Scandinavian Cardiovascular Journal最新文献

Background: Interventional left atrial appendage occlusion (LAAO) was developed as a treatment option for patients who cannot receive traditional anticoagulation therapies. To date, randomized study data on this treatment are still limited, so registries and other non-randomized studies may help define the role of LAAO in clinical practice.

Design: We performed LAAO consecutively on 599 patients. All patients had non-valvular atrial fibrillation and a guideline-based indication for anticoagulation with either a history of a clinically relevant bleeding episode under anticoagulation (post-bleeding patients, PBP) or a high bleeding risk (HBR) based on a joint clinical decision. Data on the patients' index hospital stay were completely recorded; follow-up transesophageal echocardiography (TEE) was performed on approximately 50% of these patients. Clinical and laboratory follow-up data were available for 509 and 458 of these patients, respectively.

Results: Device implantation was successful in 98.8% of cases. There were 7 (1.2%) device dislocations and 6 (1.0%) periprocedural deaths. Of these, 5 deaths were procedure-related, and 4 were due to either accession site bleeding complications or device dislocation. In 96.3% of cases, follow-up TEE showed good results after device implantation. Compared to baseline values, hemoglobin concentration in the PBP group increased significantly by 5.0 g/l during the follow-up interval, while it decreased significantly by 5.0 g/l in the HBR group. During the follow-up period, renal function deteriorated significantly in the total cohort.

Conclusion: LAAO was associated with a significant increase in hemoglobin concentration in patients with a history of clinically relevant bleeding episodes.

Background. Flecainide is a first-line rhythm control treatment for patients with atrial fibrillation (AF), however long-term treatment outcomes are understudied. Objective. To investigate associations of electro- (ECG) and echocardiographic indices with safety and efficacy outcomes of long-term flecainide treatment for recurrent AF. Methods. Consecutive patients with AF admitted for in-hospital flecainide initiation over a 5-year period were retrospectively included (n = 130, age 60 ± 12 years, 65% males, 29% with persistent AF). Baseline ECGs were processed using the 12SL algorithm. P-wave duration (PWD), Deep terminal negativity of the P-wave in lead V1 (DTNP-V1), left atrial volume index (LAVI), valvular dysfunction and right ventricular fractional area change (RV-FAC) were assessed. The primary endpoint was flecainide discontinuation for any reason. Secondary endpoints were discontinuation due to rhythm control failure and rhythm-related adverse events. Results. After hospital discharge, 120 patients were followed for a median of 1.5 years (interquartile range 0.34-3.1). During follow-up 31% discontinued flecainide, 14% due to rhythm control failure and 10% due to rhythm-related adverse events. Flecainide discontinuation was associated with PWD ≥130 ms (HR 3.65, [1.36-9.75]), DTNP-V1 > 0.1 mV (HR 3.78, [1.15-12.4]), LAVI >48 ml/m² (HR 4.43, [2.02-9.70]), moderate mitral regurgitation (HR 4.40, [1.57-12.4]), and RV-FAC <35% (HR 2.30, [1.03-5.16]). Rhythm control failure was associated with PWD, DTNP-V1, LAVI and moderate mitral regurgitation. Rhythm-related adverse events were associated with RV-FAC, LAVI and moderate mitral regurgitation. Conclusion. ECG and echocardiographic indices were associated with discontinuation of flecainide, including safety and efficacy outcomes in long-term treated patients with AF.

Background. Colchicine is an anti-inflammatory drug with promising efficacy for preventing cardiovascular events. We aimed to assess the pooled effect of colchicine on ischemic stroke among patients with established atherosclerotic cardiovascular diseases. Methods. PubMed, Scopus, Web of Science, and the Cochrane Library were systematically searched from the inception to August 5, 2024. A random-effects (DerSimonian-Laird) model was used to conduct this meta-analysis. The inclusion criteria were as follows: (I) being a randomized controlled trial; and (II) measuring the efficacy of colchicine compared to placebo for preventing ischemic stroke among those with established atherosclerotic cardiovascular diseases. Results. We identified 13 eligible clinical trials with 24900 participants. Colchicine significantly decreased the risk of ischemic stroke (relative risk (RR) 0.85, 95% confidence interval (CI) (0.72, 0.99), I²=2.92%) among those with established atherosclerotic cardiovascular diseases. Colchicine was more effective when used at 0.5 mg/day (RR 0.86, 95% CI (0.75, 0.99)), prescribed for more than 30 days (RR 0.86, 95% CI (0.75, 1.00)) or for more than 90 days (RR 0.65, 95% CI (0.46, 0.92)), or administered for patients with acute coronary syndrome (RR 0.46, 95% CI (0.23, 0.92)). In addition, colchicine was more effective in studies with a sample size of more than 500 patients, consistent with sensitivity analysis, which indicated that the results relied on large-sized clinical trials. Conclusion. Colchicine may decrease the risk of ischemic stroke among patients with established atherosclerotic cardiovascular diseases, particularly after long-term use; however, future studies are needed due to inconsistencies between existing trials.

Objectives: Sudden cardiac death (SCD) is a leading cause of mortality among individuals with congenital heart disease (CHD), and risk stratification remains challenging. This study aimed to describe the underlying structural cardiac abnormalities in a national cohort of SCD victims with CHD, their socioeconomic status, and interactions with the healthcare system before death.

Methods: The Swedish study of Sudden Cardiac Death in the Young, 2000-2010, included SCD victims under 36 years, along with population-based controls and their parents. Of 903 SCD victims, 39 with autopsy-defined CHD were included in this study, together with 195 controls. Information on socioeconomic variables and healthcare contacts was gathered from Swedish national registers.

Results: The median age for SCD was 24 years, and 64% were male. The CHD was undiagnosed before death in 31% of the cases, of whom 8 had coronary anomalies. Moderate to complex CHD was observed in 41%. Structural abnormalities of the ventricles were prevalent, with left ventricular hypertrophy present in 56% and fibrosis in 64%. The cases had a higher frequency of hospital admissions within 6 months before SCD compared to controls (OR 14.1,95% CI 3.80-52.44), p < 0.001. No socioeconomic differences were observed.

Conclusions: This study identified a broad spectrum of underlying anatomical defects, with ventricular structural abnormalities being a common autopsy finding. The majority of cases had moderate to severe lesions. An increased frequency of healthcare contacts prior to death was noted, which may be a variable needing more attention as a predictor for a higher risk of SCD.

Introduction. The ESCAPER project explores cardiovascular resilience in individuals who, despite a high-risk factor burden-longstanding Type 1 Diabetes (T1D), obesity, or kidney failure-avoid or delay macrovascular complications. This suggests underlying protective mechanisms. Initiated in September 2022, this exploratory study aims to uncover and define these mechanisms, potentially leading to novel therapeutic targets in preventive medicine. Research design and methods. Participants from the Skåne region, Southern Sweden, are divided into three subgroups: (1) T1D patients (>30 years duration) without macrovascular complications or macroalbuminuria, (2) obese individuals with normal cardiac function and no cardiovascular medications, and (3) kidney failure patients awaiting transplantation with no arterial calcification, alongside respective controls. Comprehensive phenotyping includes 24-h blood pressure, ECG monitoring, vascular ultrasound, cardiac MRI, and ergospirometry (in a subgroup), along with laboratory investigations, including biomarker and omics analyses. Arterial biopsies are collected from kidney failure patients. The study leverages Swedish national medical registries for detailed follow-up of healthcare utilization, diagnoses, and prescriptions, enabling longitudinal outcome assessments. Results. Initial findings from 90 T1D patients and 31 obese individuals indicate well-managed cardiovascular risk factors. The T1D subgroup shows a mean BMI of 25.6 kg/m² and HbA1c of 52 mmol/mol, while the obesity subgroup presents a BMI of 32.9 kg/m² with normal glucose levels. Conclusions. ESCAPER has the potential to advance understanding of cardiovascular resilience and refine prevention strategies. Its comprehensive methodology and registry-based follow-up provide robust insights into protective mechanisms and long-term outcomes.

Objectives: Patients with acute type A aortic dissection (ATAAD) presenting with cerebral malperfusion have significantly poorer postoperative outcomes, making the decision whether to perform acute surgery difficult. The aim of this study was to investigate types of neurological symptoms and radiological findings and their association with permanent neurological injury and mortality following ATAAD repair.

Methods: This was a single-center, retrospective, observational study. A total of 629 patients underwent ATAAD surgery between January 1998 and December 2023 at Skåne University Hospital, Lund, Sweden. Of these, 93 (14.7%) presented with cerebral malperfusion and constituted the study population. The primary endpoints were clinical neurological injury and 30-day mortality.

Results: Overall 30-day mortality was 25.0%. Fifty-two patients (57.1%) had persisting neurological deficit. Patients with postoperative neurological deficit had significantly higher 30-day mortality than patients without postoperative neurological deficit (37.3% vs 5.1%, p > 0.001). Common carotid artery dissection and carotid artery occlusion were significantly more frequent in patients who developed postoperative neurological injury. Preoperative hemiparesis/hemiplegia was associated with a significant increase of persisting neurological deficits, and unconsciousness was associated with a significant increase in 30-day mortality or persisting neurological deficits. After repair, 52.2% of patients showed an improvement in their clinical neurological status.

Conclusion: In ATAAD patients who present with cerebral malperfusion, the risk of permanent neurological deficit and 30-day mortality is high, but a significant proportion of patients survive and more than half demonstrate an improved neurological state postoperatively.

Background: Due to aging population, nonagenarians are increasingly undergoing percutaneous coronary intervention (PCI). However, the safety and efficacy of PCI in this elderly population remains somewhat unknown.

Methods: A retrospective study was conducted to investigate the characteristics and outcomes of consecutive nonagenarians who underwent PCI at the Oulu University Hospital between 2012 and 2022. Patients (n = 107; mean age 91.2 ± 1.4 years; 58.9% women) were stratified into three groups based on their presentation: ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndrome (NSTEACS) or stable coronary artery disease (CAD). One-year mortality was the primary outcome of this analysis. Secondary outcomes were in-hospital major bleeding and 1-year rates of myocardial infarction, stroke and repeat revascularisation.

Results: Majority had acute coronary syndrome, with STEMI in 35 (32.7%) and NSTEACS in 51 (47.7%) patients, while in 21 (19.6%) patients' indication was stable CAD. Early mortality was mainly related to STEMI (in-hospital mortality: STEMI 22.9% vs. NSTEACS 5.9% vs. stable CAD 0.0%, p = 0.011; 30-day mortality: 34.3% vs. 13.7% vs. 4.8%, respectively, p = 0.011). Rate of major in-hospital bleeding was 3.7%. There was no significant difference in 1-year mortality between groups (40.0% vs. 27.5% vs. 19.0%, respectively, p = 0.227). One-year rates for myocardial infarction, stroke and repeat revascularisation were 7.5%, 1.9% and 3.7%, respectively.

Conclusions: Excess mortality in nonagenarians undergoing PCI is mainly related to STEMI where it is driven by early adverse events. Mortality in this study can be seen as acceptable in comparison to that in general population, supporting the use of PCI in selected nonagenarians.

Aims. To investigate rates of alcohol screening and brief interventions (SBI) in cardiology, and to examine associations between patient characteristics and the implementation of screening and brief interventions (BIs). Methods. Cross-sectional survey of cardiology patients (aged ≥18 years) in three towns/cities in Sweden (Falun, Gävle, Stockholm). Self-reported study outcomes included: (a) being screened for alcohol use and (b) receiving a BI. Covariates included sociodemographic characteristics and clinical factors. We examined associations between covariates and study outcomes using logistic regression models. Results. From a total of 1051 participants (median age = 73 years, 66% men), 54% were screened for alcohol use, mostly by doctors (48%) and nurses (40%). Odds ratios (ORs) for being screened were lower among participants aged ≥80 years (OR = 0.57, 95% confidence intervals (CI) = 0.41-0.79), relative to those aged 65-79 years, and higher among participants with overweight (OR = 1.84, 95%CI = 1.38-2.44). Of those screened, 12% received BIs. Odds ratios for receiving BIs were higher among: men (OR = 3.04, 95%CI = 1.41-6.56), current smokers (OR = 10.88, 95%CI = 3.86-30.69), and participants with hazardous drinking (OR = 5.66, 95%CI = 2.59-12.36). Conclusions. Just over half cardiology patients were screened for alcohol use. Almost two-thirds of those identified with hazardous drinking did not receive BIs. Screening and BI practices varied according to individual participant characteristics, and there was a shortfall in screening among the elderly. Findings indicate inconsistent implementation of European cardiology guidelines, which recommend universal screening, and highlight a need for improved implementation strategies.

Objectives: We aimed to assess the prospective associations of sleep duration and quality with the risk of cardiometabolic multimorbidity (CMM) and the interplay with physical activity. Design: Sleep duration and quality and physical activity were self-reported using standardized questionnaires. Cardiometabolic multimorbidity was defined as the presence of at least two multiple long-term conditions (hypertension, diabetes, coronary heart disease, stroke, and other cardiovascular diseases) at follow-up. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression models adjusted for cardiometabolic risk factors including physical activity. Results: We included 3,428 participants [mean (SD) age 63 (9) years, 44.8% male] free of hypertension, coronary heart disease, diabetes, and stroke at baseline. At 15 years follow-up, 206 participants developed CMM. There was an approximate U-shaped trend between sleep duration and CMM risk. Compared to sleep duration of 7-8 hrs/day, the multivariable OR (95% CI) for CMM was 1.39 (1.03-1.90) for sleep duration ≤6 hrs/day and 1.05 (0.55-2.00) for sleep duration ≥9 hrs/day. The odds of CMM appeared to decrease with each additional hour of sleep among participants with short sleep duration (≤6 hrs/day), although this association did not reach statistical significance (OR, 0.78, 95% CI: 0.59-1.02). Sleep quality or physical activity was not associated with CMM. Conclusions: Short sleep duration is associated with an increased CMM risk independent of physical activity. The observed trend suggests that increasing sleep duration among short sleepers may help mitigate CMM risk.