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| 2. |
- Doerstling, Steven, et al.
(författare)
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Growth differentiation factor 15 in a community-based sample : age-dependent reference limits and prognostic impact
- 2018
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Ingår i: Upsala Journal of Medical Sciences. - : TAYLOR & FRANCIS LTD. - 0300-9734 .- 2000-1967. ; 123:2, s. 86-93
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite the growing body of evidence on growth differentiation factor 15 (GDF-15) reference values for patients with existing cardiovascular disease, limited investigation has been dedicated to characterizing the distribution and prognostic impact of GDF-15 in predominantly healthy populations. Furthermore, current cutoff values for GDF-15 fail to account for the well-documented age-dependence of circulating GDF-15. Methods: From 810 community-dwelling older adults, we selected a group of apparently healthy participants (n = 268). From this sample, circulating GDF-15 was modeled using the generalized additive models for location scale and shape (GAMLSS) to develop age-dependent centile values. Unadjusted and adjusted Cox proportional hazards models were used to assess the association between the derived GDF-15 reference values (expressed as centiles) and all-cause mortality. Results: Smoothed centile curves showed increasing GDF-15 with age in the apparently healthy participants. An approximately three-fold difference was observed between the 95th and 5th GDF-15 centiles across ages. In a median 8.0 years of follow-up, 97 all-cause deaths were observed in 806 participants with eligible values. In unadjusted Cox regression analyses, the hazard ratio (95% CI) for all-cause mortality per 25-unit increase in GDF-15 centile was 1.80 (1.48-2.20) and dichotomized at the 95th centile, >= 95th versus <95th, was 3.04 (1.99-4.65). Age-dependent GDF-15 centiles remained a significant predictor of all-cause mortality in all subsequent adjusted models. Conclusions: Age-dependent GDF-15 centile values developed from a population of apparently healthy older adults are independently predictive of all-cause mortality. Therefore, GDF-15 reference values could be a useful tool for risk-stratification in a clinical setting.
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| 3. |
- Hedberg, Pär, et al.
(författare)
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Long-term prognostic impact of left atrial volumes and emptying fraction in a community-based cohort
- 2017
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Ingår i: Heart. - : BMJ. - 1355-6037 .- 1468-201X. ; 103:9, s. 687-693
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We hypothesised that left atrial emptying fraction (LAEF) would predict long-term cardiovascular outcome in the general population and better so than left atrial (LA) volumes.Methods: A community-based sample (n=740) in sinus rhythm prospectively underwent clinical evaluation, echocardiography and blood analyses including N terminal pro B-type natriuretic peptide (NTproBNP). The LA maximum (LAVmax) and minimum volumes (LAVmin) were indexed to body surface area (LAVImax and LAVImin, respectively). LAEF was calculated as LAVmaxLAVmin divided by LAVmax. The participants were followed for a median of 4.9 years regarding incident cardiovascular events (cardiovascular death or hospitalisation because of myocardial infarction, heart failure or stroke). Cox regression models were used to evaluate the associations of LA volumes and LAEF with the outcome.Results: In a multivariable beta regression model, including clinical and echocardiographic baseline characteristics, higher plasma levels of NTproBNP, higher E/e' and left ventricular systolic dysfunction remained as independent determinants of a lower LAEF. After adjustment for baseline characteristics, including NTproBNP levels, LAEF (HR for 1 SD decrease 1.33, 95% CI 1.04 to 1.70, p=0.022), but not LAVImax (HR for 1 SD increase 0.88, 95% CI 0.70 to 1.10, p=0.25) or LAVImin (HR for 1 SD increase 1.02, 95% CI 0.83 to 1.27, p=0.83) remained independently associated with outcome.Conclusions: In this community-based cohort, LAEF was a powerful predictor of incident cardiovascular events and its predictive ability was stronger than for LA volumes. Our findings suggest that LA dysfunction may represent a more advanced state of LA remodelling than LA enlargement.
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| 4. |
- Henriksen, Egil, et al.
(författare)
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Associations of left atrial volumes and Doppler filling indices with left atrial function in acute myocardial infarction
- 2019
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Ingår i: Clinical Physiology and Functional Imaging. - : WILEY. - 1475-0961 .- 1475-097X. ; 39:1, s. 85-92
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Tidskriftsartikel (refereegranskat)abstract
- Recent findings suggest that left atrial (LA) function is more strongly related to adverse prognosis than LA volumes. We aimed to evaluate the associations between LA volumes and Doppler filling indices with LA function. Echocardiographic LA volumes (LAVs), mitral valve early (MV-E) and late (MV-A) peak flow velocities, and mitral atrioventricular plane tissue-Doppler early (TD-e ') and late (TD-a ') peak velocities were obtained in 320 patients with acute myocardial infarction (AMI) free from atrial fibrillation and more than moderate valvular disease. LA function was estimated as the LA emptying fraction (LAEF), that is 100x (LAVmax-LAVmin)/LAVmax. LA reservoir volume was calculated as LAVmax-LAVmin and LA transit volume as LV stroke volume-reservoir volume. In restricted cubic spline regression analyses with multivariable adjustment, a reduced LAEF was strongly associated with smaller reservoir volume, larger transit volume, LAVmax, LAVpreA and especially LAVmin. MV-E linearly increased with a lower LAEF, whereas MV-A decreased but only below LAEF levels of approximately 45%. The resulting E/A ratio showed a sudden increase in LAEF levels below similar to 45%. Lower TD-a ' was linearly associated with a lower LAEF. In conclusion, a reduced atrial function was associated with smaller LA reservoir volume, larger LA transit volume, lower TD-a ', a non-linear decrease in MV-A and a non-linear increase in E/A. Our findings are likely a reflection of the adaptation to sustain LV filling volume and counteracting a rise in pulmonary venous pressure in face of an enhanced LV end-diastolic pressure.
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| 5. |
- Henriksen, Egil, et al.
(författare)
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Echocardiographic assessment of maximum and minimum left atrial volumes : a population-based study of middle-aged and older subjects without apparent cardiovascular disease
- 2015
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Ingår i: The International Journal of Cardiovascular Imaging. - : Springer Science and Business Media LLC. - 1569-5794 .- 1875-8312 .- 1573-0743. ; 31:1, s. 57-64
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to obtain reference values of maximum and minimum left atrial volumes (maxLAV and minLAV, respectively) in a population-based subset without apparent cardiovascular disease or other factors potentially associated with left atrial enlargement. Because left ventricular diastolic dysfunction is commonly found in elderly subjects, we also tried to identify the presence of possible preclinical diastolic dysfunction in the study population. A population-based sample of 168 subjects (127 men and 41 women) underwent two-dimensional echocardiography using the single-plane disc method to determine maxLAV and minLAV. maxLAV and minLAV were indexed to body surface area (maxLAVi and minLAVi, respectively). maxLAVi was independent of age and sex, and produced reference limits (mean +/- A 1.96 SD) of 15-37 mL/m(2). minLAVi was correlated with age, and produced estimated reference limits of 3-15 and 7-23 mL/m(2) in 40- and 80-year-old subjects, respectively. Based on the age-dependent reference values from the European Association of Cardiovascular Imaging, < 5 % of the study population had possible preclinical left ventricular diastolic dysfunction. The present study established normal ranges for maxLAVi and minLAVi in a well-characterized population-based subset without apparent cardiovascular disease or other factors potentially associated with left atrial volume enlargement.
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| 6. |
- Hysing, Per, et al.
(författare)
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Prevalence and prognostic impact of electrocardiographic abnormalities in outpatients with extracardiac artery disease
- 2018
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Ingår i: Clinical Physiology and Functional Imaging. - : WILEY. - 1475-0961 .- 1475-097X. ; 38:5, s. 823-829
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Tidskriftsartikel (refereegranskat)abstract
- Identifying cardiac disease in patients with extracardiac artery disease (ECAD) is essential for clinical decision-making. Electrocardiography (ECG) is an easily accessible tool to unmask subclinical cardiac disease and to risk stratify patient with or without manifest cardiovascular disease (CV). We aimed to examine the prevalence and prognostic impact of ECG changes in outpatients with ECAD. Outpatients with carotid or lower extremity artery disease (n = 435) and community-based controls (n = 397) underwent resting ECG. The patients were followed during a median of 4.8 years for CV events (hospitalization or death caused by ischaemic heart disease, cardiac arrest, heart failure, or stroke). ECG abnormalities were classified according to the Minnesota Code. Major (33% versus 15%, P<0.001) but not minor ECG abnormalities (23% versus 26%, P = 0.42) were significantly more common in patients versus controls. During the follow-up, 141 patients experienced CV events. Both major ECG abnormalities [hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.11-2.25, P = 0.012] and any ECG abnormalities (HR 1.57, 95% CI 1.06-2.33, P = 0.024) were significantly associated with CV events after adjustment for potential risk factors. In conclusion, ECG abnormalities were common in these outpatients with ECAD. Major and any ECG abnormalities were independent predictors of CV events. Addition of easily accessible ECG information might be useful in risk stratification for such patients.
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| 7. |
- Larsson, Charlotta, et al.
(författare)
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Anal incontinence after caesarean and vaginal delivery in Sweden : a national population-based study
- 2019
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Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 393:10177, s. 1233-1239
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Tidskriftsartikel (refereegranskat)abstract
- Background: Elective caesarean delivery is increasing rapidly in many countries, and one of the reasons might be that caesarean delivery is widely believed to protect against pelvic floor disorders, including anal incontinence. Previous studies on this issue have been small and with conflicting results. The aim of present study was to compare the risk of developing anal incontinence in women who had a caesarean delivery, in those who had a vaginal delivery, and in two age-matched control groups (nulliparous women and men).Methods: In this observational population-based study, we included all women in the Swedish Medical Birth Register who gave birth by caesarean delivery or vaginal delivery during 1973-2015 in Sweden and were diagnosed with anal incontinence according to ICD 8-10 in the Swedish National Patient Register during 2001-15. Exclusion criteria were multiple birth delivery, mixed vaginal and caesarean delivery, and four or more deliveries. We compared the diagnosis of anal incontinence between women previously delivered solely by caesarean delivery and those who solely had delivered vaginally. We also compared it with two age-matched control groups of nulliparous women and men from the Swedish Total Population Register. Finally, we analysed risk factors for anal incontinence in the caesarean delivery and vaginal delivery groups.Findings: 3 755 110 individuals were included in the study. Between 1973 and 2015, 185 219 women had a caesarean delivery only and 1 400 935 delivered vaginally only. 416 (0.22 %) of the 185 219 women in the caesarean delivery group were diagnosed with anal incontinence compared with 5171 (0.37%) of 1 400 935 women in the vaginal delivery group. The odds ratio (OR) for being diagnosed with anal incontinence after vaginal delivery compared with caesarean delivery was 1 center dot 65 (95% CI 1 center dot 49-1 center dot 82; p<0.0001). When the combination vaginal delivery and caesarean delivery was compared with the nulliparous control group, the OR of being diagnosed with anal incontinence was 2 center dot 05 (1 center dot 92-2 center dot 19; p<0.0001). For the nulliparous women compared with men, the OR for anal incontinence was 1 center dot 89 (1 center dot 75-2 center dot 05; p<0.0001). The strongest risk factors for anal incontinence after vaginal delivery were high maternal age, high birthweight of the child, and instrumental delivery. The only risk factor for anal incontinence after caesarean delivery was maternal age.Interpretation: The risk of developing anal incontinence increases after pregnancy and delivery. Women with known risk factors for anal incontinence should perhaps be offered a more qualified post-partum examination to enable early intervention in case of injury. Further knowledge for optimal management are needed. Copyright (c) 2019 Elsevier Ltd. All rights reserved.
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| 8. |
- Ljungstrand, Erik, et al.
(författare)
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Åtgärdsprogram för jämtlandsmaskros, 2014–2019 : (Taraxacum crocodes)
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Jämtlandsmaskros (Taraxacum crocodes) är en flerårig växt, som endast är känd från Sverige och Norge och därav nordisk endem. Huvuddelen av lokalerna finns i landskapen Medelpad, Härjedalen, Jämtland och Lappland. De viktigaste miljöerna för jämtlandsmaskros utgörs av steniga eller grusiga stränder och strandängar vid oreglerade eller svagt reglerade vattendrag och sjöar.Inom centrala Jämtlands kalkbergrundsområde påträffas jämtlandsmaskrosen även i kalkfuktängar, som sköts med slåtter eller bete samt i kalkblekemiljöer. Den största enskilda faktorn bakom jämtlandsmaskrosens tillbakagång är vattenkraftens exploatering av vattendrag och sjöar. Därnäst i betydelse för jämtlandsmaskrosens tillbakagång kommer upphörd hävd av naturliga fodermarker.Viktiga åtgärder som föreslås är hydrologisk återställning av vattendrag och förbättrade rutiner hos myndigheter avseende artskydd vid tillsyn av pågående vattenreglering samt fortsatt skötsel av lokaler som är hävdberoende.
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| 9. |
- Magnusson, Niklas, 1975-, et al.
(författare)
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Reoperation for persistent pain after groin hernia surgery : a population-based study
- 2015
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 19:1, s. 45-51
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of the present study was to assess the outcome results after reoperation for persistent pain after hernia surgery in a population-based setting.Methods: All patients who had undergone surgery for persistent pain after previous groin hernia surgery 1999-2006 were identified in the Swedish Hernia Register (n = 237). Data on the surgical technique used were abstracted from the medical records. The patients were asked to answer a set of questions including SF-36 to evaluate the prevalence of pain after reoperation.Results: The study group consisted of 95 males and 16 females, mean age 53 years. In 27 % of cases an intervention aimed at suspected ilioinguinal neuralgia was performed. The mesh was removed completely in 28 % and partially in 13 %. A suture at the pubic tubercle was removed in 13 % of cases. Decrease in pain after the most recent reoperation was reported by 69 patients (62 %), no change in pain by 21 patients (19 %) and increase in pain in 21 patients (19 %). There was no significant difference in outcome between mesh removal, removal of sutures at the tubercle or interventions aimed at the ilioinguinal nerve. All subscales of SF-36 were significantly reduced when compared to the age-and gender-matched general population (p < 0.05).Conclusions: Patients reoperated for persistent pain after hernia surgery often report a reduction in pain, but the natural course of persistent pain, the relatively low response rate and selection of patients make it difficult to draw definite conclusions.
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| 10. |
- Nilsson, Göran, et al.
(författare)
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Basic Anthropometric Measures in Acute Myocardial Infarction Patients and Individually Sex- and Age-Matched Controls from the General Population
- 2018
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Ingår i: Journal of Obesity. - : Hindawi Limited. - 2090-0708 .- 2090-0716.
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Tidskriftsartikel (refereegranskat)abstract
- We compared weight, height, waist and hip circumferences (hip), body mass index (BMI), and waist-to-hip ratio in acute myocardial infarction (MI) patients and individually sex-and age-matched control subjects from the general population in the catchment area of the patients and predicted the risk of MI status by these basic anthropometric measures. The study cohort comprised 748 patients <= 80 years of age with acute MI from a major Swedish cardiac center and their individually sex- and age-matched controls. The analyses were stratified for sex and age (<= 65/>= 66 years). Risk of MI was assessed by conditional logistic regression. A narrow hip in men >66 years was the single strongest risk factor of MI among the anthropometric measures. The combination of hip and weight was particularly efficient in discriminating men >= 66 years with MI from their controls (area under the receiver operating characteristic (AUROC) curve = 0.82). In men <= 65 years, the best combination was hip, BMI, and height (AUROC = 0.79). In women >= 66 years, the best discriminatory model contained only waist-to-hip ratio (AUROC = 0.67), whereas in women <= 65 years, the best combination was hip and BMI (AUROC = 0.68). A narrow hip reasonably reflects small gluteal muscles. This finding might suggest an association between MI and sarcopenia, possibly related to deficiencies in physical activity and nutrition.
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