| 1. |
- Hartford, Marianne, 1944, et al.
(författare)
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Interleukin-18 as a Predictor of Future Events in Patients With Acute Coronary Syndromes.
- 2010
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Ingår i: Arteriosclerosis, thrombosis, and vascular biology. - : Lippincott Williams & Wilkins. - 1524-4636 .- 1079-5642. ; 30:10, s. 2039-2046
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to assess the short- and long-term prognostic significance of interleukin-18 (IL-18) levels in patients with acute coronary syndromes (ACS). METHODS AND RESULTS: In patients hospitalized with ACS (median age, 66 years; 30% females), we evaluated associations of serum IL-18 levels from day 1 (n=1261) with the short- (<3 months) and long-term (median, 7.6 years) risk of death, development of congestive heart failure (CHF), and myocardial infarction (MI). IL-18 was not significantly associated with short-term mortality. In the long term, IL-18 levels were significantly related to all-cause mortality, even after adjustment for clinical confounders (hazard ratio [HR], 1.19; 95% confidence interval, 1.07 to 1.33; P=0.002). Long-term, cardiovascular mortality was univariately related to IL-18, and the adjusted relation between noncardiovascular mortality and IL-18 was highly significant (HR, 1.36; 95% confidence interval, 1.11 to 1.67; P=0.003). IL-18 independently predicted CHF, MI, and cardiovascular death/CHF/MI in both the short and long term. Measurements from day 1 of ACS and 3 months after ACS had a similar power to predict late outcome. CONCLUSIONS: The addition of the measurement of IL-18 to clinical variables improved the prediction of risk of all-cause and noncardiovascular mortality. The association between IL-18 and noncardiovascular mortality is intriguing and warrants further study.
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| 2. |
- Persson, Anita, 1971
(författare)
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Echocardiographic assessment and B-type natriuretic peptide for risk evaluation in acute coronary syndromes
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Acute coronary syndromes (ACS) is one of the most common causes of emergency medical care and the single most common cause of death in Sweden in both men and women. Despite a significant improvement in survival in the acute phase, the frequency of rehospitalization and death in subsequent years is unacceptably high. An estimation of future risk should therefore be a central part of the care of patients with ACS. Echocardiography for the evaluation of left ventricular (LV) function has become an important component in risk assessment. Further, the usefulness of various biochemical variables has been recognized and B-type natriuretic peptide (BNP) has been proven to be an important prognostic marker among patients with heart failure (CHF) and recently also in ACS. The aim of this thesis was to assess whether the incorporation of BNP and Doppler echocardiographic variables in risk stratification strategies in patients with ACS can improve the prediction of mortality and rehospitalization for CHF during long-term follow-up. The study included consecutive patients with ACS who received coronary care at Sahlgrenska University Hospital from September 1995 to March 2001. Clinical variables were collected during hospitalization, blood for the determination of BNP was sampled in the acute phase and a Doppler echocardiographic examination was performed. The echocardiographic 4-chamber view and Doppler curves were saved digitally or digitized and a range of systolic and diastolic variables, which reflect cardiac structure and function, were calculated. Patients were followed prospectively for a maximum of 110 months with regard to death and rehospitalization due to CHF. We found that BNP was significantly higher in deceased patients than in those who survived. BNP provided prognostic information, even when adjusting for Killip class >1, age and LV ejection fraction (LVEF), and also among patients without clinical evidence of CHF (Killip class 1). The presence of significant mitral regurgitation, low LVEF and increased levels of BNP were all independently associated with death, while rehospitalization for CHF was predicted by mitral regurgitation and LVEF. In a multivariate analysis, the LV volume index in systole (LVVIs) and the ratio of maximum systolic and diastolic pulmonary venous flow velocities (PV-s/d) were associated with all-cause mortality, cardiovascular mortality and rehospitalization due to CHF. Patients with a restrictive LV filling pattern had a poorer prognosis than those with normal filling and this diastolic abnormality remained a significant predictor of outcome even after adjustment for BNP and clinical risk factors, as assessed by the GRACE risk score. Further, additional prognostic information was provided by the LV outflow tract velocity integral (LVOT-VTI), LVEF and PV-s/d ratio. In conclusion, our results indicate that BNP, as well as a restrictive filling pattern, mitral regurgitation and other Doppler echocardiographic variables, such as LVOT-VTI, LVVIs, LVEF and PV-s/d ratio, provide prognostic information on long-term survival and rehospitalization due to CHF in patients with ACS, over and above clinical risk factors. For this reason, both information from a single echocardiographic view and BNP levels appear to be useful tools in the identification of high-risk ACS patients. Further studies are needed to clarify exactly how these risk markers should be used in the clinical routine.
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| 3. |
- Persson, Anita, 1971, et al.
(författare)
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Effect of surgery on cardiac structure and function in mild primary hyperparathyroidism.
- 2011
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Ingår i: Clinical endocrinology. - : Wiley. - 1365-2265 .- 0300-0664. ; 74:2, s. 174-180
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Tidskriftsartikel (refereegranskat)abstract
- Context The cardiovascular (CV) risk profile is worsened in primary hyperparathyroidism (PHPT), and CV mortality is related to serum calcium levels. It is unknown whether CV mortality is increased in the most common form of PHPT and whether the increased CV risk is reversible after surgery. Objective To investigate reversibility of echocardiographic variables in patients with mild PHPT who were randomized to observation without surgery or operation, and followed for 2years. Design/Setting/Patients Forty-nine patients (mean age 63±7years, 8 men) who had performed the 2-year visit in a randomized study on mild PHPT (serum calcium at baseline 2·65±0·09mm) (observation) vs 2·67±0·06mm (surgery) and where echocardiography had been performed, participated in the study. Results Calcium and parathyroid hormone (PTH) levels were normalized following surgery and were stable in the observation group. PTH levels at baseline were highly correlated with ventricular mass. Detailed echocardiography revealed a minor and borderline significant treatment effect of surgery on left ventricular mass index (LVMI) compared to observation (P=0·066) and a significant 11% reduction in diastolic dimension of the interventricular septum (IVSd-mean) in the surgery group (P<0·01), with no alterations in the observation group. Conclusions Based on detailed echocardiographic measures over a 2-year observation period, we found only minor differences between the two groups. However, the potential treatment effect on LVMI and the within-group differences in IVSd-mean suggest that longer follow-up may yield larger and clinically important differences.
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| 4. |
- Persson, Anita, 1971, et al.
(författare)
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Long-term prognostic value of mitral regurgitation in acute coronary syndromes.
- 2010
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Ingår i: Heart (British Cardiac Society). - : BMJ. - 1468-201X .- 1355-6037. ; 96:22, s. 1803-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To determine the additional prognostic value of mitral regurgitation (MR) over B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and clinical characteristics in patients with acute coronary syndromes (ACS). DESIGN: Long-term follow-up in a prospective ACS cohort with Doppler-assessed MR, echocardiographically-determined LVEF and plasma BNP levels by ELISA. SETTING: Single-centre university hospital. PATIENTS: 725 patients with ACS. MAIN OUTCOME MEASURES: Death and readmission for congestive heart failure. RESULTS: During a median follow-up of 98 months, 235 patients (32%) died. Significant MR (grade >1 of 4) was found in 90 patients (12%). In a multivariate model including MR grade >1, LVEF <0.40 and BNP >373 pg/ml (75th percentile), MR was significantly associated with long-term mortality (HR 2.28, 95% CI 1.67 to 3.12; p<0.0001). When also adjusting for conventional risk factors, MR remained significantly associated with mortality (HR 1.53, 95% CI 1.06 to 2.19; p=0.02), as well as with congestive heart failure (HR 2.08, 95% CI 1.29 to 3.35; p=0.003). CONCLUSIONS: MR is common in patients with ACS, provides independent risk information and should be taken into account in the evaluation of the long-term prognosis.
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