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Wikström, Gerhard
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Publications (10 of 65) Show all publications
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
Keyword
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
Poelzl, G., Altenberger, J., Baholli, L., Beltran, P., Borbely, A., Comin-Colet, J., . . . Pollesello, P. (2017). Repetitive use of levosimendan in advanced heart failure: need for stronger evidence in a field in dire need of a useful therapy. International Journal of Cardiology, 243, 389-395
Open this publication in new window or tab >>Repetitive use of levosimendan in advanced heart failure: need for stronger evidence in a field in dire need of a useful therapy
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2017 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 243, p. 389-395Article in journal (Refereed) Published
Abstract [en]

Patients in the latest stages of heart failure are severely compromised, with poor quality of life and frequent hospitalizations. Heart transplantation and left ventricular assist device implantation are viable options only for a minority, and intermittent or continuous infusions of positive inotropes may be needed as a bridge therapy or as a symptomatic approach. In these settings, levosimendan has potential advantages over conventional inotropes (catecholamines and phosphodiesterase inhibitors), such as sustained effects after initial infusion, synergy with beta-blockers, and no increase in oxygen consumption. Levosimendan has been suggested as a treatment that reduces re-hospitalization and improves quality of life. However, previous clinical studies of intermittent infusions of levosimendan were not powered to show statistical significance on key outcome parameters. A panel of 45 expert clinicians from 12 European countries met in Rome on November 24-25, 2016 to review the literature and envision an appropriately designed clinical trial addressing these needs. In the earlier FIGHT trial (daily subcutaneous injection of liraglutide in heart failure patients with reduced ejection fraction) a composite Global Rank Score was used as primary end-point where death, re-hospitalization, and change in N-terminalprohormone-brain natriuretic peptide level were considered in a hierarchical order. In the present study, we tested the same end-point post hoc in the PERSIST and LEVOREP trials on oral and repeated i.v. levosimendan, respectively, and demonstrated superiority of levosimendan treatment vs placebo. The use of the same composite end-point in a properly powered study on repetitive levosimendan in advanced heart failure is strongly advocated.

Keyword
Advanced heart failure, Levosimendan, Intermittent, Repetitive, Clinical trial, Composite end-point
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-333061 (URN)10.1016/j.ijcard.2017.05.081 (DOI)000406038100076 ()28571618 (PubMedID)
Available from: 2017-11-10 Created: 2017-11-10 Last updated: 2017-11-10Bibliographically approved
Akhter, T., Wikström, A.-K., Larsson, M., Larsson, A., Wikström, G. & Naessén, T. (2017). Serum Pentraxin 3 is associated with signs of arterial alteration in women with preeclampsia.. International Journal of Cardiology, 241, 417-422
Open this publication in new window or tab >>Serum Pentraxin 3 is associated with signs of arterial alteration in women with preeclampsia.
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2017 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 241, p. 417-422Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Preeclampsia (PE) in pregnancy is a state of exaggerated inflammation and is associated with an increased risk of cardiovascular disease (CVD) later in life. Levels of pentraxin 3 (PTX3), a novel inflammation marker, are increased during PE and in individuals with CVD. The primary aim of this study was to assess whether serum PTX3 in women with PE is associated with adverse arterial effects; a thicker intima and higher intima/media (I/M) ratio in the common carotid artery (CCA).

METHODS: Serum PTX3 levels were measured using commercially available enzyme-linked immunosorbent assay kits, and individual CCA intima and media thicknesses were estimated by 22MHz non-invasive ultrasound in 55 women at PE diagnosis and 64 women with normal pregnancies at a similar gestational age, and about one year postpartum. A thick intima, thin media and high I/M ratio indicate a less healthy artery wall.

RESULTS: During pregnancy serum PTX3 correlated positively with intima thickness and I/M ratio but negatively with media thickness (all p<0.0001), indicating adverse arterial effects. About one year postpartum, PTX3 levels had decreased in both groups and there remained no significant group difference or significant correlation with CCA wall layers.

CONCLUSIONS: Higher levels of serum PTX3 in women with PE were significantly associated with signs of adverse arterial effects during pregnancy, but not one year postpartum, supporting the rapid dynamics of PTX3.

Keyword
Cardiovascular disease, Common carotid artery intima/media ratio, High-frequency ultrasound, PTX3, Preeclampsia
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-319727 (URN)10.1016/j.ijcard.2017.03.076 (DOI)000405455200072 ()28377191 (PubMedID)
Funder
Swedish Research Council, 2014-3561Swedish Heart Lung Foundation
Available from: 2017-04-07 Created: 2017-04-07 Last updated: 2018-04-09Bibliographically approved
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