| 1. |
- Albåge, Anders, et al.
(författare)
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Long-Term Risk of Ischemic Stroke After the Cox-Maze III Procedure for Atrial Fibrillation
- 2017
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975 .- 1552-6259. ; 104:2, s. 523-529
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Tidskriftsartikel (refereegranskat)abstract
- Background The long-term risk of stroke after surgical treatment of atrial fibrillation is not well known. We performed an observational cohort study with long follow-up after the “cut-and-sew” Cox-maze III procedure (CM-III), including left atrial appendage excision. The aim was to analyze the incidence of stroke/transient ischemic attack (TIA) and the association to preoperative CHA2DS2-VASc (age in years, sex, congestive heart failure history, hypertension history, stroke/TIA, thromboembolism history, vascular disease history, diabetes mellitus) score. Methods Preoperative and perioperative data were collected in 526 CM-III patients operated in four centers 1994 to 2009, 412 men, mean age of 57.1 ± 8.3 years. The incidence of any stroke/TIA was identified through analyses of the Swedish National Patient and Cause-of-Death Registers and from review of individual patient records. The cumulative incidence of stroke/TIA and association with CHA2DS2-VASc score was estimated using methods accounting for the competing risk of death. Results Mean follow-up was 10.1 years. There were 29 patients with any stroke/TIA, including 6 with intracerebral bleedings (2 fatal) and 4 with perioperative strokes (0.76%). The remaining 13 ischemic strokes and six TIAs occurred at a mean of 7.1 ± 4.0 years postoperatively, with an incidence of 0.36% per year (19 events per 5,231 patient-years). In all CHA2DS2-VASc groups, observed ischemic stroke/TIA rate was lower than predicted. A higher risk of ischemic stroke/TIA was seen in patients with CHA2DS2-VASc score 2 or greater compared with score 0 or 1 (hazards ratio 2.15, 95% confidence interval: 0.87 to 5.32) but no difference by sex or stand-alone versus concomitant operation. No patient had ischemic stroke as cause of death. Conclusions This multicenter study showed a low incidence of perioperative and long-term postoperative ischemic stroke/TIA after CM-III. Although general risk of ischemic stroke/TIA was reduced, patients with CHA2DS2-VASc score 2 or greater had a higher risk compared with score 0 or 1. Complete left atrial appendage excision may be an important reason for the low ischemic stroke rate.
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| 2. |
- Bilchick, Kenneth C., et al.
(författare)
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Survival Probability and Survival Benefit Associated With Primary Prevention Implantable Cardioverter-Defibrillator Generator Changes
- 2022
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Ingår i: Journal of the American Heart Association. - : Wiley. - 2047-9980. ; 11:13
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Tidskriftsartikel (refereegranskat)abstract
- Background As patients derive variable benefit from generator changes (GCs) of implantable cardioverter-defibrillators (ICDs) with an original primary prevention (PP) indication, better predictors of outcomes are needed. Methods and Results In the National Cardiovascular Data Registry ICD Registry, patients undergoing GCs of initial non-cardiac resynchronization therapy PP ICDs in 2012 to 2016, predictors of post-GC survival and survival benefit versus control heart failure patients without ICDs were assessed. These included predicted annual mortality based on the Seattle Heart Failure Model, left ventricular ejection fraction (LVEF) >35%, and the probability that a patients death would be arrhythmic (proportional risk of arrhythmic death [PRAD]). In 40 933 patients undergoing GCs of initial noncardiac resynchronization therapy PP ICDs (age 67.7 +/- 12.0 years, 24.5% women, 34.1% with LVEF >35%), Seattle Heart Failure Model-predicted annual mortality had the greatest effect size for decreased post-GC survival (P<0.0001). Patients undergoing GCs of initial noncardiac resynchronization therapy PP ICDs with LVEF >35% had a lower Seattle Heart Failure Model-adjusted survival versus 23 472 control heart failure patients without ICDs (model interaction hazard ratio, 1.21 [95% CI, 1.11-1.31]). In patients undergoing GCs of initial noncardiac resynchonization therapy PP ICDs with LVEF <= 35%, the model indicated worse survival versus controls in the 21% of patients with a PRAD 65%. The association of the PRAD with survival benefit or harm was similar in patients with or without pre-GC ICD therapies. Conclusions Patients who received replacement of an ICD originally implanted for primary prevention and had at the time of GC either LVEF >35% alone or both LVEF <= 35% and PRAD <43% had worse survival versus controls without ICDs.
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| 3. |
- Hashemi, Nashmil, et al.
(författare)
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Right ventricular mechanics and contractility after aortic valve replacement surgery : a randomised study comparing minimally invasive versus conventional approach
- 2018
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Ingår i: Open heart. - : BMJ Publishing Group Ltd. - 2053-3624. ; 5:2
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Tidskriftsartikel (refereegranskat)abstract
- Objective Minimally invasive aortic valve replacementsurgery (MIAVR) is an alternative surgical technique to conventional aortic valve replacement surgery (AVR) in selected patients. The randomised study Cardiac Function after Minimally Invasive Aortic Valve Implantation (CMILE) showed that right ventricular (RV) longitudinal function was reduced after both MIAVR and AVR, but the reduction was more pronounced following AVR. However, postoperative global RV function was equally impaired in both groups. The purpose of this study was to explore alterations in RV mechanics and contractility following MIAVR as compared with AVR. Methods A predefined post hoc analysis of CMILE consisting of 40 patients with severe aortic valve stenosis who were eligible for isolated surgical aortic valve replacement were randomised to MIAVR or AVR. RV function was assessed by echocardiography prior to surgery and 40 days post-surgery. Results Comparing preoperative to postoperative values, RV longitudinal strain rate was preserved following MIAVR (-1.5 +/- 0.5 vs -1.5 +/- 0.4 1/s, p=0.84) but declined following AVR (-1.7 +/- 0.3 vs -1.4 +/- 0.3 its, p<0.01). RV longitudinal strain reduced following AVR (-27.4 +/- 2.9% vs -18.8%+/- 4.7%, p<0.001) and MIAVR (-26.5 +/- 5.3% vs -20.7%+/- 4.5%, p<0.01). Peak systolic velocity of the lateral tricuspid annulus reduced by 36.6% in the AVR group (9.3 +/- 2.1 vs 5.9 +/- 1.5 cm/s, p<0.01) and 18.8% in the MIAVR group (10.1 +/- 2.9 vs 8.2 +/- 1.4 cm/s, p<0.01) when comparing preoperative values with postoperative values. Conclusions RV contractility was preserved following MIAVR but was deteriorated following AVR. RV longitudinal function reduced substantially following AVR. A decline in RV longitudinal function was also observed following MIAVR, however, to a much lesser extent.
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| 4. |
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| 5. |
- Holzmann, Martin J, et al.
(författare)
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Renal dysfunction and long-term risk of heart failure after coronary artery bypass grafting.
- 2013
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Ingår i: American heart journal. - : Elsevier BV. - 1097-6744 .- 0002-8703. ; 166:1, s. 142-9
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Tidskriftsartikel (refereegranskat)abstract
- Renal dysfunction is associated with increased long-term mortality and incidence of myocardial infarction after coronary artery bypass grafting (CABG). The aim was to investigate the relationship between renal dysfunction and long-term risk of heart failure after CABG.
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| 6. |
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| 7. |
- Kallonen, Janica, et al.
(författare)
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Quality of life and functional status after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension : A Swedish single-center study
- 2023
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Ingår i: Pulmonary Circulation. - : Wiley. - 2045-8932 .- 2045-8940. ; 13:2
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Tidskriftsartikel (refereegranskat)abstract
- Little is known about long-term quality of life (QOL) and functional status after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH). We investigated QOL and functional status late after PEA. All patients who underwent PEA for CTEPH 1993–2020 at one Swedish center were included. Baseline characteristics and data from right heart catheterization, 6-min walk test, and Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) were obtained from patient charts and national registers. The RAND 36-Item Health Survey was sent by post, and Karnofsky Performance Status (KPS) was evaluated by telephone. A total of 110 patients were included. The survey was completed by 49/66 (74%) patients who were alive in 2020. In all domains except for bodily pain, QOL was slightly lower than that of an age-matched reference population. The KPS score was obtained from 42/49 (86%) patients; of these, 31 patients (74%) had a KPS score of ≥80% (able to carry on normal activity). All 42 patients were able to live at home and care for personal needs. The median postoperative CAMPHOR scores were: 4 for symptoms, 4 for activity, and 2.5 for QOL. We observed that QOL after PEA approached the expected QOL in a reference population and that CAMPHOR scores were comparable to those of a large UK cohort after PEA. Functional status improved when assessed late after PEA. Three-quarters of the study population were able to conduct normal activities at late follow-up. Our findings suggest that many patients enjoy satisfactory QOL and high functional status late after PEA.
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| 8. |
- Makubi, Abel, et al.
(författare)
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Heart failure in Tanzania and Sweden: Comparative characterization and prognosis in the Tanzania Heart Failure (TaHeF) study and the Swedish Heart Failure Registry (SwedeHF)
- 2016
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Ingår i: International Journal of Cardiology. - : ELSEVIER IRELAND LTD. - 0167-5273 .- 1874-1754. ; 220, s. 750-758
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Tidskriftsartikel (refereegranskat)abstract
- Background: Heart failure (HF) in developing countries is poorly described. We compare characteristics and prognosis of HF in Tanzania vs. Sweden. Methods: A prospective cohort study was conducted from the Tanzania HF study (TaHeF) and the Swedish HF Registry (SwedeHF). Patients were compared overall (n 427 vs. 51,060) and after matching 1: 3 by gender and age +/- 5 years (n 411 vs. 1232). The association between cohort and all-cause mortality was assessed with multivariable Cox regression. Results: In the unmatched cohorts, TaHeF (as compared to SwedeHF) patients were younger (median age [inter-quartile range] 55 [40-68] vs. 77 [64-84] years, p amp;lt; 0.001) and more commonly women (51% vs. 40%, p amp;lt; 0.001). The three-year survival was 61% in both cohorts. In the matched cohorts, TaHeF patients had more hypertension (47% vs. 37%, p amp;lt; 0.001), more anemia (57% vs. 9%), more preserved EF, more advanced HF, longer duration of HF, and less use of beta-blockers. Crude mortality was worse in TaHeF (HR 2.25 [95% CI 1.78-2.85], p amp;lt; 0.001), with three-year survival 61% vs. 83%. However, covariate-adjusted risk was similar (HR 1.07, 95% CI 0.69-1.66; p = 0.760). In both cohorts, preserved EF was associated with higher mortality in crude but not adjusted analysis. Conclusions: Compared to in Sweden, HF patients in Tanzania were younger and more commonly female, and after age and gender matching, had more frequent hypertension and anemia, more severe HF despite higher EF, and worse crude but similar adjusted prognosis. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
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| 9. |
- Nyström, Thomas, et al.
(författare)
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Estimated glucose disposal rate and long-term survival in type 2 diabetes after coronary artery bypass grafting.
- 2017
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Ingår i: Heart and vessels. - : Springer Science and Business Media LLC. - 1615-2573 .- 0910-8327. ; 32:3, s. 269-278
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Tidskriftsartikel (refereegranskat)abstract
- We performed a nationwide population-based cohort study to investigate the association between estimated glucose disposal rate (eGDR) and long-term survival after coronary artery bypass grafting (CABG) in patients with type 2 diabetes. All patients who underwent primary CABG in Sweden from 2006 to 2013 were identified from the SWEDEHEART register and by record linkage to the National Diabetes Register; all patients with type 2 diabetes were included and formed the study population. Patients were followed until 2013 through national registers for major adverse cardiovascular events and death from any cause. eGDR was calculated using waist circumference, hemoglobin A1c, and presence or the absence of hypertension. The association between eGDR and death was estimated using multivariable Cox regression. A total of 3256 patients were included. During a mean follow-up of 3.1years (10,227 person-years), in total, 14% patients died: 17% (n=186) in the 1st tertile (lowest eGDR), 14% (n=145) in the 2nd tertile, and 13% (n=133) in the 3rd tertile (highest eGDR). There was a significant association between eGDR and increased risk of death: adjusted hazard ratio (95% confidence interval): 1.46 (1.12-1.90) for the 1st eGDR tertile compared to the 3rd and highest eGDR tertile. In conclusion, patients with type 2 diabetes who underwent CABG, a low eGDR, were associated with an increased risk of long-term all-cause mortality that was independent of other cardiovascular and metabolic risk factors. Insulin resistance measured by eGDR could be a useful risk marker in patients with type 2 diabetes and ischemic heart disease.
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| 10. |
- Nyström, Thomas, et al.
(författare)
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Estimated glucose disposal rate predicts mortality in adults with type 1 diabetes.
- 2018
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Ingår i: Diabetes, obesity & metabolism. - : Wiley. - 1463-1326 .- 1462-8902. ; 20:3, s. 556-563
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to investigate the association between insulin resistance as determined by the estimated glucose disposal rate (eGDR), and survival in adults with type 1 diabetes (T1D) in Sweden.Using the Swedish National Diabetes Register, indviduals with T1D were included from January 1, 2005 to December 31, 2012. Outcomes were retrieved from National healthcare registers. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for the associations between eGDR (mg/kg/min) categorized into <4, 4 to 5.99, 6 to 7.99, and ≥8 (reference) and outcomes. Relative survival methods were used to compare survival to a matched Swedish reference population.Among 17050 included individuals with T1D, 10.5%, 20.2%, 20.5% and 48.9% had an eGDR of <4, 4 to 5.99, 6 to 7.99, and ≥8, respectively. Individuals with an eGDR <8 were older and had more comorbidities. During a median follow-up of 7.1years, there were 946 (6%) deaths; 264 (15%), 367 (11%), 195 (6%) and 120 (1%) deaths occurred in individuals with an eGDR of <4, 4 to 5.99, 6 to 7.99 and ≥8, respectively. After adjustment for a wealth of different covariates including diabetes duration, age, sex and renal function, individuals with an eGDR <4, 4 to 5.99, and 6 to 7.99 had an increased risk of death compared to those with an eGDR ≥8 (adjusted HRs, 95% CIs, P values: 2.78, 2.04 to 3.77, <.001; 1.92, 1.49 to 2.46, <.001; 1.73, 1.34 to 2.21, <.001). Survival in individuals with an eGDR ≥8 was equal to a matched general population.There is a strong association between eGDR and all-cause mortality, as well as cardiovascular mortality, in individuals with T1D. Our findings may guide preventive measures by improving risk assessment in individuals with T1D.
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| 11. |
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| 12. |
- Persson, Michael, et al.
(författare)
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ABO blood type and risk of porcine bioprosthetic aortic valve degeneration : SWEDEHEART observational cohort study
- 2019
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- Objective Blood type A antigen on porcine aortic bioprostheses might initiate an immune reaction leading to an increased frequency of structural valve deterioration in patients with blood type B or O. The aim was to analyse the association between ABO blood type and porcine bioprosthetic aortic valve degeneration. Design Observational nationwide cohort study. Setting Swedish population-based study. Participants Adult patients (n=3417) who underwent surgical aortic valve replacement and received porcine bioprosthetic aortic valves between 1995 and 2012 from the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies register. The study database was enriched with information from other national registers. Exposure The patients were categorised into type A/AB and type B/O blood groups. Primary and secondary outcome measures Primary outcome measure was aortic valve reoperation, and secondary outcomes were heart failure and all-cause mortality. We report risk estimates that account for the competing risk of death. Results In total, 3417 patients were identified: 1724 (50.5%) with blood type A/AB and 1693 (49.5%) with blood type B/O. Both groups had similar baseline characteristics. The cumulative incidence of aortic valve reoperation was 3.4% (95% CI 2.5% to 4.4%) and 3.6% (95% CI 2.6% to 4.6%) in the type B/O and the A/AB group, respectively, at 15 years of follow-up (absolute risk difference: -0.2% (95% CI -1.5% to 1.2%)). There was no significantly increased risk for aortic valve reoperation in patients with blood type B/O compared with type A/AB (HR 0.95, 95% CI 0.62 to 1.45). There was no significant difference in absolute or relative risk of heart failure or death between the groups. Conclusions We found no significant association between patient blood type and clinical manifestations of structural valve deterioration following porcine aortic valve replacement. Our findings suggest that it is safe to use porcine bioprosthetic valves without consideration of ABO blood type in the recipient.
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| 13. |
- Persson, Michael, et al.
(författare)
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Comparison of Long-term Performance of Bioprosthetic Aortic Valves in Sweden from 2003 to 2018
- 2022
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Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 5:3
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Tidskriftsartikel (refereegranskat)abstract
- Importance: The performance of bioprosthetic aortic valves is usually assessed in single valve models or head-to-head comparisons. National databases or registries offer the opportunity to investigate all available valve models in the population and allows for a comparative assessment of their performance. Objective: To analyze the long-term rates of reintervention, all-cause mortality, and heart failure hospitalization associated with commonly used bioprosthetic aortic valves and to identify valve model groups with deviation in clinical performance. Design, Setting, and Participants: This population-based, nationwide cohort study included all adult patients who underwent surgical aortic valve replacement (with or without concomitant coronary artery bypass surgery or ascending aortic surgery) in Sweden between January 1, 2003, and December 31, 2018. Patients were identified from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. Patients with concomitant valve surgery, previous cardiac surgery, and previous transcatheter valve replacement were excluded. Follow-up was complete for all participants. Data were analyzed from March 9, 2020, to October 12, 2021. Exposures: Primary surgical aortic valve replacement with the Perimount, Mosaic/Hancock, Biocor/Epic, Mitroflow/Crown, Soprano, and Trifecta valve models. Main Outcomes and Measures: The primary outcome was cumulative incidence of reintervention, defined as a subsequent aortic valve operation or transcatheter valve replacement. Secondary outcomes were all-cause mortality and heart failure hospitalization. Regression standardization and flexible parametric survival models were used to account for intergroup differences. Mean follow-up time was 7.1 years, and maximum follow-up time was 16.0 years. Results: A total of 16983 patients (mean [SD] age, 72.6 [8.5] years; 10 685 men [62.9%]) were included in the analysis. The Perimount valve model group had the lowest and the Mitroflow/Crown valve model group had the highest cumulative incidence of reintervention. The estimated cumulative incidence of reintervention at 10 years was 3.6% (95% CI, 3.1%-4.2%) in the Perimount valve model group and 12.2% (95% CI, 9.8%-15.1%) in the Mitroflow/Crown valve model group. The estimated incidence of reintervention at 10 years was 9.3% (95% CI, 7.3%-11.3%) in the Soprano valve model group. Conclusions and Relevance: Results of this study showed that the Perimount valve was the most commonly used and had the lowest incidence of reintervention, all-cause mortality, and heart failure hospitalization, whereas the Mitroflow/Crown valve had the highest rates. These findings highlight the need for clinical vigilance in patients who receive either a Soprano or Mitroflow/Crown aortic bioprosthesis..
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| 14. |
- Persson, Michael, et al.
(författare)
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Porcine vs Bovine Bioprosthetic Aortic Valves: Long-Term Clinical Results
- 2021
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 111:2, s. 529-535
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrevious studies have reported superior hemodynamic performance with bovine bioprosthetic aortic valves compared with porcine valves. However, conflicting results mean the long-term effect on survival is not well known. The aim of this study was to examine long-term survival, rate of aortic valve reoperations, and heart failure hospitalizations after surgical aortic valve replacement (AVR) with porcine vs bovine bioprosthetic valves.MethodsThis was a population-based cohort study including all patients who had undergone AVR in Sweden from 1995 to 2012, with or without concomitant coronary artery bypass grafting. Patients were identified through the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry. Baseline and outcome data were gathered from national registries. Propensity scores and inverse probability of treatment weighting were used to control for intergroup differences. Analyses accounted for competing risk of death when appropriate.ResultsA total of 12,845 patients underwent AVR with porcine (n = 4198) or bovine (n = 8647) prostheses. We found a small but significant difference in mortality favoring porcine prostheses: 78% vs 76%, 47% vs 43%, and 17% vs 15% at 5, 10, and 15 years, respectively (hazard ratio, 0.90; 95% confidence interval, 0.85-0.96). Porcine prostheses were associated with an increased risk of reoperation (hazard ratio, 1.48; 95% confidence interval, 1.11-1.98), but no difference in the risk of heart failure hospitalization. Results were similar in patients who underwent isolated AVR.ConclusionsConsistent with previous reports, we found that patients receiving porcine prostheses had a higher rate of reoperation compared with bovine prostheses. However, porcine prostheses were associated with improved long-term survival compared with bovine prostheses.
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| 15. |
- Ragnarsson, Sigurdur, et al.
(författare)
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No-touch saphenous vein grafts in coronary artery surgery (SWEDEGRAFT): Rationale and design of a multicenter, prospective, registry-based randomized clinical trial
- 2020
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Ingår i: American Heart Journal. - : MOSBY-ELSEVIER. - 0002-8703 .- 1097-6744. ; 224, s. 17-24
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Tidskriftsartikel (refereegranskat)abstract
- The SWEDEGRAFT study (ClinicalTrials.gov Identifier: NCT03501303) tests the hypothesis that saphenous vein grafts (SVGs) harvested with the "no-touch" technique improves patency of coronary artery bypass grafts compared with the conventional open skeletonized technique. This article describes the rationale and design of the randomized trial and baseline characteristics of the population enrolled during the first 9 months of enrollment. The SWEDEGRAFT study is a prospective, binational multicenter, open-label, registry-based trial in patients undergoing first isolated nonemergent coronary artery bypass grafting (CABG), randomized 1:1 to no-touch or conventional open skeletonized vein harvesting technique, with a planned enrollment of 900 patients. The primary end point is the proportion of patients with graft failure defined as SVGs occluded or stenosed >50% on coronary computed tomography angiography at 2 years after CABG, earlier clinically driven coronary angiography demonstrating an occluded or stenosed >50% vein graft, or death within 2 years. High-quality health registries and coronary computed tomography angiography are used to assess the primary end point. The secondary end points include wound healing in the vein graft sites and the composite outcome of major adverse cardiac events during the first 2 years based on registry data. Demographics of the first 200 patients enrolled in the trial and other CABG patients operated in Sweden during the same time period are comparable when the exclusion criteria are taken into consideration.
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| 16. |
- Sartipy, Ulrik, et al.
(författare)
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Association of heart rate with mortality in sinus rhythm and atrial fibrillation in heart failure with preserved ejection fraction
- 2019
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Ingår i: European Journal of Heart Failure. - : WILEY. - 1388-9842 .- 1879-0844. ; 21:4, s. 471-479
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Tidskriftsartikel (refereegranskat)abstract
- AimsTo assess the association between atrial fibrillation (AF) and mortality, and also the association between resting heart rate (HR) and mortality in both sinus rhythm (SR) and AF in patients with heart failure with preserved ejection fraction (HFpEF). Methods and resultsA total of 9090 patients with HFpEF (ejection fraction 50%) were included from the Swedish Heart Failure registry; 4296 (47%) had SR and 4794 (53%) had AF. Patients with AF were older (80.3 vs. 75.0years) and more symptomatic compared with patients in SR. The outcome measure was all-cause mortality. The adjusted hazard ratio (95% confidence interval) for AF vs. SR was 1.21 (1.11-1.32). Compared with HR 60b.p.m., the adjusted hazard ratios (95% confidence interval) were in SR: 1.06 (0.92-1.21) for HR 61-70b.p.m., 1.30 (1.12-1.52) for HR 71-80b.p.m., 1.27 (1.07-1.51) for HR 81-90b.p.m., and 1.77 (1.45-2.17) for HR amp;gt;90b.p.m. Due to non-proportional hazards in AF, hazard ratios were estimated in three time periods. Compared with HR 60 b.p.m., the adjusted hazard ratios (95% confidence interval) were in AF: 1.30 (1.07-1.57), 1.07 (0.83-1.39), and 1.01 (0.70-1.48) for HR 61-70b.p.m., 1.35 (1.12-1.62), 0.99 (0.77-1.27), and 0.96 (0.66-1.40) for HR 71-80b.p.m., 1.41 (1.16-1.73), 1.01 (0.76-1.36), and 0.79 (0.51-1.22) for HR 81-90b.p.m., and 1.78 (1.46-2.17), 1.08 (0.80-1.46), and 0.73 (0.46-1.17) for HR amp;gt;90b.p.m., during 0-2, 2-4, and 4-6years of follow-up, respectively. ConclusionIn a large and unselected cohort of patients with HFpEF, AF was independently associated with all-cause mortality. A higher HR was associated with increased mortality in SR. In AF, the effect of a higher HR on mortality was only present during the first years of follow-up, with convergence in outcomes according to baseline HR groups over long-term follow-up.
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| 17. |
- Sartipy, Ulrik, et al.
(författare)
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Atrial Fibrillation in Heart Failure With Preserved, Mid-Range, and Reduced Ejection Fraction
- 2017
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Ingår i: JACC. Heart failure. - : ELSEVIER SCI LTD. - 2213-1779 .- 2213-1787. ; 5:8, s. 565-574
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES The study sought to assess the independent risk factors for, consequences of, and outcomes with atrial fibrillation (AF) compared with sinus rhythm (SR) in heart failure (HF) with preserved ejection fraction (HFpEF) versus HF with mid-range ejection fraction (HFmrEF) versus HF with reduced ejection fraction (HFrEF). BACKGROUND AF is common in HF, but most data are from HFrEF. The importance of AF in HFpEF and HFmrEF is less well known. METHODS In patients from 2000 to 2012 in the SwedeHF (Swedish Heart Failure Registry) registry, enriched with patient-level data from national health care registries, the authors assessed prevalence of, associations with, and prognostic impact of AF in HFpEF versus HFmrEF versus HFrEF. RESULTS Of 41,446 patients, 23% had HFpEF, 22% had HFmrEF, and 55% had HFrEF. The prevalence of AF was 65%, 60%, and 53% in HFpEF, HFmrEF, and HFrEF, respectively. Independent associations with AF were similar in HFpEF, HFmrEF, and HFrEF and included greater age, male, duration of HF, prior myocardial infarction, and prior stroke or transient ischemic attack (TIA). The adjusted hazard ratios for AF versus SR in HFpEF, HFmrEF, and HFrEF were the following: for death, 1.11 (95% confidence interval [CI]: 1.02 to 1.21), 1.22 (95% CI: 1.12 to 1.33), and 1.17 (95% CI: 1.11 to 1.23); for HF hospitalization or death, 1.17 (95% CI: 1.09 to 1.26), 1.29 (95% CI: 1.20 to 1.40), and 1.15 (95% CI: 1.10 to 1.20); and for stroke or TIA or death, 1.15 (95% CI: 1.07 to 1.25), 1.23 (95% CI: 1.13 to 1.34), and 1.19 (95% CI: 1.14 to 1.26). CONCLUSIONS AF was progressively more common with increasing ejection fraction, but was associated with similar clinical characteristics in HFpEF, HFmrEF, and HFrEF. AF was associated with similarly increased risk of death, HF hospitalization, and stroke or TIA in all ejection fraction groups. In contrast, AF and SR populations were considerably different regarding associated patient characteristics and outcomes. (C) 2017 by the American College of Cardiology Foundation.
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| 18. |
- Sartipy, Ulrik, et al.
(författare)
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Cardiac rupture during vacuum-assisted closure therapy.
- 2006
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Ingår i: The Annals of thoracic surgery. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 82:3, s. 1110-1
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Tidskriftsartikel (refereegranskat)abstract
- Vacuum-assisted closure therapy is a recently introduced technique for treatment of deep sternal wound infections after cardiac surgery. We present five cases of vacuum-assisted closure therapy-related major bleeding complications due to rupture of the right ventricle. This potentially lethal complication may be avoided by covering the heart with protective layers of paraffin gauze dressings.
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| 19. |
- Sartipy, Ulrik, et al.
(författare)
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Left ventricular reconstruction as an alternative to heart transplantation : a case report
- 2006
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Ingår i: Heart Surgery Forum. - 1098-3511 .- 1522-6662. ; 9:3, s. E638-E640
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Tidskriftsartikel (refereegranskat)abstract
- A 57-year-old man with dilated cardiomyopathy was referred to our institution to be assessed for heart transplantation. He had symptoms of severe heart failure and left ventricular dysfunction. We proposed surgical ventricular restoration (the Dor procedure) as an alternative to heart transplantation. The patient underwent successful surgery and an uneventful postoperative course. Pre- and postoperative investigations are presented. One year after surgery, the patient is in good clinical and functional condition. This case illustrates that surgical ventricular restoration can be an alternative to heart transplantation.
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| 20. |
- Sartipy, Ulrik
(författare)
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Left ventricular reconstruction in ischemic heart disease
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: [1] To review our experience with left ventricular reconstruction (LVR) regarding safety (early mortality and morbidity) and long-term survival (Study I). [2] To evaluate LVR including surgery for ventricular tachycardia in patients with preoperative spontaneous or inducible ventricular tachycardia (Study II). [3] To analyze risk factors for mortality and hospital re-admission for heart failure after LVR (Study III). [4] To prospectively investigate changes in functional status and quality of life after LVR (Study IV). [5] To prospectively investigate changes in biomarkers for heart failure (BNP and NT-pro-BNP) in relation to functional status after LVR (Study V). Background: Postinfarction cardiac remodeling with left ventricular dilatation is strongly associated with decreased survival. Surgical restoration of left ventricular size and form is proposed to improve survival, functional status, and quality of life. Methods: In three retrospective studies, 101 (Study I), 53 (Study II), and 136 (Study III) patients were included. Patients were considered for LVR if they demonstrated an enlarged, either dyskinetic or akinetic, left ventricle accompanied by left ventricular dysfunction after myocardial infarction, and had symptoms of angina or heart failure with or without ventricular tachycardia. Survival, morbidity, and freedom from re-hospitalization were ascertained by review of patients records, our institutional database, and national registers. In addition, freedom from postoperative ventricular tachycardia was evaluated by programmed ventricular stimulation in most patients in Study II. Conventional statistical methods were employed to identify factors associated with adverse outcome in Study III. Two prospective studies were conducted to investigate functional status and quality of life (Study IV, n=23) and changes in biomarkers for heart failure (Study V, n=29). Health-related quality of life and functional status was evaluated preoperatively, six months postoperatively, and at late follow-up almost two years after surgery, with the Short Form-36 questionnaire, the six-minute walk test, and New York Heart Association functional class. Blood samples were collected at equivalent timepoints for analysis of biomarkers for heart failure (BNP and NT-pro-BNP). Results and Conclusions: [1] LVR is a reproducible and safe surgical option in patients with left ventricular aneurysm or ischemic dilated cardiomyopathy. Early mortality was 7.4% and five year survival was 68%. [2] LVR including endocardiectomy and cryoablation resulted in a very high (90%) freedom from spontaneous ventricular tachycardia. [3] LVR resulted in a high degree of freedom from re-admission for heart failure. We found a strong association between increasing grade of preoperative mitral regurgitation and both long-term mortality and re-admission for heart failure. [4] Functional status and health-related quality of life improved six months after LVR and the improvement was sustained at late follow-up. [5] Severe heart failure secondary to postinfarction left ventricular remodeling can be reversed by LVR. Clinical improvement was associated with reduced levels of BNP and NT-pro- BNP six months after surgery. Clinical improvement was maintained and peptide levels were further reduced at late follow-up.
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| 21. |
- Sartipy, Ulrik, et al.
(författare)
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Predicting survival in heart failure : validation of the MAGGIC heart failure risk score in 51 043 patients from the Swedish Heart Failure Registry
- 2014
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Ingår i: European Journal of Heart Failure. - : Oxford University Press. - 1388-9842 .- 1879-0844. ; 16:2, s. 173-179
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Tidskriftsartikel (refereegranskat)abstract
- AIMS:The aim of this study was to evaluate the performance of a recently developed risk score for mortality in heart failure by external validation in a national heart failure registry.METHODS AND RESULTS:From 13 routinely available patient characteristics, the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) constructed a risk score for prediction of mortality in heart failure. We included 51 043 patients from the national Swedish Heart Failure Registry and calculated the MAGGIC risk score for each patient. The outcome measure was 3-year mortality. The predicted probability of death obtained from the calculated risk score was compared with the observed 3-year mortality, and model discrimination and calibration were assessed by formal tests and graphical means. The overall 3-year mortality in the study population was 39.4% and the MAGGIC project heart failure risk score predicted mortality was 36.4% (observed to expected ratio: 1.08). Discrimination was excellent overall (C index = 0.741). The difference between the model-predicted and the observed 3-year mortality in the six risk groups varied between 5% and -12%. Calibration plots demonstrated slight overprediction for the lowest risk patients, and underprediction in high risk patients.CONCLUSION:The MAGGIC project heart failure risk score demonstrated an excellent ability to categorize patients in separate risk strata. Although the predicted 3-year mortality risk was higher in low risk groups and lower in high risk groups compared with the observed 3-year mortality in the Swedish Heart Failure Registry, the MAGGIC project heart failure risk score performed well in a large nationwide contemporary external validation cohort.
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| 22. |
- Savarese, Gianluigi, et al.
(författare)
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Comorbidities and cause-specific outcomes in heart failure across the ejection fraction spectrum : A blueprint for clinical trial design
- 2020
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 313, s. 76-82
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundComorbidities may differently affect treatment response and cause-specific outcomes in heart failure (HF) with preserved (HFpEF) vs. mid-range/mildly-reduced (HFmrEF) vs. reduced (HFrEF) ejection fraction (EF), complicating trial design. In patients with HF, we performed a comprehensive analysis of type 2 diabetes (T2DM), atrial fibrillation (AF) chronic kidney disease (CKD), and cause-specific outcomes.Methods and resultsOf 42,583 patients from the Swedish HF registry (23% HFpEF, 21% HFmrEF, 56% HFrEF), 24% had T2DM, 51% CKD, 56% AF, and 8% all three comorbidities. HFpEF had higher prevalence of CKD and AF, HFmrEF had intermediate prevalence of AF, and prevalence of T2DM was similar across the EF spectrum. Patients with T2DM, AF and/or CKD were more likely to have also other comorbidities and more severe HF. Risk of cardiovascular (CV) events was highest in HFrEF vs. HFpEF and HFmrEF; non-CV risk was highest in HFpEF vs. HFmrEF vs. HFrEF. T2DM increased CV and non-CV events similarly but less so in HFpEF. CKD increased CV events somewhat more than non-CV events and less so in HFpEF. AF increased CV events considerably more than non-CV events and more so in HFpEF and HFmrEF.ConclusionHFpEF is distinguished from HFmrEF and HFrEF by more comorbidities, non-CV events, but lower effect of T2DM and CKD on events. CV events are most frequent in HFrEF. To enrich for CV vs. non-CV events, trialists should not exclude patients with lower EF, AF and/or CKD, who report higher CV risk.
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| 23. |
- Savarese, Gianluigi, et al.
(författare)
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Reasons for and consequences of oral anticoagulant underuse in atrial fibrillation with heart failure.
- 2018
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Ingår i: Heart. - : BMJ. - 1355-6037 .- 1468-201X. ; 104:13, s. 1093-1100
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Atrial fibrillation (AF) is common in patients with heart failure (HF), and oral anticoagulants (OAC) are indicated. The aim was to assess prevalence of, predictors of and consequences of OAC non-use.METHODS: We included patients with AF, HF and no previous valve replacement from the Swedish Heart Failure Registry. High and low CHA2DS2-VASc and HAS-BLED scores were defined as above/below median. Multivariable logistic regressions were used to assess the associations between baseline characteristics and OAC use and between CHA2DS2-VASc and HAS-BLED scores and OAC use. Multivariable Cox regressions were used to assess associations between CHA2DS2-VASc and HAS-BLED scores, OAC use and two composite outcomes: all-cause death/stroke and all-cause death/major bleeding.RESULTS: Of 21 865 patients, only 12 659 (58%) received OAC. Selected predictors of OAC non-use were treatment with platelet inhibitors, less use of HF treatments, paroxysmal AF, history of bleeding, no previous stroke, planned follow-up in primary care, older age, living alone, lower income and variables associated with more severe HF. For each 1-unit increase in CHA2DS2-VASc and HAS-BLED, the ORs (95% CI) of OAC use were 1.24 (1.21-1.27) and 0.32 (0.30-0.33), and the HRs for death/stroke were 1.08 (1.06-1.10) and for death/major bleeding 1.18 (1.15-1.21), respectively. For high versus low CHA2DS2-VASc and HAS-BLED, the ORs of OAC use were 1.23 (1.15-1.32) and 0.20 (0.19-0.21), and the HRs for death/stroke were 1.25 (1.19-1.30) and for death/major bleeding 1.28 (1.21-1.34), respectively.CONCLUSIONS: Patients with AF and concomitant HF do not receive OAC on rational grounds. Bleeding risk inappropriately affects decision-making more than stroke risk.
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| 24. |
- Vikholm, Per, 1985-, et al.
(författare)
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Validity of the Swedish Cardiac Surgery Registry
- 2018
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : OXFORD UNIV PRESS. - 1569-9293 .- 1569-9285. ; 27:1, s. 67-74
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Our goal was to validate the Swedish Cardiac Surgery Registry by reviewing the reported cardiac operations to assess the completeness and quality of the registered data and the EuroSCORE II variables. METHODS: A total of 5837 cardiac operations were reported to the Swedish Cardiac Surgery Registry in Sweden during 2015. A randomly selected sample of 753 patient records (13%) was scrutinized by 3 surgeons at all 8 units in Sweden performing open cardiac surgery in adults. RESULTS: Coverage was excellent with 99% [95% confidence interval (CI) 98-99%] of the performed procedures found in the registry. Reported waiting times for surgery were correct in 78% (95% CI 76-79%) of the cases. The main procedural code was correctly reported in 96% (95% CI 95-97%) of the cases. The correlation between reported and monitored logistic EuroSCORE II had a coefficient of 0.79 (95% CI 0.76-0.82), and the median difference in EuroSCORE II was 0% (interquartile range -0.4% to 0.4%). The majority of EuroSCORE II variables had good agreement and coherence; however, New York Heart Association functional class, preoperative renal dysfunction, left ventricular ejection fraction, Canadian Cardiovascular Society Class IV angina and poor mobility were less robust Postoperative complications were rare and in general had a high degree of completeness and agreement. CONCLUSIONS: The reliability of the variables in the national Swedish Cardiac Surgery Registry was excellent. Thus, the registry is a valuable source of data for quality studies and research. Some EuroSCORE II variables require improved and stricter definitions to obtain uniform reporting and high validity.
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