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| 2. |
- Brand, Björn, et al.
(author)
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Prognostication and risk stratification by assessment of left atrioventricular plane displacement in patients with myocardial infarction.
- 2002
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In: International Journal of Cardiology. - 0167-5273. ; 83:1, s. 35-41
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Journal article (peer-reviewed)abstract
- BACKGROUND: Mean left atrioventricular plane displacement is strongly related to prognosis in patients with heart failure. We aimed to examine its value for prognostication and risk stratification in patients hospitalised for acute myocardial infarction. METHODS AND RESULTS: Left atrioventricular plane displacement was assessed by echocardiography in 271 consecutive patients with acute myocardial infarction. Mean prospective follow-up was 628 days. Atrioventricular plane displacement was readily assessed in all patients and was significantly lower in patients who died (n=41, 15.1%) compared to the survivors: 8.2(5.6) v. 10.0(5.5) mm, P<0.0001. Overall mortality was 31.3% in the lowest quartile with regard to atrioventricular plane displacement (<8.00 mm) and 10.1% in the combined upper three quartiles. Thus, the hazard ratio for an atrioventricular plane displacement <8.0 mm compared to 8 mm or more was 3.1, P=0.0001. The combined mortality/heart failure hospitalisation incidence was 43.8% in the lowest and 14.6% in the combined upper three quartiles: Risk ratio 3.0, P<0.0001. In multivariate analysis, including age and history of atrial fibrillation, left atrioventricular plane displacement was an independent prognostic marker. CONCLUSION: In post-myocardial infarction patients, echocardiographic assessment of atrioventricular plane displacement showed a strong, independent prognostic value. Determination of left atrioventricular plane displacement can be readily performed in virtually all patients, and may in clinical practice facilitate identification of high-risk patients.
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| 3. |
- Holst, M., et al.
(author)
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Fluid restriction in heart failure patients : Is it useful? The design of a prospective, randomised study
- 2003
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In: European Journal of Cardiovascular Nursing. - : Elsevier Science. - 1474-5151 .- 1873-1953. ; 2:3, s. 237-242
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Journal article (peer-reviewed)abstract
- Thirst is a common and troublesome symptom for patients with moderate to severe heart failure. The pharmacological and non-pharmacological treatment as well as the nature of the disease itself causes increased thirst. There is no evidence in the literature about the usefulness of fluid restriction for heart failure patients. Formerly, when very little pharmacological treatment was available, fluid restriction was one of the few interventional options but nowadays when the pharmacological treatment has improved, its importance may be questioned. This article describes the design of an ongoing study with the aim to determine if an individualised and less restrictive fluid prescription can improve the quality of life, cardiac function and exercise capacity, and decrease in hospital admissions and thirst. This study will be performed as a two-group, 1:1 randomised cross-over study. In group 1, the patients are instructed to comply with a maximum fluid intake of 1.5 l. This is a standard treatment today. In group 2, the patients are recommended to intake a fluid, based on the physiological need of 30 ml/kg body weight/24 h, and are allowed to increase the fluid intake to a maximum of 35 ml/kg body weight/24 h. After 16 weeks, the patients will cross over to the other intervention strategy and continue for another 16 weeks. © 2003 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.
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| 4. |
- Höijer, Carl Johan, et al.
(author)
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Improved cardiac function and quality of life following upgrade to dual chamber pacing after long-term ventricular stimulation.
- 2002
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In: European Heart Journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 23:6, s. 490-497
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Journal article (peer-reviewed)abstract
- Aims Many patients with sinus node disease or atrioventricular block have previously received pacemakers with only ventricular stimulation (VVI or VVIR). This study aimed to investigate whether quality of life and cardiac function were affected by an upgrade to dual chamber pacing (DDDR or DDIR) following long-term ventricular stimulation. Methods After implantation of an atrial lead and a DDDR pulse generator, a randomized, double-blind crossover study was performed in 19 patients, previously treated with ventricular pacing for a median time of 6center dot8 years. Patients were randomized to 8 weeks with either VVIR or DDDR/DDIR pacing; after this time, the other mode was programmed for 8 weeks. At the end of each period, the patients' quality of life was evaluated and echocardiography was performed together with Holter monitoring and blood samples for brain natriuretic peptide. Results Sixteen of the patients preferred DDDR and two VVIR pacing (P=0center dot001); one was undecided. Seven patients demanded an early crossover while paced in the VVIR mode, vs none in the DDDR mode (P=0center dot008). Quality of life was higher in the DDDR mode in 11 of 17 modalities, reaching statistical significance for dyspnoea (P<0center dot05) and general activity (P<0center dot05). Echocardiography showed significantly larger left ventricular end-diastolic dimensions in the DDDR mode (P=0center dot01), whereas end-systolic dimensions did not differ. Left ventricular systolic function was significantly superior in the DDDR mode (mean aortic velocity--time integral: P<0center dot001) and left atrial diameter was significantly smaller in the DDDR mode (P=0center dot01). The plasma level of brain natriuretic peptide was significantly lower in DDDR mode (P=0center dot002). Conclusion An upgrade to dual chamber rate adaptive pacing results in significantly improved quality of life and cardiac function as compared to continued VVIR stimulation and should thus be considered in patients with ventricular pacemakers who have not developed permanent atrial fibrillation or flutter.
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| 5. |
- Piepoli, MF, et al.
(author)
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Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH)
- 2004
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In: BMJ: British Medical Journal. - 1756-1833. ; 328:7433, s. 189-192
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Journal article (peer-reviewed)abstract
- Objective To determine the effect of exercise training on survival in patients with heart failure due to left ventricular systolic dysfunction. Design Collaborative meta-analysis. Inclusion criteria Randomised parallel group controlled trials of exercise training, for at least eight weeks with individual patient data on survival for at least three months. Studies reviewed Nine datasets, totalling 801 patients: 395 received exercise training and 406 were controls. Main outcome measure Death from all causes. Results During a mean (SD) follow up of 705 (729) days there were 88 (22%) deaths in the exercise arm and 105 (26%) in the control arm. Exercise training significantly reduced mortality (hazard ratio 0.65, 95% confidence interval, 0.46 to 0.92; log rank chi(2) = 5.9; P = 0.015). The secondary end point of death or admission to hospital was also reduced (0.72, 0.56 to 0.93; log rank chi(2) = 6.4; P = 0.011). No statistically significant subgroup specific treatment effect was observed. Conclusion Meta-analysis of randomised trials to date gives no evidence that properly supervised medical training programmes for patients with heart failure might be dangerous, and indeed there is clear evidence of an overall reduction in mortality. Further research should focus on optimising exercise programmes and identifying appropriate patient groups to target.
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| 6. |
- Rydberg, Erik, et al.
(author)
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Left atrioventricular plane displacement but not left ventricular ejection fraction is influenced by the degree of aortic stenosis.
- 2004
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In: Heart. - : BMJ. - 1355-6037. ; 90:10, s. 5-1151
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Journal article (peer-reviewed)abstract
- Abstract in UndeterminedAims: To examine how left atrioventricular plane displacement ( AVPD), a widely used measure of left ventricular (LV) function, is related to presence and degree of aortic stenosis. Methods and results: Cardiac dimensions, LV filling, left AVPD, LV ejection fraction (LVEF), and valve function were assessed by echocardiography/Doppler in 182 patients with various cardiac diseases (mean (SD) age 69 (12) years, 36% women), 49 consecutive with and 133 consecutive without aortic stenosis. In an analysis of covariance, neither left AVPD nor LVEF was independently correlated with the presence of aortic stenosis. However, looking separately at patients with aortic stenosis, left AVPD (p = 0.03) but not LVEF correlated independently with degree of aortic stenosis in multiple linear regression analysis. In patients with aortic stenosis, an abnormal left AVPD had 94% sensitivity and 90% negative predictive value with regard to severe aortic stenosis, compared with 56% and 62%, respectively, for LVEF. Conclusion: In patients with cardiac disease, neither left AVPD nor LVEF correlated independently with presence of aortic stenosis. However, in patients with aortic stenosis, left AVPD but not LVEF correlated with the degree of aortic valve obstruction and left AVPD but not LVEF had high sensitivity and negative predictive value with regard to severe aortic stenosis. Compared with LVEF, left AVPD is an earlier and more sensitive marker of LV haemodynamic load in patients with aortic stenosis.
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| 7. |
- Rydberg, Erik, et al.
(author)
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Left atrioventricular plane displacement determined by echocardiography: a clinically useful, independent predictor of mortality in patients with stable coronary artery disease
- 2003
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In: Journal of Internal Medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 254:5, s. 479-485
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Journal article (peer-reviewed)abstract
- Background. Echocardiographically determined left atrioventricular plane displacement (AVPD) is strongly related to prognosis in patients with chronic heart failure and in postmyocardial infarction patients. We aimed at exploring whether AVPD, unlike ejection fraction, is related to mortality in patients with stable coronary artery disease (CAD). Methods and results. Atrioventricular plane displacement was assessed by two dimensionally guided M-mode echocardiography in the four and two chamber views, in 333 consecutive patients with stable CAD and an abnormal coronary angiogram. Patients were followed up for an average of 41 months. AVPD was lower in patients who died (n = 30, 9.0 %) compared with survivors (9.0 +/- 2.2 vs. 11.5 +/- 2.1 mm, P < 0.0001). Amongst patients with prior myocardial infarction (n = 184) AVPD was 8.7 +/- 2.3 mm in those who died (n = 17) and 11.2 +/- 2.3 mm in the survivors (P < 0.0001). In patients without prior myocardial infarction (n = 149), AVPD was 9.4 +/- 2.1 (n = 13) and 11.8 +/- 1.8 mm, respectively (P < 0.0001). Age, AVPD and four other echocardiographical variables correlated significantly with prognosis in univariate logistic regression analysis. In multiple logistic regression analysis only AVPD (P < 0.0001) correlated independently with mortality. Conclusion. Echocardiographically determined AVPDis a clinically useful, independent prognostic tool in patients with stable CAD. The presence of a documented previous myocardial infarction does not influence this observation.
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| 11. |
- Willenheimer, Ronnie, et al.
(author)
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Echocardiographic assessment of left atrioventricular plane displacement as a complement to left ventricular regional wall motion evaluation in the detection of myocardial dysfunction.
- 2002
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In: International Journal of Cardiovascular Imaging. - 1875-8312. ; 18:3, s. 181-186
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Journal article (peer-reviewed)abstract
- AIM: We aimed to find out if abnormal left atrioventricular plane displacement (AVPD) is a sign of myocardial dysfunction, even in patients with normal left ventricular (LV) regional wall motion (RWM). METHODS: We prospectively performed echocardiography in 1350 consecutive patients referred to our echocardiography laboratory. Left AVPD and LV RWM were evaluated in all patients. We prospectively selected all patients with normal LV RWM but impaired left AVPD for further analysis of clinical parameters. RESULTS: Eighty-eight of the 1350 patients had completely normal LV RWM but impaired left AVPD (< or = 10 mm) in at least one region (septal, lateral, posterior, anterior). Of these, 60.2% had prior and/ or acute myocardial infarction, predominantly non-Q-wave, whereas 33.0% had angina without infarction and 2.3% had hypertension. In 49 (55.7%) patients coronary angiography was performed. All were abnormal. In 4.5% (n = 4) of the patients no obvious reason for the AVPD decrease was found, but was not precluded. CONCLUSION: Almost all patients with abnormal left AVPD and completely normal LV RWM had clinical cardiac disease. Thus, decreased AVPD despite normal LV RWM seems to be a true sign of myocardial dysfunction, predominantly indicating subendocardial dysfunction. In screening for patients with myocardial dysfunction assessment of left AVPD may be useful as a complement to LV RWM evaluation. The prognosis in such patients is currently being evaluated.
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| 12. |
- Willenheimer, Ronnie, et al.
(author)
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No effects on myocardial ischaemia in patients with stable ischaemic heart disease after treatment with ramipril for 6 months
- 2001
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In: Current Controlled Trials. Cardiovascular Medicine. - : Springer Science and Business Media LLC. - 1468-6694 .- 1468-6708. ; 2:2, s. 99-105
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Journal article (peer-reviewed)abstract
- Objective: To assess the effects of a 6-month angiotensin-converting enzyme (ACE) inhibitor intervention on myocardial ischaemia.Method: We randomized 389 patients with stable coronary artery disease to double-blind treatment with ramipril 5 mg/day (n = 133), ramipril 1.25 mg/day (n = 133), or placebo (n = 123). Forty-eight-hour ambulatory electrocardiography was performed at baseline, and after 1 and 6 months.Results: Relevant baseline variables were similar in all groups. Changes over 6 months in duration of 1 mm ST-segment depression (STD), total ischaemic burden and maximum STD did not differ significantly between the treatment groups. There was no difference in the frequency of adverse events between the groups.ConclusionACE inhibitor treatment has little impact on incidence and severity of myocardial ischaemia in patients with stable ischaemic heart disease.
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| 14. |
- Winter, Reidar, et al.
(author)
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Correlation of the M-mode atrioventricular plane early diastolic downward slope and systolic parameters. Coupling of LV systolic and early diastolic function.
- 2004
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In: International Journal of Cardiovascular Imaging. - 1875-8312 .- 1569-5794. ; 20:2, s. 101-106
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Journal article (peer-reviewed)abstract
- Background: The early diastolic downward slope (EDS) of the left atrioventricular plane displacement (AVPD) is a parameter of early left ventricular (LV) diastolic filling, particularly useful in revealing pseudonormalisation of the transmitral Doppler early to atrial (E/A) ratio. In recent studies LV early diastolic function seems to be closely linked to LV systolic function. In order to further examine this relationship we studied the correlation between EDS and traditional Doppler parameters of LV diastolic function as well as between EDS and systolic parameters. Methods: LV diastolic function was assessed by echocardiography/Doppler in 62 consecutive patients by measurement of EDS and using a traditional four-grade scale based on a combination of the E/A ratio, the E-wave deceleration time (Edt), and the systolic/diastolic ratio of the pulmonary venous inflow (S/D). LV systolic function was evaluated by ejection fraction (LVEF) and AVPD. EDS was assessed from AVPD registrations. Results: In univariate analysis of variance (ANOVA), EDS was not significantly related to overall diastolic function, but highly significantly related to both LVEF (p = 0.001) and AVPD (p < 0.0001). Conclusions: EDS was more closely related to LV systolic parameters than to LV diastolic function assessed traditionally by Doppler, using a combination of E/A. Edt and S/D. This relationship between the early filling of the LV and the LV systolic function is in line with some earlier findings. It is suggestive of a relationship between the systolic and early diastolic performance of the LV.
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| 15. |
- Winter, Reidar, et al.
(author)
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Feasibility of noninvasive transthoracic echocardiography/Doppler measurement of coronary flow reserve in left anterior descending coronary artery in patients with acute coronary syndrome: A new technique tested in clinical practice
- 2003
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In: Journal of the American Society of Echocardiography. - 1097-6795. ; 16:5, s. 464-468
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Journal article (peer-reviewed)abstract
- Objective: The aim of this study was to test the feasibility and accuracy of transthoracic Doppler echocardiography measurement of coronary flow reserve (CFR) in the left anterior descending coronary artery (LAD) territory in the clinical setting of the acute coronary syndrome. Methods: Transthoracic Doppler echocardiography measurements of CFR were made in 42 consecutive patients in the distal LAD before and during adenosine infusion. The results were validated by coronary angiography. A normal CFR was predefined as a more than 2-fold increase of flow velocity during adenosine infusion. Results. We were able to detect significant stenosis in the LAD territory with 92% sensitivity and 82% specificity if we considered a stenosis greater than or equal to 50% to be significant. Defining a stenosis of greater than or equal to 70% as significant increased the sensitivity and the negative-predictive value to 100%, with a specificity of 70%. Conclusion: Measuring CFR using transthoracic Doppler echocardiography is noninvasive, feasible, accurate, and relatively inexpensive. The excellent negative-predictive value of this technique makes it a useful tool for identifying patients who can avoid repeated angiography as a result of suspected subacute LAD restenosis after percutaneous coronary intervention.
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