not significant in men; OR 1.22 (95% CI 0.97-1.54). In this comprehensive hospital population with COVID-19, BMI was not associated with 30-day mortality risk. Among the obese, women, but not men, had a higher risk of assignment to IC.
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| 32. |
- Petursson, Petur, 1973, et al.
(författare)
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Admission glycaemia and outcome after acute coronary syndrome
- 2007
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Ingår i: Int J Cardiol. - : Elsevier Ireland Ltd. - 1874-1754 .- 0167-5273. ; 116:3, s. 315-20
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Acute phase hyperglycaemia has been associated with increased mortality in patients with acute coronary syndrome. We investigated whether the predictive value of admission hyperglycaemia for mortality differs between diabetics and non-diabetics with acute coronary syndrome. METHODS: Patients with acute coronary syndrome (n=1957) were followed up prospectively for 45 months. Patients were stratified into quartile groups defined by admission plasma glucose and hyperglycaemia was defined as plasma glucose of >9.4 mmol/l, which was the cut-off value for the 4th quartile. The relationship between admission hyperglycaemia and short-term (< or =30 day) and late (>30 day) mortality was analysed. RESULTS: Of 1957 patients, 22% had a history of diabetes. Among patients without diabetes, those with hyperglycaemia had both a higher 30-day mortality rate (20.2% vs. 3.5%, p<0.0001) and late mortality rate (19.1% vs. 11.7%, p=0.007). Hyperglycaemic patients with diabetes had a higher late mortality rate than diabetic patients with plasma glucose of < or =9.4 mmol/l (29.3% vs. 14.9%, p=0.001). Of patients with hyperglycaemia at admission, those without diabetes had a higher 30-day mortality rate compared with those with diabetes (p=0.002). CONCLUSION: Admission hyperglycaemia is a strong risk factor for mortality in patients with acute coronary syndrome and may be even stronger than a previous history of diabetes. Hyperglycaemic patients without recognised diabetes have a higher short-term mortality risk than hyperglycaemic patients with known diabetes.
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| 33. |
- Petursson, Petur, 1973, et al.
(författare)
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Association between glycometabolic status in the acute phase and 21/2 years after an acute coronary syndrome
- 2006
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Ingår i: Scand Cardiovasc J. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 40:3, s. 145-51
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Tidskriftsartikel (refereegranskat)abstract
- ObJECTIVES: To evaluate the association between glycometabolic status in the acute phase and 21/2 years later in patients with acute coronary syndrome (ACS). METHODS: Non-diabetic patients (n = 762) presenting with ACS were prospectively followed up for 21/2 years. Patients were stratified by admission plasma glucose (<6.1 mmol/l, 6.1 - 6.9 mmol/l and >or=7.0 mmol/l) and HbA1c (or=5.5%). The predictive value of glucose levels >or= 7.0 mmol/l and HbA1c >or= 5.5% for glycometabolic disturbance (i.e. diabetes or impaired fasting glycaemia (IFG)) was analysed. RESULTS: Of 762 patients, 13% had a diagnosis of diabetes and 16% had IFG at follow-up. The prevalence of glycometabolic disturbance at follow-up increased with increasing plasma glucose at admission, from 19% in patients with < 6.1 mmol/l to 42% in patients with >or= 7.0 mmol/l. Sixty-one percent of patients with HbA1c >or= 5.5% had glycometabolic disturbance after 21/2 years compared to only 25% of those with HbA1c < 5.5%. CONCLUSION: Non-diabetic patients with ACS and hyperglycaemia are at high risk for developing glycometabolic disturbance. HbA1c may be an even stronger predictor of glycometabolic disturbance than plasma glucose.
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| 34. |
- Shao, Linus Ruijin, 1964, et al.
(författare)
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Increase of SUMO-1 expression in response to hypoxia: direct interaction with HIF-1alpha in adult mouse brain and heart in vivo
- 2004
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Ingår i: FEBS letters. - : Wiley. - 0014-5793. ; 569:1-3, s. 293-300
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Tidskriftsartikel (refereegranskat)abstract
- The present study investigates the regulation of small ubiquitin-related modifier-1 (SUMO-1) expression in response to hypoxia in adult mouse brain and heart. We observed a significant increase in SUMO-1 mRNAs and proteins after hypoxic stimulation in vivo. Because SUMO-1 interacts with various transcription factors, including hypoxia-inducible factor-1beta (HIF-1beta) in vitro, we not only demonstrated that the HIF-1alpha expression is increased by hypoxia in brain and heart, but also provided evidence that SUMO-1 co-localizes in vivo with HIF-1alpha in response to hypoxia by demonstrating the co-expression of these two proteins in neurons and cardiomyocytes. The specific interaction between SUMO-1 and HIF-1alpha was additionally demonstrated with co-immunoprecipitation. These results indicate that the increased levels of SUMO-1 participate in the modulation of HIF-1alpha function through sumoylation in brain and heart.
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| 35. |
- Silverdal, Jonas, et al.
(författare)
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Prognostic differences in long-standing vs. recent-onset dilated cardiomyopathy.
- 2022
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Ingår i: ESC heart failure. - : Wiley. - 2055-5822. ; 9:2, s. 1294-1303
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to evaluate the outcome and prognostic factors in patients with dilated cardiomyopathy (DCM) and long-standing heart failure (LDCM) vs. recent-onset heart failure (RODCM).We compared 2019 patients with RODCM (duration <6months, mean age 58.6years, 70.7% male) with 1714 patients with LDCM (duration ≥6months, median duration 3.5years, mean age 62.5years, 73.7% male) included in the Swedish Heart Failure Registry in the years 2003-16. Outcome measures were all-cause, cardiovascular (CV), and non-CV death and hospitalizations; heart transplantation; and a combined outcome of all-cause death, heart transplantation, or heart failure (HF) hospitalization. Multivariable risk factor analyses were performed for the combined endpoint. All outcomes were more frequent in LDCM than in RODCM. The multivariable-adjusted hazard ratios (HRs) (95% confidence interval) for LDCM vs. RODCM were 1.56 (1.34-1.82), P<0.0001, for all-cause death over a median follow-up of 4.2 and 5.0years, respectively; 1.67 (1.36-2.05), P<0.0001, for CV death; 2.12 (1.14-3.91), P<0.0001, for heart transplantation; 1.36 (1.21-1.53), P<0.0001, for HF hospitalization; and 1.37 (1.24-1.52), P<0.0001, for the combined outcome. A propensity score-matched analysis yielded similar results. CV death was the main cause of mortality in LDCM and was higher in LDCM than in RODCM (P<0.0001). Almost all co-morbidities were significantly more frequent in LDCM than in RODCM, and the mean number of co-morbidities increased significantly with increased duration of disease, also after age adjustment. Age, New York Heart Association functional class, ejection fraction, and left bundle branch block were prognostically adverse. The only co-morbidity associated with the combined outcome regardless of HF duration was diabetes, in LDCM [HR 1.34 (1.15-1.56), P=0.0002] and in RODCM [HR 1.29 (1.04-1.59), P=0.018]. Male sex [HR 1.38 (1.18-1.63), P<0.0001] and aspirin use [HR 1.33 (1.14-1.55), P=0.0004] carried increased risk only in RODCM. Heart rate ≥75b.p.m. [HR 1.20 (1.04-1.37), P=0.01], atrial fibrillation [HR 1.24 (1.08-1.42), P=0.0024], musculoskeletal or connective tissue disorder [HR 1.36 (1.13-1.63), P=0.0014], and diuretic therapy [HR 1.40 (1.17-1.67), P=0.0002] were prognostically adverse only in LDCM.This nationwide study of patients with DCM demonstrates that longer disease duration is associated with worse prognosis. Co-morbidities are more common in long-standing HF than in recent-onset HF and are associated with worse outcome. With the increased survival seen in the last decades, our results highlight the importance of careful attention to co-morbid conditions in patients with DCM.
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| 36. |
- Silverdal, Jonas, et al.
(författare)
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Prognostic impact over time of ischaemic heart disease vs. non-ischaemic heart disease in heart failure
- 2020
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Ingår i: Esc Heart Failure. - : Wiley. - 2055-5822. ; 7:1, s. 265-274
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Tidskriftsartikel (refereegranskat)abstract
- Aims The aim of this study is to investigate the prognostic impact of ischaemic heart disease (IHD) in heart failure (HF) and its association to age, sex, left ventricular ejection fraction (EF), and HF duration, and furthermore, to evaluate if the impact of IHD has changed over time, in light of improved therapy. Methods and results We studied 30 946 patients with non-valvular HF, by accessing the Swedish Heart Failure Registry, from years 2000 to 2012. The mortality in 17 778 patients with clinical IHD was compared with 13 168 patients without IHD (non-IHD). There was a significantly worse outcome in IHD, with the crude mortality of 41.1% and the event rate per 100 person-years [95% confidence interval (CI)] of 14.8 (14.4-15.1), compared with 28.2% and 9.7 (9.4-10.0) in non-IHD. After multivariable adjustment, the hazard ratio (HR) (95% CI) for mortality, IHD vs. non-IHD, was 1.16 (1.11-1.22; P < 0.0001). Subgroup analyses showed significantly increased mortality in IHD, in all age subgroups, in all subgroups with EF < 50%, in both men and women, and regardless of heart failure duration more or less than 6 months. Analyses for the combination of age and EF showed the highest HR for time to death in the youngest with the lowest EF, HR (95% CI) 2.05 (1.59-2.64) for patients <60 years of age with EF < 30%. Although a numerical reduction of the HR for mortality was seen over time, the risk for mortality in IHD, compared with the non-IHD group, was greater throughout the study period. Conclusions In non-valvular heart failure, IHD was associated with significantly increased mortality, compared with non-IHD, in groups of EF below 50%, in all age groups, and regardless of sex or HF duration. The risk increase associated with EF reduction diminished with increasing age. The mortality in IHD, compared with non-IHD, remained significantly higher throughout the 13 year study period.
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| 37. |
- Silverdal, Jonas, et al.
(författare)
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Treatment response in recent-onset heart failure with reduced ejection fraction: non-ischaemic vs. ischaemic aetiology.
- 2023
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Ingår i: ESC heart failure. - : Wiley. - 2055-5822. ; 10:1, s. 542-551
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Tidskriftsartikel (refereegranskat)abstract
- In heart failure (HF) with reduced left ventricular ejection fraction (HFrEF), the prognosis appears better in non-ischaemic than in ischaemic aetiology. Infrequent diagnostic work-up for ischaemic heart disease (IHD) in HF is reported. In this study, we compared short-term response to initiated guideline-directed medical treatment (GDMT) in recent-onset HFrEF of non-ischaemic (non-IHF) vs. ischaemic (IHF) aetiology and evaluated the frequency of coronary investigation.Patients hospitalized with recent-onset HFrEF [left ventricular ejection fraction (LVEF)<40%] between 1 January 2016 and 31 December 2019 were included. Treatment response was determined by use of a hierarchical clinical composite outcome classifying each patient as worsened, improved, or unchanged based on hard outcomes (mortality, heart transplantation, and HF hospitalization) and soft outcomes (±≥10 unit change in LVEF, ±≥30% change in N-terminal pro-B-type natriuretic peptide, and ±≥1 point change in New York Heart Association functional class) during 28weeks of follow-up. The associations between baseline characteristics and composite changes were analysed with multiple logistic regression. Among the 364 patients analysed, 47 were not investigated for IHD. Comparing non-IHF (n=203) vs. IHF (n=114), patients were younger (mean age 61.0 vs. 69.4years, P<0.001) with lower mean LVEF (26% vs. 31%, P<0.001), but with similar male predominance (70.4% vs. 75.4%, P=0.363). For non-IHF vs. IHF, the composite outcomes were worsened (19.1% vs. 43.9%, P<0.001) and improved (74.2% vs. 43.9%, P<0.001). After multivariable adjustments, IHF was associated with increased odds for worsening [odds ratio (OR) 2.94; 95% confidence interval (CI) 1.51-5.74; P=0.002] and decreased odds for improvement (OR 0.35; 95% CI 0.18-0.65; P<0.001). In cases without previous IHD or new-onset myocardial infarction (n=261), a decision for coronary investigation was made in 69.0%.In recent-onset HFrEF, patients with non-IHF responded better to GDMT than patients with IHF. Almost one-third of patients selected for follow-up at HF clinics were never investigated for IHD.
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| 38. |
- Sjöland, Helen, 1959, et al.
(författare)
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A negative T-wave in electrocardiogram at 50 years predicted lifetime mortality in a random population-based cohort
- 2020
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Ingår i: Clinical Cardiology. - : Wiley. - 0160-9289 .- 1932-8737. ; 43:11, s. 1279-1285
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Tidskriftsartikel (refereegranskat)abstract
- Background Severe electrocardiographic (ECG) abnormalities in asymptomatic subjects correlate with cardiovascular risk. Hypothesis The role of minor ECG abnormalities is less well-known. We evaluated the association between a negative T-wave and mortality, as a possible marker for prognosis. Methods A prospective, population-based cohort, examined at 50 years, and followed until death. Time to death (event rates) and predictive role of a negative T-wave (Cox regression) were analyzed. Results Participants (n = 839) with a negative T-wave (7.3%) had significantly higher blood pressure (BP) (mean systolic 157.9 mmHg vs 136.8 mmHg without negative T-wave,P= <.0001). A negative T-wave correlated with elevated risk (hazard ratio [HR] [95% CI] [confidence interval]) for all-cause and cardiovascular (CV) death (1.59 (1.20-2.11)P= .0012 vs 1.91 (1.34-2.73)P= .0004). The association remained after excluding coexisting Q/QS patterns and ST-junction/segment depression ECG abnormalities (1.66 [1.13-2.44]P= .0098 for all-cause vs 1.87 [1.13-3.09]P= .015 for CV death). Death from other causes was not associated with a negative T-wave. A major negative T-wave carried higher risk than a minor (2.17 [1.25-3.76]P= .0062 vs 1.78 [1.13-2.79]P= .012) for CV death. Conclusion A negative T-wave at 50 years, in asymptomatic individuals, carried an increased risk of all-cause and CV death during lifetime follow-up.
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| 39. |
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| 40. |
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| 41. |
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| 42. |
- Sjöland, Helen, 1959, et al.
(författare)
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Influence of patient sex and clinical history on working capacity and myocardial ischemia after coronary artery bypass surgery.
- 1995
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Ingår i: Coronary artery disease. - 0954-6928. ; 6:7, s. 561-71
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Tidskriftsartikel (refereegranskat)abstract
- Coronary artery bypass grafting (CABG) is generally accepted as effective in relieving patients from angina pectoris, and in improving survival in subgroups. However, subset evaluations of myocardial ischemia and exercise capacity after CABG are scarce. The aim of this study was to determine the outcome of CABG in terms of exercise capacity and stress ECG findings in subgroups of patients.
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| 43. |
- Sjöland, Helen, 1959, et al.
(författare)
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Lack of very strong association between pre-treatment fibrinogen and PAI-1 with long-term mortality after coronary bypass surgery
- 2007
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Ingår i: Cardiology. - : S. Karger AG. - 1421-9751 .- 0008-6312. ; 108:2, s. 82-89
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore the association between the coagulation protein fibrinogen and the fibrinolytic biomarker plasminogen activator inhibitor-1 ( PAI- 1) and the long- term mortality after coronary artery bypass grafting ( CABG). Patients and Methods: In 729 patients undergoing CABG at Sahlgrenska University Hospital, a blood sample for fibrinogen and PAI-1 was collected prior to the procedure. Patients were followed for 10 years. Results: Among patients with high levels of fibrinogen (> 3.6 g/ l; median), the 10-year mortality was 32.3 vs. 20.7% among patients with fibrinogen levels below the median ( p = 0.0005). However, patients with higher levels of fibrinogen were older and had an adverse risk factor pattern. When adjusting for these differences, pre- operative fibrinogen levels did not clearly appear as an independent predictor of long- term mortality. The 10- year mortality was similar in patients with high ( 25.3%) and low ( 26.5%) levels of PAI-1. Conclusion: Our results do not suggest that fibrinogen and PAI- 1, when evaluated prior to the operative procedure, arestrongly associated with increased mortality in the longterm after CABG, when other co-morbidity factors are simultaneously considered.
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| 44. |
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| 45. |
- Sjöland, Helen, 1959, et al.
(författare)
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Temporal trends in outcome and patient characteristics in dilated cardiomyopathy, data from the Swedish Heart Failure Registry 2003-2015
- 2021
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Ingår i: BMC Cardiovascular Disorders. - : BMC. - 1471-2261 .- 1471-2261. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Temporal trends in clinical composition and outcome in dilated cardiomyopathy (DCM) are largely unknown, despite considerable advances in heart failure management. We set out to study clinical characteristics and prognosis over time in DCM in Sweden during 2003-2015. Methods DCM patients (n = 7873) from the Swedish Heart Failure Registry were divided into three calendar periods of inclusion, 2003-2007 (Period 1, n = 2029), 2008-2011 (Period 2, n = 3363), 2012-2015 (Period 3, n = 2481). The primary outcome was the composite of all-cause death, transplantation and hospitalization during 1 year after inclusion into the registry. Results Over the three calendar periods patients were older (p = 0.022), the proportion of females increased (mean 22.5%, 26.4%, 27.6%, p = 0.0001), left ventricular ejection fraction was higher (p = 0.0014), and symptoms by New York Heart Association less severe (p < 0.0001). Device (implantable cardioverter defibrillator and/or cardiac resynchronization) therapy increased by 30% over time (mean 11.6%, 12.3%, 15.1%, p < 0.0001). The event rates for mortality, and hospitalization were consistently decreasing over calendar periods (p < 0.0001 for all), whereas transplantation rate was stable. More advanced physical symptoms correlated with an increased risk of a composite outcome over time (p = 0.0043). Conclusions From 2003 until 2015, we observed declining mortality and hospitalizations in DCM, paralleled by a continuous change in both demographic profile and therapy in the DCM population in Sweden, towards a less affected phenotype.
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