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- Brand, Björn, et al.
(författare)
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Prognostication and risk stratification by assessment of left atrioventricular plane displacement in patients with myocardial infarction.
- 2002
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Ingår i: International Journal of Cardiology. - 0167-5273. ; 83:1, s. 35-41
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mean left atrioventricular plane displacement is strongly related to prognosis in patients with heart failure. We aimed to examine its value for prognostication and risk stratification in patients hospitalised for acute myocardial infarction. METHODS AND RESULTS: Left atrioventricular plane displacement was assessed by echocardiography in 271 consecutive patients with acute myocardial infarction. Mean prospective follow-up was 628 days. Atrioventricular plane displacement was readily assessed in all patients and was significantly lower in patients who died (n=41, 15.1%) compared to the survivors: 8.2(5.6) v. 10.0(5.5) mm, P<0.0001. Overall mortality was 31.3% in the lowest quartile with regard to atrioventricular plane displacement (<8.00 mm) and 10.1% in the combined upper three quartiles. Thus, the hazard ratio for an atrioventricular plane displacement <8.0 mm compared to 8 mm or more was 3.1, P=0.0001. The combined mortality/heart failure hospitalisation incidence was 43.8% in the lowest and 14.6% in the combined upper three quartiles: Risk ratio 3.0, P<0.0001. In multivariate analysis, including age and history of atrial fibrillation, left atrioventricular plane displacement was an independent prognostic marker. CONCLUSION: In post-myocardial infarction patients, echocardiographic assessment of atrioventricular plane displacement showed a strong, independent prognostic value. Determination of left atrioventricular plane displacement can be readily performed in virtually all patients, and may in clinical practice facilitate identification of high-risk patients.
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- Holst, M., et al.
(författare)
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Fluid restriction in heart failure patients : Is it useful? The design of a prospective, randomised study
- 2003
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Ingår i: European Journal of Cardiovascular Nursing. - : Elsevier Science. - 1474-5151 .- 1873-1953. ; 2:3, s. 237-242
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Tidskriftsartikel (refereegranskat)abstract
- Thirst is a common and troublesome symptom for patients with moderate to severe heart failure. The pharmacological and non-pharmacological treatment as well as the nature of the disease itself causes increased thirst. There is no evidence in the literature about the usefulness of fluid restriction for heart failure patients. Formerly, when very little pharmacological treatment was available, fluid restriction was one of the few interventional options but nowadays when the pharmacological treatment has improved, its importance may be questioned. This article describes the design of an ongoing study with the aim to determine if an individualised and less restrictive fluid prescription can improve the quality of life, cardiac function and exercise capacity, and decrease in hospital admissions and thirst. This study will be performed as a two-group, 1:1 randomised cross-over study. In group 1, the patients are instructed to comply with a maximum fluid intake of 1.5 l. This is a standard treatment today. In group 2, the patients are recommended to intake a fluid, based on the physiological need of 30 ml/kg body weight/24 h, and are allowed to increase the fluid intake to a maximum of 35 ml/kg body weight/24 h. After 16 weeks, the patients will cross over to the other intervention strategy and continue for another 16 weeks. © 2003 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.
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- Höijer, Carl Johan, et al.
(författare)
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Improved cardiac function and quality of life following upgrade to dual chamber pacing after long-term ventricular stimulation.
- 2002
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 23:6, s. 490-497
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Tidskriftsartikel (refereegranskat)abstract
- Aims Many patients with sinus node disease or atrioventricular block have previously received pacemakers with only ventricular stimulation (VVI or VVIR). This study aimed to investigate whether quality of life and cardiac function were affected by an upgrade to dual chamber pacing (DDDR or DDIR) following long-term ventricular stimulation. Methods After implantation of an atrial lead and a DDDR pulse generator, a randomized, double-blind crossover study was performed in 19 patients, previously treated with ventricular pacing for a median time of 6center dot8 years. Patients were randomized to 8 weeks with either VVIR or DDDR/DDIR pacing; after this time, the other mode was programmed for 8 weeks. At the end of each period, the patients' quality of life was evaluated and echocardiography was performed together with Holter monitoring and blood samples for brain natriuretic peptide. Results Sixteen of the patients preferred DDDR and two VVIR pacing (P=0center dot001); one was undecided. Seven patients demanded an early crossover while paced in the VVIR mode, vs none in the DDDR mode (P=0center dot008). Quality of life was higher in the DDDR mode in 11 of 17 modalities, reaching statistical significance for dyspnoea (P<0center dot05) and general activity (P<0center dot05). Echocardiography showed significantly larger left ventricular end-diastolic dimensions in the DDDR mode (P=0center dot01), whereas end-systolic dimensions did not differ. Left ventricular systolic function was significantly superior in the DDDR mode (mean aortic velocity--time integral: P<0center dot001) and left atrial diameter was significantly smaller in the DDDR mode (P=0center dot01). The plasma level of brain natriuretic peptide was significantly lower in DDDR mode (P=0center dot002). Conclusion An upgrade to dual chamber rate adaptive pacing results in significantly improved quality of life and cardiac function as compared to continued VVIR stimulation and should thus be considered in patients with ventricular pacemakers who have not developed permanent atrial fibrillation or flutter.
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- Piepoli, MF, et al.
(författare)
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Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH)
- 2004
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Ingår i: BMJ: British Medical Journal. - 1756-1833. ; 328:7433, s. 189-192
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Tidskriftsartikel (refereegranskat)abstract
- Objective To determine the effect of exercise training on survival in patients with heart failure due to left ventricular systolic dysfunction. Design Collaborative meta-analysis. Inclusion criteria Randomised parallel group controlled trials of exercise training, for at least eight weeks with individual patient data on survival for at least three months. Studies reviewed Nine datasets, totalling 801 patients: 395 received exercise training and 406 were controls. Main outcome measure Death from all causes. Results During a mean (SD) follow up of 705 (729) days there were 88 (22%) deaths in the exercise arm and 105 (26%) in the control arm. Exercise training significantly reduced mortality (hazard ratio 0.65, 95% confidence interval, 0.46 to 0.92; log rank chi(2) = 5.9; P = 0.015). The secondary end point of death or admission to hospital was also reduced (0.72, 0.56 to 0.93; log rank chi(2) = 6.4; P = 0.011). No statistically significant subgroup specific treatment effect was observed. Conclusion Meta-analysis of randomised trials to date gives no evidence that properly supervised medical training programmes for patients with heart failure might be dangerous, and indeed there is clear evidence of an overall reduction in mortality. Further research should focus on optimising exercise programmes and identifying appropriate patient groups to target.
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| 6. |
- Rydberg, Erik, et al.
(författare)
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Left atrioventricular plane displacement but not left ventricular ejection fraction is influenced by the degree of aortic stenosis.
- 2004
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Ingår i: Heart. - : BMJ. - 1355-6037. ; 90:10, s. 5-1151
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Tidskriftsartikel (refereegranskat)abstract
- Abstract in UndeterminedAims: To examine how left atrioventricular plane displacement ( AVPD), a widely used measure of left ventricular (LV) function, is related to presence and degree of aortic stenosis. Methods and results: Cardiac dimensions, LV filling, left AVPD, LV ejection fraction (LVEF), and valve function were assessed by echocardiography/Doppler in 182 patients with various cardiac diseases (mean (SD) age 69 (12) years, 36% women), 49 consecutive with and 133 consecutive without aortic stenosis. In an analysis of covariance, neither left AVPD nor LVEF was independently correlated with the presence of aortic stenosis. However, looking separately at patients with aortic stenosis, left AVPD (p = 0.03) but not LVEF correlated independently with degree of aortic stenosis in multiple linear regression analysis. In patients with aortic stenosis, an abnormal left AVPD had 94% sensitivity and 90% negative predictive value with regard to severe aortic stenosis, compared with 56% and 62%, respectively, for LVEF. Conclusion: In patients with cardiac disease, neither left AVPD nor LVEF correlated independently with presence of aortic stenosis. However, in patients with aortic stenosis, left AVPD but not LVEF correlated with the degree of aortic valve obstruction and left AVPD but not LVEF had high sensitivity and negative predictive value with regard to severe aortic stenosis. Compared with LVEF, left AVPD is an earlier and more sensitive marker of LV haemodynamic load in patients with aortic stenosis.
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| 7. |
- Rydberg, Erik, et al.
(författare)
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Left atrioventricular plane displacement determined by echocardiography: a clinically useful, independent predictor of mortality in patients with stable coronary artery disease
- 2003
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Ingår i: Journal of Internal Medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 254:5, s. 479-485
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Tidskriftsartikel (refereegranskat)abstract
- Background. Echocardiographically determined left atrioventricular plane displacement (AVPD) is strongly related to prognosis in patients with chronic heart failure and in postmyocardial infarction patients. We aimed at exploring whether AVPD, unlike ejection fraction, is related to mortality in patients with stable coronary artery disease (CAD). Methods and results. Atrioventricular plane displacement was assessed by two dimensionally guided M-mode echocardiography in the four and two chamber views, in 333 consecutive patients with stable CAD and an abnormal coronary angiogram. Patients were followed up for an average of 41 months. AVPD was lower in patients who died (n = 30, 9.0 %) compared with survivors (9.0 +/- 2.2 vs. 11.5 +/- 2.1 mm, P < 0.0001). Amongst patients with prior myocardial infarction (n = 184) AVPD was 8.7 +/- 2.3 mm in those who died (n = 17) and 11.2 +/- 2.3 mm in the survivors (P < 0.0001). In patients without prior myocardial infarction (n = 149), AVPD was 9.4 +/- 2.1 (n = 13) and 11.8 +/- 1.8 mm, respectively (P < 0.0001). Age, AVPD and four other echocardiographical variables correlated significantly with prognosis in univariate logistic regression analysis. In multiple logistic regression analysis only AVPD (P < 0.0001) correlated independently with mortality. Conclusion. Echocardiographically determined AVPDis a clinically useful, independent prognostic tool in patients with stable CAD. The presence of a documented previous myocardial infarction does not influence this observation.
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