| 1. |
- Boano, Gabriella, et al.
(författare)
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Cox-maze IV cryoablation and postoperative heart failure in mitral valve surgery patients
- 2017
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Ingår i: Scandinavian Cardiovascular Journal. - : Taylor & Francis. - 1401-7431 .- 1651-2006. ; 51:1, s. 15-20
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The indications for and the risk and benefit of concomitant surgical ablation for atrial fibrillation (AF) have not been fully delineated. Our aim was to survey whether the Cox-maze IV procedure is associated with postoperative heart failure (PHF) or other adverse short-term outcomes after mitral valve surgery (MVS).DESIGN: Consecutive patients with AF undergoing MVS with (n = 50) or without (n = 66) concomitant Cox-maze IV cryoablation were analysed regarding perioperative data and one-year mortality.RESULTS: The patients in the Maze group were younger, were in lower NYHA classes, had better right ventricular function and had lower pulmonary artery pressure. The Maze group had 30 min longer median cross-clamp time (CCT) and 50% had PHF compared with 33% in the No-maze group, p = 0.09. Two patients in the No-maze group died within one year of surgery. Congestive heart failure (OR 4.3 [CI 95%: 1.8-10], p < 0.0001) and CCT (OR 1.03 [CI 95%: 1.01-1.04], p = 0.001) were associated with PHF.CONCLUSION: The current data cannot exclude that concomitant cryoablation increases the risk for PHF, possibly by increasing the cross clamp time.
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| 2. |
- Carlén, Anna, et al.
(författare)
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Exercise-induced ST depression in an asymptomatic population without coronary artery disease
- 2019
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Ingår i: Scandinavian Cardiovascular Journal. - : Taylor & Francis. - 1401-7431 .- 1651-2006. ; 53:4, s. 206-212
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. Exercise electrocardiogram (ExECG) in low risk populations frequently generates false positive ST depression. We aimed to characterize factors that are associated with exercise-induced ST depression in asymptomatic men without coronary artery disease. Design. Cycle ergometer exercise tests from 509 male firefighters without imaging proof of significant coronary artery disease were analysed. Analysed test data included heart rate at rest before exercise, and workload, blood pressure, heart rate, ST depression and ST segment slope at peak exercise. ST depression of amp;gt;0.1 mV was considered significant (STdep). With a mean follow-up of 6.1 +/- 1.7 years, medical records were reviewed for cardiovascular diagnoses, hyperlipidemia and diabetes. Logistic regression analysis was used for risk assessment. Results. In total, 22% had STdep in amp;gt;= 1 lead. Subjects with STdep were older than those with normal ExECG (p amp;lt; .001). Downsloping STdep was more common in extremity leads (9%) than in precordial leads (2%). STdep was categorized according to location (precordial/extremity) and slope direction into eight categories. Larger age-adjusted heart rate increase predicted STdep in seven categories (p amp;lt; .05). Age-adjusted peak heart rate correlated with STdep in five categories, predominantly where the ST slope was positive. Peak blood pressure and exercise capacity were both associated with STdep in few categories. We found no association between STdep and hypertension, hyperlipidemia or diabetes (all p amp;gt; .05). Conclusions. In asymptomatic men with a physically demanding occupation and no coronary artery disease, both age and heart rate response were associated with ST depression, whereas common cardiovascular risk factors, blood pressure response and exercise capacity were not.
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| 3. |
- Carlén, Anna, 1985-
(författare)
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Exercise Testing in Firefighters : Work Capacity and Cardiovascular Risk Assessment in a Low-Risk Population
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background. Firefighting is one of the most physically demanding occupations and it requires a high cardiorespiratory fitness level.Pre-duty medical evaluation of firefighters includes fitness testing and assessment of cardiac health to ensure that firefighters meet the minimum physical fitness standard and to ensure that they are not at increased risk of cardiac events. The medical evaluation methods for Swedish firefighters are regulated by the Swedish Work Environment Authority and include a 6 min constant workload treadmill (TM) test for fitness evaluation in which the firefighter wears full smoke diving equipment and a maximal effort exercise electrocardiography test (ExECG) at cycle ergometer (CE) for assessment of cardiac health. Previously, fitness was also evaluated by cycle ergometry.The standard parameter for evaluation of ischaemic heart disease (IHD) is exercise-induced ST depression. In general, exercise testing of asymptomatic low-risk individuals is discouraged due to low sensitivity and specificity for IHD, generating both false-positive and false-negative test results. Heart rate (HR) adjustment of the ST-segment response has been shown to be superior to simple ST depression to evaluate cardiac ischaemia in some populations, but has not been extensively evaluated in an occupational setting.Methods. We retrospectively analysed a cohort of 774 firefighters who were asymptomatic at the time of the testing.In paper I, test approval, HR response, and calculated oxygen uptake from TM tests and CE tests for 424 firefighters (44±10 years) were compared.Paper II methodologically described the process for data extraction, processing, and calculation of ExECG data from a clinical database. Procedures for noise assessment, error checking, and computerized calculation of ST/HR parameters were described.In paper III, ExECG and medical records of 521 male firefighters (44±10 years) were studied. During 8.4 ± 2.1 years of follow-up, IHD was verified angiographically in 12 subjects. The predictive value of HR-adjusted ST variables (ST/HR index, ST/HR slope, and ST/HR loop) for IHD was evaluated.In paper IV, subjects with objectively verified IHD were excluded and factors associated with exercise-induced nonischaemic ST depression were studied in the remaining 509 males (46±11 years). Results. The firefighters had an average maximal exercise capacity of 281 ± 36 W (range 186-467 W) achieved by incremental CE exercise. To enable comparison, the maximal workload was converted to the workload sustainable for 6 min. It was more common to pass the 6 min TM fitness test but to fail the supposedly equivalent CE test rather than vice versa.Twenty percent of the firefighters developed an ST depression of ≥o.1 mV in at least one lead during exercise and half of the firefighters had a horizontal or downsloping ST depression. While an abnormal ST response associated with an increased risk for IHD only in V4, both an abnormal ST/HR index and an abnormal ST/HR slope associated with IHD in three leads each. Clockwise rotation of the ST/HR loop was infrequent in all precordial leads (1%), but it associated with an increased risk for IHD.In the subgroup without evidence of coronary artery disease, age and the HR response associated with ST depression, whereas hypertension, hyperlipidaemia, diabetes, blood pressure response, and exercise capacity did not. Conclusions. Even though the calculated oxygen uptake was higher for the TM test than for the supposedly equivalent CE test, the higher treadmill approval rate may indicate that the fitness requirement for Swedish firefighters has been lowered by changing the test modality.Exercise-induced ST depression was common in asymptomatic physically active men, although there were only a few cases of IHD during follow-up. If performing ExECG in asymptomatic, low-risk populations, ST/HR analysis could be given more importance. However, the limited clinical value of ExECG in low-risk populations was emphasised and needs to be reconsidered.In asymptomatic, physically active men without coronary artery disease, false-positive ST depressions can be partially explained by HR variables rather than by common cardiovascular risk factors and blood pressure response to exercise.
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| 4. |
- Carlén, Anna, et al.
(författare)
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Loaded treadmill walking and cycle ergometry to assess work capacity : a retrospective comparison in 424 firefighters.
- 2017
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Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 37:1, s. 37-44
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Tidskriftsartikel (refereegranskat)abstract
- The fitness of firefighters is regularly evaluated using exercise tests. We aimed to compare, with respect to age and body composition, two test modalities for the assessment work capacity. A total of 424 Swedish firefighters with cycle ergometer (CE) and treadmill (TM) tests available from Jan 2004 to Dec 2010 were included. We compared results from CE (6 min at 200 W, 250 W or incremental ramp exercise) with TM (6 min at 8° inclination, 4·5 km h(-1) or faster, wearing 24-kg protective equipment). Oxygen requirements were estimated by prediction equations. It was more common to pass the TM test and fail the supposedly equivalent CE test (20%), than vice versa (0·5%), P<0·001. Low age and tall stature were significant predictors of passing both CE and TM tests (P<0·05), while low body mass predicted accomplishment of TM test only (P = 0·006). Firefighters who passed the TM but failed the supposedly equivalent CE test within 12 months had significantly lower body mass, lower BMI, lower BSA and shorter stature than did those who passed both tests. Calculated oxygen uptake was higher in TM tests compared with corresponding CE tests (P<0·001). Body constitution affected approval differently depending on the test modality. A higher approval rate in TM testing suggests lower cardiorespiratory requirements compared with CE testing, even though estimated oxygen uptake was higher during TM testing. The relevance of our findings in relation to the occupational demands needs reconsidering.
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| 5. |
- Carlén, Anna, 1985-, et al.
(författare)
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ST/HR variables in firefighter exercise ECG : relation to ischemic heart disease
- 2019
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Ingår i: Physiological Reports. - : John Wiley & Sons. - 2051-817X. ; 7:2
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Tidskriftsartikel (refereegranskat)abstract
- Exercise electrocardiography (ExECG) is regularly performed by Swedish firefighters by law. Heart rate-corrected analysis of ST segment variables (ST/HR) has shown improved prediction of ischemic heart disease (IHD) compared to ST depression alone. This has not previously been extensively studied in asymptomatic persons with a low probability of IHD. We therefore evaluated the predictive performance of ST/HR analysis in firefighter ExECG. ExECG was studied in 521 male firefighters. During 8.4 ± 2.1 years, 2.3% (n = 12) were verified with IHD by catheterization or myocardial scintigraphy (age 51.5 ± 5.5 years) and were compared with firefighters without imaging proof of IHD (44.2 ± 10.1 years). The predictive value of ST depression, ST/HR index, ST/HR slope, and area and rotation of the ST/HR loop was calculated as age-adjusted odds ratios (OR), in 10 ECG leads. Predictive accuracy was analyzed with receiver operating characteristics (ROC) analysis. ST/HR index ≤-1.6 μV/bpm and ST/HR slope ≤-2.4 μV/bpm were associated with increased IHD risk in three individual leads (all OR > 1.0, P < 0.05). ST/HR loop area lower than the fifth percentile of non-IHD subjects indicated IHD risk in V4, V5, aVF, II, and -aVR (P < 0.05). ST depression ≤-0.1 mV was associated with IHD only in V4 (OR, 9.6, CI, 2.3-40.0). ROC analysis of each of these variables yielded areas under the curve of 0.72 or lower for all variables and leads. Clockwise-rotated ST/HR loops was associated with increased risk in most leads compared to counterclockwise rotation. The limited clinical value of ExECG in low-risk populations was emphasized, but if performed, ST/HR analysis should probably be given more importance.
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| 6. |
- Roberts, Jason D., et al.
(författare)
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Ankyrin-B dysfunction predisposes to arrhythmogenic cardiomyopathy and is amenable to therapy
- 2019
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Ingår i: Journal of Clinical Investigation. - : AMER SOC CLINICAL INVESTIGATION INC. - 0021-9738 .- 1558-8238. ; 129:8, s. 3171-3184
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Tidskriftsartikel (refereegranskat)abstract
- Arrhythmogenic cardiomyopathy (ACM) is an inherited arrhythmia syndrome characterized by severe structural and electrical cardiac phenotypes, including myocardial fibrofatty replacement and sudden cardiac death. Clinical management of ACM is largely palliative, owing to an absence of therapies that target its underlying pathophysiology, which stems partially from our limited insight into the condition. Following identification of deceased ACM probands possessing ANK2 rare variants and evidence of ankyrin-B loss of function on cardiac tissue analysis, an ANK2 mouse model was found to develop dramatic structural abnormalities reflective of human ACM, including biventricular dilation, reduced ejection fraction, cardiac fibrosis, and premature death. Desmosomal structure and function appeared preserved in diseased human and murine specimens in the presence of markedly abnormal beta-catenin expression and patterning, leading to identification of a previously unknown interaction between ankyrin-B and beta-catenin. A pharmacological activator of the WNT/beta-catenin pathway, SB-216763, successfully prevented and partially reversed the murine ACM phenotypes. Our findings introduce what we believe to be a new pathway for ACM, a role of ankyrin-B in cardiac structure and signaling, a molecular link between ankyrin-B and beta-catenin, and evidence for targeted activation of the WNT/beta-catenin pathway as a potential treatment for this disease.
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| 7. |
- Rudski, Lawrence G., et al.
(författare)
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Stressing the Cardiopulmonary Vascular System: The Role of Echocardiography
- 2018
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Ingår i: Journal of the American Society of Echocardiography. - : MOSBY-ELSEVIER. - 0894-7317 .- 1097-6795. ; 31:5, s. 527-
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Forskningsöversikt (refereegranskat)abstract
- The cardiopulmonary vascular system represents a key determinant of prognosis in several cardiorespiratory diseases. Although right heart catheterization is considered the gold standard for assessing pulmonary hemodynamics, a comprehensive noninvasive evaluation including left and right ventricular reserve and function and cardiopulmonary interactions remains highly attractive. Stress echocardiography is crucial in the evaluation of many cardiac conditions, typically coronary artery disease but also heart failure and valvular heart disease. In stress echocardiographic applications beyond coronary artery disease, the assessment of the cardiopulmonary vascular system is a cornerstone. The possibility of coupling the left and right ventricles with the pulmonary circuit during stress can provide significant insight into cardiopulmonary physiology in healthy and diseased subjects, can support the diagnosis of the etiology of pulmonary hypertension and other conditions, and can offer valuable prognostic information. In this state-of-the-art document, the topic of stress echocardiography applied to the cardiopulmonary vascular system is thoroughly addressed, from pathophysiology to different stress modalities and echocardiographic parameters, from clinical applications to limitations and future directions.
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| 8. |
- Svensson, Anneli, et al.
(författare)
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Arrhythmogenic Right Ventricular Cardiomyopathy - 4 Swedish families with an associated PKP2 c.2146-1G>C variant.
- 2016
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Ingår i: American journal of cardiovascular disease. - Madison, WI, United States : E-Century Publishing Corporation. - 2160-200X. ; 6:2, s. 55-65
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Tidskriftsartikel (refereegranskat)abstract
- In this study, the genotype-phenotype correlations in four unrelated families with a PKP2 c.2146-1G>C gene variant were studied. Our primary aim was to determine the carriers that fulfilled the arrhythmogenic right ventricular cardiomyopathy (ARVC) diagnostic criteria of 2010. Our secondary aim was to investigate whether any specific clinical characteristics can be attributed to this particular gene variant. Index patients were assessed using next generation ARVC panel sequencing technique and their family members were assessed by Sanger sequencing targeted at the PKP2 c.2146-1G>C variant. The gene variant carriers were offered a clinical follow-up, with evaluation based on the patient's history and a standard set of non-invasive testing. The PKP2 c.2146-1G>C gene variant was found in 23 of 41 patients who underwent the examination. Twelve of the 19 family members showed "possible ARVC". One with "borderline ARVC" and the rest with "definite ARVC" demonstrated re-polarization disturbances, but arrhythmia was uncommon. A lethal event occurred in a 14-year-old boy. In the present study, no definitive genotype-phenotype correlations were found, where the majority of the family members carrying the PKP2 c.2146-1G>C gene variant were diagnosed with "possible ARVC". These individuals should be offered a long-term follow-up since they are frequently symptomless but still at risk for insidious sudden cardiac death due to ventricular arrhythmia.
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| 9. |
- Åström Aneq, Meriam
(författare)
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Arytmogen högerkammarkardiomyopati
- 2016
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Ingår i: Idrott och hjärtat. - : Studentlitteratur. - 9789144096186 ; , s. 141-150
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 10. |
- Åström Aneq, Meriam, 1964-
(författare)
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Progression of Right Ventricular Structural Changes and Ventricular Arrhythmias in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D).J Svetlichnaya, M Astrom Aneq, S Sharma1, M Scheinman, L Klein.
- 2015
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Ingår i: Heart Rythm Society Congress; Boston, May 13-15, 2015.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by progressive right ventricular (RV) enlargement and systolic dysfunction. Implantation of an transvenous cardioverter-defibrillator (ICD) is frequently used to treat ventricular arrhythmias in ARVC but its effect on RV structural and functional changes has not been investigated. Objective: We studied whether an ICD might affect the rate of RV structure and functional changes in patients with ARVC. Methods: In a two-center multinational cohort of 46 pts (37±12 years, 50% men) with definite ARVC by revised 2010 Task Force Criteria, we reviewed 3.5±1.6 serial echocardiograms (range 2-11) over a mean follow-up of 6.7±3.5 years. Echocardiographic measurements included RV outflow tract (RVOT) proximal diameter in parasternal long axis (PLAX) and distal diameter in short axis (PSAX), RV-end diastolic area (RVEDA) and fractional area change (FAC). Statistical analysis was performed using t-tests for continuous and chi-squared test for categorical variables. Results: ICDs were present in 29 pts (63%). All pts enrolled at US site were encouraged to have an ICD as compared to the European site (96 vs 24%, p<0.001). In the European site, only those judged to be at high risk underwent included ICD insertion for ventricular arrhythmia (X) and/or for severe RV dysfunction (Y). Patients were evenly matched with respect to age, gender, presence of a desmosomal genetic mutation and baseline medical therapy (Table 1). The mean RVEDA and RVOT PLAX were similar in pts with and without ICDs but baseline RVOT PSAX was higher in the ICD group and FAC was substantially lower (36±10 vs 46±10%, p=0.001). When adjusted for baseline values, there was a nearly 2-fold increase in the rate of annual RVEDA increase (0.9 vs 0.5 cm2/year p=0.235) and a significant increase in rate of annual PLAX enlargement (0.07 vs 0.01 cm/year, p=0.013). All patients with ICDs had 1.2+ T.R. Conclusions: Although ICDs were implanted in pts with lower baseline RV systolic function, after adjustment for baseline values, pts with ICDs had more rapid progression of RV enlargement. We hypothesize that the RV lead with attendant tricuspid regurgitation leads to further deterioration in RV structure and function.
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| 11. |
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| 12. |
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| 13. |
- Åström Aneq, Meriam, et al.
(författare)
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Right ventricular systolic function and mechanical dispersion identify patients with arrhythmogenic right ventricular cardiomyopathy.
- 2018
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Ingår i: Clinical Physiology and Functional Imaging. - : Wiley-Blackwell Publishing Inc.. - 1475-0961 .- 1475-097X. ; 38:5, s. 779-787
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To assess right ventricular (RV) regional and global systolic function using feature tracking (FT) in patients with a definite diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) and to investigate if changes in strain amplitude and mechanical dispersion indicate a propensity for arrhythmia.MATERIALS AND METHODS: Twenty-seven patients fulfilling Task Force Criteria for ARVC and 24 healthy volunteers underwent MR at 1·5 Tesla. Steady-state free precession cine of long-axis slices and a short-axis stack of the RV was acquired. Segmental longitudinal systolic strain amplitude and time-to-peak (TTP) strain were measured in the four- and two-chamber views of the RV.RESULTS: Compared to controls, patients with ARVC had lower RV ejection fraction (RVEF), (53% vs 57%, P = 0·012) and lower longitudinal strain amplitude in the RV free wall (-20·6 vs -26·3%, P = 0·014) and in the basal part of the RV (-22·8 vs -31·7%, P<0·001). Mechanical dispersion, defined as the standard deviation (SD) of TTP of RV segments, was larger in patients with ARVC (48 ms [21-74] vs 35 ms [13-66 ms], P = 0·02). Patients with ventricular tachycardia (VT) or non-sustained VT had lower RVEF (46% vs 55%, P = 0·008), but did not have significantly lower RV strain amplitude (-19·5% vs 21·0%, P = 0·073) and no signs of mechanical dispersion (49 ms vs 48 ms, P = 0·861) compared to patients without arrhythmia.CONCLUSION: ARVC patients had lower longitudinal absolute strain amplitude in basal RV segments and increased mechanical dispersion compared to healthy volunteers, but the presence of mechanical dispersion was not predictive of ventricular arrhythmia.
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| 14. |
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