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| 2. |
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| 3. |
- Lindholm, Carl-Johan, et al.
(author)
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Sinus rhythm maintenance following DC cardioversion of atrial fibrillation is not improved by temporary precardioversion treatment with oral verapamil.
- 2004
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In: Heart (British Cardiac Society). - : BMJ. - 1468-201X. ; 90:5, s. 8-534
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To evaluate prospectively the effects of pretreatment with verapamil on the maintenance of sinus rhythm after direct current (DC) cardioversion. DESIGN: Randomised, active control, open label, parallel group comparison of verapamil versus digoxin. SETTINGS: Multicentre study in three teaching and three non-teaching hospitals in Sweden. PATIENTS: 100 consecutive patients with atrial fibrillation (AF) of at least four weeks' duration and indications for cardioversion were assigned randomly to two groups, one treated with verapamil (verapamil group) and the other with digoxin (digoxin group) before cardioversion. Fifty patients were assigned randomly to each treatment arm. After dropout of four patients from the digoxin group and seven patients from the verapamil group, data obtained from 89 patients were analysed. INTERVENTIONS: After randomly assigned pretreatment with either verapamil or digoxin for four weeks, DC cardioversion was performed. If sinus rhythm was restored then verapamil treatment was discontinued. MAIN OUTCOME MEASURES: The rate of AF recurrence was assessed one, four, eight, and 12 weeks after cardioversion. RESULTS: 6 patients in the verapamil treated group and none in the digoxin treated group reverted to sinus rhythm spontaneously (p < 0.05). DC cardioversion restored sinus rhythm in 24 of 37 (65%) patients in the verapamil group and 41 of 46 patients (89%) in the digoxin group (p < 0.05). After 12 weeks' follow up 28% (13 of 46) of digoxin pretreated patients versus 9% (four of 43) of verapamil pretreated patients remained in sinus rhythm (p < 0.05). CONCLUSION: Pretreatment with verapamil alone does not improve maintenance of sinus rhythm after DC cardioversion in patients with AF. The rate of spontaneous cardioversion may be improved by verapamil.
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| 4. |
- Meurling, Carl, et al.
(author)
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Attenuation of electrical remodelling in chronic atrial fibrillation following oral treatment with verapamil
- 1999
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In: Europace. - : Oxford University Press (OUP). - 1532-2092 .- 1099-5129. ; 1:4, s. 234-241
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Journal article (peer-reviewed)abstract
- AIMS: Electrical remodelling with shortening of the atrial refractory period and increased fibrillatory rate occurs after onset of atrial fibrillation and can be attenuated by pre-treatment with intravenous verapamil. The aim of the present study was to investigate whether already established fibrillatory-induced shortening of atrial fibrillatory cycle length could be reversed with oral verapamil. METHODS AND RESULTS: Thirteen patients (nine men; mean age 67 years) with chronic atrial fibrillation (CAF) were studied. The dominant atrial cycle length (DACL) was estimated non-invasively using the frequency analysis of fibrillatory ECG (FAF-ECG) method. Measurements were repeated following treatment with slow release oral verapamil. DACL increased from 147 +/- 13 ms to 156 +/- 21 ms after 1 day (P=0.02), to 164 +/- 18 ms after 5 days (P=0.005) and finally to 160 +/- 16 ms after 6 weeks (P=0.008). CONCLUSION: Long-term oral treatment with verapamil increases the DACL significantly in patients with CAF. The prolongation is evident after 1 day and is further developed during the first 5 days of treatment. Since DACL is believed to be an index of refractoriness, the findings of the present study suggest that this treatment increases the atrial refractory period in patients with CAF.
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| 5. |
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| 6. |
- Olsson, Bertil, et al.
(author)
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Förmaksflimmer - ny kunskap ger nya behandlingsmöjligheter
- 1999
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In: Läkartidningen. - 0023-7205. ; 96:36, s. 3796-3803
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Journal article (peer-reviewed)abstract
- Atrial fibrillation (AF) is the most common cardiac arrhythmia prompting treatment. Advances in our knowledge of the pathophysiology of AF provide the basis for new and improved treatment modalities. Thus, focal excitation and localised impulse conduction defects are possible trigger factors which can be counteracted by focal ablation and pacing synchronisation, respectively. Perpetuation of AF, caused by continuous multisite re-entry, is promoted by successive shortening of repolarisation. Internal defibrillation and anatomical limitation of re-entry are treatments that counteract perpetuation of the arrhythmia. Current knowledge of AF and the application of new treatments are discussed by the Lund AF research group.
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| 7. |
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| 8. |
- Al-Rashidi, Faleh, et al.
(author)
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A new de-airing technique that reduces systemic microemboli during open surgery: a prospective controlled study.
- 2009
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In: The Journal of thoracic and cardiovascular surgery. - : Elsevier BV. - 1097-685X .- 0022-5223. ; 138:1, s. 157-162
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Journal article (peer-reviewed)abstract
- OBJECTIVE: We have evaluated a new technique of cardiac de-airing that is aimed at a) minimizing air from entering into the pulmonary veins by opening both pleurae and allowing lungs to collapse and b) flushing out residual air from the lungs by staged cardiac filling and lung ventilation. These air emboli are usually trapped in the pulmonary veins and may lead to ventricular dysfunction, life-threatening arrhythmias, and transient or permanent neurologic deficits. METHODS: Twenty patients undergoing elective true left open surgery were prospectively and alternately enrolled in the study to the conventional de-airing technique (pleural cavities unopened, dead space ventilation during cardiopulmonary bypass [control group]) and the new de-airing technique (pleural cavities open, ventilator disconnected during cardiopulmonary bypass, staged perfusion, and ventilation of lungs during de-airing [study group]). Transesophageal echocardiography and transcranial Doppler continually monitored the air emboli during the de-airing period and for 10 minutes after termination of the cardiopulmonary bypass. RESULTS: The amount of air embolism as observed on echocardiography and the number of microembolic signals as recorded by transcranial Doppler were significantly less in the study group during the de-airing time (P < .001) and the first 10 minutes after termination of cardiopulmonary bypass (P < .001). Further, the de-airing time was significantly shorter in the study group (10 vs 17 minutes, P < .001). CONCLUSION: The de-airing technique evaluated in this study is simple, reproducible, controlled, safe, and effective. Moreover, it is cost-effective because the de-airing time is short and no extra expenses are involved.
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| 9. |
- Al Rashidi, Faleh, et al.
(author)
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The modified Ross operation using a Dacron prosthetic vascular jacket does prevent pulmonary autograft dilatation at 4.5-year follow-up.
- 2010
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In: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940. ; 37, s. 928-933
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Journal article (peer-reviewed)abstract
- Objective: Following the Ross operation, pulmonary autografts tend to dilate over time. This study researches the fate of the pulmonary autograft - at 4.5 years following the modified Ross operation - with special reference to the impact of the modification on (a) pulmonary autograft dilatation, (b) the neo-aortic root geometry, (c) neo-aortic valve function and (d) the coronary artery reserve. Methods: A total of 26 patients who underwent the Ross operation were included in this study; of these, 13 consecutive patients underwent a modified Ross operation in which the free-standing autograft root was supported externally by a Dacron vascular prosthetic jacket (DVPJ). These patients were compared to a cohort of 13 matched patients who were operated on using the conventional Ross technique; all patients were followed up prospectively by echocardiography studies. The patients who underwent the modified Ross operation were also subjected to bicycle ergometry. Results: At the 47-month median follow-up, there was no significant increase in the size of the entire neo-aortic root in the patients who underwent the modified Ross operation; in addition, the geometry of the neo-aortic root was also preserved and the left ventricular function had improved significantly, whilst the aortic valve function and excursion remained satisfactory. All patients, with one exception, in the modified Ross operation group exhibited normal exercise capacity. By contrast, there were significant differences in diameters of the aortic root - between the two surgical techniques in favour of the modified Ross technique - following a median follow-up of 23 months in the patients subjected to the conventional Ross operation. Conclusions: Provision of external support to the entire pulmonary autograft with a DVPJ prevents its dilatation following free-standing pulmonary autograft Ross operation when evaluated at the 4.5-year follow-up. The function and the geometry of the neo-aortic root are not affected negatively by this modification and the patients demonstrated normal exercise capacity.
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| 10. |
- Baturova, Maria A., et al.
(author)
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Evolution of P-wave indices during long-term follow-up as markers of atrial substrate progression in arrhythmogenic right ventricular cardiomyopathy
- 2021
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In: Europace. - : Oxford University Press. - 1099-5129 .- 1532-2092. ; 23:Supplement_1, s. i29-i37
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Journal article (peer-reviewed)abstract
- AIMS: Patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) have increased prevalence of atrial arrhythmias indicating atrial involvement in the disease. We aimed to assess the long-term evolution of P-wave indices as electrocardiographic (ECG) markers of atrial substrate during ARVC progression.METHODS AND RESULTS: We included 100 patients with a definite ARVC diagnosis according to 2010 Task Force criteria [34% females, median age 41 (inter-quartile range 30-55) years]. All available sinus rhythm ECGs (n = 1504) were extracted from the regional electronic ECG databases and automatically processed using Glasgow algorithm. P-wave duration, P-wave area, P-wave frontal axis, and prevalence of abnormal P terminal force in lead V1 (aPTF-V1) were assessed and compared at ARVC diagnosis, 10 years before and up to 15 years after diagnosis.Prior to ARVC diagnosis, none of the P-wave indices differed significantly from the data at ARVC diagnosis. After ascertainment of ARVC diagnosis, P-wave area in lead V1 decreased from -1 to -30 µV ms at 5 years (P = 0.002). P-wave area in lead V2 decreased from 82 µV ms at ARVC diagnosis to 42 µV ms 10 years after ARVC diagnosis (P = 0.006). The prevalence of aPTF-V1 increased from 5% at ARVC diagnosis to 18% by the 15th year of follow-up (P = 0.004). P-wave duration and frontal axis did not change during disease progression.CONCLUSION: Initial ARVC progression was associated with P-wave flattening in right precordial leads and in later disease stages an increased prevalence of aPTF-V1 was seen.
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| 11. |
- Bollmann, Andreas, et al.
(author)
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Atrial fibrillatory rate and risk of left atrial thrombus in atrial fibrillation.
- 2007
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In: Europace. - : Oxford University Press (OUP). - 1532-2092. ; 9:8, s. 6-621
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Journal article (peer-reviewed)abstract
- ims In atrial fibrillation (AF), a relation between electrocardiogram (ECG) fibrillatory wave amplitude and thrombus formation has been sought for long with conflicting results. In contrast, the possible relation between atrial fibrillatory rate obtained from the surface ECG and left atrial thrombus formation in patients with AF is unknown and was consequently evaluated in this study. Methods and results One-hundred and twenty-five patients (mean age 64 ± 12 years, 72% male) with persistent non-valvular AF (mean duration 28 ± 80 days) undergoing transesophageal echocardiography were studied. In all patients, standard 12-lead ECG recordings were acquired before the examination. Atrial fibrillatory rate was determined using spatiotemporal QRST cancellation and time–frequency analysis of lead V1. Atrial fibrillatory rate measured 401 ± 63 fibrillations per minute (fpm, range 235–566 fpm) and was related with age (R = −0.326, P < 0.001), ventricular rate (R = −0.202, P = 0.024), gender (407 ± 62 in males vs. 387 ± 64 fpm in females, P = 0.038) but not AF duration (R = 0.088, P = 0.374), presence of lone AF (408 ± 66 vs. 394 ± 58 fpm, P = 0.228), or beta-blocker or calcium channel blocker treatment (398 ± 63 vs. 405 ± 62 fpm, P = 0.556). Age was the only independent predictor of fibrillatory rate (B = −1.714, P < 0.001). In patients with left atrial thrombus (n = 10), spontaneous echo contrast (SEC) was more frequently present (70 vs. 29 %, p = 0.007) and left atrial appendage (LAA) outflow velocity was lower (26 ± 20 vs. 37 ± 15 cm/s, P = 0.012) than in patients without thrombus (n = 115). In contrast, mean fibrillatory rate, which showed a weak inverse correlation with LAA velocity (R = −0.118, P = 0.048) was not different between both groups (380 ± 56 vs. 403 ± 63 fpm, P = 0.226). Similarly, presence of thrombus and SEC combined was not related with fibrillatory rate. Conclusion Atrial fibrillatory rate obtained from surface ECG lead V1 is not a risk marker for left atrial thrombus formation in AF.
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| 12. |
- Duraj, Frans, et al.
(author)
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Tarmtransplantation : Första svenska tunntarmstransplantationen till en vuxen patient med pseudoobstruktion
- 1998
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In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 95:28-29, s. 3172-3176
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Journal article (peer-reviewed)abstract
- Recent advances, first and foremost the development of new immunosuppressive agents, have markedly improved the outcome of intestinal transplantation, which is a treatment option for patients with serious intestinal diseases who have become dependent on total parenteral nutrition. The first small bowel transplantation in Sweden was performed at Huddinge Hospital in 1997, in the adult patient with intestinal pseudo-obstruction. The article reports the course of this patient and an update of international progress in intestinal transplantation.
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| 13. |
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| 14. |
- Faust, Ellika, et al.
(author)
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Origin and route of establishment of the invasive Pacific oyster Crassostrea gigas in Scandinavia
- 2017
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In: Marine Ecology Progress Series. - : Inter-Research Science Center. - 0171-8630 .- 1616-1599. ; 575, s. 95-105
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Journal article (peer-reviewed)abstract
- Identifying the routes and rates of introductions is fundamental for the understanding of marine invasions. Recurring introductions over the last 50 yr have led to the establishment of feral Pacific oyster Crassostrea gigas populations throughout Europe. In the northern countries, Sweden and Norway, the species first occurred in large numbers in 2006. Here, we investigated the relative importance of introduction via re-laying of cultured oysters imported for consumption from France, Ireland or the Netherlands, and dispersal of oyster larvae by ocean currents from wild oyster populations in Denmark. Using microsatellite DNA markers, we estimated genetic differentiation among Pacific oysters collected at 4 Swedish locations, 3 Norwegian locations and 9 potential source locations in Denmark, Ireland, the Netherlands and France. All Swedish samples and 1 Norwegian sample(Tromlingene) were genetically similar to each other and the Danish samples and showed significant genetic differentiation from all other populations. Consequently, it appears that the Pacific oyster populations in Sweden, Denmark and Tromlingene are closely connected and/or share a recent origin. The 2 remaining Norwegian samples(Hui and Espevik) differed from each other and all other populations, but showed similarities to wild oyster samples from Scandinavia and Ireland, respectively. Overall, the results underline a complex origin of Norwegian oysters, with gene flow from Swedish/Danish populations, as well as other unidentified sources. The apparent connectivity among most of the Scandinavian populations has implications for regional management of this invasive species, and highlights possible scenarios for other marine invasive species with a similar life history.
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| 15. |
- Havmöller, Rasmus, et al.
(author)
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Age-related changes in P wave morphology in healthy subjects.
- 2007
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In: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 7:22
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Journal article (peer-reviewed)abstract
- Background We have previously documented significant differences in orthogonal P wave morphology between patients with and without paroxysmal atrial fibrillation (PAF). However, there exists little data concerning normal P wave morphology. This study was aimed at exploring orthogonal P wave morphology and its variations in healthy subjects. Methods 120 healthy volunteers were included, evenly distributed in decades from 20–80 years of age; 60 men (age 50+/-17) and 60 women (50+/-16). Six-minute long 12-lead ECG registrations were acquired and transformed into orthogonal leads. Using a previously described P wave triggered P wave signal averaging method we were able to compare similarities and differences in P wave morphologies. Results Orthogonal P wave morphology in healthy individuals was predominately positive in Leads X and Y. In Lead Z, one third had negative morphology and two-thirds a biphasic one with a transition from negative to positive. The latter P wave morphology type was significantly more common after the age of 50 (P < 0.01). P wave duration (PWD) increased with age being slightly longer in subjects older than 50 (121+/-13 ms vs. 128+/-12 ms, P < 0.005). Minimal intraindividual variation of P wave morphology was observed. Conclusion Changes of signal averaged orthogonal P wave morphology (biphasic signal in Lead Z), earlier reported in PAF patients, are common in healthy subjects and appear predominantly after the age of 50. Subtle age-related prolongation of PWD is unlikely to be sufficient as a sole explanation of this finding that is thought to represent interatrial conduction disturbances. To serve as future reference, P wave morphology parameters of the healthy subjects are provided.
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| 16. |
- Hnatkova, K, et al.
(author)
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Computer package generating non-invasive atrial electrograms: Detection and subtraction of QRS and T waves
- 1998
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In: Computers in Cardiology. - 0780352009 ; 25, s. 533-536
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Conference paper (peer-reviewed)abstract
- Computerized systems to localize specific patterns appearing in ECG signal, such as the QRS complex and T wave usually utilize predefined templates. Where the signal is not clean, such as during atrial fibrillation (AF), analysis based on self-similarities of the ECG signal appears to be more stable. The authors describe a software package which uses self-similarity techniques to allow the subtraction of ventricular signals during AF. The dataset used in this study was Holter ECG recorded in 23 patients (11 male, age 61.1±8.7 years) with chronic AF using an Altair 6500 digital Holter (Burdick Inc., 3 channels, 1 kHz sampling). Self-similarities between corresponding QRS and corresponding T windows were assessed using Spearman correlation coefficients, utilising the commercial software derived fiducial point but with shifted windows to overcome possible minor imprecision thereof. A linear order algorithm successfully subtracted 87% of QRS's and 67% of T waves.
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| 17. |
- Holmqvist, Fredrik, et al.
(author)
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Atrial fibrillation signal organization predicts sinus rhythm maintenance in patients undergoing cardioversion of atrial fibrillation.
- 2006
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In: Europace. - : Oxford University Press (OUP). - 1532-2092. ; 8:8, s. 559-565
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Journal article (peer-reviewed)abstract
- Electrical remodelling is believed to influence the outcome following cardioversion of patients with persistent atrial fibrillation (AF). However, the results in clinical studies are conflicting. We assessed the hypothesis that non-invasively obtained atrial fibrillatory organization can be used as a predictor of sinus rhythm (SR) maintenance. METHODS AND RESULTS: Fifty-four patients (37 men, age 67+/-11) with persistent AF (median duration 3 months, 1 day to 18 months), without anti-arrhythmic drug treatment, referred for cardioversion were studied. Assessment of the atrial harmonic decay was made by time-frequency analysis of the ECG. At 1-month follow-up, 30 patients had relapsed into AF. The mean harmonic decay at inclusion of those relapsing into AF was 1.5+/-0.3 compared with 1.1+/-0.3 among those maintaining SR (P=0.0004). Using a cut-off value of harmonic decay
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| 18. |
- Holmqvist, Fredrik, et al.
(author)
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Atrial fibrillatory rate and sinus rhythm maintenance in patients undergoing cardioversion of persistent atrial fibrillation.
- 2006
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In: European Heart Journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 27:18, s. 2201-2207
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Journal article (peer-reviewed)abstract
- The study set out to explore whether an index of atrial electrical electrophysiology can be used to predict atrial fibrillation (AF) relapse, and if the predictive properties differ as a result of arrhythmia duration. METHODS AND RESULTS: The study comprised 175 consecutive patients with persistent AF (median duration 94 days, range 2 to 1044) referred for cardioversion. Twenty-nine patients had arrhythmia duration under 30 days (median 5 days, range 2-26). Atrial fibrillatory rate (AFR) was estimated using a frequency power spectrum analysis of QRST-cancelled ECG. At 1-month follow-up, 56% of the patients had relapsed to AF. The pre-cardioversion mean AFR of those patients was 399+/-52 fibrillations per minute (fpm) compared with 363+/-63 fpm among patients maintaining SR (P<0.0001). In patients with short AF duration, the difference was even more pronounced (424+/-52 vs. 345+/-65 fpm, P<0.01). In this group, a finding of an AFR above the mean value of the study population predicted AF relapse with high accuracy. CONCLUSION: In patients undergoing cardioversion of persistent AF, AF relapse is predicted by a higher AFR. A stronger association is seen in patients with short arrhythmia duration, reflecting either rapid remodelling or pre-existing changes in those who relapse to AF.
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| 19. |
- Holmqvist, Fredrik, et al.
(author)
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Indices of electrical and contractile remodeling during atrial fibrillation in man
- 2006
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In: PACE. - : Wiley. - 1540-8159. ; 29:5, s. 512-519
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Journal article (peer-reviewed)abstract
- Atrial electrical and contractile remodeling have been demonstrated to coincide during atrial fibrillation (AF) in experimental studies. We explored whether electrical and contractile remodeling correlate in man and explored its clinical implications. METHODS: Forty-nine patients with persistent AF were studied. Electrical remodeling was assessed noninvasively using spectral analysis to estimate the average fibrillatory rate (AFR). Atrial contractility was assessed by transesophageal echocardiography (TEE) measurement of left atrial appendage outflow velocity (LAAOV). RESULTS: The AFR was 403+/-43 fibrillations per minute (fpm) and the LAAOV was 0.27+/-0.14 m/s. A significant correlation was found between AFR and LAAOV (r=-0.47, P=0.001). In patients with a LAAOV>or=0.25 m/s, the AFR was 387+/-48 fpm compared to 419+/-31 fpm among patients with LAAOV<0.25 m/s (P<0.01). CONCLUSIONS: This study demonstrates that indices of electrical and contractile remodeling are strongly correlated in persistent AF in man. The interindividual overlap, however, is too large to allow predictions of LAAOV based on fibrillatory frequency alone.
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| 20. |
- Holmqvist, Fredrik, et al.
(author)
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Rapid fluctuations in atrial fibrillatory electrophysiology detected during controlled respiration.
- 2005
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In: American Journal of Physiology: Heart and Circulatory Physiology. - : American Physiological Society. - 1522-1539 .- 0363-6135. ; 289:2, s. 754-760
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Journal article (peer-reviewed)abstract
- Heart rate during sinus rhythm is modulated through the autonomic nervous system, which generates short-term oscillations. The high-frequency components in these oscillations are associated with respiration, causing sinus arrhythmia, mediated by the parasympathetic nervous system. In this study, we evaluated whether slow, controlled respiration causes cyclic fluctuations in the frequency of the fibrillating atria. Eight patients (four women; median age 63 yr, range 53–68 yr) with chronic atrial fibrillation (AF) and third-degree atrioventricular block treated by permanent pacemaker were studied. ECG was recorded during baseline rest, during 0.125-Hz frequency controlled respiration, and finally during controlled respiration after full vagal blockade. We calculated fibrillatory frequency using frequency analysis of the fibrillatory ECG for overlapping 2.5-s segments; spectral analysis of the resulting frequency trend was performed to determine the spectrum of variations of fibrillatory frequency. Normalized spectral power at respiration frequency increased significantly during controlled respiration from 1.4 (0.76–2.0) (median and range) at baseline to 2.7 (1.2–5.8) ( P = 0.01). After vagal blockade, the power at respiration frequency decreased to 1.2 (0.23–2.8) ( P = 0.01). Controlled respiration causes cyclic fluctuations in the AF frequency in patients with long-duration AF. This phenomenon seems to be related to parasympathetic modulations of the AF refractory period.
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| 21. |
- Holmqvist, Fredrik, et al.
(author)
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Variable interatrial conduction illustrated in a hypertrophic cardiomyopathy population
- 2007
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In: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 12:3, s. 227-236
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Journal article (peer-reviewed)abstract
- Background: Patients with hypertrophic cardiomyopathy (HCM) have a high incidence of atrial fibrillation. They also have a longer P-wave duration than healthy controls, indicating conduction alterations. Previous studies have demonstrated orthogonal P-wave morphology alterations in patients with paroxysmal atrial fibrillation. In the present study, the P-wave morphology of patients with HCM was compared with that of matched controls in order to explore the nature of the atrial conduction alterations. Methods and Results: A total of 65 patients (45 men, mean age 49 +/- 15) with HCM were included. The control population (n = 65) was age and gender matched (45 men, mean age 49 +/- 15). Five minutes of 12-lead ECG was recorded. The data were subsequently transformed to orthogonal lead data, and unfiltered signal-averaged P-wave analysis was performed. The P-wave duration was longer in the HCM patients compared to the controls (149 +/- 22 vs 130 +/- 16 ms, P < 0.0001). Examination of the P-wave morphology demonstrated changes in conduction patterns compatible with interatrial conduction block of varying severity in both groups, but a higher degree of interatrial block seen in the HCM population. These changes were most prominent in the Leads Y and Z. Conclusion: The present study suggests that the longer P-wave duration observed in HCM patients may be explained by a higher prevalence of block in one or more of the interatrial conduction routes.
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| 22. |
- Hyllen, Snejana, et al.
(author)
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Determinants of left atrial reverse remodeling after valve surgery for degenerative mitral regurgitation.
- 2013
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In: Journal of Heart Valve Disease. - 0966-8519. ; 22:1, s. 2-10
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Journal article (peer-reviewed)abstract
- Left atrial (LA) enlargement is a pathophysiological response to volume overload resulting from chronic mitral regurgitation (MR), is known as LA remodeling, and has been shown previously to be associated with cardioembolic events. Following mitral valve surgery (MVS), the left atrium may undergo reverse remodeling characterized by LA volume reduction. The study aim was to evaluate the incidence and determinants of postoperative left atrial reverse remodeling (LARR) following MVS.
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| 23. |
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| 24. |
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| 25. |
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| 26. |
- Ingvarsson, Annika, et al.
(author)
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Echocardiographic assessment of chamber size and ventricular function during the first year after heart transplantation
- 2021
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In: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 41:4, s. 355-365
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Journal article (peer-reviewed)abstract
- AIMS: Detecting changes in ventricular function after orthotopic heart transplantation (OHT) using transthoracic echocardiography (TTE) is important but interpretation of findings is complicated by lack of data on early graft adaptation. We sought to evaluate echocardiographic measures of ventricular size and function the first year following OHT including speckle tracking derived strain. We also aimed to compare echocardiographic findings to hemodynamic parameters obtained by right heart catheterization (RHC).METHODS AND RESULTS: Fifty OHT patients were examined prospectively with TTE and RHC at 1, 6, and 12 months after OHT. Left ventricle (LV) was assessed with fractional shortening, ejection fraction, and systolic tissue velocities. Right ventricular (RV) evaluation included tricuspid annular plane systolic excursion (TAPSE), systolic tissue velocity (S´) and fractional area change (FAC). LV global longitudinal and circumferential strain and RV global longitudinal strain (GLS) and RV lateral wall strain (RVfree) were analysed. No relevant changes occurred in LV echocardiographic parameters, whereas all measures of RV function improved significantly during follow up. There was an increase in TAPSE (12.4±3.3 mm to 14.4±4.3 mm, p<0.01), FAC (36±8% to 41±8%, p<0.01), RV GLS (-15.8±3.4% to -17.8±3.6%, p<0.01) and RVfree (-15.5±3.7% to -18.6±3.6%, p<0.001). Between one and twelve months pulmonary pressures decreased, whereas pulmonary vascular resistance did not.CONCLUSION: Stable OHT recipients reached steady state regarding LV function one month after transplantation. In contrast, RV function displayed gradual improvement the first year following OHT, indicating delayed RV-adaptation as compared to the LV. Improved RV function-parameters were independent of invasively measured pulmonary pressures.
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| 27. |
- Ingvarsson, Annika, et al.
(author)
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Impact of bridging with left ventricular assist device on right ventricular function following heart transplantation.
- 2022
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In: ESC heart failure. - : Wiley. - 2055-5822. ; 9:3, s. 1864-1874
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Journal article (peer-reviewed)abstract
- Patients awaiting orthotopic heart transplantation (OHT) can be bridged utilizing a left ventricular assist device (LVAD) that reduces left ventricular filling pressures, decreases pulmonary artery wedge pressure, and maintains adequate cardiac output. This study set out to examine the poorly investigated area of if and how pre-treatment with LVAD impacts right ventricular (RV) function following OHT.We prospectively evaluated 59 (LVAD n=20) consecutive OHT patients. Transthoracic echocardiography (TTE) was performed in conjunction with right heart catheterization (RHC) at 1, 6, and 12months after OHT. RV function TTE-parameters included tricuspid annular plane systolic excursion (TAPSE), systolic tissue velocity (S'), fractional area change, two-dimensional RV global longitudinal strain and longitudinal strain from the RV lateral wall (RVfree). At 1month after OHT, the LVAD group had significantly better longitudinal RV function than the non-LVAD group: TAPSE (15±3mm vs. 12±2mm, P<0.001), RV global longitudinal strain (-19.8±2.1% vs. -14.3±2.8%, P<0.001), and RVfree (-19.8±2.3% vs. -14.1±2.9%, P<0.001). At this time point, pulmonary vascular resistance (PVR) was also lower [1.2±0.4 Wood Units (WU) vs. 1.6±0.6 WU, P<0.05] in the LVAD group compared with the non-LVAD group. At 6 and 12months, no difference was detected in any of the TTE and RHC measured parameters between the two groups. Between 1 and 12months, all parameters of RV function improved significantly in the non-LVAD group but remained unaltered in the LVAD group.Our results indicate that pre-treatment with LVAD decreases PVR and is associated with significantly better RV function early following OHT. During the first year following transplantation, RV function progressively improved in the non-LVAD group such that at 6 and 12months, no difference in RV function was detected between the groups.
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| 28. |
- Ingvarsson, Annika, et al.
(author)
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Impact of gender on echocardiographic characteristics in heart transplant recipients
- 2019
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In: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 39:4, s. 246-254
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Journal article (peer-reviewed)abstract
- Aims: Assessment following heart transplantation (HTx) is routinely performed using transthoracic echocardiography. Differences in long-term mortality following HTx related to donor-recipient matching have been reported, but effects of gender on cardiac size and function are not well studied. The aims of this study were to evaluate differences in echocardiographic characteristics of HTx recipients defined by gender. Methods and results: The study prospectively enrolled 123 (n = 34 female) HTx recipients of which 23 recipients was donor-recipient gender mismatched. Patients were examined with 2-dimensional echocardiography using Philips iE33 ultrasound system. Data were analysed across strata based on recipient gender and gender mismatch. Male recipients had larger left ventricular (LV) mass, thicker septal wall (P<0·001) and larger absolute LV volumes (P<0·001). Mean LV ejection fraction (EF) was higher in females (P<0·05), but no differences in conventional parameters of right ventricular (RV) function were found. Ventricular strain was higher in females than in males: LV global longitudinal strain (P<0·01), RV global longitudinal strain (P<0·05) and RV lateral free wall (P<0·05). The male group receiving a female donor heart had comparable EF and strain parameters to the female group receiving a gender-matched heart. Conclusion: We found that female recipient gender was associated with smaller chamber size, higher LV EF and better LV and RV longitudinal strain. Gender-mismatched male recipients appeared to exhibit function parameters similar to gender-matched female recipients. Our results indicate that the gender aspect, analogous to current reference guidelines in general population, should be taken into consideration when examining patients post-HTx.
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| 29. |
- Ingvarsson, Annika, et al.
(author)
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Normal Reference Ranges for Transthoracic Echocardiography Following Heart Transplantation
- 2018
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In: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317. ; 31:3, s. 349-360
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Journal article (peer-reviewed)abstract
- Background: Heart function following heart transplantation (HTx) is influenced by numerous factors. It is typically evaluated using transthoracic echocardiography, but reference values are currently unavailable for this context. The primary aim of the present study was to derive echocardiographic reference values for chamber size and function, including cardiac mechanics, in clinically stable HTx patients. Methods: The study enrolled 124 healthy HTx patients examined prospectively. Patients underwent comprehensive two-dimensional echocardiographic examinations according to contemporary guidelines. Results were compared with recognized reference values for healthy subjects. Results: Compared with guidelines, larger atrial dimensions were seen in HTx patients. Left ventricular (LV) diastolic volume was smaller, and LV wall thickness was increased. With respect to LV function, both ejection fraction (62 ± 7%, P < .01) and global longitudinal strain (-16.5 ± 3.3%, P < .0001) were lower. All measures of right ventricular (RV) size were greater than reference values (P < .0001), and all measures of RV function were reduced (tricuspid annular plane systolic excursion 15 ± 4 mm [. P < .0001], RV systolic tissue Doppler velocity 10 ± 6 cm/sec [. P < .0001], fractional area change 40 ± 8% [. P < .0001], and RV free wall strain -16.9 ± 4.2% [. P < .0001]). Ejection fraction and LV global longitudinal strain were significantly lower in patients with previous rejection. Conclusion: The findings of this study indicate that the distribution of routinely used echocardiographic measures differs between stable HTx patients and healthy subjects. In particular, markedly larger RV and atrial volumes and mild reductions in both LV and RV longitudinal strain were evident. The observed differences could be clinically relevant in the assessment of HTx patients, and specific reference values should be applied in this context.
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| 30. |
- Jumatate, Raluca, et al.
(author)
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Right ventricular stroke work index by echocardiography in adult patients with pulmonary arterial hypertension
- 2021
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In: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 21:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: In adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, resulting in a poor prognosis. In this population, non-invasive assessment of RV function is challenging. RV stroke work index (RVSWI) measured by right heart catheterization (RHC) represents a promising index for RV function. The aim of the present study was to comprehensively evaluate non-invasive measures to calculate RVSWI derived by echocardiography (RVSWIECHO) using RHC (RVSWIRHC) as a reference in adult PAH patients.METHODS: Retrospectively, 54 consecutive treatment naïve patients with PAH (65 ± 13 years, 36 women) were analyzed. Echocardiography and RHC were performed within a median of 1 day [IQR 0-1 days]. RVSWIRHC was calculated as: (mean pulmonary arterial pressure (mPAP)-mean right atrial pressure (mRAP)) x stroke volume index (SVI)RHC. Four methods for RVSWIECHO were evaluated: RVSWIECHO-1 = Tricuspid regurgitant maximum pressure gradient (TRmaxPG) x SVIECHO, RVSWIECHO-2 = (TRmaxPG-mRAPECHO) x SVIECHO, RVSWIECHO-3 = TR mean gradient (TRmeanPG) x SVIECHO and RVSWIECHO-4 = (TRmeanPG-mRAPECHO) x SVIECHO. Estimation of mRAPECHO was derived from inferior vena cava diameter.RESULTS: RVSWIRHC was 1132 ± 352 mmHg*mL*m-2. In comparison with RVSWIRHC in absolute values, RVSWIECHO-1 and RVSWIECHO-2 was significantly higher (p < 0.001), whereas RVSWIECHO-4 was lower (p < 0.001). No difference was shown for RVSWIECHO-3 (p = 0.304). The strongest correlation, with RVSWIRHC, was demonstrated for RVSWIECHO-2 (r = 0.78, p < 0.001) and RVSWIECHO-1 ( r = 0.75, p < 0.001). RVSWIECHO-3 and RVSWIECHO-4 had moderate correlation (r = 0.66 and r = 0.69, p < 0.001 for all). A good agreement (ICC) was demonstrated for RVSWIECHO-3 (ICC = 0.80, 95% CI 0.64-0.88, p < 0.001), a moderate for RVSWIECHO-4 (ICC = 0.73, 95% CI 0.27-0.87, p < 0.001) and RVSWIECHO-2 (ICC = 0.55, 95% CI - 0.21-0.83, p < 0.001). A poor ICC was demonstrated for RVSWIECHO-1 (ICC = 0.45, 95% CI - 0.18-0.77, p < 0.001). Agreement of absolute values for RVSWIECHO-1 was - 772 ± 385 (- 50 ± 20%) mmHg*mL*m-2, RVSWIECHO-2 - 600 ± 339 (-41 ± 20%) mmHg*mL*m-2, RVSWIECHO-3 42 ± 286 (5 ± 25%) mmHg*mL*m-2 and for RVSWIECHO-4 214 ± 273 (23 ± 27%) mmHg*mL*m-2.CONCLUSION: The correlation with RVSWIRHC was moderate to strong for all echocardiographic measures, whereas only RVSWIECHO-3 displayed high concordance of absolute values. The results, however, suggest that RVSWIECHO-1 or RVSWIECHO-3 could be the preferable echocardiographic methods. Prospective studies are warranted to evaluate the clinical utility of such measures in relation to treatment response, risk stratification and prognosis in patients with PAH.
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| 31. |
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| 32. |
- Khoshnood, Ardavan, et al.
(author)
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Effects of oxygen therapy on wall-motion score index in patients with ST elevation myocardial infarction-the randomized SOCCER trial
- 2017
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In: Echocardiography. - : Wiley. - 0742-2822. ; 34:8, s. 1130-1137
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Journal article (peer-reviewed)abstract
- Background: Although oxygen (O2) is routinely used in patients with acute myocardial infarction (AMI), it may have negative effects. In this substudy of the SOCCER trial, we aimed to evaluate the effects of O2-treatment on myocardial function in patients with ST elevation myocardial infarction (STEMI). Methods: Normoxic (≥94%) STEMI patients were randomized in the ambulance to either supplemental O2 or room air until the end of the percutaneous coronary intervention (PCI). The patients underwent echocardiography on day 2-3 after the PCI and once again after 6 months. The study endpoints were wall-motion score index (WMSI) and left ventricular ejection fraction (LVEF). Results: Forty-six patients in the O2 group and 41 in the air group were included in the analysis. The index echocardiography showed no significant differences between the groups in WMSI (1.32±0.27 for O2 group vs 1.28±0.28 for air group) or LVEF (47.0±8.5% vs 49.2±8.1%). Nor were there differences at 6 months in WMSI (1.16±0.25 vs 1.14±0.24) or LVEF (53.5±5.8% vs 53.5±6.9%). Conclusion: The present findings indicate no harm or benefit of supplemental O2 on myocardial function in STEMI patients. Our results support that it is safe to withhold supplemental O2 in normoxic STEMI patients.
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| 33. |
- Kimblad, Per Ola, et al.
(author)
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Percutaneous transvenous mitral annuloplasty (PTMA) with the Viking device reduces pacing-induced mitral regurgitation.
- 2005
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In: EuroIntervention. - 1969-6213. ; 1:3, s. 346-351
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Journal article (peer-reviewed)abstract
- Objectives: The new percutaneous mitral annuloplasty Viking device was evaluated in surviving sheep with pacing-induced mitral regurgitation. Methods and results: Twenty sheep were subjected to rapid ventricular pacing for one to three months, leading to cardiomyopathy and mitral regurgitation. Device implantation could be successfully performed in 11 of these animals after pacemaker treatment for 64′7 days. The device-related procedure time was 12′2 min. The mean follow-up time was 58′8 days after implantation of the device. Mitral annulus septolateral diameter was significantly reduced after insertion of the device, from 35′1 mm before implantation to 30′1 mm at the final follow up intracardiac echocardiography (P= 0.0097). The degree of mitral regurgitation (on a scale from 0 to 4) was 2.6′0.2 before device implantation and decreased to 0.8′0.2 after treatment (P= 0.0039), and the vena contracta was reduced from 7′0.4 mm to 3′0.8 mm (P= 0.0019). Angiography showed no signs of impairment of the coronary arteries. No thrombosis was observed. Conclusions: These results indicate that the septa-lateral diameter of the mitral annulus, and the degree of experimentally induced mitral regurgitation, can be significantly reduced with a percutaneous catheter technique in surviving sheep.
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| 34. |
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| 35. |
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| 36. |
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| 37. |
- Koul, Bansi, et al.
(author)
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A modified Ross operation to prevent pulmonary autograft dilatation.
- 2007
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In: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940. ; 31:1, s. 127-128
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Journal article (peer-reviewed)abstract
- A modification in Ross operation is described in which the free-standing pulmonary autograft root is suspended in a Dacron prosthetic vascular jacket with a view to prevent dilatation of the neo-aortic root. In a group of 13 patients operated consecutively using this technique, there was no significant increase in the diameters of the neo-aortic root after a mean 16-month follow-up. Aortic valve function remained also satisfactory.
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| 38. |
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| 39. |
- Larsson, David, et al.
(author)
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The diagnostic and prognostic value of brain natriuretic peptides in adults with a systemic morphologically right ventricle or Fontan-type circulation.
- 2007
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 114:3, s. 345-351
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Journal article (peer-reviewed)abstract
- Background: In acquired heart disease, brain natriuretic peptide (BNP) and N-Teminal pro-brain natriuretic peptide (NT-proBNP) are increasingly used as diagnostic and prognostic markers. In adult Congenital heart disease, the abnormal anatomy and physiology complicate assessment of cardiac function. We Studied the clinical correlates of measurement of natriuretic peptides (NP) in adults with a right ventricle in the systemic position or with Fontan-type physiology. Methods: A prospective longitudinal study (follow up time 23 +/- 13 months, mean +/- S.D.) was conducted in a specialised centre on 61 patients (age 26 +/- 8 years; NYHA class 1.5 +/- 0.6) including Senning/Mustard corrected transposition, congenitally corrected transposition and Fontan/ total cavopulmonary connection. Plasma NP concentration was compared with NYHA class, exercise capacity and echocardiographically determined systemic systolic ventricular function. Results: Neurohormone concentrations were generally elevated (mean=290% of upper reference limit) and related to NYHA class (P < 0.001, NYHA I vs. II-IV). No clinically significant relationship to ventricular function or exercise capacity was found however. An NP measurement could not predict the future Course of the disease in terms of functional status or ventricular function. Conclusion: In contrast to patients with acquired heart disease, measurement of NP seems to have low clinical value in adults with a right ventricle in the systemic position or with Fontan-type physiology.
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| 40. |
- Meurling, Carl
(author)
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Atrial Fibrillation. Modulation of the atrial fibrillatory frequency. A non-invasive approach.
- 2000
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Doctoral thesis (other academic/artistic)abstract
- Aim: To non-invasively detect and explore the changes in atrial fibrillatory cycle length (i.e. changes in the atrial refractory period) in humans with chronic atrial fibrillation (CAF) following autonomic modulation and pharmacological intervention. Furthermore we investigated if the value of the atrial fibrillatory cycle length could predict outcome following DC-cardioversion. Methods: The study enrolled patients with persistent or permanent AF. Data was acquired using 12-lead standard ECG equipment, a unipolar oesophageal lead or digital Holter recorders. Assessment of atrial fibrillatory electrophysiology was made non-invasively with power spectrum frequency analysis of QRST cancelled ECG using the frequency analysis of fibrillatory ECG methodology (FAF-ECG). The peak frequency was converted to a cycle length, termed dominant atrial cycle length (DACL), which is a validated index of atrial refractoriness. Results: In the first study (I) the DACL derived from both surface and oesophageal ECG as well as additional parameters of the FAF-ECG methodology were evaluated in clinical practice. The second study (II) showed that oral treatment with verapamil increases DACL (and therefore by inference atrial refractory period) in patients with chronic AF. The two following studies (III, IV) investigated the effects of autonomic modulation on atrial fibrillatory electrophysiology. The first of these (III), demonstrated that adrenergic stimulation decreases the DACL and that vagal withdrawal initially increases the DACL. The other study (IV) found that atrial fibrillatory cycle length shows significant diurnal variation, with shorter cycle lengths during day and consequently longer cycle lengths during night. Finally, we demonstrated that the ratio of DACL and left atrial diameter is higher in patients maintaining in sinus rhythm after DC-cardioversion of persistent AF (V). Conclusion: The FAF-ECG method can estimate DACL in the majority of patients, allowing non-invasive assessment of atrial refractoriness and of spatial dispersion in DACL, power maximum and spectral width of DACL (I). Since DACL is recognised as an index of refractoriness, we have demonstrated that already established electrical remodelling can be attenuated/partly reversed with calcium channel blockade (II). Changes in the electrophysiological properties of the fibrillating atrium during pharmacological autonomic modulation are detectable by the FAF-ECG method, and sympathetic modulations appear to be more pronounced than vagal ones during chronic AF (III). DACL, and hence atrial refractoriness, exhibits significant diurnal fluctuations during chronic AF, with a shorter mean DACL during daytime (IV). Prediction of sinus rhythm maintenance following cardioversion is optimised by combining electrophysiological and anatomical measurements, but the absolute predictive accuracy is modest, suggesting other etiological factors than absolute degree of electrical remodelling are important (V).
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| 41. |
- Meurling, Carl, et al.
(author)
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Diurnal variations of the dominant cycle length of chronic atrial fibrillation
- 2001
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In: American Journal of Physiology: Heart and Circulatory Physiology. - 1522-1539. ; 280:1, s. 401-406
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Journal article (peer-reviewed)abstract
- High-resolution digital Holter recording was carried out in 21 patients (15 men, 64 +/- 12 yr) with chronic atrial fibrillation. Dominating atrial cycle length (DACL) was derived by frequency domain analysis of QRST-reduced electrocardiograms. Daytime mean DACL was 150 +/- 17 ms, and nighttime mean was 157 +/- 22 ms (P = 0. 0002). Diurnal fluctuation in DACL differed among patients: it tended to be virtually absent in those with a short mean DACL, but in those with longer DACL the night-day difference was as much as 23 ms (R = 0.72, P < 0.001, correlation of mean DACL to night-day difference). Mean DACL also correlated with ventricular cycle length (R = 0.40, P < 0.001), particularly at night (r = 0.49). The shorter cycle lengths found in this study during the day are consistent with sympathetic and/or other physiological modulation, but since increased vagal tone shortens atrial refractoriness in most models, parasympathetic influences are not likely to play a major role. Alternatively, atrial effective refractory period may not be the sole determinant of atrial cycle length during atrial fibrillation.
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| 42. |
- Meurling, Carl, et al.
(author)
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Non-invasive assessment of atrial fibrillation (AF) cycle length in man: potential application for studying AF
- 2001
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In: Annali dell'Istituto Superiore di Sanità. - 0021-2571. ; 37:3, s. 341-341
-
Journal article (peer-reviewed)abstract
- Non-invasive assessment of the fibrillatory frequency of atrial fibrillation (AF) can be performed by frequency domain analysis. The peak frequency in the derived spectrum can be converted to a dominant atrial cycle length (DACL). The DACL can be altered through autonomic modulation or pharmacologic manipulation, but the change in DACL is less marked in those with a short DACL value. In patients with AF, those with a short duration of the arrhythmia have longer DACL values. Finally, patients with paroxysmal AF generally exhibit longer DACL values than patients with permanent AF. Thus non-invasive assessment of the atrial fibrillatory cycle length provides a useful index of atrial refractoriness and has the potential of clinical utility in patient assessment and treatment planning.
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| 43. |
- Meurling, Lisbet, et al.
(author)
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Comparison of high- and low equipment fidelity during paediatric simulation team training : a case control study
- 2014
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In: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 14, s. 221-
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Journal article (peer-reviewed)abstract
- Background: High-fidelity patient simulators in team training are becoming popular, though research showing benefits of the training process compared to low-fidelity models is rare. We explored in situ training for paediatric teams in an emergency department using a low-fidelity model (plastic doll) and a high-fidelity paediatric simulator, keeping other contextual factors constant. The goal was to study differences in trainees' and trainers' performance along with their individual experiences, during in situ training, using either a low-fidelity model or a high-fidelity paediatric simulator.Methods: During a two-year period, teams involved in paediatric emergency care were trained in groups of five to nine. Each team performed one video-recorded paediatric emergency scenario. A case control study was undertaken in which 34 teams used either a low-fidelity model (n = 17) or a high-fidelity paediatric simulator (n = 17). The teams' clinical performances during the scenarios were measured as the time elapsed to prescribe as well as deliver oxygen. The trainers were monitored regarding frequency of their interventions. We also registered trainees' and trainers' mental strain and flow experience.Results: Of 225 trainees' occasions during 34 sessions, 34 trainer questionnaires, 163 trainee questionnaires, and 28 videos, could be analyzed. Time to deliver oxygen was significantly longer (p = 0.014) when a high-fidelity simulator was used. The trainees' mental strain and flow did not differ between the two types of training. The frequency of trainers interventions was lower (p < 0.001) when trainees used a high-fidelity simulator; trainers' perceived mental strain was lower (< 0.001) and their flow experience higher (p = 0.004) when using high-fidelity simulator.Conclusions: Levels of equipment fidelity affect measurable performance variables in simulation-based team training, but trainee s' individual experiences are similar. We also note a reduction in the frequency of trainers' interventions in the scenarios as well as their mental strain, when trainees used a high-fidelity simulator.
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| 44. |
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| 45. |
- Nozohoor, Shahab, et al.
(author)
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Prognostic value of pulmonary hypertension in patients undergoing surgery for degenerative mitral valve disease with leaflet prolapse.
- 2012
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In: Journal of Cardiac Surgery. - : Hindawi Limited. - 1540-8191 .- 0886-0440. ; 27:6, s. 668-675
-
Journal article (peer-reviewed)abstract
- Abstract Background and Aim of the Study: The aim of this study was to evaluate the impact of pulmonary hypertension (PH) on early and late outcomes following surgery in patients with degenerative mitral regurgitation. Methods: The study included 270 patients who had undergone isolated mitral valve surgery (MVS) for leaflet prolapse during 1998 to 2010. Pulmonary artery systolic pressure (PASP) was measured with Doppler echocardiography pre- and postoperatively. The impact of PH (PASP > 50 mmHg) on mortality and the potential for postoperative resolution of preoperatively elevated PASP was retrospectively analyzed. Results: The incidence of PH was 27% (n = 74/270). Postoperative normalization, or reduction of preoperative PASP, was demonstrated in 87% of the patients with PH at a median of two months (interquartile range 1 to 19). Absent improvement or a postoperative increase in PASP was independently predicted by age (OR 1.08, 95% CI 1.02-1.14, p = 0.010). Preoperative PH resulted in a fourfold higher risk of postoperative mortality (HR 4.3, 95% CI 1.1-17.4, p = 0.039) during the first three years of follow-up. Conclusions: PH is an independent predictor of mortality during the initial three years following MVS. The majority of patients with PH demonstrated a reduction of preoperatively elevated PASP following surgery and the increased risk of mortality gradually decreased after three years. Our findings support early admission for mitral valve surgery before the occurrence of PH. (J Card Surg 2012;27:668-675).
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