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Norum IB, Otterstad JE, Ruddox V, Bendz B, Edvardsen T. Novel regional longitudinal strain by speckle tracking to detect significant coronary artery disease in patients admitted to the emergency department for chest pain suggestive of acute coronary syndrome. J Echocardiogr 2022; 20:166-177. [PMID: 35290613 PMCID: PMC9374627 DOI: 10.1007/s12574-022-00568-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/28/2021] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
Background Global longitudinal strain has shown variable results in detecting ischemia in patients admitted to the emergency department with chest pain, but without other clear evidence of coronary artery disease (CAD). Our aim was to investigate whether assessment of regional longitudinal myocardial function could assist in detecting significant CAD in these patients. Methods Clinical evaluation, electrocardiogram, echocardiogram and troponin T were evaluated in 126 patients admitted with chest pain. A subsequent invasive coronary angiography divided patients into two groups: significant CAD (CAD+) or non-significant CAD (CAD−). Global and regional myocardial function were evaluated by speckle tracking echocardiography. Regional longitudinal strain was defined as the highest longitudinal strain values in four adjacent left ventricular segments and termed 4AS. Results CAD+ was found in 37 patients (29%) of which 51% had elevated troponin. Mean 4AS was − 13.1% (± 3.5) in the CAD+ and − 15.2% (± 2.7) (p = 0.002) in the CAD− group. Predictors for CAD+ were age [OR 1.06 (1.01–1.11, p = 0.026)], smoking [OR 3.39 (1.21–9.51, p = 0.020)], troponin [OR 3.32 (1.28–8.60, p = 0.014)) and 4AS (OR 1.24 (1.05–1.46, p = 0.010)]. A cutoff for 4AS of > − 15% showed the best diagnostic performance with event-reclassification of 0.41 (p < 0.001), non-event-reclassification of − 0.34 (p < 0.001) and net reclassification improvement 0.07 (p = 0.60). Conclusion Decreased myocardial function in four adjacent LV segments assessed by strain has the potential to detect significant CAD in patients admitted with chest pain and negative/slightly elevated initial troponin. Trial registration: Current Research information system in Norway (CRISTIN). Id: 555249. Supplementary Information The online version contains supplementary material available at 10.1007/s12574-022-00568-7.
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Affiliation(s)
- Ingvild Billehaug Norum
- Department of Cardiology, Vestfold Hospital Trust, P. O Box 2168, 3103, Tønsberg, Norway.
- Faculty of Medicine, University of Oslo, P.O Box 1078, 0316, Oslo, Norway.
| | - Jan Erik Otterstad
- Department of Cardiology, Vestfold Hospital Trust, P. O Box 2168, 3103, Tønsberg, Norway
| | - Vidar Ruddox
- Department of Cardiology, Vestfold Hospital Trust, P. O Box 2168, 3103, Tønsberg, Norway
| | - Bjørn Bendz
- Faculty of Medicine, University of Oslo, P.O Box 1078, 0316, Oslo, Norway
- Department of Cardiology, Division Rikshospitalet, Oslo University Hospital, P.O Box 4950, 0424, Oslo, Norway
| | - Thor Edvardsen
- Faculty of Medicine, University of Oslo, P.O Box 1078, 0316, Oslo, Norway
- Department of Cardiology, Division Rikshospitalet, Oslo University Hospital, P.O Box 4950, 0424, Oslo, Norway
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Peersen K, Munkhaugen J, Olsen SJ, Otterstad JE, Sverre E. Post-myocardial infarction rehabilitation and secondary prevention in hospitals. Tidsskr Nor Laegeforen 2021; 141:21-0349. [PMID: 34758605 DOI: 10.4045/tidsskr.21.0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Norwegian studies have documented poor cardiovascular risk factor control and a high incidence of new cardiovascular events in myocardial infarction patients. There is little knowledge about the scope of secondary prevention treatment and cardiac rehabilitation in Norwegian hospitals. Therefore, we wanted to conduct a survey of discharge routines and outpatient follow-up after myocardial infarction. MATERIAL AND METHOD In October 2018, the heads of cardiology departments and nurse managers/physiotherapists at cardiology outpatient clinics at all Norwegian hospitals (N = 51) were contacted and asked to take part in a telephone interview. RESULTS A total of 40 doctors (78 %) and 51 nurses/physiotherapists (100 %) conducted the telephone interview. Eleven hospitals used standardised discharge summary templates with treatment targets and expected follow-up. Ten hospitals offered routine outpatient follow-up. A total of 47 hospitals (92 %) offered multidisciplinary cardiac rehabilitation, 'heart school' classes or cardiac exercise training, and of these 9 (18 %) offered multidisciplinary comprehensive cardiac rehabilitation in line with international recommendations. INTERPRETATION The survey revealed considerable differences in reported discharge routines and the provision of cardiac rehabilitation and outpatient follow-up at Norwegian hospitals.
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Kristiansen O, Vethe NT, Peersen K, Wang Fagerland M, Sverre E, Prunés Jensen E, Lindberg M, Gjertsen E, Gullestad L, Perk J, Dammen T, Bergan S, Husebye E, Otterstad JE, Munkhaugen J. Effect of atorvastatin on muscle symptoms in coronary heart disease patients with self-perceived statin muscle side effects: a randomized, double-blinded crossover trial. Eur Heart J Cardiovasc Pharmacother 2021; 7:507-516. [PMID: 32609361 PMCID: PMC8566260 DOI: 10.1093/ehjcvp/pvaa076] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/29/2020] [Accepted: 06/24/2020] [Indexed: 12/14/2022]
Abstract
AIMS To estimate the effect of atorvastatin on muscle symptom intensity in coronary heart disease (CHD) patients with self-perceived statin-associated muscle symptoms (SAMS) and to determine the relationship to blood levels of atorvastatin and/or metabolites. METHODS AND RESULTS A randomized multi-centre trial consecutively identified 982 patients with previous or ongoing atorvastatin treatment after a CHD event. Of these, 97 (9.9%) reported SAMS and 77 were randomized to 7-week double-blinded treatment with atorvastatin 40 mg/day and placebo in a crossover design. The primary outcome was the individual mean difference in muscle symptom intensity between the treatment periods, measured by visual-analogue scale (VAS) scores. Atorvastatin did not affect the intensity of muscle symptoms among 71 patients who completed the trial. Mean VAS difference (statin-placebo) was 0.31 (95% CI: -0.24 to 0.86). The proportion with more muscle symptoms during placebo than atorvastatin was 17% (n = 12), 55% (n = 39) had the same muscle symptom intensity during both treatment periods whereas 28% (n = 20) had more symptoms during atorvastatin than placebo (confirmed SAMS). There were no differences in clinical or pharmacogenetic characteristics between these groups. The levels of atorvastatin and/or metabolites did not correlate to muscle symptom intensity among patients with confirmed SAMS (Spearman's rho ≤0.40, for all variables). CONCLUSION Re-challenge with high-intensity atorvastatin did not affect the intensity of muscle symptoms in CHD patients with self-perceived SAMS during previous atorvastatin therapy. There was no relationship between muscle symptoms and the systemic exposure to atorvastatin and/or its metabolites. The findings encourage an informed discussion to elucidate other causes of muscle complaints and continued statin use.
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Affiliation(s)
- Oscar Kristiansen
- Department of Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Dronninggata 28, Drammen 3004, Norway
- Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Domus Medica, Sognsvannsveien 9, Oslo 0372, Norway
| | - Nils Tore Vethe
- Department of Pharmacology, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway
| | - Kari Peersen
- Department of Cardiology, Vestfold Hospital Trust, Halfdan Wilhelmsens alle 17, Tønsberg 3103, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Domus Medica, Gaustad, Sognsvannsveien 9, Oslo 0372, Norway
| | - Elise Sverre
- Department of Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Dronninggata 28, Drammen 3004, Norway
- Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Domus Medica, Sognsvannsveien 9, Oslo 0372, Norway
| | - Elena Prunés Jensen
- Department of Laboratory Medicine, Vestre Viken Hospital Trust, Dronninggata 28, Drammen 3004, Norway
| | - Morten Lindberg
- Central Laboratory, Vestfold Hospital Trust, Halfdan Wilhelmsens alle 17, Tønsberg 3103, Norway
| | - Erik Gjertsen
- Department of Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Dronninggata 28, Drammen 3004, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 20, Oslo 0372, Norway
- KG Jebsen Cardiac Research Centre, Oslo University Hospital, Postbox 4956 Nydalen, Oslo 0424, Norway
| | - Joep Perk
- Department of Cardiology, Public Health Department, Linnaeus University, Kalmar 391 82, Sweden
| | - Toril Dammen
- Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Domus Medica, Sognsvannsveien 9, Oslo 0372, Norway
| | - Stein Bergan
- Department of Pharmacology, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Dronninggata 28, Drammen 3004, Norway
| | - Jan Erik Otterstad
- Department of Cardiology, Vestfold Hospital Trust, Halfdan Wilhelmsens alle 17, Tønsberg 3103, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Dronninggata 28, Drammen 3004, Norway
- Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Domus Medica, Sognsvannsveien 9, Oslo 0372, Norway
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Otterstad JE, Norum IB, Ruddox V, Le ACM, Bendz B, Munkhaugen J, Klungsøyr O, Edvardsen T. Prognostic impact of non-improvement of global longitudinal strain in patients with revascularized acute myocardial infarction. Int J Cardiovasc Imaging 2021; 37:3477-3487. [PMID: 34327649 PMCID: PMC8604850 DOI: 10.1007/s10554-021-02349-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
Global longitudinal strain (GLS) is a more sensitive prognostic factor than left ventricular ejection fraction (LVEF) in various cardiac diseases. Little is known about the clinical impact of GLS changes after acute myocardial infarction (AMI). The present study aimed to explore if non-improvement of GLS after 3 months was associated with higher risk of subsequent composite cardiovascular events (CCVE). Patients with AMI were consecutively included at a secondary care center in Norway between April 2016 and July 2018 within 4 days following percutaneous coronary intervention. Echocardiography was performed at baseline and after 3 months. Patients were categorized with non-improvement (0 to − 100%) or improvement (0 to 100%) in GLS relative to the baseline value. Among 214 patients with mean age 65 (± 10) years and mean LVEF 50% (± 8) at baseline, 50 (23%) had non-improvement (GLS: − 16.0% (± 3.7) to − 14.2% (± 3.6)) and 164 (77%) had improvement (GLS: − 14.0% (± 3.0) to − 16.9% (± 3.0%)). During a mean follow-up of 3.3 years (95% CI 3.2 to 3.4) 77 CCVE occurred in 52 patients. In adjusted Cox regression analyses, baseline GLS was associated with all recurrent CCVE (HR 1.1, 95% CI 1.0 to 1.2, p < 0.001) whereas non-improvement versus improvement over 3 months follow-up was not. Baseline GLS was significantly associated with the number of CCVE in revascularized AMI patients whereas non-improvement of GLS after 3 months was not. Further large-scale studies are needed before repeated GLS measurements may be recommended in clinical practice. Trial registration: Current Research information system in Norway (CRISTIN). Id: 506563
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Affiliation(s)
- Jan Erik Otterstad
- Department of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway, P. O Box 2168, 3103, Tønsberg, Norway
| | - Ingvild Billehaug Norum
- Department of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway, P. O Box 2168, 3103, Tønsberg, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway, Blindern, P.O Box 1078, 0316, Oslo, Norway.
| | - Vidar Ruddox
- Department of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway, P. O Box 2168, 3103, Tønsberg, Norway
| | - An Chau Maria Le
- Department of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway, P. O Box 2168, 3103, Tønsberg, Norway
| | - Bjørn Bendz
- Faculty of Medicine, University of Oslo, Oslo, Norway, Blindern, P.O Box 1078, 0316, Oslo, Norway.,Division Rikshospitalet, Department of Cardiology, Oslo University Hospital, Oslo, Norway, Nydalen, P.O Box 4950, 0424, Oslo, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital Trust, Drammen, Norway, Vestre Viken HF, P.O box 800, 3004, Drammen, Norway
| | - Ole Klungsøyr
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway, Sogn Arena 3.etg, Nydalen, P.O Box 4950, 0424, Oslo, Norway
| | - Thor Edvardsen
- Faculty of Medicine, University of Oslo, Oslo, Norway, Blindern, P.O Box 1078, 0316, Oslo, Norway.,Division Rikshospitalet, Department of Cardiology, Oslo University Hospital, Oslo, Norway, Nydalen, P.O Box 4950, 0424, Oslo, Norway
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Sverre E, Peersen K, Perk J, Husebye E, Gullestad L, Dammen T, Otterstad JE, Munkhaugen J. Challenges in coronary heart disease prevention - experiences from a long-term follow-up study in Norway. SCAND CARDIOVASC J 2020; 55:73-81. [PMID: 33274648 DOI: 10.1080/14017431.2020.1852308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective. To determine longitudinal changes in lifestyle behaviour and lipid management in a chronic coronary heart disease (CHD) population. Design. A multi-centre cohort study consecutively included 1127 patients at baseline in 2014-2015, on average 16 months after a CHD event. Data were collected from hospital records, a questionnaire and clinical examination. Seven hundred and seven of 1021 eligible patients participated in a questionnaire-based follow-up in 2019. Data were analysed with univariate statistics. Results. After a mean follow-up of 4.7 years (SD 0.4) from baseline, the percentage of current smokers (15% versus 16%), obesity (23% versus 25%) and clinically significant symptoms of anxiety (21% versus 17%) and depression (13% versus 14%) remained unchanged, whereas the proportion with low physical activity increased from 53% to 58% (p < .001). The proportions with reduced physical activity level were similar in patients over and under 70 years of age. Most patients were still taking statins (94% versus 92%) and more patients used high-intensity statin (49% versus 54%, p < .001) and ezetimibe (5% versus 15%, p < .001) at follow-up. 73% reported ≥1 primary-care consultation(s) for CHD during the last year while 27% reported no such follow-up. There were more smokers among participants not attending primary-care consultations compared to those attending (19% versus 14%, p = .026). No differences were found for other risk factors. Conclusions. We found persistent suboptimal risk factor control in coronary outpatients during long-term follow-up. Closer follow-up and intensified risk management including lifestyle and psychological health are needed to improved secondary prevention and outcome of CHD. Trial registration: Registered at ClinicalTrials.gov: NCT02309255.Registered at 5 December 2014, registered retrospectively.
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Affiliation(s)
- E Sverre
- Department of Medicine, Drammen Hospital, Drammen, Norway.,Department of Behavioral Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - K Peersen
- Department of Medicine, Vestfold Hospital, Tønsberg, Norway
| | - J Perk
- Department of Cardiology, Public Health Department Linnaeus University, Kalmar, Sweden
| | - E Husebye
- Department of Medicine, Drammen Hospital, Drammen, Norway
| | - L Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet and Faculty of Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Cardiac Research Center and Center for Heart Failure Research, Oslo University Hospital Ullevål, Oslo, Norway
| | - T Dammen
- Department of Behavioral Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - J E Otterstad
- Department of Medicine, Vestfold Hospital, Tønsberg, Norway
| | - J Munkhaugen
- Department of Medicine, Drammen Hospital, Drammen, Norway.,Department of Behavioral Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway
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Norum IB, Edvardsen T, Ruddox V, Gunther A, Dahle G, Otterstad JE. Three-dimensional versus two-dimensional transthoracic echocardiography for left ventricular outflow tract measurements in severe aortic stenosis. A cross-sectional study using computer tomography and Haegar sizers as reference. SCAND CARDIOVASC J 2020; 54:220-226. [PMID: 32408833 DOI: 10.1080/14017431.2020.1761559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives. In grading of aortic stenosis, two-dimensional transthoracic echocardiography (2D TTE) routinely results in underestimation of the left ventricular outflow tract (LVOT) area, and hence the aortic valve area (AVA). We investigated whether three-dimensional (3D) TTE measurements of the LVOT would be more accurate. We evaluated the feasibility, agreement and inter-observer variability of 3D TTE LVOT measurements with computed tomography (CT) and Haegar sizers as reference. Design. Sixty-one patients with severe aortic stenosis were examined with 2D and 3D TTE. 41 had CT and 13 also had perioperative Haegar sizing. Pearson's correlation and Bland-Altman plots were used to compare methods. Inter-observer variability was tested for 2D and 3D TTE. Trial registration: Current research information system in Norway (CRISTIN). Id: 555249. Results. Feasibility was 67% with 3D TTE and 100% with 2D TTE and CT. Mean LVOT area for 2D, 3D, CT and Haegar sizers were 3.7 ± 0.6 cm2, 4.0 ± 0.9 cm2, 5.2 ± 0.8 cm2 and 4.4 ± 1.0 cm2 respectively. Bias and limits of agreements for 2D TTE was 1.5 ± 1.3 cm2, compared with CT and 0.4 ± 1.5 cm2 with Haegar sizers. Corresponding results for 3D TTE were 1.2 ± 1.6 cm2 and 0.2 ± 1.8 cm2. Intraclass correlation coefficients for LVOT area were 0.62 for 3D and 0.86 for 2D. Conclusions. 2D TTE showed better feasibility and inter-observer variability in measurements of LVOT than 3D TTE. Both echocardiographic methods underestimated LVOT area compared to CT and Haegar sizers. These observations suggest that 2D TTE is still preferable to 3D TTE in the assessment of aortic stenosis.
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Affiliation(s)
- Ingvild Billehaug Norum
- Department of Cardiology, Vestfold Hospital trust, Tonsberg, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Thor Edvardsen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Vidar Ruddox
- Department of Cardiology, Vestfold Hospital trust, Tonsberg, Norway
| | - Anne Gunther
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Gry Dahle
- Department of Cardiothoracic surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Munkhaugen J, Sverre E, Peersen K, Kristiansen O, Gjertsen E, Gullestad L, Erik Otterstad J. Is the novel LDL-cholesterol goal <1.4 mmol/L achievable without a PCSK9 inhibitor in a chronic coronary population from clinical practice? Eur J Prev Cardiol 2020; 28:e10-e11. [PMID: 33611511 DOI: 10.1177/2047487320923187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Norway
- Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Elise Sverre
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Norway
- Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Kari Peersen
- Department of Medicine, Vestfold Hospital Trust, Norway
| | - Oscar Kristiansen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Norway
- Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Erik Gjertsen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Faculty of Medicine, University of Oslo, Norway
- KG Jebsen Center for Cardiac Research, University of Oslo, Norway
- Center for Heart Failure Research, Oslo University Hospital, Norway
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8
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Otterstad JE, Norum IB, Ruddox V, Bendz B, Haugaa KH, Edvardsen T. The impact of semi-automatic versus manually adjusted assessment of global longitudinal strain in post-myocardial infarction patients. Int J Cardiovasc Imaging 2020; 36:1283-1290. [PMID: 32236908 PMCID: PMC7256100 DOI: 10.1007/s10554-020-01826-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/23/2020] [Indexed: 01/24/2023]
Abstract
There are unresolved questions related to the proper use of editing the region of interest (ROI) for measurements of global longitudinal strain (GLS). The purpose of the present study was to compare the semi-automatic default GLS value by the vendor's software with manually adjusted GLS and test the impact on GLS measures with different ROI widths. We selected 25 patients post myocardial infarction treated with PCI who had excellent echocardiographic recordings after 2-5 days and 3 months. The different GLS values were assessed from these 50 analyses in three steps. The semi-automatically GLS by default ROIs was compared with manually adjusted ROIs widths selected by an expert and then with manual adjustments, but with fixed ROIs being narrow, medium and wide. Their mean age was 64 (± 12) years, 52% had ST elevation MI and mean LVEF was 52 (± 4)%. Mean default GLS was - 15.3 (± 2.5)% with the widest ROI level selected semi-automatically in 78% of all widths. The mean expert GLS with manually adjusted ROI was - 14.7 (± 2.4)%, and the medium ROI level was selected by the expert in 85% of all examinations. The mean adjusted GLS, but with fixed ROIs widths was - 15.0 (± 2.5%)% with narrow ROI, - 14.7 (± 2.6)% with medium and - 13.5 (± 2.3)% with wide ROI width (p < 0.001 vs. default GLS). The Intra Class Coefficient Correlation between default and manually adjusted expert GLS was 0.93 (p < 0.001). The difference between the default and the manually adjusted expert GLS was neglectable. These findings may represent a simplification of the assessment of GLS that might increase its use in clinical practice. The GLS measurements with a fixed wide ROIs were significantly different from the expert measurements and indicate that a wide ROI should be avoided.
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Affiliation(s)
| | | | - Vidar Ruddox
- Department of Medicine, Hospital of Vestfold, Tonsberg, Norway
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, and University of Oslo, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, and University of Oslo, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, and University of Oslo, Sognsvannsveien 20, 0372, Oslo, Norway.
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Sverre E, Peersen K, Weedon-Fekjær H, Perk J, Gjertsen E, Husebye E, Gullestad L, Dammen T, Otterstad JE, Munkhaugen J. Preventable clinical and psychosocial factors predicted two out of three recurrent cardiovascular events in a coronary population. BMC Cardiovasc Disord 2020; 20:61. [PMID: 32024471 PMCID: PMC7003324 DOI: 10.1186/s12872-020-01368-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relative importance of lifestyle, medical and psychosocial factors on the risk of recurrent major cardiovascular (CV) events (MACE) in coronary patients' needs to be identified. The main objective of this study is to estimate the association between potentially preventable factors on MACE in an outpatient coronary population from routine clinical practice. METHODS This prospective follow-up study of recurrent MACE, determine the predictive impact of risk factors and a wide range of relevant co-factors recorded at baseline. The baseline study included 1127 consecutive patients 2-36 months after myocardial infarction (MI) and/or revascularization procedure. The primary composite endpoint of recurrent MACE defined as CV death, hospitalization due to MI, revascularization, stroke/transitory ischemic attacks or heart failure was obtained from hospital records. Data were analysed using cox proportional hazard regression, stratified by prior coronary events before the index event. RESULTS During a mean follow-up of 4.2 years from study inclusion (mean time from index event to end of study 5.7 years), 364 MACE occurred in 240 patients (21, 95% confidence interval: 19 to 24%), of which 39 were CV deaths. In multi-adjusted analyses, the strongest predictor of MACE was not taking statins (Relative risk [RR] 2.13), succeeded by physical inactivity (RR 1.73), peripheral artery disease (RR 1.73), chronic kidney failure (RR 1.52), former smoking (RR 1.46) and higher Hospital Anxiety and Depression Scale-Depression subscale score (RR 1.04 per unit increase). Preventable and potentially modifiable factors addressed accounted for 66% (95% confidence interval: 49 to 77%) of the risk for recurrent events. The major contributions were smoking, low physical activity, not taking statins, not participating in cardiac rehabilitation and diabetes. CONCLUSIONS Coronary patients were at high risk of recurrent MACE. Potentially preventable clinical and psychosocial factors predicted two out of three MACE, which is why these factors should be targeted in coronary populations. TRIAL REGISTRATION Registered at ClinicalTrials.gov: NCT02309255. Registered at December 5th, 2014, registered retrospectively.
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Affiliation(s)
- E Sverre
- Department of Medicine, Drammen Hospital, Drammen, Norway. .,Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - K Peersen
- Department of Medicine, Vestfold Hospital, Oslo, Norway
| | - H Weedon-Fekjær
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - J Perk
- Department of Cardiology, Public Health Department Linnaeus University, Kalmar, Sweden
| | - E Gjertsen
- Department of Medicine, Drammen Hospital, Drammen, Norway
| | - E Husebye
- Department of Medicine, Drammen Hospital, Drammen, Norway
| | - L Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Faculty of Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Cardiac Research Center, Oslo University Hospital Ullevål, Oslo, Norway
| | - T Dammen
- Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - J E Otterstad
- Department of Medicine, Vestfold Hospital, Oslo, Norway
| | - J Munkhaugen
- Department of Medicine, Drammen Hospital, Drammen, Norway.,Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway
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10
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Sverre E, Peersen K, Weedon-Fekjar H, Perk J, Gjertsen E, Husebye E, Otterstad JE, Gullestad L, Dammen T, Munkhaugen J. P4398Potentially modifiable clinical and psychosocial factors associated with recurrent cardiovascular events in an outpatient coronary population. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Regular assessment and management of lifestyle, biological and psychosocial factors are recommended in coronary patients. The relative importance of these factors on risk of recurrent cardiovascular (CV) events in the outpatient coronary population is not well known.
Purpose
To estimate the relative effect of potentially modifiable risk factors on recurrent CV events in coronary patients from routine clinical practice.
Methods
A prospective cohort multicenter study from Norway included 1127 (21% women, 83% participation rate) consecutive patients aged 18–80 years 2–36 (mean 16) months after myocardial infarction and/or a coronary revascularization procedure. Thirty percent had at least one coronary event prior to the index event. The primary composite endpoint of recurrent major adverse CV events (MACE): myocardial infarction, revascularization, stroke, heart failure or cardiovascular death was obtained from the hospital records. Cox proportional hazard models stratified for 1 vs. 2+ previous coronary events were performed with model 1 adjusting for age and model 2 with add-on for coronary risk factors and CV comorbidity.
Results
At baseline 99% used platelet inhibition, 93% were taking antihypertensive agents and statins, and 45% had participated in cardiac rehabilitation (CR). During follow-up of mean 4.2 (SD 0.3) years, a total of 355 MACE occurred in 240 patients corresponding to a MACE risk of 31.5%. In model 1, smoking, insufficient physical activity, diabetes, not taking statin therapy, no participation in CR, peripheral artery disease (PAD), previous stroke, kidney failure and higher anxiety and depression scores were significantly associated with recurrent MACE (Table). In model 2, smoking, no physical activity, not taking statin, PAD, kidney failure, anxiety and depression remained significant.
Conclusions
Coronary patients in routine clinical practice were at significant risk of recurrent MACE, particularly in the presence of CV comorbidity. Not taking statin therapy, insufficient physical activity, smoking, anxiety and depression were the major potentially modifiable factors contributing to CV risk. Preventive efforts that target these factors are required to further reduce CV risk in the coronary population.
Acknowledgement/Funding
Grants from the Norwegian ExtraFoundation for Health and Rehabilitation and Vestre Viken Trust
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Affiliation(s)
- E Sverre
- Drammen Hospital, Drammen, Norway
| | | | | | - J Perk
- Linnaeus University, Kalmar, Sweden
| | | | | | | | | | - T Dammen
- University of Oslo, Oslo, Norway
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11
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Munkhaugen J, Vethe NT, Fagerland MW, Dammen T, Perk J, Gjertsen E, Otterstad JE, Gullestad L, Bergan S, Husebye E. Statin-associated muscle symptoms in coronary patients: design of a randomized study. SCAND CARDIOVASC J 2019; 53:162-168. [DOI: 10.1080/14017431.2019.1612085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
- Department of Behavioural Science in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nils Tore Vethe
- Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Toril Dammen
- Department of Behavioural Science in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Joep Perk
- Institute of Health and Caring Sciences, Linneus University, Kalmar, Sweden
| | - Erik Gjertsen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
| | | | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Stein Bergan
- Department of Pharmacology, Oslo University Hospital, Oslo, Norway
- School of Pharmacy, University of Oslo, Oslo, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
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12
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Dahl Aarvik M, Sandven I, Dondo TB, Gale CP, Ruddox V, Munkhaugen J, Atar D, Otterstad JE. Effect of oral β-blocker treatment on mortality in contemporary post-myocardial infarction patients: a systematic review and meta-analysis. Eur Heart J Cardiovasc Pharmacother 2019; 5:12-20. [PMID: 30192930 PMCID: PMC6321955 DOI: 10.1093/ehjcvp/pvy034] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/02/2018] [Indexed: 12/28/2022]
Abstract
Aims Guidelines concerning β-blocker treatment following acute myocardial infarction (AMI) are based on studies undertaken before the implementation of reperfusion and secondary prevention therapies. We aimed to estimate the effect of oral β-blockers on mortality in contemporary post-AMI patients with low prevalence of heart failure and/or reduced left ventricular ejection fraction. Methods and results A random effects model was used to synthetize results of 16 observational studies published between 1 January 2000 and 30 October 2017. Publication bias was evaluated, and heterogeneity between studies examined by subgroup and random effects meta-regression analyses considering patient-related and study-level variables. The pooled estimate showed that β-blocker treatment [among 164 408 (86.8%) patients, with median follow-up time of 2.7 years] was associated with a 26% reduction in all-cause mortality [rate ratio (RR) 0.74, 95% confidence interval (CI) 0.64–0.85] with moderate heterogeneity (I2 = 67.4%). The patient-level variable mean age of the cohort explained 31.5% of between study heterogeneity. There was presence of publication bias, or small study effect, and when controlling for bias by the trim and fill simulation method, the effect disappeared (adjusted RR 0.90, 95% CI 0.77–1.04). Also, small study effect was demonstrated by a cumulative meta-analysis starting with the largest study showing no effect, with increasing effect as the smaller studies were accumulated. Conclusion Evidence from this study suggests that there is no association between β-blockers and all-cause mortality. A possible beneficial effect in AMI survivors needs to be tested by large randomized clinical trials.
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Affiliation(s)
- Magnus Dahl Aarvik
- Institute of Clinical Sciences, University of Oslo, Sognsvannsveien 9, Oslo, Norway
| | - Irene Sandven
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Sogn Arena, Nydalen, Oslo, Norway
| | - Tatendashe B Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicince, Clarendon Way, University of Leeds, Leeds, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicince, Clarendon Way, University of Leeds, Leeds, UK
| | - Vidar Ruddox
- Department of Cardiology, Vestfold Hospital Trust, N-3103 Toensberg, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Wergelandsgate 10, Drammen, Norway
| | - Dan Atar
- Institute of Clinical Sciences, University of Oslo, Sognsvannsveien 9, Oslo, Norway.,Department of Cardiology B, Oslo University Hospital, Ullevaal, Kirkeveien 166, Oslo, Norway
| | - Jan Erik Otterstad
- Department of Cardiology, Vestfold Hospital Trust, N-3103 Toensberg, Norway
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13
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Munkhaugen J, Ruddox V, Halvorsen S, Dammen T, Fagerland MW, Hernæs KH, Vethe NT, Prescott E, Jensen SE, Rødevand O, Jortveit J, Bendz B, Schirmer H, Køber L, Bøtker HE, Larsen AI, Vikenes K, Steigen T, Wiseth R, Pedersen T, Edvardsen T, Otterstad JE, Atar D. BEtablocker Treatment After acute Myocardial Infarction in revascularized patients without reduced left ventricular ejection fraction (BETAMI): Rationale and design of a prospective, randomized, open, blinded end point study. Am Heart J 2019; 208:37-46. [PMID: 30530121 DOI: 10.1016/j.ahj.2018.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/20/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Current guidelines on the use of β-blockers in post-acute myocardial infarction (MI) patients without reduced left ventricular ejection fraction (LVEF) are based on studies before the implementation of modern reperfusion and secondary prevention therapies. It remains unknown whether β-blockers will reduce mortality and recurrent MI in contemporary revascularized post-MI patients without reduced LVEF. DESIGN BETAMI is a prospective, randomized, open, blinded end point multicenter study in 10,000 MI patients designed to test the superiority of oral β-blocker therapy compared to no β-blocker therapy. Patients with LVEF ≥40% following treatment with percutaneous coronary intervention or thrombolysis and/or no clinical signs of heart failure are eligible to participate. The primary end point is a composite of all-cause mortality or recurrent MI obtained from national registries over a mean follow-up period of 3 years. Safety end points include rates of nonfatal MI, all-cause mortality, ventricular arrhythmias, and hospitalizations for heart failure obtained from hospital medical records 30 days after randomization, and from national registries after 6 and 18 months. Key secondary end points include recurrent MI, heart failure, cardiovascular and all-cause mortality, and clinical outcomes linked to β-blocker therapy including drug adherence, adverse effects, cardiovascular risk factors, psychosocial factors, and health economy. Statistical analyses will be conducted according to the intention-to-treat principle. A prespecified per-protocol analysis (patients truly on β-blockers or not) will also be conducted. CONCLUSIONS The results from the BETAMI trial may have the potential of changing current clinical practice for treatment with β-blockers following MI in patients without reduced LVEF. EudraCT number 2018-000590-75.
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Affiliation(s)
- John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway; Department of Behavioural Science in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Vidar Ruddox
- Department for Cardiology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital, Ullevaal and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Toril Dammen
- Department of Behavioural Science in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Morten W Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Kjersti H Hernæs
- Clinical Trial Unit Health economics, Oslo University Hospital, Oslo, Norway
| | - Nils Tore Vethe
- Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Olaf Rødevand
- LHL Department of Cardiology, LHL Hospital Gardermoen, Gardermoen, Norway
| | - Jarle Jortveit
- Department of Cardiology, Sørlandet Hospital Arendal, Arendal, Norway
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Henrik Schirmer
- Department of Cardiology, Akershus University Hospital AHUS, Lørenskog, Norway
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital Skejby, Skejby, Denmark
| | - Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Kjell Vikenes
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Terje Steigen
- Department of Cardiology, University Hospital of North Norway and the Arctic University of Norway, Tromsø, Norway
| | - Rune Wiseth
- Clinic of Cardiology, St Olavs University Hospital, Trondheim, Norway
| | - Terje Pedersen
- Oslo University Hospital, Ullevaal and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jan Erik Otterstad
- Department of Behavioural Science in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ullevaal and Faculty of Medicine, University of Oslo, Oslo, Norway
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14
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Munkhaugen J, Hjelmesæth J, Otterstad JE, Helseth R, Sollid ST, Gjertsen E, Gullestad L, Perk J, Moum T, Husebye E, Dammen T. Managing patients with prediabetes and type 2 diabetes after coronary events: individual tailoring needed - a cross-sectional study. BMC Cardiovasc Disord 2018; 18:160. [PMID: 30075751 PMCID: PMC6091110 DOI: 10.1186/s12872-018-0896-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 07/24/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Understanding the determinants associated with prediabetes and type 2 diabetes in coronary patients may help to individualize treatment and modelling interventions. We sought to identify sociodemographic, medical and psychosocial factors associated with normal blood glucose (HbA1c < 5.7%), prediabetes (HbA1c 5.7-6.4%), and type 2 diabetes. METHODS A cross-sectional explorative study applied regression analyses to investigate the factors associated with glycaemic status and control (HbA1c level) in 1083 patients with myocardial infarction and/or a coronary revascularization procedure. Data were collected from hospital records at the index event and from a self-report questionnaire and clinical examination with blood samples at 2-36 months follow-up. RESULTS In all, 23% had type 2 diabetes, 44% had prediabetes, and 33% had normal blood glucose at follow-up. In adjusted analyses, type 2 diabetes was associated with larger waist circumference (Odds Ratio 1.03 per 1.0 cm, p = 0.001), hypertension (Odds Ratio 2.7, p < 0.001), lower high-density lipoprotein cholesterol (Odds Ratio 0.3 per1.0 mmol/L, p = 0.002) and insomnia (Odds Ratio 2.0, p = 0.002). In adjusted analyses, prediabetes was associated with smoking (Odds Ratio 3.3, p = 0.001), hypertension (Odds Ratio 1.5, p = 0.03), and non-participation in cardiac rehabilitation (Odds Ratio 1.7, p = 0.003). In patients with type 2 diabetes, a higher HbA1c level was associated with ethnic minority background (standardized beta [β] 0.19, p = 0.005) and low drug adherence (β 0.17, p = 0.01). In patients with prediabetes or normal blood glucose, a higher HbA1c was associated with larger waist circumference (β 0.13, p < 0.001), smoking (β 0.18, p < 0.001), hypertension (β 0.08, p = 0.04), older age (β 0.16, p < 0.001), and non-participation in cardiac rehabilitation (β 0.11, p = 0.005). CONCLUSIONS Along with obesity and hypertension, insomnia and low drug adherence were the major modifiable factors associated with type 2 diabetes, whereas smoking and non-participation in cardiac rehabilitation were the factors associated with prediabetes. Further research on the effect of individual tailoring, addressing the reported significant predictors of failure, is needed to improve glycaemic control. TRIAL REGISTRATION Retrospectively registered at ClinicalTrials.gov: NCT02309255 , December 5th 2014.
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Affiliation(s)
- John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Health Trust, Dronninggata 41, 3004, Drammen, Norway. .,Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Jøran Hjelmesæth
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Ragnhild Helseth
- Centre for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Erik Gjertsen
- Department of Medicine, Drammen Hospital Trust, Drammen, Norway
| | - Lars Gullestad
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Torbjørn Moum
- Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital Trust, Drammen, Norway
| | - Toril Dammen
- Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway
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15
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Munkhaugen J, Otterstad JE, Dammen T, Gjertsen E, Moum T, Husebye E, Gullestad L. The prevalence and predictors of elevated C-reactive protein after a coronary heart disease event. Eur J Prev Cardiol 2018; 25:923-931. [DOI: 10.1177/2047487318768940] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective An interleukin-beta antagonist reduces the risk of subsequent cardiovascular events in coronary patients with high-sensitivity C-reactive protein (hs-CRP) ≥2 mg/L. It remains to be defined how large the coronary population at inflammatory risk is, and what the predictors of elevated risk are. Methods A cross-sectional study investigated the proportion of patients with elevated hs-CRP (i.e. ≥2 mg/L) and the respective demographic and clinical predictors in 971 patients without concomitant inflammatory diseases who had been hospitalized with myocardial infarction (80%) and/or a revascularization procedure. Data were collected from hospital records, a self-report questionnaire and a clinical examination with blood samples. Results After 2–36 month follow-up, 39% ( n = 378) had hs-CRP ≥ 2 mg/L, among whom 64% ( n = 243) had low-density lipoprotein cholesterol (LDL-C) ≥1.8 mmol/L and 47% ( n = 176) used a low-intensity statin regime. Only 24% had both LDL and hs-CRP at target range, 27% had elevation of both, whereas 12% had hs-CRP ≥ 2 mg/L and LDL-C < 1.8 mmol/L. Somatic comorbidity (odds ratio (OR) 1.3/1.0 point on the Charlson score), ≥1 previous coronary event (OR 2.4), smoking (OR 2.2), higher body mass index (OR 1.2/1.0 kg/m2), high LDL-C (OR 1.4/1.0 mmol/L) and higher anxiety scores (OR 1.1/1.0 point increase on the Hospital Anxiety and Depression Scale-Anxiety subscale score) were significantly associated with hs-CRP ≥2 mg/L in adjusted analyses. Conclusions Elevated hs-CRP was frequently observed after a coronary event and associated with unfavourable LDL-C and unhealthy lifestyles and psychosocial distress. Intensified statin therapy and strategies to target these modifiable factors are the encouraged first steps to reduce inflammation and improve LDL-C in these patients.
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Affiliation(s)
- John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Norway
- Department of Behavioural Sciences in Medicine and the Faculty of Medicine, University of Oslo, Norway
| | | | - Toril Dammen
- Department of Behavioural Sciences in Medicine and the Faculty of Medicine, University of Oslo, Norway
| | - Erik Gjertsen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Norway
| | - Torbjørn Moum
- Department of Behavioural Sciences in Medicine and the Faculty of Medicine, University of Oslo, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet and the Faculty of Medicine, University of Oslo, Norway
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16
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Munkhaugen J, Peersen K, Sverre E, Gjertsen E, Gullestad L, Dammen T, Husebye E, Otterstad JE. The follow-up after myocardial infarction - is it good enough? Tidsskr Nor Laegeforen 2018. [PMID: 29513442 DOI: 10.4045/tidsskr.17.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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17
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Sverre E, Peersen K, Otterstad JE, Gullestad L, Perk J, Gjertsen E, Moum T, Husebye E, Dammen T, Munkhaugen J. Optimal blood pressure control after coronary events: the challenge remains. ACTA ACUST UNITED AC 2017; 11:823-830. [PMID: 29128603 DOI: 10.1016/j.jash.2017.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 01/21/2023]
Abstract
We identified sociodemographic, medical, and psychosocial factors associated with unfavorable blood pressure (BP) control in 1012 patients, hospitalized with myocardial infarction and/or a coronary revascularization procedure. This cross-sectional study collected data from hospital records, a comprehensive self-report questionnaire, clinical examination, and blood samples after 2-36 (mean 17) months follow-up. Forty-six percent had unfavorable BP control (≥140/90 [80 in diabetics] mm Hg) at follow-up. Low socioeconomic status and psychosocial factors did not predict unfavorable BP control. Patients with unfavorable BP used on average 1.9 (standard deviation 1.1) BP-lowering drugs at hospital discharge, and the proportion of patients treated with angiotensin inhibitors and beta-blockers decreased significantly (P < .001) from discharge to follow-up. Diabetes (odds ratio [OR] 2.4), higher body mass index (OR 1.05 per 1.0 kg/m2), and older age (OR 1.04 per year) were significantly associated with unfavorable BP control in adjusted analyses. Only age (standardized beta [β] 0.24) and body mass index (β 0.07) were associated with systolic BP in linear analyses. We conclude that BP control was insufficient after coronary events and associated with obesity and diabetes. Prescription of BP-lowering drugs in hypertensive patients seems suboptimal. Overweight and intensified drug treatment thus emerge as the major factors to target to improve BP control.
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Affiliation(s)
- Elise Sverre
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway; Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Kari Peersen
- Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Joep Perk
- Faculty of Health and Life Sciences, Linneus University, Kalmar, Sweden
| | - Erik Gjertsen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
| | - Torbjørn Moum
- Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
| | - Toril Dammen
- Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
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Sverre E, Otterstad JE, Gjertsen E, Gullestad L, Husebye E, Dammen T, Moum T, Munkhaugen J. Medical and sociodemographic factors predict persistent smoking after coronary events. BMC Cardiovasc Disord 2017; 17:241. [PMID: 28877684 PMCID: PMC5588720 DOI: 10.1186/s12872-017-0676-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/30/2017] [Indexed: 11/18/2022] Open
Abstract
Background Understanding the determinants of persistent smoking after a coronary event constitutes the basis of modelling interventions of smoking cessation in secondary prevention programs. We aim to identify the potentially modifiable medical, sociodemographic and psychosocial factors, comprising the study factors, associated with unfavourable risk factor control after CHD events. Methods A cross-sectional explorative study used logistic regression analysis to investigate the association between study factors and smoking status in 1083 patients hospitalized with myocardial infarction and/or coronary revascularization. Hospital record data, a self-report questionnaire, clinical examination and blood samples were applied. Results At the index hospitalization, 390 patients were smoking and at follow-up after 2–36 months 167 (43%) of these had quit, while 230 reported persistent smoking. In adjusted analyses, unemployed or disability benefits (Odds ratio (OR) 4.1), low education (OR 3.5), longer smoking duration (OR 2.3) and not having ST-elevation myocardial infarction (STEMI) as index event (OR 2.3) were significantly associated with persistent smoking. Psychosocial factors at follow-up were not associated with persistent smoking. Smokers reported high motivation for cessation, with 68% wanting help to quit. Only 42% had been offered nicotine replacement therapy or other cessation aids. Smokers rated use of tobacco as the most important cause of their coronary disease (6.8 on a 1–10 Likert scale). Conclusions Low socioeconomic status, prior duration of smoking, and not having STEMI as index event were associated with persisting smoking. Persistent smokers in this study seem to have an acceptable risk perception and were motivated to cease smoking, but needed assistance through cessation programs including prescription of pharmacological aids. Trial registration Registered at ClinicalTrials.gov: NCT02309255, registered retrospectively.
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Affiliation(s)
- Elise Sverre
- Department of Medicine, Drammen Hospital, PB 800, 3004, Drammen, Norway. .,Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway.
| | | | - Erik Gjertsen
- Department of Medicine, Drammen Hospital, PB 800, 3004, Drammen, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, The Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, PB 800, 3004, Drammen, Norway
| | - Toril Dammen
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Moum
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, PB 800, 3004, Drammen, Norway
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Ruddox V, Sandven I, Munkhaugen J, Skattebu J, Edvardsen T, Otterstad JE. Atrial fibrillation and the risk for myocardial infarction, all-cause mortality and heart failure: A systematic review and meta-analysis. Eur J Prev Cardiol 2017; 24:1555-1566. [PMID: 28617620 PMCID: PMC5598874 DOI: 10.1177/2047487317715769] [Citation(s) in RCA: 189] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background In contemporary atrial fibrillation trials most deaths are cardiac related, whereas stroke and bleeding represent only a small subset of deaths. We aimed to evaluate the long-term risk of cardiac events and all-cause mortality in individuals with atrial fibrillation compared to no atrial fibrillation. Design A systematic review and meta-analysis of studies published between 1 January 2006 and 21 October 2016. Methods Four databases were searched. Studies had follow-up of at least 500 stable patients for either cardiac endpoints or all-cause mortality for 12 months or longer. Publication bias was evaluated and random effects models were used to synthesise the results. Heterogeneity between studies was examined by subgroup and meta-regression analyses. Results A total of 15 cohort studies was included. Analyses indicated that atrial fibrillation was associated with an increased risk of myocardial infarction (relative risk (RR) 1.54, 95% confidence interval (CI) 1.26–1.85), all-cause mortality (RR 1.95, 95% CI 1.50–2.54) and heart failure (RR 4.62, 95% CI 3.13–6.83). Coronary heart disease at baseline was associated with a reduced risk of myocardial infarction and explained 57% of the heterogeneity. A prospective cohort design accounted for 25% of all-cause mortality heterogeneity. Due to there being fewer than 10 studies, sources of heterogeneity were inconclusive for heart failure. Conclusions Atrial fibrillation seems to be associated with an increased risk of subsequent myocardial infarction in patients without coronary heart disease and an increased risk of, all-cause mortality and heart failure in patients with and without coronary heart disease.
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Affiliation(s)
- Vidar Ruddox
- 1 Department of Cardiology, Vestfold Hospital Trust, Norway
| | - Irene Sandven
- 2 Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Norway
| | | | - Julie Skattebu
- 1 Department of Cardiology, Vestfold Hospital Trust, Norway
| | - Thor Edvardsen
- 4 Department of Cardiology, Oslo University Hospital, Norway
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Ruddox V, Norum IB, Stokke TM, Edvardsen T, Otterstad JE. Focused cardiac ultrasound by unselected residents-the challenges. BMC Med Imaging 2017; 17:22. [PMID: 28259149 PMCID: PMC5336635 DOI: 10.1186/s12880-017-0191-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/21/2017] [Indexed: 11/22/2022] Open
Abstract
Background Focus Cardiac Ultrasound (FoCUS) performed by internal medicine residents on call with 2 h of training can provide a means for ruling out cardiac disease, but with poor sensitivity. The purpose of the present study was to evaluate diagnostic usefulness as well as diagnostic accuracy of FoCUS following 4 h of training. Methods All residents on call were given a 4-h training course with an additional one-hour training course after 6 months. They were asked to provide a pre- and post-FoCUS diagnosis, with the final diagnosis at discharge as reference. Results During a 7 month period 113 FoCUS examinations were reported; after 53 were excluded this left 60 for evaluation with a standard echocardiogram performed on average 11.5 h after FoCUS. Examinations were performed on the basis of chest pain and dyspnoea/edema. The best sensitivity was found in terms of the detection of reduced left ventricular (LV) ejection fraction (EF) (92%), LV dilatation (85%) and pericardial effusion (100%). High values were noted for negative predictive values, although false positives were seen. A kappa > 0.6 was observed for reduced LVEF, right ventricular area fraction and dilatation of LV and left atrium. In 48% of patients pre- and post-FoCUS diagnoses were identical and concordant with the final diagnosis. Importantly, in 30% examinations FoCUS correctly changed the pre-FoCUS diagnosis. Conclusions A FoCUS protocol with a 4-h training program gained clinical usefulness in one third of examinations. False positive findings represented the major challenge.
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Affiliation(s)
- Vidar Ruddox
- Department of cardiology, Vestfold Hospital Trust, Po. Box 2168, N3103, Tønsberg, Norway. .,Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Ingvild Billehaug Norum
- Department of cardiology, Vestfold Hospital Trust, Po. Box 2168, N3103, Tønsberg, Norway.,Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thomas Muri Stokke
- Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thor Edvardsen
- Department of cardiology, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway.,Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jan Erik Otterstad
- Department of cardiology, Vestfold Hospital Trust, Po. Box 2168, N3103, Tønsberg, Norway
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Peersen K, Munkhaugen J, Gullestad L, Dammen T, Moum T, Otterstad JE. Reproducibility of an extensive self-report questionnaire used in secondary coronary prevention. Scand J Public Health 2017; 45:269-276. [PMID: 28181463 PMCID: PMC5405837 DOI: 10.1177/1403494816688375] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aims: Self-reported information from questionnaires is frequently used in clinical epidemiological studies, but few provide information on the reproducibility of instruments applied in secondary coronary prevention studies. This study aims to assess the test–retest reproducibility of the questionnaire applied in the cross-sectional NORwegian CORonary (NOR-COR) Prevention Study. Methods: In the NOR-COR study 1127 coronary heart disease (CHD) patients completed a self-report questionnaire consisting of 249 questions, of which there are both validated instruments and de novo questions. Test–retest reliability of the instrument was estimated after four weeks in 99 consecutive coronary patients. Intraclass Correlation Coefficient (ICC) and Kappa (κ) were calculated. Results: The mean interval between test and retest was 33 (±6.4) days. Reproducibility values for questions in the first part of the questionnaire did not differ from those in the latter. A good to very good reproducibility was found for lifestyle factors (smoking: κ = 1.0; exercise: ICC = 0.90), medical factors (drug adherence: ICC = 0.74; sleep apnoea: ICC = 0.87), and psychosocial factors (anxiety and depression: ICC = 0.95; quality of life 12-Item Short-Form Health Survey (SF12): ICC = 0.89), as well as for the majority of de-novo-created variables covering the patient’s perceptions, motivation, needs, and preferences. Conclusions: The present questionnaire demonstrates a highly acceptable reproducibility for all key items and instruments. It thus emerges as a valuable tool for evaluating patient factors associated with coronary risk factor control in CHD patients.
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Affiliation(s)
- Kari Peersen
- 1 Department of Medicine, Hospital of Vestfold, Norway.,2 Faculty of Medicine, University of Oslo, Norway
| | - John Munkhaugen
- 3 Department of Medicine, Drammen Hospital, Norway.,4 Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Lars Gullestad
- 2 Faculty of Medicine, University of Oslo, Norway.,5 Department of Cardiology, Oslo University Hospital, Norway
| | - Toril Dammen
- 4 Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Torbjorn Moum
- 4 Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
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Sverre E, Peersen K, Husebye E, Gjertsen E, Gullestad L, Moum T, Otterstad JE, Dammen T, Munkhaugen J. Unfavourable risk factor control after coronary events in routine clinical practice. BMC Cardiovasc Disord 2017; 17:40. [PMID: 28109259 PMCID: PMC5251244 DOI: 10.1186/s12872-016-0387-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 10/26/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Risk factor control after a coronary event in a recent European multi-centre study was inadequate. Patient selection from academic centres and low participation rate, however, may underscore failing risk factor control in routine clinical practice. Improved understanding of the patient factors that influence risk factor control is needed to improve secondary preventive strategies. The objective of the present paper was to determine control of the major risk factors in a coronary population from routine clinical practice, and how risk factor control was influenced by the study factors age, gender, number of coronary events, and time since the index event. METHODS A cross-sectional study determined risk factor control and its association with study factors in 1127 patients (83% participated) aged 18-80 years with acute myocardial infarction and/or revascularization identified from medical records. Study data were collected from a self-report questionnaire, clinical examination, and blood samples after 2-36 months (median 16) follow-up. RESULTS Twenty-one percent were current smokers at follow-up. Of those smoking at the index event 56% continued smoking. Obesity was found in 34%, and 60% were physically inactive. Although 93% were taking blood-pressure lowering agents and statins, 46% were still hypertensive and 57% had LDL cholesterol >1.8 mmol/L at follow-up. Suboptimal control of diabetes was found in 59%. The patients failed on average to control three of the six major risk factors, and patients with >1 coronary events (p < 0.001) showed the poorest overall control. A linear increase in smoking (p < 0.01) and obesity (p < 0.05) with increasing time since the event was observed. CONCLUSIONS The majority of coronary patients in a representative Norwegian population did not achieve risk factor control, and the poorest overall control was found in patients with several coronary events. New strategies for secondary prevention are clearly needed to improve risk factor control. Even modest advances will provide major health benefits. TRIAL REGISTRATION Registered at ClinicalTrials.gov (ID NCT02309255 ).
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Affiliation(s)
- Elise Sverre
- Department of Medicine, Drammen Hospital, 3004 Drammen, Norway
| | - Kari Peersen
- Department of Medicine, Vestfold Hospital, Tonsberg, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, 3004 Drammen, Norway
| | - Erik Gjertsen
- Department of Medicine, Drammen Hospital, 3004 Drammen, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Medical Faculty, University of Oslo, Oslo, Norway
| | - Torbjørn Moum
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | | | - Toril Dammen
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, 3004 Drammen, Norway
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Munkhaugen J, Sverre E, Peersen K, Egge Ø, Gjertsen Eikeseth C, Gjertsen E, Gullestad L, Erik Otterstad J, Husebye E, Dammen T. Patient characteristics and risk factors of participants and non-participants in the NOR-COR study. SCAND CARDIOVASC J 2016; 50:317-322. [PMID: 27323914 DOI: 10.1080/14017431.2016.1202445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We aim to compare patient characteristics and coronary risk factors among participants and non-participants in a survey of CHD patients. METHODS A cross-sectional study explored characteristics and risk factors in patients hospitalized for acute myocardial infarction and/or revascularization. Study data collected from hospital medical records were compared between participants (n = 1127, 83%) and non-participants (n = 229, 16%), who did not consent to participation in the clinical study. RESULTS Non-participants showed statistically higher prevalence of women (28% versus 21%), ethnic minorities (6% versus 3%), patients living alone (26% versus 19%), depression (19% versus 6%), anxiety (9% versus 3%), hypertension (54% versus 43%) and diabetes (24% versus 17%). Significantly higher multi-adjusted odds ratios were found for Charlson comorbidity index 3.4 (95% confidence interval (CI), 2.8, 4.3) and depression 14.5 (4.4, 121.5) in non-participants. CONCLUSIONS Non-participants do have higher prevalence of important coronary risk factors compared to participants, and risk factor control may thus be overestimated in available prevention studies. Patients with somatic comorbidity and depression appear to be at particular risk of non-participation in the present study. New strategies accounting for the causes of nonadherence are important to improve secondary prevention in CHD.
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Affiliation(s)
- John Munkhaugen
- a Department of Medicine , Drammen Hospital , Drammen , Norway
| | - Elise Sverre
- a Department of Medicine , Drammen Hospital , Drammen , Norway
| | - Kari Peersen
- b Department of Medicine , Vestfold Hospital , Toensberg , Norway
| | | | | | - Erik Gjertsen
- a Department of Medicine , Drammen Hospital , Drammen , Norway
| | - Lars Gullestad
- d Department of Cardiology , Oslo University Hospital Rikshospitalet, Faculty of Medicine, University of Oslo , Oslo , Norway
| | | | - Einar Husebye
- a Department of Medicine , Drammen Hospital , Drammen , Norway
| | - Toril Dammen
- e Department of Behavioral Sciences in Medicine, Medical Faculty , University of Oslo , Oslo , Norway
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Otterstad JE, Munkhaugen J, Ruddox VDB, Haffner J, Thelle DS. Utdatert kunnskapsgrunnlag for betablokkere etter hjerteinfarkt? Tidsskriftet 2016; 136:624-7. [DOI: 10.4045/tidsskr.15.0884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Munkhaugen J, Sverre E, Peersen K, Gjertsen E, Gullestad L, Moum T, Erik Otterstad J, Perk J, Husebye E, Dammen T. The role of medical and psychosocial factors for unfavourable coronary risk factor control. SCAND CARDIOVASC J 2015; 50:1-8. [DOI: 10.3109/14017431.2015.1111408] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Elise Sverre
- Department of Medicine, Drammen Hospital, Drammen, Norway
| | - Kari Peersen
- Department of Medicine, Vestfold Hospital, Tønsberg, Norway
| | - Erik Gjertsen
- Department of Medicine, Drammen Hospital, Drammen, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Torbjorn Moum
- Department of Behavioral Sciences in Medicine, University of Oslo, Oslo, Norway
| | | | - Joep Perk
- Department of Cardiology, Public Health Department, Linnaeus University, Kalmar, Sweden
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, Drammen, Norway
| | - Toril Dammen
- Department of Behavioral Sciences in Medicine, University of Oslo, Oslo, Norway
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Norum IB, Ruddox V, Edvardsen T, Otterstad JE. Diagnostic accuracy of left ventricular longitudinal function by speckle tracking echocardiography to predict significant coronary artery stenosis. A systematic review. BMC Med Imaging 2015. [PMID: 26204938 PMCID: PMC4513709 DOI: 10.1186/s12880-015-0067-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Patients evaluated for acute and chronic chest pain comprise a large, heterogeneous group that often provides diagnostic challenges. Although speckle tracking echocardiography (STE) has proved to have diagnostic value in acute coronary syndrome it is not commonly incorporated in everyday practice. The purpose of the present systematic review was to assess the diagnostic accuracy of left ventricular (LV) longitudinal function by STE to predict significant coronary artery stenosis (CAD+) or not (CAD-) verified by coronary angiography in patients with chest pain suspected to be of cardiac ischemic origin. Methods 4 electronic databases; Embase, Medline, Cochrane and PubMed ahead-of print were searched for per 19.05.14. Only full-sized articles including > 40 patients were selected. Results A total of 166 citations were identified, 16 full-size articles were assessed of which 6 were found eligible for this review. Of 781 patients included 397 (60 %) had CAD+. The overall weighted mean global longitudinal strain (GLS) was −17.2 % (SD = 2.6) among CAD+ vs. -19.2 % (SD = 2.8) in CAD- patients. Mean area under curve in 4 studies for predicting CAD+ ranged from 0.68 to 0.80. The study cut-off levels for prediction of CAD+ in the ROC analysis varied between −17.4 % and −19.7 % with sensitivity from 51 % to 81 % and specificity between 58 % and 81 %. In 1 study GLS obtained during dobutamine stress echocardiography (DSE) had the best accuracy. Regional strain measurements were not uniform, but may have potential in detecting CAD. Conclusions GLS measurements at rest only have modest diagnostic accuracy in predicting CAD+ among patients presenting with acute or chronic chest pain. The results from regional strain, layer specific strain and DSE need to be verified in larger studies. Electronic supplementary material The online version of this article (doi:10.1186/s12880-015-0067-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingvild Billehaug Norum
- Department of Cardiology, Vestfold Hospital Trust, Pb 2168, 3103, Tønsberg, Norway. .,University of Oslo, Faculty of Medicine, Pb 1078 , Blindern, 0316, Oslo, Norway.
| | - Vidar Ruddox
- Department of Cardiology, Vestfold Hospital Trust, Pb 2168, 3103, Tønsberg, Norway. .,University of Oslo, Faculty of Medicine, Pb 1078 , Blindern, 0316, Oslo, Norway.
| | - Thor Edvardsen
- University of Oslo, Faculty of Medicine, Pb 1078 , Blindern, 0316, Oslo, Norway. .,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Pb 4950, Nydalen, 0424, Oslo, Norway.
| | - Jan Erik Otterstad
- Department of Cardiology, Vestfold Hospital Trust, Pb 2168, 3103, Tønsberg, Norway.
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Lindholm EE, Aune E, Frøland G, Kirkebøen KA, Otterstad JE. Analysis of transthoracic echocardiographic data in major vascular surgery from a prospective randomised trial comparing sevoflurane and fentanyl with propofol and remifentanil anaesthesia. Anaesthesia 2014; 69:558-72. [PMID: 24720268 DOI: 10.1111/anae.12604] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/28/2022]
Abstract
The aim of this study was to define pre-operative echocardiographic data and explore if postoperative indices of cardiac function after open abdominal aortic surgery were affected by the anaesthetic regimen. We hypothesised that volatile anaesthesia would improve indices of cardiac function compared with total intravenous anaesthesia. Transthoracic echocardiography was performed pre-operatively in 78 patients randomly assigned to volatile anaesthesia and 76 to total intravenous anaesthesia, and compared with postoperative data. Pre-operatively, 16 patients (10%) had left ventricular ejection fraction < 46%. In 138 patients with normal left ventricular ejection fraction, 5/8 (62%) with left ventricular dilatation and 41/130 (33%) without left ventricular dilatation had evidence of left ventricular diastolic dysfunction (p < 0.001). Compared with pre-operative findings, significant increases in left ventricular end-diastolic volume, left atrial maximal volume, cardiac output, velocity of early mitral flow and early myocardial relaxation occurred postoperatively (all p < 0.001). The ratio of the velocity of early mitral flow to early myocardial relaxation remained unchanged. There were no significant differences in postoperative echocardiographic findings between patients anaesthetised with volatile anaesthesia or total intravenous anaesthesia. Patients had an iatrogenic surplus of approximately 4.1 l of fluid volume by the first postoperative day. N-terminal prohormone of brain natriuretic peptide increased on the first postoperative day (p < 0.001) and remained elevated after 30 days (p < 0.001) in both groups. Although postoperative echocardiographic alterations were most likely to be related to increased preload due to a substantial iatrogenic surplus of fluid, a component of peri-operative myocardial ischaemia cannot be excluded. Our hypothesis that volatile anaesthesia improved indices of cardiac function compared with total intravenous anaesthesia could not be verified.
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Affiliation(s)
- E E Lindholm
- Department of Anaesthesiology, Vestfold Hospital Trust, Tønsberg, Norway
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Ruddox V, Mathisen M, Bækkevar M, Aune E, Edvardsen T, Otterstad JE. Is 3D echocardiography superior to 2D echocardiography in general practice? Int J Cardiol 2013; 168:1306-15. [DOI: 10.1016/j.ijcard.2012.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 09/11/2012] [Accepted: 12/01/2012] [Indexed: 02/07/2023]
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Ruddox V, Stokke TM, Edvardsen T, Hjelmesæth J, Aune E, Bækkevar M, Norum IB, Otterstad JE. The diagnostic accuracy of pocket-size cardiac ultrasound performed by unselected residents with minimal training. Int J Cardiovasc Imaging 2013; 29:1749-57. [PMID: 23974908 DOI: 10.1007/s10554-013-0278-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/15/2013] [Indexed: 01/16/2023]
Abstract
Pocket-size imaging devices may represent a tool for fast initial cardiac screening in the emergency setting. Pocket-size cardiac ultrasound (PCU) examinations performed by experienced echocardiographers yield acceptable diagnostic accuracy compared to standard echocardiogram (SE). However, the success of this method when used by unselected non-cardiologists remains unexplored. The current study studies the diagnostic accuracy of PCU when used by unselected internal medicine residents with minimal training. All residents were given a 2-hour introductory course in PCU (Vscan) and reported PCU results for up to 15 predefined cardiac landmarks. These were arbitrarily divided into 3 priority groups, such that left ventricle (LV) and pericardium were of first priority. Diagnostic accuracy [sensitivity/specificity and negative/positive predictive values (PPV/NPV)] and agreement were evaluated using a subsequent SE as reference. During a 9.2 months period a total of 303 patients were included in the study, the majority on the basis of presenting with chest pain or suspected heart failure. In the pooled LV and pericardial (1st priority) data, sensitivity/specificity/PPV/NPV were 61/92/70/89% respectively. Similar specificities and NPVs were observed for the 11 remaining indices, as were lower sensitivities and PPVs. The best PCU sensitivity (76%) was attained for the assessment of LV wall motion abnormalities. Overall agreement was k = 0.50. PCU examination performed by internal medicine residents with minimal training could provide a suitable means of ruling out cardiac pathology, as reflected in the high specificities and NPVs. It is not, however, a satisfactory tool for identifying patients with various cardiac disorders.
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Affiliation(s)
- Vidar Ruddox
- Department of Cardiology, Vestfold Hospital Trust, Pb 2168, 3103, Tønsberg, Norway,
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Mathisen M, Hjelmesæth J, Aune E, Ruddox V, Otterstad JE. Tidsskriftet bør stille strengere krav til litteratursøk. Tidsskriftet 2013; 133:1615-7. [DOI: 10.4045/tidsskr.13.0613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Ruddox V, Mathisen M, Otterstad JE. Prevalence and prognosis of non-specific chest pain among patients hospitalized for suspected acute coronary syndrome - a systematic literature search. BMC Med 2012; 10:58. [PMID: 22691301 PMCID: PMC3391179 DOI: 10.1186/1741-7015-10-58] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 06/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The term non-specific chest pain (NSCP) is applied to hospitalized patients in order to designate that they neither have an acute coronary syndrome (ACS) nor display evidence of a coronary ischemia. The number of NSCP patients is increasing and comprehensive guidelines specifying their optimal management have not yet been introduced. The objective of this review was to explore the prevalence and prognosis of NSCP versus ACS among patients recruited in consecutive series hospitalized for chest pain suspected to be ACS. METHODS This is a systematic literature search where three databases were searched from 1990 to 14 November 2011. In addition, one database was searched for Epub ahead of print per 24 March 2012. Three inclusion criteria were applied: 1. documentation of an unselected consecutive series of patients admitted for chest pain, where this review is based upon two groups of patients defined as follows: a) 'ACS/high-risk' and b) NSCP; 2. at least 100 cases with NSCP; and 3. follow-up of hospital readmissions and mortality for at least six months. RESULTS A total of 2,204 citations were screened after removal of duplicates. Out of 80 full text articles assessed for eligibility 12 studies were included, comprising 24,829 patients (inter-study range 250 to 13,762), with 11,008 (44%) categorized as NSCP and 13,821 (56%) as 'ACS/high-risk'. The mean one-year total mortality rate among patients with NSCP in nine studies was 3.2% (inter-study range 1.4% to 8.1%), with the highest mortality among patients with pre-existing coronary heart disease (CHD). The mean one-year mortality rate among 'ACS/high-risk' patients was 18.0% (inter-study range 14.0% to 19.9%) in four studies with available data. In six studies the mean one-year readmission rate for patients with NSCP was 17.5% (inter-study range 2.5% to 40%). CONCLUSIONS Patients with NSCP represent a large, heterogeneous and important group. Due to co-existing CHD in nearly 40% of these patients, their prognosis is not necessarily benign. Although their average one-year mortality rate was almost six times lower than those with 'ACS/high-risk', the subset with concomitant CHD had a relatively poor prognosis when compared with NSCP patients without evidence of CHD.
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Affiliation(s)
- Vidar Ruddox
- Department of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway.
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Bjørnstad CCL, Gjertsen E, Thorup F, Gundersen T, Tobiasson K, Otterstad JE. Temporary cardiac pacemaker treatment in five Norwegian regional hospitals. SCAND CARDIOVASC J 2012; 46:137-43. [PMID: 22390277 DOI: 10.3109/14017431.2012.672763] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Over the last few decades the number of temporary pacemaker placements has declined, while the number of operators has increased. The present study was undertaken in order to assess the quality of present day temporary pacing in Norwegian general hospitals. DESIGN Prospective, multi-center study from five general hospitals in Norway with a catchment area of 998,000 inhabitants. All temporary pacing procedures performed at these hospitals during a 1-year period should be registered. RESULTS Fifty patients were treated with temporary pacing and six repeated procedures were performed due to pacing failure. The yearly procedure-rate was five per 100,000 inhabitants. Twenty-nine physicians were involved in these procedures, of whom five were experienced implanters, and 18 physicians participated in only one procedure each. Following temporary pacing a permanent pacemaker was implanted in 60% of patients. In-hospital mortality was 18%, and the incidence of bacteremia was 6%. CONCLUSIONS Temporary pacemaker treatment is currently performed with less than the required amount of skill, with a high number of complications. Cardiologists on call and the possibility of fast-track permanent implantation could improve the quality of care of patients with acute bradyarrhythmias.
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Aune E, Røislien J, Mathisen M, Thelle DS, Otterstad JE. The "smoker's paradox" in patients with acute coronary syndrome: a systematic review. BMC Med 2011; 9:97. [PMID: 21861870 PMCID: PMC3179733 DOI: 10.1186/1741-7015-9-97] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 08/23/2011] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Smokers have been shown to have lower mortality after acute coronary syndrome than non-smokers. This has been attributed to the younger age, lower co-morbidity, more aggressive treatment and lower risk profile of the smoker. Some studies, however, have used multivariate analyses to show a residual survival benefit for smokers; that is, the "smoker's paradox". The aim of this study was, therefore, to perform a systematic review of the literature and evidence surrounding the existence of the "smoker's paradox". METHODS Relevant studies published by September 2010 were identified through literature searches using EMBASE (from 1980), MEDLINE (from 1963) and the Cochrane Central Register of Controlled Trials, with a combination of text words and subject headings used. English-language original articles were included if they presented data on hospitalised patients with defined acute coronary syndrome, reported at least in-hospital mortality, had a clear definition of smoking status (including ex-smokers), presented crude and adjusted mortality data with effect estimates, and had a study sample of > 100 smokers and > 100 non-smokers. Two investigators independently reviewed all titles and abstracts in order to identify potentially relevant articles, with any discrepancies resolved by repeated review and discussion. RESULTS A total of 978 citations were identified, with 18 citations from 17 studies included thereafter. Six studies (one observational study, three registries and two randomised controlled trials on thrombolytic treatment) observed a "smoker's paradox". Between the 1980s and 1990s these studies enrolled patients with acute myocardial infarction (AMI) according to criteria similar to the World Health Organisation criteria from 1979. Among the remaining 11 studies not supporting the existence of the paradox, five studies represented patients undergoing contemporary management. CONCLUSION The "smoker's paradox" was observed in some studies of AMI patients in the pre-thrombolytic and thrombolytic era, whereas no studies of a contemporary population with acute coronary syndrome have found evidence for such a paradox.
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Affiliation(s)
- Erlend Aune
- Department of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway.
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Aune E, Endresen K, Roislien J, Hjelmesaeth J, Otterstad JE. The effect of tobacco smoking and treatment strategy on the one-year mortality of patients with acute non-ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2010; 10:59. [PMID: 21159165 PMCID: PMC3009612 DOI: 10.1186/1471-2261-10-59] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 12/15/2010] [Indexed: 12/03/2022] Open
Abstract
Background The aim of the present study was to investigate whether a previously shown survival benefit resulting from routine early invasive management of unselected patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) may differ according to smoking status and age. Methods Post-hoc analysis of a prospective observational cohort study of consecutive patients admitted for NSTEMI in 2003 (conservative strategy cohort [CS]; n = 185) and 2006 (invasive strategy cohort [IS]; n = 200). A strategy for transfer to a high-volume invasive center and routine early invasive management was implemented in 2005. Patients were subdivided into current smokers and non-smokers (including ex-smokers) on admission. Results The one-year mortality rate of smokers was reduced from 37% in the CS to 6% in the IS (p < 0.001), and from 30% to 23% for non-smokers (p = 0.18). Non-smokers were considerably older than smokers (median age 80 vs. 63 years, p < 0.001). The percentage of smokers who underwent revascularization (angioplasty or coronary artery bypass grafting) within 7 days increased from 9% in the CS to 53% in the IS (p < 0.001). The corresponding numbers for non-smokers were 5% and 27% (p < 0.001). There was no interaction between strategy and age (p = 0.25), as opposed to a significant interaction between strategy and smoking status (p = 0.024). Current smoking was an independent predictor of one-year mortality (hazard ratio 2.61, 95% confidence interval 1.43-4.79, p = 0.002). Conclusions The treatment effect of an early invasive strategy in unselected patients with NSTEMI was more pronounced among smokers than non-smokers. The benefit for smokers was not entirely explained by differences in baseline confounders, such as their younger age.
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Affiliation(s)
- Erlend Aune
- Department of Cardiology, Vestfold Hospital Trust, Toensberg, Norway.
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Aune E, Bækkevar M, Rødevand O, Otterstad JE. Reference values for left ventricular volumes with real-time 3-dimensional echocardiography. SCAND CARDIOVASC J 2010; 44:24-30. [DOI: 10.3109/14017430903114446] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
OBJECTIVE Since the publication of the large trials on streptokinase and aspirin improving mortality related to an acute ST-elevation myocardial infarction (STEMI) there has been numerous studies on improving treatment results with new fibrinolytics, adjuvant heparin therapy and primary percutaneous intervention (PCI). The aim of the present overview is, in a historic perspective, to link some of the pathophysiology of mechanisms related to plaque rupture and following thrombosis to the effects of drug combinations and PCI observed in major clinical trials conducted in patients with STEMI. DESIGN The overview comprises short analyses of the initial streptokinase trials (GISSI-1 and ISIS-2), the comparisons between streptokinase and tissue plasminogen activator (rt-PA) and the role of adjuvant heparin treatment (GISSI-2, ISIS-3, GUSTO I). Also included is the comparison between the new bolus-teplases and traditional, accelerated infusion of rt-PA (GUSTO III and ASSENT-2) and between unfractionated heparin (UFH) and low molecular weight heparin (LWMH) given in addition to tenecteplase (ASSENT-3). The pathophysiology of the antiplatelet and antithrombin effects is described, in order to elucidate the treatment differences observed in the trials. In addition, the role of primary PCI is discussed in view of the results in a recent meta-analysis of controlled comparisons with fibrinolytic therapy. RESULTS Based upon these trials it seems that the optimal thrombolytic treatment is a combination of a bolus-teplase (tenecteplae) and LMWH given on top of aspirin. Primary PCI may be the most optimal treatment, provided given early following STEMI (<1 h), but whether PCI is the best alternative for all patients with STEMI is still a matter of debate. CONCLUSION During the last 15 years the optimal antithrombotic treatment of STEMI has developed from a combination of streptokinase and aspirin to the new bolus-teplases combined with LMWH and aspirin. The use of primary PCI may be a better alternative than fibrinolytic therapy, but such a statement needs confirmation in a large comparison between PCI and a quick infusion of modern fibrinolytic agents.
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Hjortshøj S, Otterstad JE, Lindahl B, Danielsen R, Pulkki K, Ravkilde J. Biochemical diagnosis of myocardial infarction evolves towards ESC/ACC consensus: Experiences from the Nordic countries. SCAND CARDIOVASC J 2009; 39:159-66. [PMID: 16146978 DOI: 10.1080/14017430510009140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To investigate the diagnostic approach in Nordic hospitals receiving patients suspected of acute myocardial infarction (MI), especially focusing on implementation of the recently proposed criteria by the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) for the definition of MI. DESIGN A survey with questionnaires of the diagnostic approach was conducted among all relevant departments (220) in the Nordic countries. RESULTS Seventy-six percent (167) of hospitals responded. Troponins I and T (TnI and TnT) and creatinine kinase monobasic fraction (mass concentration) (CKMB(mass)) covered 93 and 65% of hospitals, respectively. Of troponin users, 34% indicated use of TnI vs 66% using TnT. Sporadic use of AST, CK, LD and myoglobin was reported. There was a tendency to lower cut-off levels in Sweden and Finland. Among troponin assays, there was considerable heterogeneity regarding cut-off levels. CONCLUSIONS The Nordic countries are approaching ESC/ACC consensus on cardiac markers. Compared with previous national surveys (1995-1999), there is a shift towards the use of troponins. However, differences in cut-off levels of troponin emphasize the need for harmonization of assays.
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Affiliation(s)
- Søren Hjortshøj
- Cardiovascular Research Center and Department of Cardiology, Aalborg Hospital, Denmark
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Abstract
OBJECTIVES The revised diagnostic criteria for the acute coronary syndrome (ACS) have created the need for accurate and representative data on treatment and outcome for the three categories of ACS. DESIGN Consecutive patients admitted with a suspected ACS (n = 755) from February 1, 2003 to January 31, 2004 was registered and categorised into five diagnostic groups: 1) ST-elevation myocardial infarction (STEMI) (n = 126), 2) Non-ST-elevation myocardial infarction (NSTEMI) (n = 185), 3) Unstable angina pectoris (UAP) (n = 55), 4) Coronary heart disease (CHD) without ACS (n = 164) and 5) Non-coronary chest pain (n = 225). RESULTS All-cause one-year mortality rates were 20%, 32%, 7%, 10% and 3%, in patients with STEMI, NSTEMI, UAP, CHD without ACS and non-coronary chest pain, respectively. In patients with STEMI, 61% received immediate reperfusion therapy (ratio thrombolysis: primary PCI = 18:1). Only 3% of those with NSTEMI had PCI within two days. CONCLUSION In this conservatively managed population of consecutive patients with ACS, the one-year mortality rate is significantly higher than seen in most registries and clinical trials.
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Affiliation(s)
- Erlend Aune
- Department of Cardiology, Vestfold Hospital, Tønsberg, Norway.
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Aune E, Baekkevar M, Rodevand O, Otterstad JE. The limited usefulness of real-time 3-dimensional echocardiography in obtaining normal reference ranges for right ventricular volumes. Cardiovasc Ultrasound 2009; 7:35. [PMID: 19580673 PMCID: PMC2713207 DOI: 10.1186/1476-7120-7-35] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 07/06/2009] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To obtain normal reference ranges and intraobserver variability for right ventricular (RV) volume indexes (VI) and ejection fraction (EF) from apical recordings with real-time 3-dimensional echocardiography (RT3DE), and similarly for RV area indexes (AI) and area fraction (AF) with 2-dimensional echocardiography (2DE). METHODS 166 participants; 79 males and 87 females aged between 29-79 years and considered free from clinical and subclinical cardiovascular disease. Normal ranges are defined as 95% reference values and reproducibility as coefficients of variation (CV) for repeated measurements. RESULTS None of the apical recordings with RT3DE and 2DE included the RV outflow tract. Upper reference values were 62 ml/m2 for RV end-diastolic (ED) VI and 24 ml/m2 for RV end-systolic (ES) VI. Lower normal reference value for RVEF was 41%. The respective reference ranges were 17 cm2/m2 for RVEDAI, 11 cm2/m2 for RVESAI and 27% for RVAF. Males had higher upper normal values for RVEDVI, RVESVI and RVEDAI, and a lower limit than females for RVEF and RVAF. Weak but significant negative correlations between age and RV dimensions were found with RT3DE, but not with 2DE. CVs for repeated measurements ranged between 10% and 14% with RT3DE and from 5% to 14% with 2DE. CONCLUSION Although the normal ranges for RVVIs and RVAIs presented in this study reflect RV inflow tract dimensions only, the data presented may still be regarded as a useful tool in clinical practice, especially for RVEF and RVAF.
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Affiliation(s)
- Erlend Aune
- Department of Cardiology, Vestfold Hospital Trust, Box 2168, NO-3103 Toensberg, Norway
| | - Morten Baekkevar
- Department of Cardiology, Vestfold Hospital Trust, Box 2168, NO-3103 Toensberg, Norway
| | - Olaf Rodevand
- Department of Cardiology, Feiringklinikken, Feiring, Norway
| | - Jan Erik Otterstad
- Department of Cardiology, Vestfold Hospital Trust, Box 2168, NO-3103 Toensberg, Norway
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Aune E, Baekkevar M, Roislien J, Rodevand O, Otterstad JE. Normal reference ranges for left and right atrial volume indexes and ejection fractions obtained with real-time three-dimensional echocardiography. Eur J Echocardiogr 2009; 10:738-44. [PMID: 19435735 DOI: 10.1093/ejechocard/jep054] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS The aim of this study was to obtain normal reference ranges and intra-observer reproducibility for left (L) and right (R) atrial (A) volume indexes (VI, corrected for body surface area) and ejection fractions (EF) with real-time three-dimensional echocardiography. METHODS AND RESULTS One hundred and sixty-six participants, 79 males and 87 females, aged 29-79 years considered free from clinical and subclinical cardiovascular disease, were included. Normal ranges are defined as 95% reference values for atrial dimensions and reproducibility as coefficients of variations (CVs) for repeated measurements. Upper normal reference values were 41 mL/m(2) for maximum (max) LAVI and 19 mL/m(2) for minimum (min) LAVI. The lower normal reference value was 45% for LAEF. The respective values for RA were 47 mL/m(2), 20 mL/m(2), and 46%. The only relevant gender difference was a higher upper normal max RAVI among males vs. females. The CVs for repeated measurements were 9% for max LAVI, 8% for max RAVI, 13% for LAEF, and 14% for RAEF. CONCLUSION The present study provides normal ranges for atrial dimensions and contractility with a new, fast, and reproducible technique that can be used bedside without offline analysis.
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Affiliation(s)
- Erlend Aune
- Department of Cardiology, Vestfold Hospital Trust, NO-3103 Toensberg, Norway.
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Erikssen J, Rollag A, Otterstad JE. A new water-soluble, selective beta-blocker with intrinsic sympathomimetic activity (ICI 141.292) in angina pectoris. Acta Med Scand 2009; 223:35-43. [PMID: 2894747 DOI: 10.1111/j.0954-6820.1988.tb15762.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In a placebo-controlled, randomized double-blind study the effect of ICI 141.292 (beta 1-selective beta-blocker with intrinsic sympathomimetic activity = ISA) was studied in 11 patients with severe angina pectoris. The doses used were 100, 200 and 300 mg once daily. The 24-hour heart rate was significantly reduced by all regimens, and the Holter-monitoring pattern indicated the presence of ISA-effect at least 20 hours after the 300-mg dose. Maximal heart rate and blood pressure were significantly reduced and exercise duration increased during a symptom-limited bicycle exercise test on 200 and 300 mg, but not on 100 mg daily. Resting heart rate and blood pressure were uninfluenced on all regimens. ICI 141.292 is an effective agent in patients with severe angina pectoris. The response pattern suggests the presence of clinically relevant ISA.
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Affiliation(s)
- J Erikssen
- Department of Internal Medicine, Central Hospital of Akershus, Nordbyhagen, Norway
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Otterstad JE, Erikssen J, Frøysaker T, Simonsen S. Long term results after operative treatment of isolated ventricular septal defect in adolescents and adults. Acta Med Scand Suppl 2009; 708:1-39. [PMID: 3461690 DOI: 10.1111/j.0954-6820.1986.tb18124.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A series of 125 consecutive patients with isolated ventricular septal defect (VSD) aged 10 or over, were followed until death or beyond the age of 30 (31-73) years. A prospective restudy was performed after a mean follow-up of 15 (3-21) years. Forty-one patients (group 1) were treated with surgical repair of VSD at a mean age of 23 (10-51) years, and early mortality was 10%, i.e. 3 with severe aortic insufficiency and one with systemic pulmonary artery pressure. Surgery was initially not regarded indicated in 70 patients with small defects (group 2). A further 14 patients were judged inoperable (group 3). Long-term mortality was 5% in group 1, 9% in group 2 and 71% in group 3. When restudied, group 2 patients had significantly higher (p less than 0.01) and group 1, lower (p less than 0.01) pulmonary artery pressures than initially. A moderate deterioration in NYHA-rating was noted in group 2 (p less than 0.05) vs. a slight improvement in group 1 (p less than 0.05). The non-operated patients had a higher incidence of valvular lesions (19% vs. 13%) and bacterial endocarditis (4.3% vs. 2.7%) than the operated but not to a statistically significant level. Spontaneous closure was 6% in group 2 whereas mostly small residual defects were found in 34% of the operated. Patients with uncomplicated VSDs (absence of valvular lesions or coronary heart disease) had subnormal exercise tolerance as judged from a standardized ergometer bicycle test. These patients also had impaired left ventricular function based upon haemodynamic studies during moderate supine exercise. No major differences were noted between groups 1 and 2, but operated patients with residual VSDs tended to have the poorest cardiac performance. Non-cardiac disease represented only a minor problem and no significant differences in psychosocial function were observed between groups 1 and 2. Only 50% in group 1 and 60% in group 2 attended a regular medical clinic. Antibiotic prophylaxis had only been practiced by 50% in both groups. Although small, but differences between groups 1 and 2 favour surgery. This must be regarded as a positive result of surgical treatment since those operated on had basically larger and thus more severe defects than the others. In view of the very low operative risk associated with modern surgical technique one should direct patients with significant shunts to operative treatment.
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Abstract
A 54-year-old man, who was treated with propranolol for severe angina pectoris, developed severe symptomatic bradycardia during this treatment. Coronary angiography revealed severe coronary artery stenosis, but a bypass operation was judged to be technically impossible. When propranolol was withdrawn, the effort angina deteriorated and anginal pains even developed at rest. A favourable symptomatic effect was obtained with a combined regimen of propranolol and a permanent demand pacemaker. Nitroglycerin consumption was reduced from about 20 to less than 3 tablets a day. His condition remained stable during the observation period of 44 months. The symptomatic effect of a beta-blocking agent combined with a permanent pacemaker is considered to be due to the reduced inotropic and chronotropic effect of propranolol during exercise as well as the elimination of a bradycardia-induced angina at rest. Placebo effect to a certain extent cannot be excluded.
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Knutsen KM, Otterstad JE, Strom O. Myocardial scintigraphy with 99mtechnetium stannous pyrophosphate in patients with possible acute myocardial infarction. Acta Med Scand 2009; 202:107-11. [PMID: 899872 DOI: 10.1111/j.0954-6820.1977.tb16794.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Fifty-six patients with a preliminary diagnosis of possible acute myocardial infarction (AMI) were studied on the second or third day after onset of symptoms by 99mtechnetium stannous pyrophosphate myocardial imaging. The scintigraphy was positive in 25 (44.6%). The final clinical diagnoses upon discharge were: definite AMI in 11 with positive scintigraphy in 9 (82%), intermediate coronary syndrome (ICS) in 37 with positive scintigraphy in 15 (40.5%), postinfarction failure in 4 with positive scintigraphy in 1, no diagnosis of coronary heart disease in 4 patients with negative scintigraphy in all. Of the 37 patients with a final diagnosis of ICS, 25 were admitted to the Coronary Care Unit with chest pain as the only symptom. In this group the mean percentage increase in ASAT was significantly higher in 9 patients with positive scintigrams than in 16 with negative. It is therefore assumed that among patients with ICS, a positive scintigraphy may reflect a more serious myocardial injury than a negative scintigram. Of six patients with an acute tachyarrhythmia and ICS, scintigraphy was positive in the three with the most long-lasting or severe arrhythmmias. False negative scintigrams may be seen in some patients with definite AMI.
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Abstract
Prodromal symptoms within four weeks prior to an acute event leading to coronary care unit admission have been studied in 276 consecutive patients interviewed within 24 hours after arrival at hospital. Coronary heart disease (CHD) was diagnosed in 237 patients, 140 of whom did develop acute myocardial infarction (AMI) (Group 1) and 97 who did not (Group 2). Of the remainder, 15 had miscellaneous heart diseases (Group 3) and 24 no heart disease (Group 4). Unstable angina pectoris was equally frequent among CHD patients with and without development of AMI and was related to a higher hospital mortality in AMI patients. Less specific symptoms occurred with equal frequency in the four groups. Patients who developed AMI were not possible to identify by prodromal symptoms.
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Otterstad JE, Ihlen H, Vatne K. Aortic regurgitation associated with ventricular septal defects in adults. Clinical course, haemodynamic, angiographic and echocardiographic findings. Acta Med Scand 2009; 218:85-96. [PMID: 4050554 DOI: 10.1111/j.0954-6820.1985.tb08830.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In 125 consecutive patients, aged greater than or equal to 10 years (mean 27, range 10-64), evaluated for isolated ventricular septal defects (VSD) the initial prevalence of aortic regurgitation (AR) was 12/125. Forty-one patients were operated on, and post-operative mortality was 3/6 in patients operated on for VSD and AR and 1/35 in those operated on for VSD alone. All but one of the patients have been followed until death or beyond the age of 30 years (mean 42, range 31-73) and a prospective restudy has been performed after a mean observation time of 15 years (range 4-21). The incidence of new cases of AR arising during this period was 10/111. AR was severe in 5 cases (one died from heart failure), moderate in 1 and mild in 4. Surgical repair of AR and VSD was performed in 3 cases. Common characteristics of patients who developed AR were advanced age, male sex, history of bacterial endocarditis, small subaortic VSDs and tricuspid aortic valves without prolapse. Echocardiography revealed larger aortic root diameter (p less than 0.001), increased eccentricity factor (p less than 0.001) and increased left ventricular dimensions (p less than 0.02) in those with complicating AR. AR in adults with VSD may have an unpredictable clinical course; it may be difficult to assess clinically and the need for close clinical control is emphasized. Echocardiography remains of considerable value in selected cases.
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Nitter-Hauge S, Otterstad JE. Characteristics of atrioventricular conduction disturbances in ankylosing spondylitis (Mb. Bechterew). Acta Med Scand 2009; 210:197-200. [PMID: 7293837 DOI: 10.1111/j.0954-6820.1981.tb09800.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Atrioventricular (AV) conduction disturbances in 30 patients with ankylosing spondylitis (Mb. Bechterew) have been examined. Nine patients had AV block I with intermittent AV block II (Wenckebach block), 3 had complete heart block, 1 patient had atrial fibrillation and another had intermittent sinoatrial (SA) block. Thus, 14 (48%) patients had conduction defects. Electrophysiological investigations in 5 patients with AV block and in 1 patient with SA block revealed that the site of the block was proximal to the bundle of His. Two additional patients had prolonged sinus node recovery time implying dysfunction of the sinus node. An association between aortic valvular insufficiency and conduction disturbances was found, but AV block occurred also in patients without signs of valvular regurgitation. Four patients were treated with a permanent pacemaker and 5 with a temporary pacemaker in connection with aortic valvular surgery.
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