Scandinavian Cardiovascular Journal最新文献

Objectives. This study aimed to estimate the prevalence of atrial fibrillation (AF) and identify its associated comorbidities in adults aged 45 years and older, using data from the Swedish general population study EpiHealth. Design. In a cross-sectional design, data of health history, lifestyle factors, anthropometric measurement, and 1-lead ECG recordings from participants in the EpiHealth study were linked to data from the Swedish Patient Registry. Results. Among the 22,616 participants (56.2% women), the overall prevalence of AF was 3.9%, of which 0.3% were newly diagnosed cases identified by single 1-lead ECG at cohort examination. AF prevalence was higher in men than in women across all age groups and increased with age, reaching 17.2% among men aged 75 years and older. Participants with AF had a higher prevalence of cardiovascular comorbidities compared to those without AF. Conclusions. The findings highlight the increasing prevalence of AF with advancing age and its higher occurrence in men compared to women. The screening-detected prevalence of AF of 0.3% among participants in this general population study suggests that simple 1-lead ECG could be a manageable approach to screen for AF. The strong association between AF and cardiovascular comorbidities emphasizes the need for management strategies to address this condition, particularly in older adults.

Aim. Exercise-based cardiac rehabilitation (exCR) reduces morbidity and mortality after acute coronary syndrome (ACS). Little is known about physical activity (PA) levels at exCR program completion and associated demographic, medical, and psychosocial factors. Methods. Cross-sectional data from the ongoing Keep-Up-Going study were used, including 100 participants with recent ACS and ≥80% attendance to 3 months supervised exCR program. Physical activity was assessed by an accelerometer and self-reported psychosocial characteristics were collected at the end of the exCR. Associations between achieving the PA target (>150 min of moderate-to-vigorous-intensity PA/week) and biopsychosocial characteristics were assessed using univariable logistic regression analyses. Results. Mean age was 67 years and 24% were women. Participants achieving the PA target (76%) were more likely to have higher levels of social support, higher outcome expectations for PA, and higher intrinsic regulation (motivation, p < .05 for all). Those not achieving the PA target (24%) had a higher proportion of sedentary time, fewer steps/day, and were more likely to be older, retired, and have reduced left ventricular ejection fraction (LVEF) (p < .05 for all). Conclusions. Although exCR participation provides exercise routines, one-fourth of individuals did not reach the guideline-directed PA targets after an ACS. In addition to higher age and reduced LVEF, lower levels of social support, outcome expectations, and motivation were associated with low levels of PA. Exploring these factors could be of importance to support individuals' behavior change toward increased PA during the exCR period.

Objectives: The adipocyte-derived hormone leptin has been associated with the pathogenesis of cardiovascular disease. The mechanisms underlying this association are unclear but may relate to effects on the vascular endothelium. Our aim was to explore the effects of leptin on endothelial vasomotor and fibrinolytic function in healthy volunteers and patients with coronary artery disease.

Design: The vascular effects of leptin were assessed infusing recombinant human leptin in healthy volunteers during measuring vasomotor response by venous occlusion plethysmography. Additionally, circulating levels of leptin were analysed in relation to endothelial dysfunction in patients with established coronary artery disease.

Results: In healthy male volunteers, intra-arterial infusion of recombinant human leptin (80, 800 and 8,000 ng/min; n = 10) did not affect basal forearm blood flow, plasma tissue plasminogen activator (tPA) or plasminogen activator inhibitor type 1 concentrations (all p > 0.05). However, during concomitant co-infusion with leptin (800 ng/min; n = 10), drug-induced vasodilatation was reduced (p = 0.001), and tPA activity increased (p = 0.002). In patients with coronary artery disease, those with the high plasma leptin levels had reduced drug-induced vasodilatation (p < 0.001), and increased net release of tPA antigen and activity (p < 0.001 and p = 0.03, respectively) compared to those with low levels. The study has been registered retrospectively at Clinical Trials with number NCT04374500.

Conclusion: Intrabrachial leptin infusion did not affect the basal vascular tone, whereas acute and chronic hyperleptinemia was associated with blunted vasoreactivity in healthy volunteers, and in patients with coronary artery disease.

Background: Patients with atrial fibrillation (AF) are often treated with antiarrhythmic drugs (AADs) to maintain sinus rhythm and with heart rate-lowering drugs to achieve the optimal rate control. In this study, we investigated trends in the use of AADs and rate control drugs in Finnish patients with AF.

Methods and results: The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study is a nationwide study including all patients with AF in Finland from 2007 to 2018. The number of AAD purchases and the proportions of all prevalent AF patients in a certain year of interest were calculated. In total, 391030 AF patients were identified between 2007 and 2018, and 39,816 (10.2%) of them had purchased either class I or III AADs. The proportion of patients using classes I and III AADs decreased from 8.6% to 6.3%. Flecainide and amiodarone were the most often used AADs. The use of flecainide and amiodarone decreased from 4.9% to 3.9% and 1.9% to 1.5%, respectively. The proportion of patients on beta-blockers remained stable at 75%. Dronedarone became available in 2011 when it also was the most used (0.8% of patients), but the use decreased thereafter. The use of sotalol and digoxin decreased from 1.5% to 0.6% and 24.6% to 11.0% over the study period.

Conclusion: The number of AAD purchases increased alongside with the increasing prevalence of AF, whereas the proportion of AF patients on classes I and III AADs and digoxin decreased between 2007 and 2018. Flecainide remained the most used AAD followed by amiodarone.

Objectives. This study investigated the role and underlying regulatory mechanisms of circular RNA fibronectin type III domain containing 3B (circFNDC3B) in abdominal aortic aneurysm (AAA). Methods. The expression of circFNDC3B in AAA and normal tissues was assessed by quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). To evaluate the biological functions of circFNDC3B, assays were employed including 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT), flow cytometry, and Caspase-3 activity assays. Additionally, RNA immunoprecipitation (RIP), dual-luciferase reporter assay, Western blotting, and rescue experiments were utilized to elucidate the molecular mechanism of circFNDC3B. Results. Our findings revealed a significant upregulation of circFNDC3B expression in AAA clinical specimens compared to normal tissues. Functionally, overexpression of circFNDC3B inhibited vascular smooth muscle cells (VSMCs) proliferation and induced apoptosis, contributing to AAA formation in the Ang II-induced AAA model. Mechanistically, circFNDC3B acted as a molecular sponge for miR-1270, leading to the upregulation of programmed cell death 10 (PDCD10). Decreased expression of PDCD10 abrogated the -promoting effects of circFNDC3B overexpression on AAA development. Conclusions. This study demonstrates that circFNDC3B promotes the progression of AAA by targeting the miR-1270/PDCD10 pathway. Our findings suggest that circFNDC3B as well as miR-1270/PDCD10 pathway may serve as a potential therapeutic target for AAA treatment.

Objectives. In September 2019, the preferred surgical approach shifted for patients undergoing mitral valve (MV) surgery at our institution. The aim of this study was to compare minimally invasive surgery (MIS) with prior conventional sternotomy (CS) approach, to assess quality and safety of MIS in a non-high volume center. Methods. This single-center retrospective observational study comprised 254 patients, 102 CS patients and 152 MIS patients, who underwent MV surgery for mitral regurgitation with or without concomitant procedures (i.e. tricuspid valve surgery, atrial fibrillation ablation, closure of ASD) between January 2015 and October 2023. Results. CS patients were older with a higher preoperative risk profile. Mitral repair was the predominant procedure regardless of surgical approach. MIS had longer intraoperative times, yet were equal to CS in regard to myocardial injury, intensive care unit stay and postoperative complications. MIS had lower rates of permanent pacemaker insertions (4% vs. 13%; p < .014) and a shorter postoperative length of stay (5 vs. 7 days; p < .001). The 30-day mortality was low (1% vs 2%; p > .5). Proposed learning curve of MIS was demonstrated by a tendency of reduced intraoperative times with growing experience. Conclusions. MIS is a feasible alternative to the CS approach for MV surgery even at non-high volume centers. MV surgery with MIS results in a shorter postoperative length of stay, with comparable outcomes in terms of low mortality as well as surgical and postoperative morbidity. We believe that the prolonged intraoperative times will shorten with increased experience of these procedures.

Objective: The aim was to resuscitate and evaluate hearts ex vivo after 22 min of cardiac arrest with the goal of increasing the number of usable hearts from controlled donation after circulatory death (cDCD).

Design: Eight pigs (39-61 kg) underwent 22 min of ventricular fibrillation, after which the heart was first perfused in vivo for three minutes with an oxygenated, erythrocyte-containing cardioplegic preservation solution. The heart was then explanted and perfused ex vivo with the same solution for three hours at 18 °C in a transportable heart preservation system. Functional evaluation was performed ex vivo (n = 7), while one heart underwent orthotopic transplantation and was monitored for 24 h.

Results: The seven hearts evaluated ex vivo easily pumped twice the cardiac output measured in vivo. The transplanted heart maintained normal blood pressure, blood gases, and urine output throughout the 24-hour observation period. At the end of this period the aortic pressure was 104/80 mmHg with a heart rate of 129 beats per minute. Intravenous administration of 20, 40, and 100 µg adrenaline resulted in an aortic pressures of 238/171, 284/196, and 287/201 mmHg with corresponding heart rates of 162, 188, and 223 beats per minute.

Conclusion: Hearts exposed to 22 min of cardiac arrest were successfully resuscitated ex vivo and demonstrated adequate function when evaluated.