Scandinavian Cardiovascular Journal最新文献

Aim: To examine sex differences in care-seeking when afflicted by an acute myocardial infarction (AMI).

Method: This was a cross-sectional study in the region of Stockholm, Sweden. All patients from the Swedish national registry SWEDEHEART who were hospitalized due to an acute myocardial infarction in Stockholm, between March and June 2020, were asked to participate. A self-administered questionnaire Patients' appraisal, emotions, and action tendencies preceding care-seeking in acute myocardial infarction' (PA-AMI) including demographical questions, was sent out via mail, which was answered by a total of 326 participants. Additional variables for each participant were obtained from SWEDEHEART.

Results: There were no differences between women and men regarding patients' thoughts, feelings, and actions prior to care-seeking, as well as the time from symptom onset to care-seeking, both the patients' own assessed time, and the times reported to SWEDEHEART. However, the results shows that both women and men experience a high degree of uncertainty when afflicted by an AMI.

Conclusions: Our results indicate that there are no significant sex differences in care-seeking patterns when afflicted by an AMI. Regardless of sex, AMI is associated with a high level of uncertainty among patients. To address this uncertainty and improve timely care, it is crucial to implement enhanced educational initiatives at both the individual and community levels. These efforts should focus on increasing awareness of the diverse symptom presentation of AMI and emphasize the critical importance of seeking immediate medical attention. Such interventions could help reduce delays in care and improve patient outcomes.

Objectives: Primary dysmenorrhea is a common condition characterized by cramp-like menstrual pain in young women. Recently, its effects on the cardiovascular system have garnered attention. Endothelial dysfunction is an early indicator of cardiovascular risk; however, its relationship with primary dysmenorrhea remains unclear. This study aims to evaluate endothelial function in individuals with primary dysmenorrhea using post-ischemic flow-mediated dilation (FMD) and volumetric flow (VolFlow) methods, and to compare the results with healthy controls.

Design: This study included 31 women with a clinical diagnosis of primary dysmenorrhea and 31 healthy control women. Endothelial function was assessed using Flow-Mediated Dilation (FMD) and VolFlow methods. FMD measures the dilation of the brachial artery, while VolFlow evaluates arterial blood flow volume. Differences between the groups were analyzed using SPSS, and a p-value of < 0.05 was considered statistically significant. Normality was assessed using the Shapiro-Wilk test, and between-group comparisons were performed using appropriate parametric and non-parametric methods.

Findings: The FMD values were significantly lower in the dysmenorrhea group (5.97 ± 5.29 vs. 10.95 ± 3.78, p < 0.001), and the proportion of individuals with endothelial dysfunction was higher (%51.6 vs. %6.45, p < 0.001). In the dysmenorrhea group, the baseline VolFlow value was 77.4 ± 24.1 ml/min, which increased to 81.4 ± 25.1 ml/min after cuff inflation (p < 0.001). In healthy controls, the VolFlow increased from 69.8 ± 15.3 ml/min to 92.0 ± 15.3 ml/min, but this change was not statistically significant (p = 0.08). The change in VolFlow (ΔVF) was significantly lower in the dysmenorrhea group (p < 0.001).

Results: Our findings indicate a significant impairment of endothelial function in the primary dysmenorrhea group compared to the control group. Specifically, individuals with primary dysmenorrhea exhibited lower flow-mediated dilation (FMD) and Δ vascular function (ΔVF) values. To further investigate this relationship, large-scale studies are needed.

Purpose. This study utilizes untargeted metabolomics to identify novel serum biomarkers and metabolic pathways linked to in-stent restenosis (ISR). Methods. This retrospective study included patients who underwent percutaneous coronary intervention (PCI) at the Chinese PLA General Hospital between February 2018 and December 2018. Serum metabolites were analyzed using gas chromatography-mass spectrometry (GC-MS). Multivariate analysis was used to identify differential metabolites, and pathway enrichment analysis was performed to explore their biological significance. Results. A total of 61 patients were enrolled, comprising 18 in the ISR group and 43 in the non-ISR group. The ISR group demonstrated a higher prevalence of smoking (50% vs. 21%, p = 0.023), a greater incidence of previous myocardial infarction (72% vs. 37%, p = 0.004), and a lower left ventricular ejection fraction (51% vs. 58%, p = 0.004) compared to the non-ISR group. Seven differential metabolites were identified, with five being upregulated (inosine, myo-inositol, 3-cyanoalanine, monostearin, and glutamine) and two downregulated (biuret and 3-methylcatechol). Pathway enrichment analysis revealed three major metabolic pathways associated with ISR: inositol phosphate metabolism, alanine-aspartate-glutamate metabolism, and the phosphatidylinositol signaling system. Receiver operating characteristic (ROC) analysis indicated that inosine had the highest diagnostic performance [The area under the curve (AUC) = 0.807], followed by myo-inositol (AUC = 0.705) and monostearin (AUC = 0.643). The combined biomarker panel significantly enhanced diagnostic accuracy, achieving an AUC of 0.925, indicating strong predictive potential for ISR. Conclusions. This study identified seven potential serum biomarkers and three metabolic pathways linked to ISR. These findings enhance our understanding of the metabolic mechanisms underlying ISR and could aid in the development of non-invasive diagnostic tools and therapeutic strategies.

Background: Several aspects of acute type A aortic dissection (ATAAD) management remain debated. The strategies for arterial cannulation, cerebral protection, temperature management and extent of aortic resection are all contested. We aimed to explore and describe variations in the current management of patients with ATAAD in the Nordic countries, which form a limited geographic region with similar healthcare systems.

Methods: A 32-item questionnaire regarding the organizational and periprocedural aspects of care for patients with ATAAD was sent to 17 Nordic cardiac surgery units, prospective collaborators in the Nordic Consortium for Acute type A Aortic Dissection. Results were summarized using descriptive statistics.

Results: The response rate was 12/17 (71%). Fifty-eight per cent of centres used femoral artery cannulation, of which two centres (17%) used femoral artery cannulation in addition to another method. Nine centres (75%) used cerebral perfusion in most of surgical repairs requiring HCA, and among those using cerebral perfusion, 92% opted for antegrade cerebral perfusion. Five centres (42%) stated that total arch replacements were never performed. Valve sparing root replacements were performed by seven centres (58%). Regarding postoperative surveillance, all centres reported that CT-scans were performed at 6-12 months intervals.

Conclusion: Although strategies for pre-, peri-, and postoperative management of patients with ATAAD could be expected to be reasonably similar, we found several differences in almost all aspects of management. The current survey may help identify relevant research questions that can be explored in the NORCAAD2 database, ultimately contributing to the development of consensus documents and guidelines.

Background: A newly discovered renal syndrome, shrunken pore syndrome (SPS), has been shown to increase mortality regardless of renal function. SPS is defined as an estimated glomerular filtration rate (eGFR) of cystatin C ≤ 60% than eGFR_creatinine. We set out to study SPS in relation to the survival of heart transplantation patients with a follow-up of up to 12 years. Methods. This was a single-center cohort study including 253 consecutive patients undergoing heart transplantation. The prevalence of SPS at different time points post-transplantation and its effect on survival was evaluated using Kaplan-Meier's analysis and multivariable Cox proportional hazards regression. Results. The prevalence of SPS was 7.5% the day after transplantation (D1), which rose to 71% week 4 after surgery. There was no difference in survival for patients with SPS D1 compared to patients without SPS D1. Patients with SPS 4 weeks compared to patients without SPS 4 weeks after transplantation showed a 5- and 10-year survival of 73% vs. 93% (p = .02) and 63% vs. 90% (p = .005), respectively. SPS developed during the postoperative period was also found to be an independent predictor of mortality (HR 4.65; 95% CI 1.36-15.8). Discussion. SPS that developed in the postoperative course after heart transplantation was found to be an independent predictor of mortality with a severe negative impact on 5- and 10-year survival.

Purpose. Transcatheter aortic valve implantation (TAVI) is increasingly performed in patients with longer life expectancies. The need for permanent pacemaker implantation (PPI) following TAVI has been associated with increased all-cause mortality and morbidity. This study aimed to identify ECG, CT, and procedural predictors of PPI following TAVI. Methods. We conducted a retrospective observational study at the University Hospital of North Norway. Patients who underwent TAVI with SAPIEN 3 or SAPIEN 3 Ultra valves were included, while those with prior pacemakers, self-expanding valves, or valve-in-valve procedures were excluded. Data were collected from medical records, pre-operative CT scans, and procedural angiography. Results. A total of 416 low- to intermediate-risk patients with a median age of 82 years were included. Of these, 64 patients (15.4%) required PPI within ≤30 days following the index procedure. Multivariable regression analysis identified the following predictors for PPI: pre-existing right bundle branch block (odds ratio (OR), 10.7; 95% CI, 4.74-24.3), first-degree atrioventricular block (OR, 2.62; 95% CI, 1.08-6.32), membranous septum length (OR, 0.77; 95% CI, 0.65-0.90), left ventricular outflow tract calcification (OR, 2.18; 95% CI, 1.12-4.27), and the use of 29 mm valves (OR, 2.33; 95% CI, 1.09-4.97). Conclusions. Our study found the following predictors of PPI following TAVI: pre-existing right bundle branch block, first-degree atrioventricular block, the use of 29 mm valves and the presence of left ventricular outflow tract calcification. Additionally, a short MS was found to increase the chance of PPI; therefore, MS measurements should be included in pre-operative assessments to identify at-risk patients.

Objectives: Recent guidelines advocate postoperative aortic surveillance without clear distinction between aortic valve phenotypes. We sought to determine the long-term occurrence and location of distal aortic complications and aortic growth rates postoperatively in patients with bicuspid and tricuspid aortic valves, respectively.

Design: Patients underwent elective ascending aorta replacement, with or without concomitant aortic valve surgery, and computed tomography of the aorta preoperatively. Repeat imaging was performed 10 years after surgery and medical records were reviewed to identify aortic events.

Results: Overall, 127 patients (bicuspid n = 85 [66.9%], tricuspid n = 42 [33.1%]; male n = 88 [69.3%]) were included at baseline. Ten patients (23.8%) in the tricuspid group developed an acute aortic event, indication for surgery at a distal segment, or underwent aortic intervention, compared with two (2.4%) in the bicuspid group (p < 0.001). 96 patients (75.6%, bicuspid n = 67, tricuspid n = 29) returned for repeat aortic imaging, with a median follow-up of 10.8 years. The frequency of arch complications was significantly higher in the tricuspid group (n = 4 vs. n = 0, p = 0.007). Multivariable logistic regression identified tricuspid aortic valve (OR 8.52, p = 0.012) and baseline distal aortic diameter (OR 1.27 per mm increment, p < 0.001) as risk factors for a distal aortic complication.

Conclusions: Patients with a tricuspid aortic valve are at high risk of a distal aortic complication, whereas patients with a bicuspid aortic valve are at low risk. Long-term surveillance should be individualized accordingly.

Background. Invasive coronary angiography (ICA) is the gold standard in evaluating stent patency after percutaneous coronary intervention (PCI), but it carries a risk of potentially life-threatening complications. Third-generation coronary computed tomography angiography (CCTA) offers a non-invasive, safer follow-up method, but real-world data are lacking. This study evaluated the ability of CCTA to rule out in-stent restenosis (ISR) in long stents at long-term follow-up. Methods. This prospective, single-centre study (NCT06543641) included consecutive patients treated with PCI for coronary chronic total occlusion with long stents (left anterior descending coronary artery and right coronary artery ≥38 mm, left circumflex coronary artery ≥30 mm) in 2014-2019. All patients underwent third-generation dual-source CCTA. Patients with CCTA showing significant ISR, inconclusive results, or symptomatic native artery lesions underwent ICA. Results. The study included 45 patients (median age 67 (IQR 62-73) years, 87% males) with 47 stents (median length 51 mm, range 36-132 mm). CCTA ruled out significant ISR in 87% (n = 39) of the patients. CCTA indicated five ISRs and one inconclusive result in six (13%) patients, all of whom underwent ICA. Additionally, ICA was conducted for five patients due to a native artery lesion(s) on CCTA and angina. ICA showed significant stenosis in all six patients (100%) with ISR or inconclusive CCTA finding in the long stent. Conclusions. Third-generation CCTA could rule out significant ISR in a vast majority of cases (87%, n = 39) and without a risk of complications associated with ICA. CCTA provides a non-invasive, lower risk method for long-term revascularization follow-up.

Objective. In this study, we investigated the different effects of roller and centrifugal pumps on blood and myocardial tissue structure in a normothermic machine-perfused ex vivo porcine heart model. Methods. We selected 16 healthy Guangxi Bama miniature pigs weighing 25-30 kg and randomly divided them into two groups, one perfused by a roller pump and the other perfused by a centrifugal pump. We recorded hemodynamic parameters, measured blood gases to test for erythrocyte destruction, coagulation, myocardial injury markers, and inflammatory factors, and observed pathological and ultrastructural changes in the left ventricular wall myocardial tissue. Results. There were no differences in perfusion, heart rate, blood gases, hemolysis, or cardiac enzyme levels between the two groups (p > .05). The centrifugal pump group had a higher platelet count, fibrinogen level, and prothrombin time and lower levels of D-dimer (p < .05). In the centrifugal pump group, compared to the roller pump group, the pro-inflammatory factor levels were significantly higher and interleukin-10 levels were significantly lower (p < .05). Hematoxylin-eosin staining and transmission electron microscopy results showed no difference in the degree of myocardial tissue damage between the two groups. Conclusion. The results of this study suggested that the centrifugal pump model reduced platelet destruction, prolonged prothrombin time, avoided excessive fibrinogen activation, and attenuated elevated D-dimer levels. However, the centrifugal pump induced a greater inflammatory response compared to roller pump.

Objectives. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to provide cardiorespiratory support in cardiogenic shock (CS), but selection of patients and timing of ECMO-start remain a challenge. This study aims to describe the 1 year outcome of VA-ECMO for CS with focus on etiology and severity of shock. Methods. VA-ECMO was used on 371 occasions between 2004 and 2019 at our center. Of these, 177 patients received VA-ECMO for CS and were included in this retrospective single-center study. Univariable and multivariable logistic regression models were used to determine predictors of all-cause mortality at 1 year. Results. Patients were grouped according to underlying etiology: non-ischemic heart failure (NIHF, N = 49), ischemic heart disease (IHD, N = 83) and miscellaneous diagnoses (Misc, N = 45). Markers of disease severity were lower for patients with NIHF. One year survival was 40% for all patients, 57%, 36% and 27% for the NIHF-, IHD and Misc-groups, respectively (p < .01). Univariable logistic regression analysis identified several variables associated with 1-year mortality, such as underlying etiology, pH and lactate, while biventricular failure was associated with a better prognosis. However, in the multivariable analysis, only ECPR remained significantly associated with increased mortality (OR 3.67, (CI 1.66-8.31), p < .01) Conclusions. In this retrospective study of VA-ECMO for CS, we found an acceptable one-year survival rate of 40%, with a more favorable outcome for NIHF-patients. The negative association of ECPR with a higher 1 year mortality suggests the importance of patient selection as well as timing of the VA-ECMO before deterioration to cardiac arrest.