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Biomedical subjects

A Hjalmarson

Publications and source records attributed to A Hjalmarson.

At least 73 records · Page 4Linked to original sources
PubMed1996

Female sex is associated with increased mortality and morbidity early, but not late, after coronary artery bypass grafting.

OBJECTIVE: To describe mortality and morbidity during a period of 2 years after coronary artery bypass grafting in relation to gender. DESIGN: Prospective follow-up study. SETTING: Two regional cardiothoracic centres which performed all the coronary artery bypass operations in western Sweden at the time. SUBJECTS: A total of 2129 (1727 (81%) men and 402 (19%) women) consecutive patients undergoing coronary artery bypass surgery between June 1988 and June 1991 without concomitant procedures. RESULTS: Females were older and more frequently had a history of hypertension, diabetes mellitus, congestive heart failure, renal dysfunction and obesity. In a multivariate analysis, taking account of age, history of cardiovascular diseases and renal dysfunction, female sex appeared as a significant independent predictor of mortality during the 30 days after coronary artery bypass grafting (P < 0.05), but not thereafter. Various postoperative complications including neurological deficit, hydro- and pneumo-thorax, perioperative myocardial damage and the need for assist devices and prolonged reperfusion were more common in females than males. CONCLUSION: Females run an increased risk of early death and the development of postoperative complications after coronary artery bypass surgery as compared with males. Late mortality does not appear to be influenced by gender and the long-term benefit of the coronary artery bypass graft operation is similar in men and women.

Aged↗
PubMed1996

Mortality and morbidity during a period of 2 years after coronary artery bypass surgery in patients with and without a history of hypertension.

OBJECTIVE: To describe mortality and morbidity during a period of 2 years after coronary artery bypass grafting (CABG) in relation to a history of hypertension. PATIENTS: All patients in western Sweden in whom CABG was undertaken between June 1988 and June 1991 and in whom simultaneous valve surgery was not performed were included in the study. DESIGN: A prospective 2-year follow-up study. RESULTS: Patients with a history of hypertension (n = 777) differed from patients without such a history (n = 1348) in that the proportion of women was higher, they were older and more frequently had a history of congestive heart failure, diabetes mellitus, renal dysfunction, cerebro-vascular disease, intermittent claudication and obesity, and the number of smokers and patients with previous CABG was lower. They were also more likely to develop post-operative cerebrovascular complications and signs of myocardia damage. Patients with hypertension tended to have increased mortality during the first 30 days after CABG and the late mortality (between day 30 and 2 years) was significantly higher than in non-hypertensive participants. Whereas the development of myocardial infarction was similar in both groups, the hypertensive study participants more frequently developed stroke during 2 years of follow-up. In a multivariate analysis including age, sex, history of different cardiovascular diseases, smoking, ejection fraction, and the occurrence of three-vessel disease, hypertension did not emerge as an independent predictor of death in the early or late phase or during a total of 2 years of follow-up. CONCLUSION: Among CABG patients, those with a history of hypertension have a different pattern of risk factors. They have a higher mean age, include a higher proportion of women and have a higher prevalence of congestive heart failure, diabetes mellitus, renal dysfunction, cerebro-vascular disease, intermittent claudication, and obesity. They also have an increased frequency of immediate post-operative complications and an increased 2-year mortality, even if a history of hypertension was not an independent predictor of death during 2 years of follow-up.

Blood Pressure↗
PubMed1996

Death, mode of death, morbidity and requirement for rehospitalization during 2 years after coronary artery bypass grafting in relation to preoperative ejection fraction.

OBJECTIVE: To describe the impact of ejection fraction on the prognosis during 2 years after coronary artery bypass grafting (CABG). PATIENTS: All patients in western Sweden who underwent CABG without concomitant valve surgery between June 1988 and June 1991. RESULTS: In all, 2121 patients were operated upon and information on ejection fraction was available for 1961 patients (92%). Of these patients, 178 (9%) had an ejection fraction < 40%, 517 (26%) an ejection fraction of 40-59% and 1266 (65%) an ejection fraction > or = 60%. In these groups the mortalities during the first 30 days after CABG were 5.1, 4.3 and 2.2%, respectively (P < 0.01). The corresponding values for mortalities between 30 days and 2 years were 7.7, 4.3 and 3.3%, respectively (P < 0.01). Patients with a lower ejection fraction were more frequently men and more frequently had a history of cardiovascular disease. In multivariate analysis the preoperative ejection fraction was an independent predictor for total 2-year mortality. Patients with a low ejection fraction died more frequently in association with ventricular fibrillation. Morbidity was, with the exception of that for rehospitalization due to heart failure and infection, not associated significantly with the preoperative ejection fraction. CONCLUSION: During the 2 years after CABG a low preoperative ejection fraction was associated with a higher mortality, but the association with morbidity was more complex.

Adult↗
PubMed1996

Distress correlates with the degree of chest pain: a description of patients awaiting revascularisation.

AIM: To describe various symptoms other than pain among consecutive patients on the waiting list for possible coronary revascularisation in relation to estimated severity of chest pain. DESIGN: All patients were sent a postal questionnaire for symptom evaluation. SUBJECTS: All patients in western Sweden on the waiting list in September 1990 who had been referred for coronary angiography or coronary revascularisation (n = 904). RESULTS: 88% of the patients reported chest pain symptoms that limited their daily activities to a greater or lesser degree. Various psychological symptoms including anxiety and depression were strongly associated with the severity of pain (P < 0.001), as were sleep disturbances (P < 0.001), and dyspnoea and various psychosomatic symptoms (P < 0.001). Nevertheless only 44% of the patients reported chest pain as the major disruptive symptom, whereas the remaining 56% reported uncertainty about the future, fear, or unspecified symptoms as being the most disturbing. CONCLUSIONS: In a consecutive series of patients on the waiting list for possible coronary revascularisation, half the participants reported that uncertainty and fear were more disturbing than chest pain.

Aged↗
PubMed1996

Immunocytochemical studies of M2 muscarinic receptors in guinea pig atria and ventricles using anti-peptide antibodies.

The localization and density of M2 muscarinic receptors in guinea pig atria and ventricles were studied by immunocytochemical techniques, with anti-peptide antibodies against the second extracellular loop of human muscarinic receptor-2. It was shown that the positive immunoreaction of M2 muscarinic receptor was characterized by brown-yellow granules of variable size and shape, which were located mainly on the cell surface and in the cytoplasm far from nuclei. The positive immunoreactive substances appeared in both atrial and ventricular myocytes, with the density being greater in atria than in ventricles. Pre-incubation with atropine, but not carbachol, significantly reduced the intensity of positive immunoreactivity. This indicates that the binding of antibody to receptor site can be partially blocked by M2 muscarinic receptor antagonist.

Animals↗
PubMed1996

Effects of anti-peptide antibodies against human M2 muscarinic receptors on the cAMP generating system in guinea pig ventricles.

The effects of anti-peptide antibodies (Ab) against the second extracellular loop of human muscarinic receptor-2 on the cAMP generating system in guinea pig ventricles were studied. These effects were compared with those of the muscarinic receptor agonist carbachol (Carb). It was shown that: (1) both Carb and Ab were able to inhibit the isoproterenol (Iso)-stimulated cAMP production of ventricles in a dose-dependent manner. Carb at 2 microM, 10 microM and 50 microM decreased Iso-stimulated cAMP production by 8.0 +/- 1.1, 15.8 +/- 1.2 and 28.4 +/- 1.7%, respectively; whereas Ab at 50 nM, 100 nM and 400 nM decreased it by 5.8 +/- 0.4, 16.8 +/- 1.4 and 30.6 +/- 2.5%, respectively. (2) Both Carb and Ab could also inhibit the basal cAMP content of ventricles significantly. Carb at 10 microM and Ab at 100 nM decreased it by 46.9 +/- 4.2% and 60.2 +/- 4.6%, respectively. (3) The inhibitory effects of both Ab and Carb on Iso-stimulated cAMP production were significantly prevented by atropine at 1.5 microM. (4) The inhibitory effect of Ab at 100 nM was almost completely abolished by the peptide (700 nM) used as immunogen. These findings suggest that the antibodies exhibit a stimulatory muscarinic activity similar to carbachol in the inhibitory modulation of cAMP production.

Animals↗
PubMed1996

Effects of anti-peptide antibodies against human M2 muscarinic receptors on cardiac function in rats in vivo.

The effects of anti-peptide antibodies (Ab) against the second extracellular loop of human muscarinic receptor-2 on cardiac function in rats in vivo were studied. These effects were compared with those of the muscarinic receptor agonist, carbachol (Carb). It was shown that: (1) both Carb and Ab administered intravenously in the same doses of 0.4 nmol, 1.0 nmol, and 2.0 nmol were able to inhibit the maximal rate of rise of ventricular pressure (+dp/dt max) in a dose-dependent manner. (2) The isoproterenol (Iso)-induced increase in HR and +dp/dt max were also markedly inhibited by Carb and Ab. Administration of 1.0 nmol Carb decreased the Iso-stimulated increase of HR from 13.6 +/- 2.0 to 4.9 +/- 0.7% and decreased the increase of +dp/dt max from 27.9 +/- 3.2 to 4.8 +/- 0.6%, respectively; whereas Ab decreased the HR to 6.5 +/- 1.1% and +dp/dt max to 13.5 +/- 1.2%, respectively. (3) Both the inhibitory effects of Carb and Ab could be significantly blocked by atropine (1.4 nmol). These findings suggest that the Ab display a stimulatory muscarinic activity similar to Carb in inhibiting the cardiac function as evidenced by its negative chronotropic and inotropic effects.

Animals↗
PubMed1996

Agonistic effects of anti-peptide antibodies and autoantibodies directed against adrenergic and cholinergic receptors: absence of desensitization.

Affinity-purified autoantibodies and anti-peptide antibodies directed against the second extracellular loop of the beta 1-adrenoceptor increase the beating rate of cultured cardiomyocytes just like the beta-adrenergic agonist isoprenaline. Their positive chronotropic action is blocked by beta-adrenergic antagonists. Affinity-purified autoantibodies and anti-peptide antibodies directed against the muscarinic cholinergic M2 receptor exert in these myocytes, like the muscarinic cholinergic agent carbachol, a negative chronotropic effect that is antagonized by atropine. In contrast to the agonism of isoprenaline and carbachol, the described agonistic effects of the antibodies are not subject to desensitization.

Adrenergic beta-Agonists↗
PubMed1995

Beta-blockers and sudden cardiac death.

OBJECTIVES: To 1) consider the problem of sudden death from heart disease and the role of beta-blockers and other agents in preventing sudden death and 2) review perceived problems with beta-blocker therapy, such as effects on blood lipids, complications in diabetes, and adverse effects on heart failure and quality of life. DATA SOURCES: MEDLINE and EMBASE searches done from July 1994 on, and recognized texts. STUDY SELECTION: More than 400 original and review articles were evaluated, of which the most relevant were selected. DATA EXTRACTION: Data were extracted and reviewed by two authors. Accuracy was confirmed, when necessary, by the other authors. DATA SYNTHESIS: Of all of the therapies currently available for the prevention of sudden cardiac death, none is more established or more effective than beta-blockers. Indeed, the evidence that beta-blockers have a cardioprotective effect is compelling. They probably reduce the rate of atheroma formation; they reduce the risk for ventricular fibrillation in animal models of myocardial ischemia; they appear to reduce cardiac mortality in primary prevention trials; and they reduce mortality, particularly from sudden death, in patients who have had infarction. Moreover, withholding beta-blockers because of problems perceived to be associated with them is usually not warranted and may frequently prevent their use in those who will benefit most from them. CONCLUSION: Clinicians should reappraise the evidence for the significant effect of beta-blockers on morbidity and mortality, and they should recognize the importance of initiating and maintaining beta-blocker therapy when the less well-informed might suggest otherwise.

Adrenergic beta-Antagonists↗
PubMed1995

Risk indicators for death and prognosis among patients in whom acute myocardial infarction was not confirmed in relation to prescription of beta blockers at discharge.

A large number of studies have shown the prognosis after acute myocardial infarction (AMI) to be favorably affected by treatment with beta blockers. Whether such treatment also will have a favorable effect on the prognosis in patients in whom AMI was not confirmed has not been shown. A study was undertaken at Sahlgren's Hospital, Göteborg, to determine risk indicators for death and prognosis among 1,443 patients in whom AMI was not confirmed and who survived hospitalization in relation to whether or not beta blockers were prescribed at discharge. One-year mortality was determined and p values were corrected for differences at baseline. Of the 1,443 patients who participated in the analyses, 44% were prescribed beta blockers. They differed from the remaining patients by younger age, predominance of men, a more frequent history of AMI, angina pectoris, and hypertension, and a less frequent history of congestive heart failure. Patients in whom beta blockers were prescribed had a 1-year mortality of 6% compared with 16% in those not on beta blockers (p < 0.001). The difference was similar in various subgroups according to clinical history.

Adrenergic beta-Antagonists↗
PubMed1995

In consecutive patients hospitalized with acute myocardial infarction, infarct location according to routine electrocardiogram is of minor importance for the outcome.

Most studies have suggested that patients with anterior myocardial infarction have an adverse prognosis compared with patients with inferior infarction. The objective of this study was to compare the mortality and morbidity in anterior versus inferior acute myocardial infarction (AMI) during 1 year in a consecutive series of patients hospitalized with AMI. All patients fulfilling the criteria for AMI who were admitted to a single hospital during 21 months (n = 921) participated in the study. Patients with anterior infarction (n = 312) had a 1-year mortality rate of 26% versus a rate of 24% for patients with inferior infarction (n = 269) (p > 0.2). The corresponding figures for patients with no previous infarction who developed Q waves were 27 and 21%, respectively (p > 0.2). Reinfarction, thromboembolic events, and other aspects of morbidity during long-term follow-up appeared with similar frequency in the two groups. Thus, in a nonselected group of patients admitted to a single hospital because of AMI, the prognosis was found to be similar among patients with inferior and those with anterior infarction. In the subset of patients with a first myocardial infarction who developed Q waves, there was a trend indicating higher mortality in anterior infarction.

Adrenergic beta-Antagonists↗
PubMed1995

High prevalence of antibodies against beta 1- and beta 2-adrenoceptors in patients with primary electrical cardiac abnormalities.

OBJECTIVES: This study sought to determine the prevalence of autoantibodies directed against the beta-adrenoceptors in patients with primary electrical cardiac abnormalities, including atrial arrhythmias, ventricular arrhythmias and conduction disturbances, in the absence of any other cardiac abnormality. BACKGROUND: Using synthetic peptides corresponding to the predicted sequences for the second extracellular loop of the human beta 1- and beta 2-adrenoceptors as antigenic targets, autoantibodies directed against the beta-adrenoceptors were recently shown to occur in patients with idiopathic dilated cardiomyopathy and Chagas' heart disease. METHODS: Eighty-six patients (57 with primary electrical abnormalities, 29 with idiopathic dilated cardiomyopathy) and 101 healthy and cardiopathic control subjects were studied. Antibodies against the beta 1- and beta 2-peptides were detected with an enzyme immunoassay performed in blinded manner. In nine selected (seropositive) cases, the immunoglobulin G (IgG) fraction was tested for functional effects on the rate of beating of cultured neonatal rat cardiomyocytes. RESULTS: Antibodies recognizing the beta 1- and beta 2-peptides were found in 11 (52.3%) of 21 patients with ventricular arrhythmias (p < 0.01), 5 (35.7%) of 14 patients with conduction disturbances (p < 0.05), 3 (13.6%) of 22 patients with atrial arrhythmias (p > 0.05) and 11 (37.9%) of 29 patients with dilated cardiomyopathy (p < 0.05) compared with 15 (14.8%) of 101 control subjects. A rapid increase in the rate of beating of the cultured cardiomyocytes was induced by IgG from a selected group of patients, suggesting an agonist-like interaction with a functional epitope. This response was mediated by stimulation of both the beta 1- and beta 2-adrenoceptors in the patients with primary ventricular arrhythmias but only the beta 1-adrenoceptors in the patients with idiopathic dilated cardiomyopathy. CONCLUSIONS: Primary ventricular arrhythmias and conduction disturbances, like idiopathic cardiomyopathy, show a high prevalence of antibodies interacting with functional epitopes of the beta-adrenoceptors, suggesting a common or similar abnormal immunoregulatory process.

Adult↗
PubMed1995

Functional epitope analysis of the second extracellular loop of the human heart muscarinic acetylcholine receptor.

Two synthetic peptides corresponding to amino acids 172-181 and 169-193 of the second extracellular loop of the human M2 muscarinic receptor respectively were used to raise antibodies in rabbits. Affinity-purified antibodies were able not only to recognize a major band with a molecular weight of about 80 kDa on the electrotransferred membrane proteins of rat ventricular membranes but also to localize the muscarinic receptors on the sarcolemma and t-tubules of rat cardiomyocytes. Antibodies were also able to mimic muscarinic agonist stimulation as demonstrated by a negative chronotropic effect on cultured neonatal cardiomyocytes. In contrast with the antibodies raised against the peptide 169-193, the antibodies against the peptide 172-181 were unable to inhibit muscarinic ligand binding. These results suggest that the decapeptide 172-181 contains the B-cell epitope responsible for the functional effect of antibodies directed against the second extracellular loop of the receptor. Coupling this peptide by cystein 177 blocks the induction of antibodies with pharmacological effects but induces antibodies which are able to recognize the denatured receptor protein and to exert a negative chronotropic effect.

Amino Acid Sequence↗
PubMed1995

Localization of muscarinic receptors in human heart biopsies using rabbit anti-peptide antibodies.

Immunocytochemistry of muscarinic receptors on human heart biopsies from patients with heart disease was studied using rabbit antibodies against a synthetic peptide corresponding to amino acids 168-192 of the second extracellular loop of the human M2 muscarinic receptor. By using both light and electron microscopic immunocytochemistry techniques, muscarinic receptors were visualized on sarcolemma of human myocytes from patients with different heart diseases such as coronary heart disease and dilated cardiomyopathy in adults and congenital heart disease in children. The patchy distribution of immunoreactivity suggests a muscarinergic activity in vivo. These reactivities were abolished by preincubation of antibodies with antigenic peptide and were not shown in the absence of antibodies. Moreover, these antibodies were able to interfere with muscarinic ligand binding in myocardium from human dilated cardiomyopathy as shown by decreases in binding sites and antagonist affinity. These results demonstrate that the antibodies against the second extracellular loop of the human M2 muscarinic receptor can specifically recognize muscarinic receptors in human tissue and display pharmacological activity in human diseased myocardium, confirming their usefulness for the study of localization and function of muscarinergic activity in the human heart.

Adult↗
PubMed1995

Does a history of diabetes mellitus adversely affect the outcome in hypertensive patients with acute chest pain?

BACKGROUND: We evaluated the impact of diabetes mellitus on the prognosis in hypertensive patients admitted to hospital as a result of acute chest pain. PATIENTS: All patients in this study had a history of hypertension and were admitted to the Emergency Department at Sahlgrenska Hospital, Göteborg, Sweden, complaining of chest pain, or other symptoms suggestive of acute myocardial infarction, between 15 February 1986 and 9 November 1987. METHODS: All patients were prospectively registered on admission to the Emergency Department and followed for 1 year in terms of mortality and morbidity. RESULTS: Of the 1274 patients who fulfilled the inclusion criteria, 187 (15%) had a history of diabetes mellitus. The 1-year mortality rate for all hypertensive patients was 18%, whereas it was 24% for those who also had diabetes mellitus, and 16% for hypertensive patients without diabetes mellitus (P < 0.05). However, in a multivariate analysis considering age, sex, and history of cardiovascular diseases, the following appeared as independent predictors of death in the hypertensive patients: age (P < 0.001), a history of congestive heart failure (P < 0.001), and male sex (P < 0.01). CONCLUSION: Hypertensive patients who were admitted to the Emergency Department of Sahlgrenska Hospital with acute chest pain had a poor prognosis, which was even worse if they also had a history of diabetes mellitus. The relationship between diabetes mellitus and hypertension could not, however, be clearly defined.

Age Factors↗
PubMed1995

Metoprolol treatment for two years after coronary bypass grafting: effects on exercise capacity and signs of myocardial ischaemia.

OBJECTIVE: To evaluate whether prophylactic treatment with metoprolol for two years after coronary artery bypass grafting improves working capacity and reduces the occurrence of myocardial ischaemia in patients with coronary artery disease. METHODS: After coronary artery bypass grafting, patients were randomised to treatment with metoprolol or placebo for two years. Two years after randomisation, a computerised 12-lead electrocardiogram was obtained during a standardised bicycle exercise test in 618 patients (64% of all those randomised). RESULTS: The median exercise capacity was 140 W in the metoprolol group (n = 307) and 130 W in the placebo group (n = 311) (P > 0.20). An ST depression of > or = 1 mm at maximum exercise was present in 34% of the patients in the metoprolol group and 38% in the placebo group (P > 0.20) and an ST depression of > or = 2 mm at maximum exercise was present in 11% in the metoprolol group and 16% in the placebo group (P = 0.09). The median values for maximum systolic blood pressure were 200 mm Hg in the metoprolol group and 210 mm Hg in the placebo group (P < 0.0001), while the median values for maximum heart rate were 126 beats/min in the metoprolol group and 143 beats/min in the placebo group (P < 0.0001). The occurrence of cardiac and neurological clinical events two years postoperatively among exercised patients was comparable in the treatment groups. CONCLUSIONS: Treatment with metoprolol for two years after coronary artery bypass grafting did not significantly change exercise capacity or electrocardiographic signs of myocardial ischaemia.

Adrenergic beta-Antagonists↗
PubMed1995

Prognosis in patients with acute chest pain in relation to chronic beta-blocker treatment prior to admission to hospital.

We evaluated the prognosis among consecutive patients hospitalized for acute chest pain or other symptoms suggestive of acute myocardial infarction (AMI) in relation to whether they were on chronic treatment with beta-blockers at onset of symptoms or not. In all, 3,504 patients were included in the analyses, of whom 936 (27%) were on chronic beta-blockade. Of the patients on beta-blockade, 25% developed AMI as compared with 21% of the remaining patients (p > 0.2). The mortality during the first 28 days was 7% in patients on chronic beta-blockade as compared with 5% in those not on beta-blockade (p > 0.2). When correcting for differences at baseline, chronic treatment with beta-blockers did not significantly influence the outcome.

Acute Disease↗