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- Labaf, A., et al.
(författare)
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Predictive accuracies of CHA2DS2-VASc and HAS-BLED, and anticoagulation quality in relation to thromboemblism and bleeding in patients with mechanical heart valves
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 34:Supplement: 1, s. 379-379
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: The variability of international normalized ratio (INR) is considered a risk factor in patients with mechanical heart valves (MHV)and INR target range still remains unestablished. CHA2DS2-VASc andHAS-BLED are risk stratification schemas designed for atrial fibrillation. Their ability to discriminate thromboembolism (TE) and bleeding for patients with MHV have never been investigated.Methods: We conducted a complete study of all patients with MHV followed in two centres. A total of 407 and 140 patients respectively were followed between 2008-2011. Data on INR, time in therapeutic range (TTR), variability, CHA2DS2-VASc and HAS-BLED were extracted.Results: The mean (±SD) age in centre 1 and 2 were 70 (14) and 61 (14) respectively. The target INR range for all MHV was 2-4 in centre 1 and 2-3 in centre 2 and mean INR was 2.9 (0.31) and 2.6 (0.19) respectively. The incidence of TE was 3.4 per 100 patient-years in centre 1 and 1.4 per 100 patient-years in centre 2, p=0.035, and for major bleeding 4.9 per 100 patient-years and 1.7 per 100 patient-years respectively, p=0.005. TheHAS-BLED score correlated well with bleeding, with area under the curveof 0.63 (95% confidence interval [CI]: 0.57-0.70). CHA2DS2-VASc had 0.56 (95% CI: 0.48-0.64) for TE. Adding atrial fibrillation as a risk factor did not improve the c statistic. INR variability (SD), comparing the 3rd tertile with the first had (Odds ratio [OR]: 4.05; 95% [CI]: 2.09-7.84) for major bleeding and (OR: 2.01; 95% [CI]: 1.0-3.99) for TE. INR SD was higher with a higher mean INR and target range 2-4 (p<0.001) andindependently predicted bleeding.Conclusion: HAS-BLED predicted bleeding with discriminatory ability similar to previous reports to atrial fibrillation whilst CHA2DS2-VAScpredictive ability for TE was modest. Higher INR intensity is associated with higher variability, which correlates to primarily bleeding, but also TE. Some of the difference between the groups considering TE can be accounted for more significant risk factors in the centre 1 cohort. A more narrow INR target range could be recommended to reduce variability ofanticoagulation.
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- Malmgren, A., et al.
(författare)
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Electrocardiographic manifestations in female team handball players : analyzing ECG changes in athletes
- 2024
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Ingår i: Frontiers in Sports and Active Living. - : Frontiers Media S.A.. - 2624-9367. ; 6, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Long-term intense training leads to structural, functional, and electrical remodeling of the heart. How different sports affect the heart has not been fully investigated, particularly for female athletes. The aim of the present study was to investigate the morphology of 12-lead resting electrocardiogram (ECG) in elite female handball players compared to non-athlete female subjects. Potential changes will be explored to see if they could be explained by differences in cardiac dimensions and exercise hours.Materials and methods: A cross-sectional study of 33 elite female team handball players compared to 33 sex and age-matched, non-athletic controls (age range 18-26 years) was performed. All participants underwent a resting 12-lead ECG and an echocardiographic examination. ECG variables for left ventricular hypertrophy and durations were evaluated and adjusted for cardiac dimensions and exercise hours using ANCOVA analysis. A linear regression analysis was used to describe relation between echocardiographic and ECG measures and exercise hours.Results: The female handball players had larger cardiac dimensions and significantly lower heart rate and QTc duration (Bazett's formula) as well as increased QRS and QT durations compared to controls. The 12-lead sum of voltage and the 12-lead sum of voltage & lowast; QRS were significantly higher among handball players. Changes in ECG variables reflecting the left ventricle could in part be explained by left ventricular size and exercise hours. Correlation with exercise hours were moderately strong in most of the echocardiographic measures reflecting left ventricular (LV), left ventricular mass (LVM), left atrium (LA) and right atrium (RA) size. Poor to fair correlations were seen in the majority of ECG measures.Conclusions: Female team handball players had altered ECGs, longer QRS and QT durations, higher 12-lead sum of voltage and 12-lead sum of voltage & lowast; QRS as well as shorter QTc (Bazett's formula) duration compared to non-athletic controls. These findings could only partly be explained by differences in left ventricular size. Despite larger atrial size in the athletes, no differences in P-wave amplitude and duration were found on ECG. This suggest that both structural, and to some degree electrical remodeling, occur in the female team handball players' heart and highlight that a normal ECG does not rule out structural adaptations. The present study adds knowledge to the field of sports cardiology regarding how the heart in female team handball players adapts to this type of sport.
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