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- Hedberg, Pär, 1962-
(author)
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Left Ventricular Systolic Dysfunction in 75-year-old Men and Women : A Community-based Study of Prevalence, Screening and Mitral Annulus Motion for Diagnosis and Prognostics
- 2005
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Doctoral thesis (other academic/artistic)abstract
- Reduced performance of the left ventricle to eject blood – left ventricular systolic dysfunction (LVSD) – is a common predecessor of the heart failure syndrome. With or without symptoms, LVSD is associated with a poor prognosis. However, with adequate treatment, the development or progression of symptoms, the need for hospitalisation and mortality can all be reduced. In the present work, the occurrence of LVSD was evaluated by echocardiography in a community-based sample of 75-year-old men and women (n = 433). LVSD was a common condition, with a prevalence rate of 6.8%. In nearly half the participants with LVSD, there was no clinical evidence of heart failure.Community-based screening for asymptomatic LVSD has been proposed as a strategy to reduce the incidence of heart failure. Because of the high costs and low availability, echocardiography is not a suitable screening tool. The plasma concentration of B-type natriuretic peptide (BNP) has been the most advocated screening tool. Another alternative is the standard 12-lead electrocardiogram (ECG). Both the ECG and BNP were effective in excluding LVSD in our 75-year-old community-based sample. However, compared with BNP, the ECG had considerably better specificity. In screening for LVSD, BNP had a diagnostic value in addition to the ECG, but only in individuals with abnormal ECGs.The left ventricular ejection fraction (LVEF) measured by echocardiography is a well-established index for describing left ventricular systolic function. The wall motion index (WMI) and the amplitude of mitral annulus motion (MAM) are suggested as alternative echocardiographic methods. Compared with MAM, the WMI had a more favourable agreement with the LVEF in our 75-year-old participants. Nonetheless, MAM was a strong predictor of mortality. MAM predicted the risk of all-cause and cardiac mortality independently of other risk factors. In addition, when it came to cardiac mortality, the predictive ability of MAM was independent of the LV function measured as the WMI.
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- Henriksen, Egil, et al.
(author)
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Left ventricular end-diastolic geometrical adjustments during exercise in endurance athletes
- 2008
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In: Clinical Physiology and Functional Imaging. - 1475-0961 .- 1475-097X. ; 28:2, s. 76-80
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Journal article (peer-reviewed)abstract
- The increase in left ventricular (LV) end-diastolic volume has recently been shown to explain more than 70% of the increase in stroke volume during upright exercise in endurance athletes. As the end-diastolic volume enhancement not could be explained by an increase in axial cavity length an augmentation in LV short-axis diameters is to be expected. To investigate LV end-diastolic geometrical alterations during exercise, 15 endurance athletes were examined using contrast exercise echocardiography. LV end-diastolic short-axis diameters were made from apical views at several LV cavity levels. From upright rest to upright exercise the LV end-diastolic internal cavity measurements increased significantly. During exercise, the LV cavity became geometrically more spherical with the largest increase in the LV end-diastolic short-axis cavity diameters in the mid and apical parts of the left ventricle. The LV internal long axis showed significant increase from rest to exercise but the absolute increase was small.
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- Nilsson, Göran, et al.
(author)
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Heart rate recovery is more strongly associated with the metabolic syndrome, waist circumference, and insulin sensitivity in women than in men among the elderly in the general population
- 2007
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In: American Heart Journal. - : Elsevier BV. - 0002-8703 .- 1097-6744. ; 154:3, s. 460.e1-460.e7
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Journal article (peer-reviewed)abstract
- Background: Low heart rate recovery (HRR) at exercise test and the metabolic syndrome (MetS) are both predictors of cardiovascular morbidity and mortality. We studied in 75-year-old women and men, representative of the general population, the relationship between (1) HRR and the MetS, (2) HRR and the individual components of the MetS, and (3) HRR and insulin sensitivity. Methods: A cross-sectional study of randomly selected 75-year-olds from a general population was performed (191 women and 194 men). The MetS was defined according to the National Cholesterol Education Program criteria. Heart rate was measured as beats per minute immediately after exercise and at 4 minutes into recovery. Results: Heart rate recovery (median and interquartile range, beat/min) was 48 (37-58) for women and 49 (38-58) for men. Thirty-seven percent of the women and 25% of the men had the MetS. Heart rate recovery was 52 (42-61) for women with the MetS and 42 (31-49) for those without. The corresponding values for men was 50 (39-61) and 47 (35-54); the difference between individuals with and without the MetS was significant for women (P < .001) but not for men (P = .084). The following significant correlation coefficients between HRR and MetS components were found: for women, waist circumference (-0.43, P < .001), high-density lipoprotein cholesterol (0.37, P < .001), insulin sensitivity (-0.37, P < .001), fasting plasma glucose (-0.30, P < .001), and triglycerides (-0.24, P = .001); for men, triglycerides (-0.20, P = .005). The sex disparity in the strength of correlation reached statistical significance for insulin sensitivity (P < .001) and waist circumference (P = .042). Conclusion: Among 75-year-olds, the MetS and related components are more strongly correlated to HRR in women than in men.
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- Nilsson, Göran, et al.
(author)
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Ten-Year Survival in 75-Year-Old Men and Women : Predictive Ability of Total Cholesterol, HDL-C, and LDL-C
- 2009
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In: Current gerontology and geriatrics research. - : Hindawi Limited. - 1687-7063 .- 1687-7071. ; , s. 158425-
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Journal article (peer-reviewed)abstract
- Objective. The purpose of this study was to investigate prognostic impact of cholesterol and its subfractions among 75-year-old people from the general population. Methods and Results. The study comprised a random sample (222 women and 210 men) from the general population (participation rate 70%). During 10-year follow-up, 19% of women and 35% of men experienced a major cardiovascular event (MCVE). The all-cause mortality was 29% for women and 47% for men. After adjustment for cardiovascular risk factors, a low level of high-density lipoprotein cholesterol (HDL-C) was significantly associated with MCVE (P = .006) and mortality (P = .011) in men but not in women. The prognostic sex disparity was nearly significant (P = .051 for MCVE and .067 for mortality). The associations of adjusted HDL-C to MCVE and mortality were unchanged after excluding individuals with prevalent stroke or MI. Total cholesterol and low-density lipoprotein cholesterol (LDL-C) were not significantly related to prognosis in either sex. Main Conclusions. HDL-C was associated with dismal prognosis in men but not in women. Elderly men with HDL-C <40 mg/dL deserve particular attention for cardiovascular prevention.
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- Nilsson, Göran, et al.
(author)
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Waist circumference alone predicts insulin resistance as good as the metabolic syndrome in elderly women
- 2008
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In: European journal of internal medicine. - : Elsevier BV. - 0953-6205 .- 1879-0828. ; 19:7, s. 520-526
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Journal article (peer-reviewed)abstract
- Background: Insulin resistance (IR) is a risk factor for diabetes and atherosclerotic diseases. The metabolic syndrome (MetS) reflects IR. Waist circumference (WC) is the most easily registered component of MetS. The objective was to compare WC alone with MetS as defined by the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (W) for their abilities to predict IR in elderly without known diabetes. Methods: The study included 223 women and 2 10 men comprising 70% of a random sample of 75-year-olds from a general population. IR was conventionally defined as the gender-specific upper quartile of the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) index in individuals without known diabetes. Results: 1) The positive association between WC and IR is stronger in women than in men. 2) WC > 88 cm alone is nearly as good as MetS, using NCEP criteria, in predicting IR in women. 3) According to the ROC curve, the optimal cut-off point for WC predicting IR was between 96 and 97 cm (men) and between 88 and 89 cm (women). The relative risk of IR was 5.6 (95% CI: 3.1-11.9) for women with WC > 88 cm and 1.9 (1.5-2.8) for men with WC > 96 cm. 4) The NCEP criteria predicts IR significantly better than the IDF criteria. Conclusion: WC > 88 cm in women indicates a high likelihood of IR and is almost as good as MetS defined using the NCEP criteria in predicting IR. MetS defined using the NCEP criteria predicts IR better than MetS defined using the IDF criteria. (C) 2008 European Federation of internal Medicine. Published by Elsevier B.V. All rights reserved.
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| 7. |
- Sundstedt, Milena, et al.
(author)
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Echocardiographic doppler assessments of left ventricular filling and ejection during upright exercise in endurance athletes
- 2007
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In: Clinical Physiology and Functional Imaging. - 1475-0961 .- 1475-097X. ; 27:1, s. 36-41
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Journal article (peer-reviewed)abstract
- Doppler echocardiography was used to describe left ventricular filling and ejection during upright bicycle exercise in 24 healthy male endurance athletes. The transmitral pressure gradient was estimated and isovolumetric relaxation, filling and ejection time and transmitral and aortic flow velocities were measured at rest and during exercise. From rest to peak exercise (at a heart rate of 160 bpm), the mean left ventricular filling time was shortened by 73%, the ejection time by 31%, while the isovolumetric relaxation time was shortened by 62%. At peak exercise, the maximum aortic flow velocity almost doubled and the maximum transmitral flow velocity more than doubled, with a tenfold increase in the mean transmitral pressure gradient. The increase was significant (P<0·001) at each level of exercise. The left ventricular filling rate measured as volume per time was 185 ± 62 ml s−1 at rest and it increased to 986 ± 192 ml s−1 at peak exercise. This study demonstrates large changes in diastolic filling indices during upright exercise and it shows that the heart is able to increase its filling rate five times from rest to peak exercise.
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| 8. |
- Sundstedt, Milena, et al.
(author)
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Mitral annular excursion during exercise in endurance athletes
- 2008
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In: Clinical Physiology and Functional Imaging. - 1475-0961 .- 1475-097X. ; 28:1, s. 27-31
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Journal article (peer-reviewed)abstract
- The aim of the present study was to quantify the left ventricular (LV) longitudinal motion during exercise at rest and during upright exercise in 24 healthy male endurance athletes. By using M-mode and two-dimensional echocardiography, the relative mitral annular motion and the absolute LV longitudinal axis was measured at end-diastole and end-systole at rest and during exercise. From rest to peak exercise at a heart rate of 160 beats per minute (bpm) the mitral annular motion increased in the septal and lateral annular borders by 68% and 49% respectively. At rest, mitral annular excursion was significantly (13%) higher in the lateral than in the septal wall but at peak exercise at a heart rate of 160 bpm there was no difference between the septal and lateral annular motion. The total end-diastolic LV axial length did not increase from rest to peak exercise. In conclusion, during upright exercise, mitral annular motion increased significantly with no difference between the septal and lateral annular excursion at peak exercise. The absolute increase in mitral annular motion during exercise was explained by a decrease in axial end-systolic length.
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| 9. |
- Öhrvik, John, et al.
(author)
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Factor Analysis of the Individual Components of the Metabolic Syndrome Among Elderly Identifies Two Factors With Different Survival Patterns-A Population-Based Study
- 2009
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In: Metabolic Syndrome and Related Disorders. - : Mary Ann Liebert Inc. - 1540-4196 .- 1557-8518. ; 7:3, s. 171-177
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Journal article (peer-reviewed)abstract
- Background: Factor analysis reduces a set of directly measured variables into a smaller set of underlying factors representing unique statistically independent domains termed "factors." In middle-aged people, previous factor analyses of the components of the metabolic syndrome have identified two to four factors. Many of these analyses report blood pressure as one of these factors. Methods: We performed a factor analysis of the individual continuous components of the metabolic syndrome among 198 men and 203 women comprising 65% of all 75 year olds from the city of Vasteras in Sweden. Results: The metabolic syndrome comprised two factors. Factor 1, the metabolic factor, consisted of waist circumference, high-density lipoprotein cholesterol, triglycerides, and fasting glucose, whereas factor 2, the blood pressure factor, consisted of systolic and diastolic blood pressure. These two factors explained 58% (factor 1, 31%, and factor 2, 27%) of the total variation in men. The corresponding figures for women were 63% (factor 1, 36%, and factor 2, 27%). Factor 1 was significantly related to a decreased 10 years of survival for men, with a hazard ratio (HR) of 1.30 (95% confidence interval [CI] 1.07-1.58, P = 0.008), and nearly significantly for women, with a HR of 1.27 (95% CI 0.98-1.64, P = 0.071). In a pooled analysis adjusting for sex, known cardiovascular disease, and hypertension, high blood pressure, and current smoking, the HR for factor 1 was 1.20 (95% CI 1.02-1.49, P = 0.026). Factor 2 was not significantly related to survival. Conclusions: Factor analysis of the basic variables of the metabolic syndrome among 75 year olds from a general population identified a metabolic factor and a blood pressure factor. The former factor was significantly related to 10-year survival and the relationship remained after adjusting for known cardiovascular disease and hypertension and current smoking.
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