| 1. |
- Nilsson, Lars T., et al.
(author)
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Electrocardiographic abnormalities and NT-proBNP levels at long-term follow-up of patients with dyspnea after pulmonary embolism
- 2024
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In: Scandinavian Cardiovascular Journal. - : Taylor & Francis. - 1401-7431 .- 1651-2006. ; 58:1
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Journal article (peer-reviewed)abstract
- Objectives: Electrocardiogram (ECG) and measurement of plasma brain natriuretic peptides (BNP) are established markers of right ventricular dysfunction (RVD) in the setting of acute pulmonary embolism (PE) but their value at long-term follow-up is largely unknown. The purpose of this prospective study was to determine the prevalence of ECG abnormalities, describe levels of N-terminal proBNP (NT-proBNP), and establish their association with dyspnea at long-term follow-up after PE.Design: All Swedish patients diagnosed with acute PE in 2005 (n = 5793) were identified through the Swedish National Patient Registry. Surviving patients in 2007 (n = 3510) were invited to participate. Of these, 2105 subjects responded to a questionnaire about dyspnea and comorbidities. Subjects with dyspnea or risk factors for development of chronic thromboembolic pulmonary hypertension were included in the study in a secondary step, which involved collection of blood samples and ECG registration.Results: Altogether 49.3% had a completely normal ECG. The remaining participants had a variety of abnormalities, 7.2% had atrial fibrillation/flutter (AF). ECG with any sign of RVD was found in 7.2% of subjects. Right bundle branch block was the most common RVD sign with a prevalence of 6.4%. An abnormal ECG was associated with dyspnea. AF was associated with dyspnea, whereas ECG signs of RVD were not. 61.2% of subjects had NT-proBNP levels above clinical cut-off (>125 ng/L). The degree of dyspnea did not associate independently with NT-proBNP levels.Conclusions: We conclude that the value of ECG and NT-proBNP in long term follow-up after PE lies mostly in differential diagnostics.
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| 2. |
- Andersson, Lars Gustaf, et al.
(author)
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Introduction
- 2022
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In: The Forbidden Door : The selected poetry of Lasse Söderberg translated by Lars Gustaf Andersson and Carolyn Forché - The selected poetry of Lasse Söderberg translated by Lars Gustaf Andersson and Carolyn Forché. - 9798986340111
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Book chapter (pop. science, debate, etc.)abstract
- Inledning till översättningsvolymen "The Forbidden Door" som innehåller dikter av den svenske poeten Lasse Söderberg (f. 1931), översatta till engelska av Lars Gustaf Andersson och Carolyn Forché.
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| 3. |
- Andersson, Therese, 1983-, et al.
(author)
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Long-term sequelae following acute pulmonary embolism : a nationwide follow-up study regarding the incidence of CTEPH, dyspnea, echocardiographic and V/Q scan abnormalities
- 2023
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In: Pulmonary Circulation. - : John Wiley & Sons. - 2045-8932 .- 2045-8940. ; 13:4
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Journal article (peer-reviewed)abstract
- We aimed to follow a nationwide cohort of patients with pulmonary embolism (PE) without any exclusions to generate information regarding long-term symptoms, investigational findings and to determine the prevalence of chronic thromboembolic pulmonary hypertension (CTEPH). We hypothesized that this approach would yield generalizable estimates of CTEPH prevalence and incidence. All individuals diagnosed with acute PE in Sweden in 2005 were identified using the National Patient Register. In 2007, survivors were asked to complete a questionnaire regarding current symptoms. Those with dyspnea were referred for further examinations with laboratory tests, electrocardiogram (ECG), and a ventilation/perfusion scan (V/Q scan). If CTEPH was suspected, a referral to the nearest pulmonary arterial hypertension-center was recommended. Of 5793 unique individuals with PE diagnosis in 2005, 3510 were alive at the beginning of 2007. Altogether 53% reported dyspnea at some degree whereof a large proportion had V/Q scans indicating mismatched defects. Further investigation revealed 6 cases of CTEPH and in parallel 18 cases were diagnosed outside this study. The overall prevalence of CTEPH was 0.4% (95% confidence interval [CI]: 0.2%–0.6%) and 0.7% (95% CI: 0.4%–1.0%) among the survivors. The cumulative incidence of CTEPH in the group of patients who underwent a V/Q scan was 1.1% (95% CI: 0.2%–2.0%). There was a high mortality following an acute PE, a high proportion of persistent dyspnea among survivors, whereof several had pathological findings on V/Q scans and echocardiography. Only a minority developed CTEPH, indicating that CTEPH is the tip of the iceberg of post-PE disturbances.
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| 4. |
- Bayani, Mohsen, 1981, et al.
(author)
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Geometric robustness and dynamic response management by structural topometry optimisation to reduce the risk for squeak and rattle
- 2022
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In: Design Science. - : Cambridge University Press (CUP). - 2053-4701. ; 8
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Journal article (peer-reviewed)abstract
- Historically, squeak and rattle (S&R) sounds have been among the top quality problems and a major contributor to the warranty costs in passenger cars. Geometric variation is among the main causes of S&R. Though, geometric variation analysis and robust design techniques have been passively involved in the open-loop design activities in the predesign-freeze phases of car development. Despite the successful application of topometry optimisation to enhance attributes such as weight, durability, noise and vibration and crashworthiness in passenger cars, the implementation of closed-loop structural optimisation in the robust design context to reduce the risk for S&R has been limited. In this respect, the main obstacles have been the demanding computational resources and the absence of quantified S&R risk evaluation methods. In this work, a topometry optimisation approach is proposed to involve the geometric variation analysis in an attribute balancing problem together with the dynamic response of the system. The proposed method was used to identify the potential areas of a door component that needed structural reinforcement. The main objective was to enhance the design robustness to minimise the risk for S&R by improving the system response to static geometrical uncertainties and dynamic excitation.
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| 5. |
- Bayani, Mohsen, 1981, et al.
(author)
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Squeak and rattle prevention by geometric variation management using a two-stage evolutionary optimisation approach
- 2020
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In: ASME International Mechanical Engineering Congress and Exposition, Proceedings (IMECE). ; 2B-2020
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Conference paper (peer-reviewed)abstract
- Squeak and rattle are annoying sounds that often are regarded as the indicators for defects and quality issues by the automotive customers. Among the major causes for the generation of squeak and rattle sounds, geometric variation or tolerance stack-up is a key contributor. In the assembly process, the dimensional variation in critical interfaces for generating squeak and rattle events can be magnified due to tolerance stackup. One provision to manage the tolerance stack-up in these critical interfaces is to optimise the location of connectors between parts in an assembly. Hence, the focus of this work is to prevent squeak and rattle by introducing a geometric variation management approach to be used in the design phase in the automotive industry. The objective is to identify connection configurations that result in minimum variation and deviation in selected measure points from the critical interfaces for squeak and rattle. In this study, a two-stage evolutionary optimisation scheme, based on the genetic algorithm employing the elitism pool, is introduced to fine-tune the connectors’ configuration in an assembly. The objective function was defined as the variation and the deviation in the normal direction and the squeak plane. In the first stage, the location of one-dimensional connectors was found by minimising the objective function in the rattle direction. In the second stage, the best combination of some of the connectors from the first stage was found to define planar fasteners to optimise the objective function both in the rattle direction and the squeak plane. It was shown that by using the proposed two-stage optimisation scheme, the variation and deviation results in critical interfaces for squeak and rattle improved compared to the baseline results.
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| 6. |
- Bayani, Mohsen, 1981, et al.
(author)
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Squeak and rattle prevention by geometric variation management using a two-stage evolutionary optimization approach
- 2022
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In: Journal of Computing and Information Science in Engineering. - : ASME International. - 1530-9827 .- 1944-7078. ; 22:1
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Journal article (peer-reviewed)abstract
- Squeak and rattle are annoying sounds that are often regarded as failure indicators by car users. Geometric variation is a key contributor to the generation of squeak and rattle sounds. Optimization of the connection configuration in assemblies can be a provision to minimize this risk. However, the optimization process for large assemblies can be computationally expensive. The focus of this work is to propose a two-stage evolutionary optimization scheme to find the fittest connection configurations that minimize the risk for squeak and rattle. This was done by defining the objective functions as the measured variation and deviation in the rattle direction and the squeak plane. In the first stage, the location of the fasteners primarily contributing to the rattle direction measures is identified. In the second stage, fasteners primarily contributing to the squeak plane measures are added to the fittest configuration from phase one. It was assumed that the fasteners from the squeak group plane have a lower-order effect on the rattle direction measures, compared to the fasteners from the rattle direction group. This assumption was falsified for a set of simplified geometries. Also, a new uniform space filler algorithm was introduced to efficiently generate an inclusive and feasible starting population for the optimization process by incorporating the problem constraints in the algorithm. For two industrial cases, it was shown that by using the proposed two-stage optimization scheme, the variation and deviation measures in critical interfaces for squeak and rattle improved compared to the baseline results.
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| 7. |
- Bergström, Göran, 1964, et al.
(author)
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Body weight at age 20 and in midlife is more important than weight gain for coronary atherosclerosis: Results from SCAPIS.
- 2023
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In: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 373, s. 46-54
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Journal article (peer-reviewed)abstract
- Elevated body weight in adolescence is associated with early cardiovascular disease, but whether this association is traceable to weight in early adulthood, weight in midlife or to weight gain is not known. The aim of this study is to assess the risk of midlife coronary atherosclerosis being associated with body weight at age 20, body weight in midlife and body weight change.We used data from 25,181 participants with no previous myocardial infarction or cardiac procedure in the Swedish CArdioPulmonary bioImage Study (SCAPIS, mean age 57 years, 51% women). Data on coronary atherosclerosis, self-reported body weight at age 20 and measured midlife weight were recorded together with potential confounders and mediators. Coronary atherosclerosis was assessed using coronary computed tomography angiography (CCTA) and expressed as segment involvement score (SIS).The probability of having coronary atherosclerosis was markedly higher with increasing weight at age 20 and with mid-life weight (p<0.001 for both sexes). However, weight increase from age 20 until mid-life was only modestly associated with coronary atherosclerosis. The association between weight gain and coronary atherosclerosis was mainly seen in men. However, no significant sex difference could be detected when adjusting for the 10-year delay in disease development in women.Similar in men and women, weight at age 20 and weight in midlife are strongly related to coronary atherosclerosis while weight increase from age 20 until midlife is only modestly related to coronary atherosclerosis.
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| 8. |
- Bergström, Göran, 1964, et al.
(author)
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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
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In: Circulation. - Philadelphia : American Heart Association. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
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Journal article (peer-reviewed)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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| 9. |
- Bergström, Göran, et al.
(author)
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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
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In: Circulation. - : Wolters Kluwer. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
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Journal article (peer-reviewed)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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| 10. |
- Bergström, Göran, et al.
(author)
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Self-report tool for identification of individuals with coronary atherosclerosis : the Swedish cardiopulmonary bioimage study
- 2024
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In: Journal of the American Heart Association. - : John Wiley & Sons. - 2047-9980. ; 13:14
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Journal article (peer-reviewed)abstract
- BACKGROUND: Coronary atherosclerosis detected by imaging is a marker of elevated cardiovascular risk. However, imaging involves large resources and exposure to radiation. The aim was, therefore, to test whether nonimaging data, specifically data that can be self-reported, could be used to identify individuals with moderate to severe coronary atherosclerosis.METHODS AND RESULTS: We used data from the population-based SCAPIS (Swedish CardioPulmonary BioImage Study) in individuals with coronary computed tomography angiography (n=25 182) and coronary artery calcification score (n=28 701), aged 50 to 64 years without previous ischemic heart disease. We developed a risk prediction tool using variables that could be assessed from home (self-report tool). For comparison, we also developed a tool using variables from laboratory tests, physical examinations, and self-report (clinical tool) and evaluated both models using receiver operating characteristic curve analysis, external validation, and benchmarked against factors in the pooled cohort equation. The self-report tool (n=14 variables) and the clinical tool (n=23 variables) showed high-to-excellent discriminative ability to identify a segment involvement score ≥4 (area under the curve 0.79 and 0.80, respectively) and significantly better than the pooled cohort equation (area under the curve 0.76, P<0.001). The tools showed a larger net benefit in clinical decision-making at relevant threshold probabilities. The self-report tool identified 65% of all individuals with a segment involvement score ≥4 in the top 30% of the highest-risk individuals. Tools developed for coronary artery calcification score ≥100 performed similarly.CONCLUSIONS: We have developed a self-report tool that effectively identifies individuals with moderate to severe coronary atherosclerosis. The self-report tool may serve as prescreening tool toward a cost-effective computed tomography-based screening program for high-risk individuals.
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