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Elisabeth Ståhle

Publications and source records attributed to Elisabeth Ståhle.

At least 19 recordsLinked to original sources
PubMed2006

Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002.

BACKGROUND: Current knowledge of prevalence, incidence, and survival in thoracic aortic diseases (aneurysm and dissection) is based on small studies from a dated era of treatment and diagnostic procedures. The objective of the present study was to reappraise epidemiology and long-term outcomes in subjects with thoracic aortic disease in a large contemporary population. METHODS AND RESULTS: All subjects with thoracic aortic aneurysm or dissection identified in Swedish national healthcare registers from 1987 to 2002 were included in the present study. Of 14,229 individuals with thoracic aortic disease, 11,039 (78%) were diagnosed before death. Incidence of thoracic aortic disease rose by 52% in men and by 28% in women to reach 16.3 per 100,000 per year and 9.1 per 100,000 per year, respectively. Operations increased 7-fold in men and 15-fold in women over time. Of the 2455 patients who underwent operation, 389 (16%) died within 30 days, with older age and thoracic aortic rupture as risk factors. In Cox analysis, increasing age was the only variable associated with long-term mortality. Both short- and long-term mortality improved over time. In patients who underwent operation, actuarial survival (95% CI) at 1, 5, and 10 years was 92% (91% to 93%), 77% (75% to 80%), and 57% (53% to 61%), respectively. The cumulative incidence of thoracic aortic reoperations was 7.8% at 10 years. CONCLUSIONS: The prevalence and incidence of thoracic aortic disease was higher than previously reported and increasing. The annual number of operations increased substantially. Surgical (30-day) and long-term survival improved significantly over time to form a growing cohort of patients needing counseling, management decisions, operations, and extended postoperative surveillance.

Adult↗
PubMed2006

The platelet inhibiting effect of a clopidogrel bolus dose in patients on long-term acetylsalicylic acid treatment.

INTRODUCTION: Addition of clopidogrel to patients treated with ASA has been shown to decrease the incidence of in-stent thrombosis after percutaneous coronary interventions. However, it has also been reported that up to 30% of patients do not achieve adequate platelet inhibition from standard dosages of ASA and clopidogrel. There is a demand for reliable methods to measure the individual platelet inhibiting effect of this combination therapy. MATERIALS AND METHODS: The primary aim of the present investigation was to compare three methods for evaluation of the platelet inhibiting effect of a clopidogrel bolus dose in patients on long-term acetylsalicylic acid treatment. Thirty patients presenting for coronary angiography/PCI were included. Two patients were excluded due to technical problems. All patients were on 75-100 mg ASA/day for at least 8 days. Blood samples were analysed before and 16 h after a 300 mg clopidogrel bolus dose. The platelet inhibiting effect was measured with (1) Whole blood flow cytometry (17 patients); (2) a bed-side test, Platelet Mapping assay for the thrombelastograph (28 patients); and (3) PFA (Platelet function analyser) -100 (26 patients). RESULTS: With flow cytometry, the percentage of platelets expressing P-selectin (p=0.03) on their surface decreased significantly after the bolus dose of clopidogrel. There was also a reduction of platelets binding fibrinogen when stimulated with ADP. A significantly (p=0.002) increased platelet inhibition could also be demonstrated with Platelet Mapping. PFA-100 could not measure any significant platelet inhibiting effect of clopidogrel. CONCLUSION: A significant platelet inhibition could be demonstrated with flow cytometry and the Platelet Mapping assay, but not with PFA-100. However, levels of response for the individual patient with these three methods were inconsistent. Further studies are needed to evaluate how the results correlate to the clinical risk of thrombosis and bleeding.

Aged↗
PubMed2006

5-year outcomes in the FRISC-II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: a follow-up study.

BACKGROUND: The FRISC-II invasive trial compared an early invasive with a non-invasive strategy in terms of death and myocardial infarction in non-ST-elevation acute coronary syndrome. We present 5-year follow-up results, overall and in subgroups based on recommended risk stratification criteria. METHODS: In the FRISC-II trial, 2457 patients with non-ST-elevation acute coronary syndrome were randomised to early invasive strategy (coronary angiography and, if appropriate, revascularisation, within 7 days from admission) or non-invasive primarily medical strategy. Risk stratification was done on the basis of risk indicators at randomisation: age older than 65 years, male sex, diabetes mellitus, previous myocardial infarction, ST-segment depression, raised troponin concentration (>0.03 mug/L), and raised C-reactive protein or interleukin 6. Information on events after 24 months was taken from national registries. Analyses were done on an intention-to-treat basis. FINDINGS: At 5 years the groups differed in terms of the primary composite endpoint of death, myocardial infarction, or both (invasive 217, 19.9 %; noninvasive 270, 24.5 %; risk ratio 0.81; 95% CI 0.69-0.95; p=0.009). 5-year mortality was 117 (9.7%) in the invasive group compared with 124 (10.1%) in the noninvasive group (0.95; 0.75 -1.21; p=0.693). Rates of myocardial infarction were 141 (12.9 %) in the invasive and 195 (17.7%) in the non-invasive group (0.73; 0.60-0.89; p=0.002). The benefit of the invasive strategy was confined to male patients, non-smokers, and patients with two or more risk indicators. INTERPRETATION: The 5-year outcome of this trial indicates sustained benefit of an early invasive strategy in patients with non-ST-elevation acute coronary syndrome at moderate to high risk.

Adult↗
PubMed2006

Outcome of percutaneous coronary intervention in hospitals with and without on-site cardiac surgery standby.

OBJECTIVE: To compare characteristics and outcome of patients undergoing percutaneous coronary intervention (PCI) in clinics with (WSB) or without (NOSB) on-site cardiac surgery backup. DESIGN: Analysis according to hospital, type of prospectively collected data of all patients who underwent PCI during 2000-3. SETTING: The Swedish Coronary Angiography and Angioplasty Registry covers all PCI procedures performed in Sweden. PATIENTS: 34,363 patients underwent PCI between January 2000 and December 2003. 8838 procedures were performed in NOSB (mean age of patients was 64.5 years) hospitals and 25,525 in WSB (mean age of patients was 64.1 years) hospitals (p = 0.002). RESULTS: More patients in NOSB hospitals had diabetes (17.8% vs 16.8%; p = 0.03). Other clinical characteristics (previous infarct, previous coronary artery bypass graft (CABG)) also showed a tendency towards worse patients being treated in NOSB hospitals. However, there was a higher percentage of patients with ST-segment elevation myocardial infarction (18% vs 9.7%; p<0.01) in WSB hospitals. After adjusting for differences in baseline risk no significant differences regarding outcome (30-day mortality, 1-year mortality, stroke and emergency CABG) were observable between WSB and NOSB hospitals. This applied to elective and non-elective procedures. CONCLUSIONS: On the basis of these data it does not seem warranted to recommend against percutaneous transluminal coronary angioplasty in NOSB hospitals.

Angioplasty, Balloon, Coronary↗
PubMed2006

The Swedish Heart Surgery Register: data quality for proximal thoracic aortic operations.

OBJECTIVES: To review the data quality and validity in the nationwide Swedish Heart Surgery register for patients operated on the proximal thoracic aorta. DESIGN: Medical records from a random sample of 300 patients in The Swedish Heart Surgery register were reviewed with register data items systematically re-reported. Variable reporting frequency, proportion of adequately reported data, and number and correctness of diagnostic and procedural codes were analysed. RESULTS: After exclusions, 251 patients (84%) remained in the analysis. Reporting frequency for individual items varied from 12% to 100% (median 61%). For core variables, reporting frequency was 96%-100%. In 40 of 43 (93%) reviewed variables, registry data were at least 85% correct. A total of 485 diagnoses and 673 procedures were reported, compared to 617 diagnoses and 758 procedures identified in the review process. CONCLUSIONS: The register data quality and validity for patients operated on the proximal thoracic aorta was satisfactory overall, but need further improvement for complications. The register coverage and completeness was very high. Register-based reports should be accompanied by review of data quality.

Aorta, Thoracic↗
PubMed2006

The central circulation in congestive heart failure non-invasively evaluated with dynamic positron emission tomography.

BACKGROUND: Positron emission tomography (PET) with [15O]-H2O-PET (WAT-PET) or [11C]-acetate (AC-PET) quantifies myocardial perfusion and oxidative metabolism, but routine clinical use is hampered by the need for additional investigations to assess cardiac performance. OBJECTIVE: To apply classical tracer kinetics to dynamic PET could provide important haemodynamic parameters. METHODS: First-pass PET data were used with indicator dilution techniques to measure stroke volume index (SVI). Early pulmonary retention of [11C]-acetate was converted to standard uptake values (SUV) (Lung(AC-SUV)). Regional lung water (rLW) content was computed from the WAT-PET scan at equilibrium. PET was compared with radionuclide angiography and echocardiography in patients with ischaemic cardiomyopathy with New York Heart Association class II (n = 10) or III (n = 18) congestive heart failure. Elderly male volunteers without heart disease (n = 11) underwent AC-PET as controls. RESULTS: SVI with both tracers correlated in patients (r = 0.91, P<0.001, estimated standard error = 4 ml m(-2)) and with left ventricular ejection fraction (both tracers r>0.6, P<0.001). SVI was significantly different between all groups (ANOVA: P<0.001). Lung(AC-SUV) correlated with rLW (r = 0.78, P<0.001) and both were elevated in severe heart failure (P<0.05 for both). Elevated Lung(AC-SUV) was associated with a restrictive left ventricular (LV) filling pattern by Doppler echocardiography. CONCLUSION: Dynamic PET with first-pass analysis and tracers of myocardial perfusion enables quantification of the haemodynamic consequences of LV systolic and diastolic dysfunctions in ischaemic cardiomyopathy and could be useful in the evaluation of the central circulation in heart failure.

Acetates↗
PubMed2005

Quality of life after heart valve surgery with prolonged intensive care.

BACKGROUND: A small proportion of patients undergoing heart valve operations require prolonged intensive care after surgery. Little is known about the quality of life that such patients attain after hospital discharge. METHODS: All consecutive patients who underwent primary heart valve surgery from 1998 to 2003 and required 8 days or more of treatment in an intensive care unit (ICU) were included (n = 225). At follow-up on August 31, 2004, 154 of these patients were alive. A cohort (n = 154) matched for sex, age, type of procedure, and week of operation, with an uncomplicated postoperative course (ICU stay of 2 days or less), served as the control group. All patients received the Medical Outcomes Study Short-Form 36, the Nottingham Health Profile, and the Hospital Depression and Anxiety scale to evaluate their quality of life. RESULTS: Survival at 5 years in the total ICU group was 68% (154 of 225). According to SF-36, the ICU study cohort reported poorer physical health but equal mental health compared with controls. On the Nottingham Health Profile, the ICU group reported more problems in all domains except emotional reactions and sleep. There was no difference in anxiety or depression between the groups. The ICU patients were in more advanced New York Heart Association functional classes preoperatively and postoperatively. No patient in the ICU study cohort regretted undergoing the operation, and 80% experienced improvement after surgery. CONCLUSIONS: This study showed reduced quality of life in terms of physical health and equal mental health in patients who required prolonged intensive care after heart valve surgery compared with controls without complications.

Adult↗
PubMed2004

Quantitative T-wave analysis predicts 1 year prognosis and benefit from early invasive treatment in the FRISC II study population.

AIMS: To investigate the prognostic value of T-wave abnormalities in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), and whether such ECG changes may predict benefit from an early coronary angiography. Although ST-segment changes are considered the most important ECG feature in NSTE-ACS, T-wave abnormalities are the most common ECG finding. We hypothesize that a new quantitative approach to T-wave analysis could improve the prognostic value of this ECG abnormality. METHODS AND RESULTS: Quantitative T-wave analysis was performed on the admission ECG in 1609 patients with NSTE-ACS. Nine different categories of T-wave abnormality were analysed for their prognostic value concerning clinical outcome in patients not randomized to early coronary angiography. Also, the presence of one category (i.e. T-wave abnormality in > or =6 leads) was analysed for its predictive value concerning benefit from early coronary angiography. The combined study endpoint was death or myocardial infarction at 1 year follow-up. Patients with > or =6 leads with abnormal T-waves and concomitant ST-segment depression had a higher risk when not receiving early coronary angiography (24 vs. 12%, respectively; P=0.003), but could be brought to the same level of risk as the remaining patients with this treatment. For non-invasively treated patients five different categories of T-wave abnormality were significantly associated with an adverse outcome. CONCLUSION: New quantitative T-wave analysis of the admission ECG gives additional predictive information concerning clinical outcome and identifies patients who benefit from early coronary angiography.

Aged↗
PubMed2004

Survival after mitral valve replacement: rationale for surgery before occurrence of severe symptoms.

BACKGROUND: This study was undertaken to evaluate survival after mitral valve replacement, with a focus on the impact of age and preoperative symptoms. METHODS: Survival was analyzed in 784 patients undergoing mitral valve replacement from 1980 through 2000. Relative survival was estimated by relating the observed survival to the expected survival in a cohort, comparable regarding sex, age group, and calendar period, in the general Swedish population. RESULTS: Early mortality was 9.7%. Relative survival rates after 5, 10, and 15 years were 83%, 70%, and 54%, respectively. The corresponding rates for observed survival were 75%, 56%, and 36%. Advanced New York Heart Association class, but not high age, was a risk factor for early mortality, whereas both factors decreased survival. An association between age and New York Heart Association class was found, the majority of old patients also being severely symptomatic. Patients in New York Heart Association classes I and II showed excellent relative survival. CONCLUSIONS: Survival is reduced after mitral valve replacement in patients with severe preoperative symptoms, whereas patients with less-severe symptoms show excellent survival. Older patients were more often severely symptomatic at the time of surgery. Irrespective of age, surgery before the occurrence of advanced symptoms should improve the long-term outcome.

Adult↗
PubMed2004

Body mass index and albumin in the preoperative evaluation of cardiac surgery patients.

BACKGROUND AND AIMS: An increasing proportion of cardiac surgery is performed in the elderly where nutritional status is an important predictor of outcome. Our aim was to evaluate serum albumin concentration (S-albumin) and body mass index (BMI) as markers of malnutrition in relation to outcome measured as mortality and frequency of infections. PATIENTS AND METHODS: We studied 886 consecutive patients who underwent cardiac surgery with extra-corporeal circulation for valve procedures, coronary artery bypass grafting or a combination of those. Preoperative assessment included age, gender, BMI, smoking habits, diabetes, left-ventricular function, S-albumin and C-reactive protein. Postoperative data was type of surgery, in-hospital stay, signs of infections and mortality. Risk factors for mortality were identified using the Cox proportional hazard model and risk factors for infections by using the logistic-regression model. RESULTS: The patients (age 67+/-9.5 years) were followed for 22+/-6 months. In an univariate analysis low BMI and low S-albumin increased relative hazard for death and risk for infection. In a multivariate analysis low BMI, but not S-albumin, increased relative hazard for death and low S-albumin, but not BMI, increased risk for infection. Age, diabetes and longer bypass time increased the risk for infection. CONCLUSION: In cardiac surgery patients a low BMI increased the relative hazard for death and low S-albumin increased the risk for infection. We suggest that these parameters provide useful information in the preoperative evaluation.

Age Factors↗
PubMed2004

Visualisation and quantification of peri-operative myocardial infarction after coronary artery bypass surgery with contrast-enhanced magnetic resonance imaging.

AIMS: To evaluate if elevated biochemical marker levels after coronary artery bypass grafting (CABG) correspond to the amount of peri-operatively infarcted myocardium, quantified by magnetic resonance imaging (MRI) post-operatively. METHODS AND RESULTS: A total of 23 patients without evidence of previous myocardial infarction or myocarditis and with normal pre-operative ECG and left ventricular function and who underwent elective, primary CABG, without any other concomitant cardiac surgery, were included. Plasma creatinine kinase MB (CK-MB) and troponin I and T were measured on the first, second and fourth post-operative days. Between the fourth and ninth post-operative days, cardiac MRI was carried out. Infarctions were found in 18 patients. The infarction mass at MRI was numerically largest in patients with transmural infarctions, all of whom had a CK-MB more than five times the upper normal limit. All three cardiac markers correlated to the mass of infarction. CONCLUSION: Elevated biochemical markers after CABG correspond to the amount of peri-operatively infarcted myocardium.

Aged↗
PubMed2003

Survival in primary lung cancer potentially cured by operation: influence of tumor stage and clinical characteristics.

BACKGROUND: Surgical resection is currently standard treatment in early stage lung cancer. The aim of the present study was to identify stage-related factors and patient characteristics influencing survival after complete resection. METHODS: We identified 395 patients with non-small cell lung cancer who had undergone potentially radical operation during 1987 to 1999 at one thoracic surgery institution in central Sweden. Factors independently related to survival were identified in a multivariate analysis. Survival was analyzed in low-, medium-, and high-risk groups based on a risk score calculated from relative hazards for identified risk factors. RESULTS: Overall 5-year survival among the 395 patients was 51%. The strongest factor predicting prognosis was positive lymph nodes at operation. Higher age, earlier period for operation, impaired lung function, current smoking, and major operative complication were all related to poorer prognosis. Patients with tumor stage Ia had a 5-year survival of 69%, compared to 73% in patients in the low-risk group. CONCLUSIONS: Tumor stage is the best prognostic indicator after radical operation. Inclusion of other tumor- and patient-related variables did not add prognostic information of clinical relevance beyond that provided by tumor stage alone.

Adenocarcinoma↗
PubMed2003

Evaluation of laboratory markers for the detection of infections in open-heart surgery patients.

This study compared the efficiency of interleukin-6 (IL-6), human neutrophil lipocalin (HNL), C-reactive protein (CRP) and white blood cell (WBC) count for the early detection of postoperative bacterial infections after open-heart surgery. These laboratory markers were determined preoperatively and monitored daily during the first 6 postoperative days. Postoperative bacterial infections were diagnosed in 17 of 54 studied patients needing at least 3 d of intensive care. Patients with less than 3 d of intensive care were not studied. HNL and WBC count showed no significant differences between infected and non-infected groups, whereas both IL-6 and CRP were significantly higher in the infected group. IL-6 levels were higher (p < 0.01) in the infected patients on the first postsurgical day, although with considerable interindividual variation. CRP levels rose on the second postsurgical day and showed less variation (p < 0.01). Calculation of the differences between preoperative and postoperative levels of IL-6 and CRP was not helpful for early detection of postoperative infections. Although IL-6 showed an earlier mean rise than CRP in patients developing postoperative infection, its substantial interindividual variation limits its clinical usefulness. HNL and WBC counts were ineffectual as indicators of postoperative infections in this study.

Adult↗
PubMed2003

Nasal and hand carriage of Staphylococcus aureus in staff at a Department for Thoracic and Cardiovascular Surgery: endogenous or exogenous source?

OBJECTIVE: To investigate the rates of Staphylococcus aureus carriage on the hands and in the noses of healthcare workers (HCWs) and the relatedness of S. aureus isolates found in the two sites. DESIGN: Point-prevalence study. SETTING: Department for Thoracic and Cardiovascular Surgery at the University Hospital of Uppsala, Uppsala, Sweden. SUBJECTS AND METHODS: Samples were obtained from 133 individuals, 18 men and 115 women, using imprints of each hand on blood agar and a swab from the nose. S. aureus isolates were identified by standard methods and typed by pulsed-field gel electrophoresis. RESULTS: S. aureus was found on the hands of 16.7% of the men and 9.6% of the women, and in the noses of 33.3% of the men and 17.4% of the women. The risk ratio for S. aureus carriage on the hands with nasal carriage was 7.4 (95% confidence interval, 2.7 to 20.2; P < .001). Among the 14 HCWs carrying S. aureus on their hands, strain likeness to the nasal isolate was documented for 7 (50%). CONCLUSIONS: Half of the HCWs acquired S. aureus on the hands from patients or the environment and half did so by apparent self-inoculation from the nose. Regardless of the source of contamination, good compliance with hand hygiene is needed from all HCWs to protect patients from nosocomial infections. The moderate rate of S. aureus carriage on hands in this setting could be the result of the routine use of alcoholic hand antisepsis.

Adult↗
PubMed2003

Simple and accurate assessment of forward cardiac output by use of 1-(11)C-acetate PET verified in a pig model.

UNLABELLED: Dynamic 1-(11)C-acetate PET (AC-PET) allows quantification of myocardial blood flow and oxidative metabolism. We wanted to determine the accuracy of AC-PET in measuring cardiac output (CO) using first-pass analysis and the indicator dilution principle. Further, we wanted to investigate the pulmonary uptake of acetate in relation to left atrial filling pressures and ventricular function. METHODS: Twenty-four steady-state experiments were performed in 5 domestic pigs. Pulmonary capillary wedge pressure (PCWP) and CO by thermodilution (CO(thermo)) were recorded invasively simultaneous with AC-PET scans at baseline (n = 9), dobutamine infusion (n = 6), high-dose metoprolol and morphine (n = 6), and angiotensinamide infusion (n = 3). 1-(11)C-Acetate was injected as a rapid manual bolus. Regions of interest (ROIs) were placed in the right (RV) and left (LV) heart cavities. Time-activity curves were constructed and the area under the curve (AUC) was integrated from beginning the scan to the time of visually determined recirculation by simple arithmetic. CO by PET (CO(PET)) was calculated as injected dose/AUC. Image handling and curve analysis were repeated by a blinded observer. Total pulmonary extravascular retention of (11)C, expressed as percentage of injected dose (lung-uptake %ID), was measured using a combination of transmission, (15)O-carbon monoxide, and AC-PET scans. RESULTS: CO(thermo) ranged from 2.1 to 8.2 L/min. CO(PET) determined from both LV and RV was linearly related to CO(thermo) with slopes close to 1 (LV, r = 0.98; RV, r = 0.96; both P < 0.001). Interobserver reproducibility was r = 0.98, P < 0.001. The PCWP range was 6-14 mm Hg and the lung-uptake %ID was 2.7-8.5 %ID. When normalized to baseline, lung-uptake %ID was correlated with PCWP (r = 0.56, P = 0.01) and linearly correlated with LV input resistance (PCWP divided by CO(thermo); r = 0.91, P < 0.001). When both lung-uptake %ID and stroke volume were normalized to baseline, a piecewise linear relation was found (r = 0.95, P < 0.001). CONCLUSION: Our results suggest that measurements of CO by AC-PET are feasible and accurate. Using RV ROIs might favor CO measurements by any injectable PET tracer. The lung-uptake %ID might be useful in evaluation of pulmonary congestion, but further studies are needed.

Acetates↗