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Christersson, ChristinaORCID iD iconorcid.org/0000-0001-9116-8084
Publications (10 of 54) Show all publications
Zeitouni, M., Giczewska, A., Lopes, R. D., Wojdyla, D. M., Christersson, C., Siegbahn, A., . . . Alexander, J. H. (2020). Clinical and Pharmacological Effects of Apixaban Dose Adjustment in the ARISTOTLE Trial. Journal of the American College of Cardiology, 75(10), 1145-1155
Open this publication in new window or tab >>Clinical and Pharmacological Effects of Apixaban Dose Adjustment in the ARISTOTLE Trial
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2020 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 75, no 10, p. 1145-1155Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, patients with atrial fibrillation and >= 2 dose-adjustment criteria (age >= 80 years, weight <= 60 kg, or creatinine >= 1.5 mg/dl [133 mu mol/l]) were randomized to receive apixaban 2.5 mg twice daily or warfarin.

OBJECTIVES: The purpose of this study was to describe the effects of apixaban dose adjustment on clinical and pharmacological outcomes.

METHODS: Patients receiving the correct dose of study drug were included (n = 18,073). The effect of apixaban 2.5 mg twice daily versus warfarin on population pharmacokinetics, D-dimer, prothrombin fragment 1 + 2 (PF1+2), and clinical outcomes was compared with the standard dose (5 mg twice daily).

RESULTS: Patients receiving apixaban 2.5 mg twice daily exhibited lower apixaban exposure (median area under the concentration time curve at a steady state 2,720 ng/ml vs. 3,599 ng/ml; p < 0.0001) than those receiving the standard dose. In patients with >= 2 dose-adjustment criteria, reductions in D-dimers (p interaction = 0.20) and PF1+2 (p interaction = 0.55) were consistent with those observed in the standard-dose population. Patients with >= 2 dose-adjustment criteria (n = 751) were at higher risk for stroke/systemic embolism, major bleeding, and all-cause death than the standard-dose population (0 or 1 dose-adjustment criterion, n = 17,322). The effect of apixaban 2.5 mg twice daily versus warfarin in the >= 2 dose-adjustment criteria population was consistent with the standard dose in the reductions in stroke or systemic embolism (p interaction = 0.26), major bleeding (p interaction = 0.25), and death (p interaction = 0.72).

CONCLUSIONS: Apixaban drug concentrations were lower in patients receiving 2.5 mg twice daily compared with 5 mg twice daily. However, the effects of apixaban dose adjustment to 2.5 mg versus warfarin were consistent for coagulation biomarkers and clinical outcomes, providing reassuring data on efficacy and safety. (Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation [ARISTOTLE]; NCT00412984) 

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2020
Keywords
apixaban, atrial fibrillation, DOAC, dose adjustment, high bleeding risk, oral anticoagulation, stroke prevention
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-408516 (URN)10.1016/j.jacc.2019.12.060 (DOI)000519577500007 ()32164888 (PubMedID)
Available from: 2020-04-08 Created: 2020-04-08 Last updated: 2020-04-08Bibliographically approved
Täufer Cederlöf, E., Johnston, N., Leppert, J., Hedberg, P., Lindahl, B. & Christersson, C. (2019). Do self-reported pregnancy complications add to risk evaluation in older women with established cardiovascular disease?. BMC Women's Health, 19(1), Article ID 160.
Open this publication in new window or tab >>Do self-reported pregnancy complications add to risk evaluation in older women with established cardiovascular disease?
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2019 (English)In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 19, no 1, article id 160Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In postmenopausal women with established cardiovascular disease (CVD), it is unknown whether a history of pregnancy complications are related to multisite artery disease (MSAD), defined as atherosclerotic lesions in at least two major vascular beds. Pregnancy complications are an established risk factor for CVD. This study aimed to investigate the frequency of pregnancy complications and their association to specific atherosclerotic manifestations and prediction of MSAD in older women with and without CVD.

METHODS: In total, 556 women were invited to participate in the study. Of these women 307 reported former pregnancy from a cohort of women with (n = 233) and without CVD (n = 74). The self-reported frequency of pregnancy complications were surveyed retrospectively by a questionnaire that included miscarriage, subfertility, gestational hypertension (GHT) and/or preeclampsia (PE), low birth weight, preterm birth, bleeding in late pregnancy, gestational diabetes mellitus and high birth weight. Three vascular beds were examined, the peripheral, carotid and coronary arteries.

RESULTS: The mean age was 67.5 (SD 9.5) years. GHT and/or PE tended to be more common, but not significant, in women with CVD than in women without (20.3% vs 10.8%, p = 0.066). Among women with GHT and/or PE, hypertension later in life were more frequent than in women without (66.7% vs 47.4%, p = 0.010). GHT and/or PE were not associated with specific atherosclerotic manifestations or prediction of MSAD.

CONCLUSIONS: In older women with established CVD, pregnancy complications was not associated to specific atherosclerotic manifestations and may not provide additional value to the risk evaluation for MSAD.

Keywords
Atherosclerosis, Cardiovascular disease, Pregnancy complications
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-401250 (URN)10.1186/s12905-019-0851-x (DOI)000511362400001 ()31842885 (PubMedID)
Funder
Erik, Karin och Gösta Selanders Foundation
Available from: 2020-01-07 Created: 2020-01-07 Last updated: 2020-03-25Bibliographically approved
Christersson, C., Wallentin, L., Andersson, U., Alexander, J. H., Alings, M., De Caterina, R., . . . Siegbahn, A. (2019). Effect of apixaban compared with warfarin on coagulation markers in atrial fibrillation.. Heart, 105(3), 235-242
Open this publication in new window or tab >>Effect of apixaban compared with warfarin on coagulation markers in atrial fibrillation.
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2019 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 105, no 3, p. 235-242Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Compare the effect of apixaban and warfarin on coagulation and primary haemostasis biomarkers in atrial fibrillation (AF).

METHODS: The biomarker substudy from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial included 4850 patients with AF randomised to treatment with apixaban or warfarin. Sixty per cent of patients used vitamin K antagonist (VKA) within 7 days before randomisation. Prothrombin fragment 1+2 (F1+2), D-dimer, soluble CD40 ligand (sCD40L) and von Willebrand factor (vWF) antigen were analysed at randomisation and after 2 months of study treatment.

RESULTS: In patients not on VKA treatment at randomisation, F1+2 and D-dimer levels were decreased by 25% and 23%, respectively, with apixaban, and by 59% and 38%, respectively, with warfarin (p<0.0001 for treatment differences for both). In patients on VKA at randomisation, F1+2 and D-dimer levels increased by 41% and 10%, respectively, with apixaban and decreased by 37% and 11%, respectively, with warfarin (p<0.0001 for treatment differences for both). sCD40L levels were slightly increased at 2 months, regardless of VKA or randomised treatment. Apixaban and warfarin also both reduced vWF antigen regardless of VKA treatment. The efficacy (stroke) and safety (bleeding) of apixaban compared with warfarin was similar irrespectively of biomarker levels at 2 months.

CONCLUSIONS: Treatment with apixaban compared with warfarin for stroke prevention in patients with AF was associated with less reduction in thrombin generation and fibrin turnover. This effect of apixaban could contribute to the clinical results where apixaban was superior to warfarin both in stroke prevention and in reducing bleeding risk.

TRIAL REGISTRATION NUMBER: NCT00412984.

Keywords
atrial fibrillation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-374491 (URN)10.1136/heartjnl-2018-313351 (DOI)000459806200013 ()30209126 (PubMedID)
Available from: 2019-01-21 Created: 2019-01-21 Last updated: 2020-01-07Bibliographically approved
Sandtröm, A., Sandberg, C., Rinnstrom, D., Engström, G., Dellborg, M., Thilen, U., . . . Johansson, B. (2019). Factors associated with health-related quality of life among adults with tetralogy of Fallot. Open heart, 6(1), Article ID UNSP e000932.
Open this publication in new window or tab >>Factors associated with health-related quality of life among adults with tetralogy of Fallot
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2019 (English)In: Open heart, E-ISSN 2053-3624, Vol. 6, no 1, article id UNSP e000932Article in journal (Refereed) Published
Abstract [en]

Background Due to improved care, the numbers of patients with tetralogy of Fallot (ToF) are increasing. However, long-term morbidity and need for reinterventions are concerns and also address issues of quality of life (QoL). Methods Patients with ToF and valid EuroQol-5 dimensions questionnaire (EQ-5D) were identified in the national Swedish register on congenital heart disease. EQ5D index was calculated and dichotomised into best possible health-related QoL (EQ-5D index = 1) or differed from 1. Results 288 patients met the criteria and were analysed. Univariate logistic regression showed a positive association between New York Heart Association (NYHA) class I (OR 8.32, 95% CI 3.80 to 18.21), physical activity > 3 h/ week (OR 3.34, 95% CI 1.67 to 6.66) and a better right ventricular function (OR 2.56, 95% CI 1.09 to 6.02). A negative association between symptoms (OR 0.23, 95% CI 0.13 to 0.42), cardiovascular medication (OR 0.31, 95% CI 0.18 to 0.53), age (OR 0.97, 95% CI 0.96 to 0.99) and EQ-5D index was observed. In multivariate logistic regression, NYHA I (OR 7.28, 95% CI 3.29 to 16.12) and physical activity > 3 h/ week (OR 2.27, 95% CI 1.07 to 4.84) remained associated with best possible health-related QoL. Replacing NYHA with symptoms in the model yielded similar results. Conclusion In this registry study, self-reported physical activity, staff-reported NYHA class and absence of symptoms were strongly associated with best possible health-related QoL measured by EQ-5D. Physical activity level is a potential target for intervention to improve QoL in this population but randomised trials are needed to test such a hypothesis.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-389986 (URN)10.1136/openhrt-2018-000932 (DOI)000471922200023 ()30997127 (PubMedID)
Funder
Swedish Heart Lung FoundationVästerbotten County Council
Available from: 2019-08-02 Created: 2019-08-02 Last updated: 2020-01-07Bibliographically approved
Jönelid, B., Kragsterman, B., Berglund, L., Andrén, B., Johnston, N., Lindahl, B., . . . Christersson, C. (2019). Low Walking Impairment Questionnaire score after a recent myocardial infarction identifies patients with polyvascular disease. JRSM Cardiovascular Disease, 8, 1-9
Open this publication in new window or tab >>Low Walking Impairment Questionnaire score after a recent myocardial infarction identifies patients with polyvascular disease
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2019 (English)In: JRSM Cardiovascular Disease, ISSN 2048-0040, Vol. 8, p. 1-9Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate whether the Walking Impairment Questionnaire score could identify patients with polyvascular disease in a population with recent myocardial infarction and their association with cardiovascular events during two-year follow-up.

Design: A prospective observational study.

Setting: Patients admitted to the acute coronary care unit, the Department of Cardiology, Uppsala University Hospital.

Participants: Patients admitted with acute Non-STEMI- or STEMI-elevation myocardial infarction.

Main outcome measures: The Walking Impairment Questionnaire, developed as a self-administered instrument to assess walking distance, speed, and stair climbing in patients with peripheral artery disease, predicts future cardiovascular events and mortality. Two hundred and sixty-three patients with recent myocardial infarction answered Walking Impairment Questionnaire. Polyvascular disease was defined as abnormal findings in the coronary- and carotid arteries and an abnormal ankle-brachial index. The calculated score for each of all three categories were divided into quartiles with the lowest score in first quartile.

Results: The lowest (worst) quartile in all three Walking Impairment Questionnaire categories was associated with polyvascular disease, fully adjusted; distance, odds ratio (OR) 5.4 (95% confidence interval (CI) 1.8-16.1); speed, OR 7.4 (95% CI 1.5-36.5); stair climbing, OR 8.4 (95% CI 1.0-73.6). In stair climbing score, patients with the lowest (worst) score had a higher risk for the composite cardiovascular endpoint compared to the highest (best) score; hazard ratio 5.3 (95% CI 1.5-19.0). The adherence to medical treatment was high (between 81.7% and 99.2%).

Conclusions: The Walking Impairment Questionnaire is a simple tool to identify myocardial infarction patients with more widespread atherosclerotic disease and although well treated medically, stair climbing predicts cardiovascular events.

Keywords
Peripheral vascular disease, cardiovascular disease, coronary artery disease, polyvascular disease
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-382843 (URN)10.1177/2048004019841971 (DOI)000464951000001 ()31019682 (PubMedID)
Available from: 2019-05-24 Created: 2019-05-24 Last updated: 2020-01-08Bibliographically approved
Sandberg, C., Johansson, K., Christersson, C., Hlebowicz, J., Thilen, U. & Johansson, B. (2019). Sarcopenia is common in adults with complex congenital heart disease. International Journal of Cardiology, 296, 57-62
Open this publication in new window or tab >>Sarcopenia is common in adults with complex congenital heart disease
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2019 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 296, p. 57-62Article in journal, Editorial material (Other academic) Published
Abstract [en]

Background: Adults with complex congenital heart disease (CHD) have reduced aerobic capacity and impaired muscle function. We therefore hypothesized that patients have a lower skeletal muscle mass and higher fat mass than controls. Methods: Body composition was examined with full body Dual-Energy x-ray Absorptiometry (DXA) in 73 patients with complex CHD (mean age 35.8 +/- 14.3, women n = 22) and 73 age and sex matched controls. Patients fulfilling criteria for low skeletal muscle mass in relation to their height and fat mass were defined as sarcopenic. Results: Male patients (n = 51) were shorter (177.4 +/- 6.6 cm vs. 180.9 +/- 6.7 cm, p = 0.009) and weighed less (76.0 +/- 10.8 kg vs. 82.0 +/- 12.4 kg, p = 0.01) than controls. Also, patients had a lower appendicular lean mass-index (ALM-index) (7.57 +/- 0.97 kg/m(2) vs. 8.46 +/- 0.90 kg/m(2), p < 0.001). Patients' relative tissue fat mass (27.9 +/- 7.0% vs. 25.4 +/- 8.6%, p = 0.1) did not differ. Forty-seven percent of the men (n = 24) were classified as sarcopenic. Female patients (n = 22) were also shorter (163.5 +/- 8.7 cm vs. 166.7 +/- 5.9 cm, p = 0.05) but had a higher BMI (25.7 +/- 4.2 vs. 23.0 +/- 2.5, p = 0.02) than controls. Patients also had a lower ALM-index (6.30 +/- 0.75 vs. 6.67 +/- 0.55, p = 0.05), but their relative body fat mass (40.8 +/- 7.6% vs. 32.0 +/- 7.0%, p < 0.001) were higher. Fifty-nine percent of the women (n = 13) were classified as sarcopenic. Conclusions: The body composition was altered toward lower skeletal muscle mass in patients with complex CHD. Approximately half of the patients were classified as sarcopenic. Contrary to men, the women had increased body fat and a higher BMI. Further research is required to assess the cause, possible adverse long-term effects and whether sarcopenia is preventable or treatable. (C) 2019 Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Adult congenital heart disease, Complex congenital heart disease, DXA, Dual-energy x-ray absorptiometry, Sarcopenia
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-396460 (URN)10.1016/j.ijcard.2019.06.011 (DOI)000488960200014 ()31230936 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20100355Swedish Heart Lung Foundation, 20130472Swedish Heart Lung Foundation, E140-15Swedish Heart Lung Foundation, E109-16Swedish Heart Lung Foundation, FA2017:13
Available from: 2019-11-15 Created: 2019-11-15 Last updated: 2020-01-07Bibliographically approved
Sandberg, C., Crenshaw, A. G., Elcadi, G. H., Christersson, C., Hlebowicz, J., Thilen, U. & Johansson, B. (2019). Slower Skeletal Muscle Oxygenation Kinetics in Adults With Complex Congenital Heart Disease. Canadian Journal of Cardiology, 35(12), 1815-1823
Open this publication in new window or tab >>Slower Skeletal Muscle Oxygenation Kinetics in Adults With Complex Congenital Heart Disease
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2019 (English)In: Canadian Journal of Cardiology, ISSN 0828-282X, E-ISSN 1916-7075, Vol. 35, no 12, p. 1815-1823Article in journal (Refereed) Published
Abstract [en]

Background:

Adults with complex congenital heart disease (CHD) show reduced aerobic exercise capacity and impaired skeletal muscle function compared with healthy peers. Peripheral muscle factors are presumed to be important contributors to the aerobic capacity, but the mechanisms are poorly understood. The aim of the present study was to investigate differences between adults with CHD and controls in muscle oxygenation kinetics at rest, and during and after exercise.

Methods:

Seventy-four patients with complex CHD (mean age 35.6 +/- 14.3 years, female n = 22) were recruited. Seventy-four age- and sex-matched subjects were recruited as controls. Muscle oxygenation was successfully determined on the anterior portion of the deltoid muscle using near-infrared spectroscopy in 65 patients and 71 controls. Measurements were made at rest, during isotonic shoulder flexions (0-90 degrees) to exhaustion, and during recovery.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-400761 (URN)10.1016/j.cjca.2019.05.001 (DOI)000500935900026 ()31473068 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20100355Swedish Heart Lung Foundation, 20130472Swedish Heart Lung Foundation, E140-15Swedish Heart Lung Foundation, E109-16Swedish Heart Lung Foundation, FA2017:13
Available from: 2020-01-03 Created: 2020-01-03 Last updated: 2020-01-07Bibliographically approved
Henriksson, C., Wernroth, L. & Christersson, C. (2018). An Observational Study of the Occurence of Anxiety, Depression and self-reported Quality of Life 2 Years after Myocardial Infarction. Journal of Cardiology and Cardiovascular Medicine (3), 052-063
Open this publication in new window or tab >>An Observational Study of the Occurence of Anxiety, Depression and self-reported Quality of Life 2 Years after Myocardial Infarction
2018 (English)In: Journal of Cardiology and Cardiovascular Medicine, ISSN ISSN: 2575-0143, no 3, p. 052-063Article in journal (Refereed) Published
Abstract [en]

Background: Patients with myocardial infarction (MI) often experience anxiety, depression and poor quality of life (QoL) compared with a normative population. Mood disturbances and QoL have been extensively investigated, but only a few studies have examined the long-term effects of MI on these complex phenomena.

Aims: To examine the levels and associated predictors of anxiety, depression, and QoL in patients 2 years after MI.

Methods: This was a single center, observational study of patients with MI (n=377, 22% women, median age 66 years). Two years after MI (2012-2014), the patients were asked to answer the Hospital Anxiety and Depression Scale (HADS) and EuroQol 5-dimension (EQ-5D-3L) questionnaires.

Results: Most patients experienced neither anxiety (87%, 95% confidence interval [CI]: 83-90%) nor depression (94%, 95% CI: 92-97%) 2 years post-MI. Elderly patients experienced more depression than younger patients (p=0.003) and women had higher anxiety levels than men (p=0.009).

Most patients had “no problems” with any of the EQ-5D-3L dimensions (72-98%), but 48% (95% CI: 43%-53%) self-reported at least “some problems” with pain/discomfort. In a multiple logistic regression model (EQ-5D-3L) higher age (p<0.001) and female sex (p<0.001) were associated with more pain/discomfort. Female sex (p=0.047) and prior MI (p=0.038) were associated with anxiety/depression. History of heart failure was associated with worse mobility (p=0.005) and problems with usual activities (p=0.006). The median total health status of the patients (EQ-VAS) was 78 (95% CI: 75-80)

Place, publisher, year, edition, pages
Stillwater CT: Heighten sciences, 2018
Keywords
Myocardial infarction; Quality of life; Anxiety and depression
National Category
Medical and Health Sciences
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-367255 (URN)10.29328/journal.jccm.1001027 (DOI)
Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2019-01-17Bibliographically approved
Baron, T., Christersson, C., Hjorthén, G., Hedin, E.-M. & Flachskampf, F. (2018). Changes in global longitudinal strain and left ventricular ejection fraction during the first year after myocardial infarction: results from a large consecutive cohort. European Heart Journal Cardiovascular Imaging, 19(10), 1165-1173
Open this publication in new window or tab >>Changes in global longitudinal strain and left ventricular ejection fraction during the first year after myocardial infarction: results from a large consecutive cohort
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2018 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 19, no 10, p. 1165-1173Article in journal (Refereed) Published
Abstract [en]

Aims: To determine changes of global longitudinal strain (GLS) and their predictors in relation to classical echocardiographic parameters of left ventricular (LV) function, over 1 year, in consecutive patients with myocardial infarction (MI) and initially normal or impaired LV ejection fraction (EF).

Methods and results: A total of 285 patients with MI prospectively included in the REBUS (RElevance of Biomarkers for future risk of thromb-oembolic events in UnSelected post-myocardial infarction patients) study underwent echocardiography within 72 h from admission and after 1 year. At baseline, 213 (74.7%) of MI patients had a normal EF (≥52% in men or ≥54% in women), but in 70.4% of them, an impaired GLS ( ≥ -18.0%) was observed. During 1-year follow-up, in patients with normal EF at baseline, GLS improved from -15.8% to - 17.4% (10.1% relative change); EF decreased from 62.5% to 59.9% (4.0% relative change); indexed end-diastolic volume, indexed end-systolic volume, and indexed stroke volume increased with 15.6%, 24.8%, and 10.0% of relative change, respectively (P < 0.001 for all the comparisons). In the whole cohort, initial impairment of LV function [by EF, wall motion score index (WMSI), or GLS], male gender, non-smoking, and treatment with beta-blockers were the independent predictors of GLS improvement. In the group with initially impaired EF, over 1 year GLS improved from -11.9% to - 14.8% (24.4% relative change) and EF from 44.6% to 52.6% (18.2% relative change) (P < 0.001 for both). Improvement in GLS significantly correlated with EF increase in the group with impaired EF (r = -0.41, P = 0.001) but not in the patients with normal EF (r = -0.14, P = ns).

Conclusions: Despite diveregent evolution of GLS compared with EF and ventricular volumes, one year after MI GLS significantly improved in patients with initially both normal and impaired EF. Initial impairment of LV function (by EF, WMSI, or GLS), male gender, non-smoking, and treatment with beta-blockers were independent predictors of GLS improvement. LV remodelling was present even in patients with normal EF at baseline and during follow-up, confirming limited functional assessment by EF alone.

Keywords
global longitudinal strain, left ventricular function, myocardial infarction, remodelling
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-340847 (URN)10.1093/ehjci/jex260 (DOI)000455357200011 ()29145641 (PubMedID)
Funder
Erik, Karin och Gösta Selanders Foundation
Available from: 2018-02-04 Created: 2018-02-04 Last updated: 2019-04-17Bibliographically approved
Dimberg, A., Alström, U., Ståhle, E. & Christersson, C. (2018). Higher Preoperative Plasma Thrombin Potential in Patients Undergoing Surgery for Aortic Stenosis Compared to Surgery for Stable Coronary Artery Disease. Clinical and applied thrombosis/hemostasis, 24(8), 1282-1290
Open this publication in new window or tab >>Higher Preoperative Plasma Thrombin Potential in Patients Undergoing Surgery for Aortic Stenosis Compared to Surgery for Stable Coronary Artery Disease
2018 (English)In: Clinical and applied thrombosis/hemostasis, ISSN 1076-0296, E-ISSN 1938-2723, Vol. 24, no 8, p. 1282-1290Article in journal (Refereed) Published
Abstract [en]

Aortic stenosis (AS) and coronary artery disease (CAD) influence the coagulation system, potentially affecting hemostasis during cardiac surgery. Our aim was to evaluate 2 preoperative global hemostasis assays, plasma thrombin potential and thromboelastometry, in patients with severe aortic valve stenosis compared to patients with CAD. A secondary aim was to test whether the assays were associated with postoperative bleeding. Calibrated automated thrombogram (CAT) in platelet-poor plasma and rotational thromboelastometry (ROTEM) in whole blood were analyzed in patients scheduled for elective surgery due to severe AS (n = 103) and stable CAD (n = 68). Patients with AS displayed higher plasma thrombin potential, both thrombin peak with median 252 nmol/L (interquartile range 187-319) and endogenous thrombin potential (ETP) with median 1552 nmol/L/min (interquartile range 1340-1838), when compared to patients with CAD where thrombin peak was median 174 nmol/L (interquartile range 147-229) and ETP median 1247 nmol/L/min (interquartile range 1034-1448; both P < .001). Differences persisted after adjustment for age, gender, comorbidity, and antithrombotic treatment. Differences observed in thromboelastometry between the groups did not persist after adjustment for baseline characteristics. Bleeding amount showed no relationship with plasma thrombin potential but weakly to thromboelastometry (R-2 = .064, P = .001). Patients with AS exhibited preoperatively increased plasma thrombin potential compared to patients with CAD. Plasma thrombin potential was not predictive for postoperative bleeding in patients scheduled for elective surgery.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC, 2018
Keywords
bleeding, hemostasis, in vitro diagnostic systems
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-367017 (URN)10.1177/1076029618776374 (DOI)000446338400013 ()29768939 (PubMedID)
Available from: 2018-11-27 Created: 2018-11-27 Last updated: 2019-01-21Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-9116-8084

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