| 1. |
- Houltz, Birgitta, 1952, et al.
(author)
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Left ventricular diastolic function and right atrial size are important rhythm outcome predictors after intraoperative ablation for atrial fibrillation.
- 2010
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In: Echocardiography (Mount Kisco, N.Y.). - : Wiley. - 1540-8175 .- 0742-2822. ; 27:8, s. 961-8
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Journal article (peer-reviewed)abstract
- BACKGROUND: Left ventricular (LV) diastolic function and right atrial (RA) size are not routinely included in preoperative echocardiographic examination in patients undergoing cardiac surgery with concomitant ablation for atrial fibrillation (AF). OBJECTIVE: To investigate the role of echocardiographic variables including LV diastolic function and RA area in long-term rhythm outcome prediction, in patients with documented AF undergoing intraoperative ablation concomitant to coronary artery bypass grafting (CABG). METHODS: Thirty-five consecutive patients, scheduled for CABG, and with a history of paroxysmal or permanent AF for 8.5 ± 11.3 years (mean ± SD) (median 5.8 years), were included in this prospective study. Echocardiography was performed prior to and 2.3 ± 0.4 years after the surgical procedure. RESULTS: Both LA and RA areas, LV diastolic function, paroxysmal AF, and sinus rhythm (SR) preoperatively were associated with SR at long-term follow-up. In the multivariate analysis, RA area (P = 0.004), and decreased LV diastolic function preoperatively, measured as the maximal LV long-axis relaxation velocity (P = 0.02), predicted SR at follow-up. CONCLUSIONS: RA size and LV diastolic function may be important variables in prediction of long-term rhythm outcome after intraoperative ablation for AF.
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| 2. |
- Johansson, Birgitta, 1957, et al.
(author)
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Cardiac function in relation to rhythm outcome after intraoperative epicardial left atrial cryoablation.
- 2011
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In: Scandinavian cardiovascular journal. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 45:6, s. 327-35
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Journal article (peer-reviewed)abstract
- Abstract Objectives. To assess the effects of intraoperative left atrial epicardial cryoablation on rhythm and atrial and ventricular function. Design. Thirty five patients with coronary artery disease and documented atrial fibrillation underwent coronary artery bypass surgery and concomitant cryoablation. An age and gender matched control group of 35 patients with atrial fibrillation underwent bypass surgery alone. Echocardiography was performed 9 ? 32 days before and 22 ? 6 months after surgery. Results. The proportion of patients in sinus rhythm at follow-up was 63% and 34% (p = 0.04) in the cryoablation and control groups, respectively. In patients with sinus rhythm both before surgery and at follow-up, the left atrial area increased (p = 0.002) and the mitral annular excursion during atrial contraction decreased (p = 0.01) after cryoablation. The mitral flow velocity during atrial systole decreased after cryoablation (p = 0.002). The LV diameter increased (p = 0.03) and the left ventricular ejection fraction (LVEF) decreased (p = 0.03) in cryoablated but not in control patients. Continued deterioration was seen in patients with atrial fibrillation both pre- and postoperatively. Conclusions. At long-term follow-up, a significantly higher proportion of patients was in sinus rhythm in the cryoablation than in the control group. The atrial and ventricular function had decreased at follow-up two years after surgery. This decrease was small and occurred within or close to the reference values in patients with sinus rhythm at follow-up, while patients remaining in atrial fibrillation showed a significant continued deterioration. Some subgroups were small, and the findings, although statistically significant, should be interpreted with caution.
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| 3. |
- Johansson, Birgitta, 1960, et al.
(author)
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Short-term sinus rhythm predicts long-term sinus rhythm and clinical improvement after intraoperative ablation of atrial fibrillation.
- 2008
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In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 10:5, s. 610-7
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Journal article (peer-reviewed)abstract
- AIMS: Our aim was to compare the long-term effects on rhythm and quality of life (QoL) after left atrial epicardial radiofrequency (RF) ablation vs. no ablation in patients undergoing cardiac surgery. METHODS AND RESULTS: Thirty-nine patients with ECG documented atrial fibrillation (AF) scheduled for coronary artery bypass grafting (CABG) with or without concomitant valve surgery were consecutively elected for epicardial RF ablation. Thirty-nine age- and gender-matched patients scheduled for CABG with or without concomitant valve surgery only and with documented AF served as controls. The follow-up after ablation was 32 +/- 11 months. The percentage of patients in sinus rhythm (SR) at long-term follow-up was 62 vs. 33% (P = 0.03) after ablation and no ablation, respectively. SR at 3 months was highly predictive of that at 32 months (sensitivity 95%, positive predictive value 86%). Long-term SR was associated with better QoL, fewer symptoms, higher ejection fraction, and smaller left and right atria than AF. CONCLUSION: SR at 3 months was highly predictive of long-term SR that was associated with clinical improvement when compared with patients still in AF. AF at 3 months did not preclude a later stabilization to SR.
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| 4. |
- Andersson, Anders, et al.
(author)
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Interleukin-16-producing NK cells and T-cells in the blood of tobacco smokers with and without COPD
- 2016
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In: International Journal of Chronic Obstructive Pulmonary Disease. - : Informa UK Limited. - 1178-2005. ; 11, s. 2245-2258
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Journal article (peer-reviewed)abstract
- Background: Long-term exposure to tobacco smoke causes local inflammation in the airways that involves not only innate immune cells, including NK cells, but also adaptive immune cells such as cytotoxic (CD8(+)) and helper (CD4(+)) T-cells. We have previously demonstrated that long-term tobacco smoking increases extracellular concentration of the CD4(+)-recruiting cytokine interleukin (IL)-16 locally in the airways. Here, we hypothesized that tobacco smoking alters IL-16 biology at the systemic level and that this effect involves oxygen free radicals (OFR). Methods: We quantified extracellular IL-16 protein (ELISA) and intracellular IL-16 in NK cells, T-cells, B-cells, and monocytes (flow cytometry) in blood samples from long-term tobacco smokers with and without chronic obstructive pulmonary disease (COPD) and in never-smokers. NK cells from healthy blood donors were stimulated with water-soluble tobacco smoke components (cigarette smoke extract) with or without an OFR scavenger (glutathione) in vitro and followed by quantification of IL-16 protein. Results: The extracellular concentrations of IL-16 protein in blood did not display any substantial differences between groups. Notably, intracellular IL-16 protein was detected in all types of blood leukocytes. All long-term smokers displayed a decrease in this IL-16 among NK cells, irrespective of COPD status. Further, both NK and CD4(+) T-cell concentrations displayed a negative correlation with pack-years. Moreover, cigarette smoke extract caused release of IL-16 protein from NK cells in vitro, and this was not affected by glutathione, in contrast to the decrease in intracellular IL-16, which was prevented by this drug. Conclusion: Long-term exposure to tobacco smoke does not markedly alter extracellular concentrations of IL-16 protein in blood. However, it does decrease the intracellular IL-16 concentrations in blood NK cells, the latter effect involving OFR. Thus, long-term tobacco smoking exerts an impact at the systemic level that involves NK cells; innate immune cells that are critical for host defense against viruses and tumors-conditions that are over-represented among smokers.
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| 5. |
- Bake, Björn, 1939, et al.
(author)
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High tidal end expiratory flow -- an index of dynamic hyperinflation?
- 2007
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In: Clin Physiol Funct Imaging. - 1475-0961. ; 27:2, s. 116-21
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Journal article (peer-reviewed)abstract
- Dynamic hyperinflation is considered an important mechanism behind shortness of breath and reduced exercise capacity in chronic obstructive pulmonary disease (COPD) patients. Prevailing methods to assess dynamic hyperinflation are crude because of the large normal variation of both functional residual capacity and inspiratory capacity (IC). In the present study, we hypothesized that expiratory flow on a relatively high level near the end of tidal expiration is an indication of dynamic hyperinflation. A method to measure tidal end expiratory flow (TEEF), i.e. the flow between 0.6 s and 0.04 s before start of inspiration is presented and evaluated in 15 healthy subjects and 16 COPD patients. The COPD patients had more than twice as high TEEF values compared with the healthy subjects (45.4 +/- 23.8 and 20.4 +/- 7.3 ml s(-1) respectively; mean +/- SD; P = 0.0002, for TEEF at 0.4 s before start of inspiration). TEEF values correlated to IC, e.g. TEEF at 0.4 s before start of inspiration expressed as a fraction of mean expiratory flow, correlated to IC (% pred.) (r = 0.74; P<0.0001). These results justifies further testing of the relationship between TEEF and dynamic hyperinflation.
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| 6. |
- Gatzinsky, Vladimir, 1966, et al.
(author)
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Impaired peripheral airway function in adults following repair of esophageal atresia.
- 2014
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In: Journal of pediatric surgery. - : Elsevier BV. - 1531-5037 .- 0022-3468. ; 49:9, s. 1347-52
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Journal article (peer-reviewed)abstract
- Esophageal atresia (EA) often leads to persistent symptoms and impaired respiratory function in adulthood. The role of peripheral airways in this impairment has not been previously investigated. Furthermore, asthma-like symptoms are common in these patients.
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| 7. |
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| 8. |
- Gustafsson, Per M., 1952, et al.
(author)
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Slow and fast lung compartments in cystic fibrosis measured by nitrogen multiple-breath washout.
- 2014
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In: Journal of applied physiology (Bethesda, Md. : 1985). - : American Physiological Society. - 1522-1601 .- 8750-7587. ; 117:7, s. 720-9
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Journal article (peer-reviewed)abstract
- Imaging studies describe significant ventilation defects across a wide range of cystic fibrosis (CF) related lung disease severity. These are unfortunately poorly reflected by phase III slope analysis-derived Scond and Sacin from multiple-breath washout (MBW). Methodology extending previous two-lung compartment model-based analysis is presented describing size and function of fast- and slow-ventilating lung compartments from nitrogen (N2) MBW and correlation to obstructive lung disease severity. In 37 CF subjects (forced expiratory volume in 1 s [FEV1] mean [SD] 84.8 [19.9] % predicted; abnormal lung clearance index [LCI] in 36/37, range 7.28-18.9) and 74 matched healthy controls, volume and specific ventilation of both fast and slowly ventilated lung compartments were derived from N2-based MBW with commercial equipment. In healthy controls lung emptying was characterized by a large compartment constituting 75.6 (8.4)% of functional residual capacity (FRC) with a specific ventilation (regional alveolar tidal volume/regional lung volume) of 13.9 (3.7)% and a small compartment with high specific ventilation (48.4 [15.7]%). In CF the slowly ventilated lung compartment constituted 51.9(9.1)% of FRC, with low specific ventilation of 5.3 (2.4)%. Specific ventilation of the slowly ventilated lung compartment showed stronger correlation with LCI (r(2) = 0.70, P < 0.001) vs. Sacin (r(2) = 0.44, P < 0.001) or Scond (no significant correlation). Overventilation of the fast lung compartment was no longer seen in severe CF lung disease. Magnitude and function of under- and overventilated lung volumes can be derived from routine N2 MBW in CF. Reported values agree with previous modelling-derived estimates of impaired ventilation and offer improved correlation to disease severity, compared with SnIII analysis.
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| 9. |
- Houltz, Birgitta, 1952
(author)
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Antiarrhythmic and arrhythmic effects of an Ikr-blocking class III agent. A clinical and electrocardiographic study of almokalant
- 2000
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Doctoral thesis (other academic/artistic)abstract
- The interest in class III drugs has increased over the last decades as being potent antiarrhythmic agents in their mode of action by prolongation of repolarization and with no effect on conduction. Class I antiarrhythmic agents have proven effective in conversion of atrial fibrillation (AF), but may cause serious proarrhythmia. Older class III drugs, i.e. amiodarone and sotalol, are also afflicted with adverse effects, which limit their use. However, the pure class III antiarrhythmic drugs, potassium channel blockers, may also induce proarrhythmia, i.e. torsades de pointes (TdP).Almokalant is a selective potassium - Ikr- channel blocker. The aims of the present thesis were to assess the antiarrhythmic and proarrhythmic effects of a 6-hour infusion of almokalant when given to 100 patients with chronic AF or flutter (AFL) aiming at conversion to sinus rhythm (SR), and to find predictors of conversion, and development of TdP in case it should occur. On the following day an identical infusion was given for 90 minutes during SR to 61 of the patients.Paper I evaluated the efficacy of almokalant in conversion of AF or AFL to SR. A second aim was to find predictors of conversion to SR. The electrophysiological effects of almokalant were assessed by surface 12-lead electrocardiogram (ECG) and transesophageal atrial electrograms (TAE). Thirty-two patients converted to SR. The ECG changes observed were consistent with a class III effect. The QT, corrected QT, QTtop intervals and QT dispersion increased, the T wave amplitude and atrial rate decreased, with no differences between patients converting to SR and those who did not. A decrease in T wave amplitude early during infusion was a predictor of conversion to SR.Paper II assessed the proarrhythmic effect of almokalant and ECG variables associated with TdP. Six patients developed TdP, five of these after conversion to SR. Patients who developed TdP were characterized by an abnormal ventricular repolarization when exposed to the drug and, soon after the start of infusion, developed a pronounced QT prolongation, a larger QT dispersion, and marked morphological T wave changes. These ECG changes were observed during AF, as well as after conversion to SR, before the proarrhythmic event. Predictors of TdP were at baseline: female gender, PVCs, diuretics and, after 30 minutes of infusion, the development of sequential bilateral bundle branch aberrancy, PVCs in bigeminy, and a biphasic T wave.Paper III assessed QT dispersion, as a measure of the inhomogeneity of ventricular repolarization, during AF and SR in sixty-one patients, who received almokalant infusion on both study days. QT dispersion did not differ during AF and SR at normal ventricular repolarization. At prolonged repolarization, QT dispersion was larger during SR than during AF. QT dispersion was not related to the QT or RR interval or almokalant plasma concentration. Increased QT dispersion may contribute to the increased risk of TdP shortly after conversion to SR.Paper IV evaluated the occurrence of aberrant conduction during AF at rest and during exercise prior to and during almokalant infusion in 92 of the patients. Almokalant caused a marked, and dose-related, increase in the number of patients with intermittent aberration during rest, which was further increased during exercise. Predictors of the development of aberrant conduction on almokalant were decreased left ventricular ejection fraction, female gender, longer arrhythmia duration, while the use of calcium antagonists decreased the risk. Aberration is an expression of the class III effect and seems to be more common in patients with more advanced myocardial disease
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| 10. |
- Houltz, Birgitta, 1952, et al.
(author)
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Pre-operative evaluation of lung function test results.
- 2010
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In: The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. - : European Respiratory Society (ERS). - 1399-3003. ; 35:4
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Journal article (other academic/artistic)
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| 11. |
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| 12. |
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| 13. |
- Kjellberg, S., et al.
(author)
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Clinical characteristics of adult asthma associated with small airway dysfunction
- 2016
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In: Respiratory Medicine. - : Elsevier BV. - 0954-6111. ; 117, s. 92-102
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Journal article (peer-reviewed)abstract
- Suboptimal asthma control is common despite modern asthma therapy. The degree of peripheral airway involvement remains unclear and poor medication delivery to these regions might be a contributing reason for this failure in obtaining adequate symptom control. A cohort of 196 adults (median (range) age 44 (18-61) years, 109 females, 54 ex-smokers, six current smokers) with physician-diagnosed asthma were recruited from primary care. Subjects were characterized clinically by interviews, questionnaires, skin prick tests (SPT) and blood eosinophil counts. Lung function was assessed by spirometry, impulse oscillometry (IOS) and nitrogen multiple breath washout (N-2 MBW). IOS assessed peripheral airway resistance (FDR, frequency dependence of resistance). N-2 MBW assessed global ventilation inhomogeneity (LCI, lung clearance index), specific indices of peripheral airway function (S-cond x V-T and S-acin x V-T; V-T, tidal volume), and inter-regional inhomogeneity (specific ventilation ratio). Never-smoking healthy cohorts of 158 and 400 adult subjects provided local reference values for IOS and N2 MBW variables, respectively. Peripheral airway dysfunction was detected in 31% (FDR or specific ventilation ratio) to 47% (S-cond x V-T) of subjects. Risk factors for peripheral airway dysfunction were identified. Among subjects with low FEV1 and either positive smoking history and/or blood eosinophilia (>4.0%), 63% had abnormality across all peripheral airway outcomes, whilst only one subject was completely normal. Abnormal peripheral airway function was present in a large proportion of adult asthmatics at baseline. Reduced FEV1, a positive smoking history, and/or blood eosinophilia identified " a small airway asthma subtype" that might benefit from peripheral airway targeted therapy. (C) 2016 Elsevier Ltd. All rights reserved.
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| 14. |
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| 15. |
- Olofson, Jan, 1947, et al.
(author)
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COPD ‘diagnosis’ based on spirometric reference equations
- 2008
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In: The Clinical Respiratory Journal. - 1752-699X. ; 2:4, s. 214-219
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Journal article (peer-reviewed)abstract
- Introduction: Chronic obstructive pulmonary disease (COPD) is suspected if the ratio between forced expired volume in 1 s (FEV1) and forced vital capacity is below 0.7 after bronchodilatation, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). As this ratio varies with age and gender, the lower limit of normality (LLN) of appropriate reference equations appears more adequate. Objectives: To study the prevalences of suspected COPD according to the GOLD criterion and various reference equations in a well-defined population sample. Methods: Spirometries obtained in a random population sample of 598 men, 50 or 60 years of age, were analysed. The prevalences of suspected COPD were calculated according to the GOLD criterion and the LLNs of four Nordic and two European reference equations. Results: The GOLD criterion resulted in prevalences of COPD of 9.3% and 23.7% in the 50- and 60-year-old never-smokers, respectively. Depending on the reference equation, the calculated prevalences of COPD varied between 9.3% and 23.4% and 12.0% and 39.1% among all of the 50- and 60-year-old men, respectively. Conclusions: The GOLD criterion is inadequate because of substantial overestimation in 60-year-old never-smokers. LLNs of the various reference equations are unreliable because of obvious lack of consistency. Spirometric criteria for airway obstruction, and suspicion of COPD, therefore need to be revised.
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| 16. |
- Olofson, Jan Yngve, et al.
(author)
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Respiratory symptoms and peripheral airways disease in a cross-sectional study on a random population sample
- 2012
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In: BMJ Open. - : BMJ. - 2044-6055. ; 2:6
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Journal article (peer-reviewed)abstract
- Objectives: Respiratory symptoms are associated with spirometry results but more strongly with smoking history, suggesting that alterations in the lung other than those revealed by spirometry contribute to cause symptoms. Smoking may cause obstruction of peripheral airways that is poorly detected by spirometry. The slope of phase III of the single-breath nitrogen (N2) test detects smoking-induced alterations in smokers before spirometry is impaired. The aim of the present investigation was to study the association between respiratory symptoms and the slope of phase III adjusting for spirometry results and smoking history. Design: Single-centre retrospective cross-sectional study. Setting: University hospital in Gothenburg, Sweden. Participants: A random population sample of 430 elderly men. Methods: The presence of seven different respiratory symptoms were analysed by a multiple logistic regression model in relation to spirometry results, smoking history (pack-years) and the slope of phase III in a population sample of 430 elderly men, age span 50-67 years. Furthermore, smoking normalised values of the slope of phase III were calculated and differences between subjects reporting/not reporting symptoms were tested. Results: The presence of some cough symptoms was significantly associated with a steep slope of phase III also when adjusting for spirometry results and smoking history. Furthermore, smoking normalised slope of phase III was significantly steeper among subjects with cough symptoms compared to those without cough symptoms. Conclusions: Cough symptoms may be an effect of abnormalities in peripheral airways at least among elderly men.
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| 17. |
- Riise, Gerdt C., 1956, et al.
(author)
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Prediction of BOS by the single-breath nitrogen test in double lung transplant recipients.
- 2011
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In: BMC research notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 4:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: The present study analyses the ability of the alveolar slope of the single-breath nitrogen washout test (N2-slope) to diagnose and predict the development of the bronchiolitis obliterans syndrome (BOS). METHODS: We present a retrospective analysis of 61 consecutive bilateral lung or heart-lung transplant recipients who were followed at regular control visits during a three year follow-up. The operating characteristics of the N2-slope to diagnose BOS and potential BOS (BOS 0-p) and to predict BOS were determined based on cut off values of 95% specificity. RESULTS: The sensitivity of the N2-slope to identify BOS was 96%, and BOS 0-p 100%. The predictive ability to predict BOS with a N2-slope > 478% of the predicted normal was 56%, and if combined with a coincident FEV1 < 90% of the basal value, the predictive ability was 75%. CONCLUSIONS: The predictive ability of either the N2-slope or of FEV1 to diagnose BOS is limited but the combination of the two appears useful. Follow-up protocols of bilateral lung and heart-lung transplant recipients should consider including tests sensitive to obstruction of the peripheral airways.
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