| 1. |
- Wedin, Johan O, et al.
(author)
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Patients With Bicuspid Aortic Stenosis Demonstrate Adverse Left Ventricular Remodeling and Impaired Cardiac Function Before Surgery With Increased Risk of Postoperative Heart Failure
- 2022
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In: Circulation. - : Lippincott Williams & Wilkins. - 0009-7322 .- 1524-4539. ; 146:17, s. 1310-1322
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Journal article (peer-reviewed)abstract
- Background: Differences in adverse cardiac remodeling between patients who have bicuspid (BAV) and tricuspid aortic valve (TAV) with severe isolated aortic stenosis (AS) and its prognostic impact after surgical aortic valve replacement remains unclear. We sought to investigate differences in preoperative diastolic and systolic function in patients with BAV and TAV who have severe isolated AS and the incidence of postoperative heart failure hospitalization and mortality. Methods: Two hundred seventy-one patients with BAV (n=152) or TAV (n=119) and severe isolated AS without coronary artery disease or other valvular heart disease, scheduled for surgical aortic valve replacement, were prospectively included. Comprehensive preoperative echocardiographic assessment of left ventricular (LV) diastolic and systolic function was performed. The heart failure events were registered during a mean prospective follow-up of 1260 days versus 1441 days for patients with BAV or TAV, respectively. Results: Patients with BAV had a more pronounced LV hypertrophy with significantly higher indexed LV mass ([LVMi] 134 g/m(2) versus 104 g/m(2), P<0.001), higher prevalence of LV diastolic dysfunction (72% versus 44%, P<0.001), reduced LV ejection fraction (55% versus 60%, P<0.001), significantly impaired global longitudinal strain (P<0.001), significantly higher NT-proBNP (N-terminal pro-brain natriuretic peptide) levels (P=0.007), and a higher prevalence of preoperative levosimendan treatment (P<0.001) than patients with TAV. LVMi was associated with diastolic dysfunction in both patients with BAV and TAV. There was a significant interaction between aortic valve morphology and LVMi on LV ejection fraction, which indicated a pronounced association between LVMi and LV ejection fraction for patients with BAV and lack of association between LVMi and LV ejection fraction for patients with TAV. Postoperatively, the patients with BAV required significantly more inotropic support (P<0.001). The patients with BAV had a higher cumulative incidence of postoperative heart failure admissions compared with patients with TAV (28.2% versus 10.6% at 6 years after aortic valve replacement, log-rank P=0.004). Survival was not different between patients with BAV and TAV (log-rank P=0.165). Conclusions: Although they were significantly younger, patients with BAV who had isolated severe AS had worse preoperative LV function and an increased risk of postoperative heart failure hospitalization compared with patients who had TAV. Our findings suggest that patients who have BAV with AS might benefit from closer surveillance and possibly earlier intervention.
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| 2. |
- Beusch, Christian M., et al.
(author)
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Analysis of local extracellular matrix identifies different aetiologies behind bicuspid and tricuspid aortic valve degeneration and suggests therapies
- 2023
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In: Cellular and Molecular Life Sciences (CMLS). - : Springer Nature. - 1420-682X .- 1420-9071. ; 80:9
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Journal article (peer-reviewed)abstract
- Aortic valve degeneration (AVD) is a life-threatening condition that has no medical treatment and lacks individual therapies. Although extensively studied with standard approaches, aetiologies behind AVD are unclear. We compared abundances of extracellular matrix (ECM) proteins from excised valve tissues of 88 patients with isolated AVD of normal tricuspid (TAV) and congenital bicuspid aortic valves (BAV), quantified more than 1400 proteins per ECM sample by mass spectrometry, and demonstrated that local ECM preserves molecular cues of the pathophysiological processes. The BAV ECM showed enrichment with fibrosis markers, namely Tenascin C, Osteoprotegerin, and Thrombospondin-2. The abnormal physical stress on BAV may cause a mechanical injury leading to a continuous Tenascin C-driven presence of myofibroblasts and persistent fibrosis. The TAV ECM exhibited enrichment with Annexin A3 (p = 1.1 x 10(-16) and the fold change 6.5) and a significant deficit in proteins involved in high-density lipid metabolism. These results were validated by orthogonal methods. The difference in the ECM landscape suggests distinct aetiologies between AVD of BAV and TAV; warrants different treatments of the patients with BAV and TAV; elucidates the molecular basis of AVD; and implies possible new therapeutic approaches. Our publicly available database (human_avd_ecm.surgsci. uu.se) is a rich source for medical doctors and researchers who are interested in AVD or heart ECM in general. Systematic proteomic analysis of local ECM using the methods described here may facilitate future studies of various tissues and organs in development and disease.
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| 3. |
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| 4. |
- Wedin, Johan O, et al.
(author)
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Commando procedure in a patient with double-valve endocarditis after transcatheter aortic valve implantation
- 2020
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In: Journal of Surgical Case Reports. - : Oxford University Press (OUP). - 2042-8812. ; :8
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Journal article (peer-reviewed)abstract
- The indication for transcatheter aortic valve implantation (TAVI) is continuously expanding with a simultaneous increase in number of TAVI associated prosthetic valve endocarditis (TAVI-PVE). Evidence for management of TAVI-PVE is lacking but the need for surgical management of complex TAVI-PVE is expected to increase. The Commando procedure, a technically challenging surgery for treatment of complex endocarditis, has never been described in a patient with TAVI-PVE. An 80-year-old female with TAVI-PVE, native mitral valve endocarditis and an abscess in the intervalvular fibrous body was admitted to our clinic. She successfully underwent the Commando procedure with implantation of biological mitral and aortic valve prostheses and reconstruction of the intervalvular fibrous body. We demonstrate that the Commando procedure is a feasible surgical alternative in patients with TAVI-PVE and that it can be considered in patients with high surgical risk.
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| 5. |
- Wedin, Johan O, et al.
(author)
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Heparin-binding protein as a marker of ventriculostomy related infection and central nervous system inflammation in neuro-intensive care
- 2023
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In: Clinical neurology and neurosurgery. - : Elsevier BV. - 0303-8467 .- 1872-6968. ; 229
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Journal article (peer-reviewed)abstract
- Objective: Diagnosis of ventriculostomy related infections (VRI) in the neuro-intensive care unit remains chal-lenging and current biomarkers lack adequate precision. The aim of this study was to explore the potential of Heparin-binding protein (HBP) in cerebrospinal fluid (CSF) as a diagnostic biomarker of VRI.Methods: All patients treated with an external ventricular drain (EVD) between January 2009 and March 2010 at Skane university hospital in Lund, Sweden, were consecutively included. CSF samples obtained during routine care were analyzed for HBP. VRI was defined as a positive bacterial microbiology test result on a CSF sample with an erythrocyte-corrected leukocyte count of > 50 x 106/l. HBP levels at VRI diagnosis was compared to peak HBP levels in non-VRI controls.Results: In total, 394 CSF samples from 103 patients were analyzed for HBP. Seven patients (6.8%) fulfilled VRI criteria. Levels of HBP were significantly higher in VRI subjects (31.7 ng/mL [IQR 26.9-40.7 ng/mL]) compared to non-VRI controls (7.7 ng/mL [IQR 4.1-24.5 ng/mL]) (p = 0.024). The AUC of the receiver operating char-acteristic (ROC) curve was 0.76 (95% confidence interval [CI], 0.62-0.90). Among non-VRI patients, HBP was highest in patients with acute bacterial meningitis. Patients with subarachnoid hemorrhage displayed higher HBP levels than those with traumatic brain injury or shunt dysfunction.Conclusions: HBP levels were higher in VRI subjects and varied between patients and different diagnoses. To validate the clinical usefulness and added value of HBP as a biomarker for VRI, the results need to be confirmed in larger studies with head-to-head comparisons to current biomarkers.
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| 6. |
- Wedin, Johan O., et al.
(author)
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Impact of training specificity on exercise-induced cardiac troponin elevation in professional athletes : A pilot study
- 2020
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In: World Journal of Cardiology. - : Baishideng Publishing Group Inc.. - 1949-8462. ; 12:1, s. 35-43
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Journal article (peer-reviewed)abstract
- BACKGROUND Release of cardiac biomarkers is common after strenuous endurance exercise, but data on intermittent exercise are scarce. It has not been investigated whether cardiac troponin elevation is influenced depending on the type of exercise that an athlete is adapted to perform. We hypothesized that intermittent but not continuous exercise induces cardiac troponin elevation in professional athletes adapted to high-intensity intermittent exercise. AIM To examine how training specificity impacts high-sensitivity cardiac troponin T (hs-cTnT) release. METHODS Nine professional floorball players participated in the study, which comprised two different exercise tests: a continuous incremental cycle ergometer test and a Yo-Yo Intermittent Recovery 2 (Yo-Yo IR2) test. Serial assessment of hs-cTnT was performed after the cycle ergometer test and the Yo-Yo IR2 test (baseline, 0, 2, 6, and 24 h). RESULTS No hs-cTnT elevation above the myocardial damage cutoff (>= 14 ng/L) was shown after the cycle ergometer test, whereas hs-cTnT levels rose over the cutoff in three of nine participants after the Yo-Yo IR2 test. The hs-cTnT levels peaked at 6 h after both tests, but were significantly higher after the Yo-Yo IR2 test compared to the cycle ergometer test (median hs-cTnT concentration 10.6 ng/L vs 7.8 ng/L, P = 0.038). All levels returned to baseline within 24 h. CONCLUSION In professional athletes adapted to high-intensity intermittent exercise, hs-cTnT was significantly elevated after intermittent but not continuous exercise. This principle of specificity training should be considered when designing future studies to avoid misinterpretation of hs-cTnT elevation.
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| 7. |
- Wedin, Johan O, et al.
(author)
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Surgical Removal of a Detached Mitral Valve Repair Clip to Resolve Cardiogenic Shock
- 2022
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In: JACC. - : Elsevier. - 2666-0849. ; 4:11, s. 658-662
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Journal article (peer-reviewed)abstract
- Transcatheter edge-to-edge mitral valve repair (TEER) with a clip device relieves symptoms and improves outcomes in patients not suitable for open heart surgery. Here, we present a patient in whom ventricular arrhythmias developed as a result of clip embolization shortly after TEER. He underwent successful emergent surgical clip removal and mitral valve replacement. (Level of Difficulty: Advanced.).
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| 8. |
- Wedin, Johan O., et al.
(author)
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The Influence of Floorball on Hematological Parameters : Consequences in Health Assessment and Antidoping Testing
- 2020
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In: Journal of Sports Medicine. - : Hindawi Limited. - 2356-7651 .- 2314-6176.
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Journal article (peer-reviewed)abstract
- Assessment of hematological parameters is common in sports medicine. Although physical exercise is an important preanalytical variable, data about acute hematological changes after high-intensity intermittent exercise are scarce. This study aimed to examine floorball as a potential preanalytical variable for hematological parameters used in health assessment and antidoping testing. Twenty-three professional male floorball players participated in a floorball game. Hematological parameters including hemoglobin, erythrocyte count and erythrocyte indices, reticulocytes, white blood cells (WBC), platelets, reticulocytes, and OFF-hr score were assessed at baseline, immediately postgame, and at 2 h postgame. Median hemoglobin concentration decreased significantly from 146 g/L pregame to 141 g/L immediately postgame (). WBC count increased from 7.2 × 109/L pregame to 10.1 × 109/L 2 h postgame (). The median OFF-hr score decreased from 99.5 to 94.2 immediately postgame and remained significantly lower than baseline at 2 h postgame (94.4, ). Looking at individual results, the highest OFF-hr score increased from 120 at baseline to 124 at 2 h postgame. Our findings suggest that participation in a floorball game affects several hematological parameters and consequently can affect health assessment and antidoping testing.
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