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Wikström, Gerhard
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Publications (10 of 67) Show all publications
Lundgren, J., Sandqvist, A., Hedeland, M., Bondesson, U., Wikström, G. & Rådegran, G. (2018). Alterations in plasma L-arginine and methylarginines in heart failure and after heart transplantation. Scandinavian Cardiovascular Journal, 52(4), 196-204
Open this publication in new window or tab >>Alterations in plasma L-arginine and methylarginines in heart failure and after heart transplantation
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2018 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 52, no 4, p. 196-204Article in journal (Refereed) Published
Abstract [en]

Objective: Endothelial function, including the nitric oxide (NO)-pathway, has previously been extensively investigated in heart failure (HF). In contrast, studies are lacking on the NO pathway after heart transplantation (HT). We therefore investigated substances in the NO pathway prior to and after HT in relation to hemodynamic parameters.

Design: 12 patients (median age 50.0 yrs, 2 females), heart transplanted between June 2012 and February 2014, evaluated at our hemodynamic lab, at rest, prior to HT, as well as four weeks and six months after HT were included. All patients had normal left ventricular function post-operatively and none had post-operative pulmonary hypertension or acute cellular rejection requiring therapy at the evaluations. Plasma concentrations of ADMA, SDMA, L-Arginine, L-Ornithine and L-Citrulline were analyzed at each evaluation.

Results: In comparison to controls, the plasma L-Arginine concentration was low and ADMA high in HF patients, resulting in low L-Arginine/ADMA-ratio pre-HT. Already four weeks after HT L-Arginine was normalized whereas ADMA remained high. Consequently the L-Arginine/ADMA-ratio improved, but did not normalize. The biomarkers remained unchanged at the six-month evaluation and the L-Arginine/ADMA-ratio correlated inversely to pulmonary vascular resistance (PVR) six months post-HT.

Conclusions: Plasma L-Arginine concentrations normalize after HT. However, as ADMA is unchanged, the L-Arginine/ADMA-ratio remained low and correlated inversely to PVR. Together these findings suggest that (i) the L-Arginine/ADMA-ratio may be an indicator of pulmonary vascular tone after HT, and that (ii) NO-dependent endothelial function is partly restored after HT. Considering the good postoperative outcome, the biomarker levels may be considered “normal” after HT.

Keywords
Nitric Oxide, ADMA, L-Arginine, heart transplantation, heart failure, right heart catheterization
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-358210 (URN)10.1080/14017431.2018.1459823 (DOI)000436583700005 ()29648475 (PubMedID)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-09-20Bibliographically approved
Sandqvist, A., Schneede, J., Kylhammar, D., Henrohn, D., Lundgren, J., Hedeland, M., . . . Wikström, G. (2018). Plasma l-arginine levels distinguish pulmonary arterial hypertension from left ventricular systolic dysfunction. Heart and Vessels, 33(3), 255-263
Open this publication in new window or tab >>Plasma l-arginine levels distinguish pulmonary arterial hypertension from left ventricular systolic dysfunction
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2018 (English)In: Heart and Vessels, ISSN 0910-8327, E-ISSN 1615-2573, Vol. 33, no 3, p. 255-263Article in journal (Refereed) Published
Abstract [en]

Pulmonary arterial hypertension (PAH) is a life-threatening condition, characterized by an imbalance of vasoactive substances and remodeling of pulmonary vasculature. Nitric oxide, formed from l-arginine, is essential for homeostasis and smooth muscle cell relaxation in PAH. Our aim was to compare plasma concentrations of l-arginine, asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) in PAH compared to left ventricular systolic dysfunction (LVSD) and healthy subjects. This was an observational, multicenter study comparing 21 patients with PAH to 14 patients with LVSD and 27 healthy subjects. Physical examinations were obtained and blood samples were collected. Plasma levels of ADMA, SDMA, l-arginine, l-ornithine, and l-citrulline were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Plasma levels of ADMA and SDMA were higher, whereas l-arginine and l-arginine/ADMA ratio were lower in PAH patients compared to healthy subjects (p < 0.001). Patients with PAH also had lower levels of l-arginine than patients with LVSD (p < 0.05). l-Arginine correlated to 6 min walking distance (6MWD) (r (s) = 0.58, p = 0.006) and l-arginine/ADMA correlated to WHO functional class (r (s) = -0.46, p = 0.043) in PAH. In conclusion, l-arginine levels were significantly lower in treatment na < ve PAH patients compared to patients with LVSD. Furthermore, l-arginine correlated with 6MWD in PAH. l-arginine may provide useful information in differentiating PAH from LVSD.

Place, publisher, year, edition, pages
SPRINGER, 2018
Keywords
Pulmonary arterial hypertension, Left heart failure, Systolic dysfunction, L-Arginine, Dimethylarginines
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-350494 (URN)10.1007/s00380-017-1055-7 (DOI)000426278900005 ()28975394 (PubMedID)
Available from: 2018-05-09 Created: 2018-05-09 Last updated: 2018-05-09Bibliographically approved
Fu, M., Ahrenmark, U., Berglund, S., Lindholm, C. J., Lehto, A., Broberg, A. M., . . . Andersson, B. (2017). Adherence to optimal heart rate control in heart failure with reduced ejection fraction: insight from a survey of heart rate in heart failure in Sweden (HR-HF study). Clinical Research in Cardiology, 106(12), 960-973
Open this publication in new window or tab >>Adherence to optimal heart rate control in heart failure with reduced ejection fraction: insight from a survey of heart rate in heart failure in Sweden (HR-HF study)
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2017 (English)In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 106, no 12, p. 960-973Article in journal (Refereed) Published
Abstract [en]

Despite that heart rate (HR) control is one of the guideline-recommended treatment goals for heart failure (HF) patients, implementation has been painstakingly slow. Therefore, it would be important to identify patients who have not yet achieved their target heart rates and assess possible underlying reasons as to why the target rates are not met. The survey of HR in patients with HF in Sweden (HR-HF survey) is an investigator-initiated, prospective, multicenter, observational longitudinal study designed to investigate the state of the art in the control of HR in HF and to explore potential underlying mechanisms for suboptimal HR control with focus on awareness of and adherence to guidelines for HR control among physicians who focus on the contributing role of beta-blockers (BBs). In 734 HF patients the mean HR was 68 +/- 12 beats per minute (bpm) (37.2% of the patients had a HR > 70 bpm). Patients with HF with reduced ejection fraction (HFrEF) (n = 425) had the highest HR (70 +/- 13 bpm, with 42% > 70 bpm), followed by HF with preserved ejection fraction and HF with mid-range ejection fraction. Atrial fibrillation, irrespective of HF type, had higher HR than sinus rhythm. A similar pattern was observed with BB treatment. Moreover, non-achievement of the recommended target HR (< 70 bpm) in HFrEF and sinus rhythm was unrelated to age, sex, cardiovascular risk factors, cardiovascular diseases, and comorbidities, but was related to EF and the clinical decision of the physician. Approximately 50% of the physicians considered a HR of > 70 bpm optimal and an equal number considered a HR of > 70 bpm too high, but without recommending further action. Furthermore, suboptimal HR control cannot be attributed to the use of BBs because there was neither a difference in use of BBs nor an interaction with BBs for HR > 70 bpm compared with HR < 70 bpm. Suboptimal control of HR was noted in HFrEF with sinus rhythm, which appeared to be attributable to physician decision making rather than to the use of BBs. Therefore, our results underline the need for greater attention to HR control in patients with HFrEF and sinus rhythm and thus a potential for improved HF care.

Place, publisher, year, edition, pages
SPRINGER HEIDELBERG, 2017
Keywords
Heart rate, Heart failure, Awareness, Adherence, Beta-blocker
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-342660 (URN)10.1007/s00392-017-1146-6 (DOI)000416042400004 ()28795299 (PubMedID)
Available from: 2018-02-27 Created: 2018-02-27 Last updated: 2018-02-27Bibliographically approved
Akhter, T., Wikström, A.-K., Larsson, M., Larsson, A., Wikström, G. & Naessén, T. (2017). Association between angiogenic factors and signs of arterial aging in women with pre-eclampsia. Ultrasound in Obstetrics and Gynecology, 50, 93-99
Open this publication in new window or tab >>Association between angiogenic factors and signs of arterial aging in women with pre-eclampsia
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2017 (English)In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 50, p. 93-99Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Pre-eclampsia (PE) is associated with an increased risk of cardiovascular disease (CVD) later in life. In PE there is a substantial increase in levels of the anti-angiogenic factor soluble fms-like tyrosine kinase-1 (sFlt1) and decreased levels of the pro-angiogenic factor placental growth factor (PlGF). Elevated levels of sFlt1 are also found in individuals with CVD. The aims of this study were to assess sFlt1, PlGF and the sFlt1/PlGF ratio and their correlation with signs of arterial aging by measuring common carotid artery (CCA) intima and media thicknesses and their ratio (I/M ratio) in women with and without PE.

METHODS: Serum sFlt1 and PlGF levels were measured using commercially available enzyme-linked immunosorbent assay kits, and CCA intima and media thicknesses were estimated using high-frequency (22 MHz) ultrasonography in 55 women at PE diagnosis and 64 women with normal pregnancies at a similar gestational age, with reassessment one year postpartum. A thick intima, thin media and a high I/M ratio indicate a less healthy arterial wall.

RESULTS: During pregnancy, higher levels of sFlt1, lower levels of PlGF and thicker intima, thinner media and higher I/M ratios were found in women with PE vs. controls (all p < 0.0001). Further, sFlt1 and the sFlt1/PlGF ratio were positively correlated with intima thickness and I/M ratio (all p < 0.0001), but negatively correlated with media thickness (p = 0.002 and 0.03, respectively). About one year postpartum, levels of sFlt1 and the sFlt1/PlGF ratio had decreased in both groups, but compared with controls women in the PE group still had higher levels (p = 0.001 and 0.02, respectively). Further, sFlt1 levels and the sFlt1/PlGF ratio were still positively correlated with intima thickness and I/M ratio.

CONCLUSIONS: Higher sFlt1 levels and sFlt1/PlGF ratios in women with PE were positively associated with signs of arterial aging during pregnancy. About one year postpartum sFlt1 levels and the sFlt1/PlGF ratios were still higher in the PE group, and also associated with the degree of arterial aging.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-296005 (URN)10.1002/uog.15981 (DOI)000404985500012 ()27256927 (PubMedID)
Available from: 2016-06-12 Created: 2016-06-12 Last updated: 2018-04-09Bibliographically approved
Boman, K., Lindmark, K., Stålhammar, J., Wikström, G., Bergman, G. J., Tornblom, M., . . . Olofsson, M. (2017). Costs associated with heart failure with preserved versus reduced ejection fraction: a retrospective population-based cohort study in Sweden. European Journal of Heart Failure, 19, 346-347
Open this publication in new window or tab >>Costs associated with heart failure with preserved versus reduced ejection fraction: a retrospective population-based cohort study in Sweden
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2017 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, p. 346-347Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
WILEY, 2017
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-333644 (URN)000401005301142 ()
Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2017-12-07
Wikström, G., Lindmark, K., Olofsson, M., Stålhammar, J., Bergman, G. J., Tornblom, M., . . . Boman, K. (2017). Drug treatment patterns in patients newly diagnosed with heart failure: a retrospective population-based cohort study in Sweden. European Journal of Heart Failure, 19(Suppl. 1), 55-55
Open this publication in new window or tab >>Drug treatment patterns in patients newly diagnosed with heart failure: a retrospective population-based cohort study in Sweden
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2017 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no Suppl. 1, p. 55-55Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
WILEY, 2017
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-333643 (URN)000401005300131 ()
Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2017-12-07Bibliographically approved
Lindmark, K., Boman, K., Olofsson, M., Wikström, G., Bergman, G. J., Tornblom, M., . . . Stålhammar, J. (2017). Epidemiology of heart failure in Sweden: a retrospective population-based cohort study. European Journal of Heart Failure, 19, 364-364
Open this publication in new window or tab >>Epidemiology of heart failure in Sweden: a retrospective population-based cohort study
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2017 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, p. 364-364Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
WILEY, 2017
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-333648 (URN)000401005301181 ()
Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2017-12-07Bibliographically approved
Boman, K., Lindmark, K., Olofsson, M., Stålhammar, J., Bergman, G. J., Tornblom, M., . . . Wikström, G. (2017). Healthcare resource utilization associated with heart failure with preserved versus reduced ejection fraction: a retrospective population-based cohort study in Sweden. European Journal of Heart Failure, 19, 346-346
Open this publication in new window or tab >>Healthcare resource utilization associated with heart failure with preserved versus reduced ejection fraction: a retrospective population-based cohort study in Sweden
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2017 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, p. 346-346Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
WILEY, 2017
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-333645 (URN)000401005301141 ()
Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2017-12-07
Lundgren, J., Sandqvist, A., Hedeland, M., Bondesson, U., Wikström, G. & Radegran, G. (2017). L-Arginine and Methylarginines Prior to and After Heart Transplantation. Paper presented at 37th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation (ISHLT), APR 05-08, 2017, San Diego, CA. The Journal of Heart and Lung Transplantation, 36(4), S227-S227
Open this publication in new window or tab >>L-Arginine and Methylarginines Prior to and After Heart Transplantation
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2017 (English)In: The Journal of Heart and Lung Transplantation, ISSN 1053-2498, E-ISSN 1557-3117, Vol. 36, no 4, p. S227-S227Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2017
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-328831 (URN)000398839800582 ()
Conference
37th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation (ISHLT), APR 05-08, 2017, San Diego, CA
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2017-10-31Bibliographically approved
Stålhammar, J., Boman, K., Olofsson, M., Wikström, G., Bergman, G. J., Tornblom, M., . . . Lindmark, K. (2017). Management of patients with heart failure with preserved versus reduced ejection fraction: a retrospective population-based cohort study in Sweden. European Journal of Heart Failure, 19, 54-55
Open this publication in new window or tab >>Management of patients with heart failure with preserved versus reduced ejection fraction: a retrospective population-based cohort study in Sweden
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2017 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, p. 54-55Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
WILEY, 2017
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-333641 (URN)000401005300129 ()
Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2017-12-07Bibliographically approved
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