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Biomedical subjects

P Albertsson

Publications and source records attributed to P Albertsson.

At least 37 records · Page 2Linked to original sources

Preoperative left-ventricular ejection fraction does not influence the improvement in quality of life after coronary artery bypass surgery.

Coronary artery bypass grafting (CABG) is an established treatment for angina pectoris which conveys relief of chest pain and improved physical performance. However, increased survival has only been observed in selected subgroups of patients with advanced coronary artery disease, particularly in the presence of depressed left-ventricular ejection fraction (LVEF). It is therefore of interest to study whether the outcome in terms of quality of life (QoL) is also more favorable in candidates with depressed LVEF. All patients who underwent CABG without concomitant valve surgery in western Sweden between 6.1988 and 6.1991 (n = 2121) were sent questionnaires on QoL involving 3 different instruments, the Physical Activity Score, the Nottingham Health Profile, and the Psychological General Well-being Index. They were submitted before surgery and 3 times in the 2 years thereafter. QoL was improved on all postoperative occasions. The degree of improvement was not associated with preoperative LVEF for any of the instruments. The postoperative Physical Activity Score was associated with preoperative LVEF. The other instruments showed no such association with LVEF. The improvement in QoL during 2 years after CABG is not dependent on the LVEF determined prior to operation. Self-estimated physical abilities are postoperatively associated with preoperative LVEF whereas health-related QoL and general well-being are not.

Aged↗

Effects of spinal cord stimulation on coronary blood flow velocity.

BACKGROUND: Spinal cord stimulation (SCS) has been used in the treatment of severe angina pectoris since the 1980s. Several studies have shown both an antianginal and an anti-ischaemic effect. There are several theories about the mechanism behind the anti-ischaemic effect of SCS, including the possibility that it is dependent on an increase in coronary flow velocity. OBJECTIVE: To determine if there were effects of SCS on coronary flow velocity during cardiac stress. METHOD: Eight patients with severe anginal pain secondary to coronary artery disease who had been implanted with an SCS device were included in the study. In addition, four patients with syndrome X were examined. If possible, a Doppler guidewire was placed in the vessel corresponding to the ischaemic area revealed on a prior myocardial scintigram. A temporary pacemaker electrode was placed in the right atrium. Atrial pacing started at 80 beats/min and increased by 10 beats/min every 2 min until the patient experienced moderate angina; the pacing frequency was then maintained at the same level. After 2 min of pacing at this frequency, SCS treatment commenced; after a further 5 min, pacing was stopped. Throughout the procedure, coronary flow velocity, assessed as average peak velocity (APV), was monitored continually. RESULTS: APV increased during pacing in all the patients with coronary artery disease (mean increase 53%; P < 0.02). There were no significant changes in APV during maximum pacing frequency when stimulation was introduced. CONCLUSIONS: The results of this study do not support the theory that the anti-ischaemic effect of SCS is dependent on an increase in coronary flow velocity.

Angina Pectoris↗

Morbidity and use of medical resources in patients with chest pain and normal or near-normal coronary arteries.

To evaluate morbidity and use of medical resources in patients with chest pain and normal or near-normal coronary angiograms: 2,639 consecutive patients who underwent coronary angiograms due to chest pain were registered. Two years thereafter all patients who showed normal or near-normal coronary angiograms were approached with a questionnaire regarding hospitalization during the last 4 years (2 years before and 2 years after angiography). All medical files were also examined. Of the patients who underwent angiography, 163 (6%) had no significant stenoses, and of these, 113 showed complete normal angiograms and 50 showed mild (i.e. <50%) stenoses. During the 2 years before diagnostic angiogram, 66% of the patients were hospitalized compared with only 35% during 2 years after angiography (p <0.001). The reduction in hospitalization was due to curtailed utilization of medical resources for cardiac reasons; mean days in hospital was 6.6 days before angiography versus 2.8 days after (p <0.001). There were no significant differences in hospitalization when comparing patients with mild stenoses and completely normal angiograms. There were, furthermore, no differences between patients with positive or negative exercise tests. Thus, the need for hospitalization is significantly reduced after a diagnostic angiogram reveals normal or near-normal coronary arteries.

Adult↗

Mortality and morbidity among patients who undergo combined valve and coronary artery bypass surgery: early and late results.

AIM: To describe mortality and morbidity early and late after combined valve surgery and coronary artery bypass grafting (CABG) as compared with CABG alone. PATIENTS AND METHODS: All patients from western Sweden in whom CABG in combination with valve surgery or CABG alone was carried out in 1988-1991. RESULTS: Among 2116 patients who underwent CABG, 35 (2%) had this combined with mitral valve surgery and 134 (6%) had this combined with aortic valve surgery, whereas the remaining 92% underwent CABG alone. Patients who underwent combined valve surgery and CABG were older, included more women and had a higher prevalence of previous congestive heart failure and renal dysfunction but on the other hand a less severe coronary artery disease. Among patients who underwent mitral valve surgery in combination with CABG the mortality over the subsequent 5 years was 45%). The corresponding figure for patients who underwent aortic valve surgery in combination with CABG was 24%. Both were higher than for CABG alone (14%; P < 0.0001 and P = 0.003, respectively). In a stepwise multiple regression model mitral valve surgery in combination with CABG was found to be an independent significant predictor for death but aortic valve surgery in combination with CABG was not. Among patients who underwent mitral valve surgery in combination with CABG and were discharged alive from hospital 77% were rehospitalized during the 2 years following the operation as compared with 48% among patients who underwent aortic valve surgery in combination with CABG and 43% among patients with CABG alone. Multiple regression identified mitral valve surgery in combination with CABG as a significant independent predictor for rehospitalization but not aortic valve plus CABG. CONCLUSION: Among patients who either underwent CABG in combination with mitral valve surgery or aortic valve surgery or CABG alone, mitral valve surgery in combination with CABG was independently associated with death and rehospitalization, but the combination of aortic valve surgery and CABG was not.

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Intracoronary blockade of angiotensin-converting enzyme in humans: interaction with cardiac sympathetic neurotransmission?

The present study was designed to identify an interaction between the renin-angiotensin system and noradrenergic transmission in the human heart. It is still under debate whether angiotensin II facilitates noradrenaline release in the heart. Clinical studies of congestive heart failure, involving systemic angiotensin-converting enzyme (ACE) inhibitor administration, have indicated anti-adrenergic effects, without giving a clear mechanistic picture. The influence on cardiac sympathetic transmission by local intracardiac administration of an ACE inhibitor has not been determined. Seven angina patients with normal left ventricular function, who underwent control coronary angiography after successful percutaneous transluminal coronary angioplasty were studied. Baseline measurements of haemodynamics and total and cardiac noradrenaline spillover were followed by handgrip exercise in the absence and presence of intracoronary enalaprilat infusion (0.05 mg min-1, 1 mL min-1). Baseline total body and cardiac noradrenaline spillover remained unchanged following intracoronary enalaprilat infusion, being 3745 +/- 349 and 3896 +/- 257 pmol min-1, and 148 +/- 56 and 149 +/- 55 pmol min-1, before and after drug administration, respectively. Mean arterial pressure, peripheral plasma renin activity and angiotensin II levels were also unaffected by enalaprilat infusion. During handgrip exercise procedures, both total body and cardiac noradrenaline spillover increased substantially, showing no reduction in the presence of intracardiac enalaprilat. Direct administration of the ACE inhibitor enalaprilat to the human heart failed to attenuate cardiac sympathetic drive during baseline conditions or following cardiac adrenergic activation by handgrip exercise. Thus, in the non-failing heart, without chronic adrenergic activation, no angiotensin II-facilitated effect on cardiac noradrenaline spillover could be detected.

Aged↗

Death, mode of death, morbidity, and rehospitalization after coronary artery bypass grafting in relation to occurrence of and time since a previous myocardial infarction.

To describe the prognosis during 2 years after coronary artery bypass grafting (CABG) in relation to occurrence of and time since a previous acute myocardial infarction (AMI), data of all patients in western Sweden who underwent CABG without simultaneous valve surgery in the period June 1988-June 1991 were evaluated. In all, 2120 patients were included in the analyses. Of these, 1296 (61%) had a history of AMI and 127 (6%) had suffered an AMI within the last month before CABG. Mortality during the first 30 days after CABG was for patients with no previous AMI, previous AMI > 30 days prior to CABG, and previous AMI < or = 30 days prior to CABG 2.4%, 4.1%, and 5.5%, respectively (p < 0.05). The corresponding figures for the period between 30 days and 2 years after CABG were 3.6%, 4.4%, and 3.4% respectively (NS). In a multivariate analysis among patients with a previous AMI, a recent infarction (< or = 30 days prior to CABG) did not turn out as an independent predictor of death during 2 years of follow-up. A history of AMI was associated with increased mortality during the first 30 days but not thereafter, but recent AMI was not an independent predictor of total 2-year mortality.

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Predictors of hospital readmission two years after coronary artery bypass grafting.

OBJECTIVE: To determine the clinical factors before, and in association with, coronary artery bypass grafting (CABG) that increase the risk of readmission to hospital in the first two years after surgery. PATIENTS: All patients in western Sweden who had CABG without simultaneous valve surgery between 1 June 1988 and 1 June 1991. METHODS: All patients who were readmitted to hospital were evaluated by postal inquiry and hospital records. RESULTS: A total of 2121 patients were operated on, of whom 2037 were discharged from hospital. Information regarding readmission was missing in four patients, leaving 2033 patients; 44% were readmitted to hospital. The most common reasons for readmission were angina pectoris and congestive heart failure. There were 12 independent significant predictors for readmission: clinical history (a previous history of either congestive heart failure or myocardial infarction, or CABG); acute operation; postoperative complications (time in intensive care unit greater than two days, neurological complications); clinical findings four to seven days after the operation (arrhythmia, systolic murmur equivalent to mitral regurgitation); medication four to seven days after the operation (antidiabetics, diuretics for heart failure, other antiarrhythmics (other than beta blockers, calcium antagonists, and digitalis), and lack of treatment with aspirin). CONCLUSION: 44% of patients were readmitted to hospital two years after CABG. The most common reasons for readmission were angina pectoris and congestive heart failure. Four clinical markers predicted readmission: clinical history; acute operation status; postoperative complications; and clinical findings and medication four to seven days after operation.

Adrenergic beta-Antagonists↗

Limitation of physical activity, dyspnea and chest pain prior to and during two years after coronary artery bypass grafting in relation to a history of hypertension.

AIM: To describe the limitation of physical activity, the cause of limitation of physical activity and symptoms of dyspnea and chest pain before and 2 years after coronary artery bypass grafting (CABG) in relation to a history of hypertension. METHODS: All patients from western Sweden who underwent CABG between 1988 and 1991 were approached with a questionnaire--prior to, 3 months and 2 years after CABG--evaluating the issues raised above. RESULTS: Of 2121 patients, 37% had a history of hypertension. By 3 months after CABG, physical activity tolerance had improved markedly and in a similar way for both hypertensive (p<0.001) and non-hypertensive patients (p<0.001); this level was sustained for 2 years. Absence of dyspnea increased markedly and similarly among both hypertensive and non-hypertensive patients (p < 0.001) after CABG. The presence of chest pain decreased markedly and similarly among hypertensive (p<0.001) and non-hypertensive patients (p<0.001), both 3 months and 2 years after compared to prior to the operation. CONCLUSION: There was a marked improvement in terms of physical activity and cardiovascular symptoms 3 months and 2 years after CABG as compared with the situation prior to the operation. A previous history of hypertension did not seem to affect these results.

Activities of Daily Living↗

Stenting in Chronic Coronary Occlusion (SICCO): a randomized, controlled trial of adding stent implantation after successful angioplasty.

OBJECTIVES: This study investigated whether stenting improves long-term results after recanalization of chronic coronary occlusions. BACKGROUND: Restenosis is common after percutaneous transluminal coronary angioplasty (PTCA) of chronic coronary occlusions. Stenting has been suggested as a means of improving results, but its use has not previously been investigated in a randomized trial. METHODS: We randomly assigned 119 patients with a satisfactory result after successful recanalization by PTCA of a chronic coronary occlusion to 1) a control (PTCA) group with no other intervention, or 2) a group in which PTCA was followed by implantation of Palmaz-Schatz stents with full anticoagulation. Coronary angiography was performed before randomization, after stenting and at 6-month follow-up. RESULTS: Inguinal bleeding was more frequent in the stent group. There were no deaths. One patient with stenting had a myocardial infarction. Subacute occlusion within 2 weeks occurred in four patients in the stent group and in three in the PTCA group. At follow-up, 57% of patients with stenting were free from angina compared with 24% of patients with PTCA only (p < 0.001). Angiographic follow-up data were available in 114 patients. Restenosis (> or = 50% diameter stenosis) developed in 32% of patients with stenting and in 74% of patients with PTCA only (p < 0.001); reocclusion occurred in 12% and 26%, respectively (p = 0.058). Minimal lumen diameter (mean +/- SD) at follow-up was 1.92 +/- 0.95 mm and 1.11 +/- 0.78 mm, respectively (p < 0.001). Target lesion revascularization within 300 days was less frequent in patients with stenting than in patients with PTCA only (22% vs. 42%, p = 0.025). CONCLUSIONS: Stent implantation improved long-term angiographic and clinical results after PTCA of chronic coronary occlusions and is thus recommended regardless of the primary PTCA result.

Angioplasty, Balloon, Coronary↗

The cost-benefit balance of coronary artery bypass grafting: need for hospitalization during the two years before and the two years after.

To derive and compare the need for hospitalization during 2 years prior to coronary artery bypass grafting (CABG) and 2 years after, all the patients from western Sweden in whom CABG without simultaneous valve surgery was performed between June 1988 and June 1991 were evaluated. Hospitalization prior to and after surgery was derived via questionnaires sent to the patients and via data from their hospital medical record forms. In all, 2099 patients were studied. The mean total number of days in hospital was 16 during the 2 years before and 24 including surgery and postoperative complications during the 2 years after the operation (p < 0.001). When the days for operation and postoperative complications were excluded, the mean number of days after operation was 7 (p < 0.001). Hospitalization due to myocardial infarction, angina pectoris, percutaneous transluminal coronary angioplasty and other investigations for heart disease were significantly reduced after CABG. On the other hand, hospitalization due to chest pain with causes other than ischemic heart disease, congestive heart failure, arrhythmias, and reoperation was more frequent during the 2 years after surgery. The total number of days in hospital was higher during the 2 years after CABG than during the 2 years before, despite the fact that hospitalization due to ischemic events was significantly reduced after the operation.

Adult↗

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↗

Mortality and morbidity in diabetic and nondiabetic patients during a 2-year period after coronary artery bypass grafting.

OBJECTIVE: To describe mortality and morbidity during a 2-year period after coronary artery bypass grafting (CABG) among diabetic and nondiabetic patients. RESEARCH DESIGN AND METHODS: All the patients in western Sweden in whom CABG was undertaken between June 1988 and June 1991 and in whom concomitant procedures were not performed were registered prospectively. The study was a prospective follow-up. RESULTS: Diabetic patients (n = 268) differed from nondiabetic patients (n = 1,859) in that more women were included, and the patients more frequently had a previous history of myocardial infarction (MI), hypertension, congestive heart failure, intermittent claudication, and obesity. Diabetic patients more frequently required reoperation and had a higher incidence of peri- and postoperative neurological complications. Mortality during the 30 days after CABG was 6.7% in diabetic patients versus 3.0% in nondiabetic patients (P < 0.01). Mortality between day 30 and 2 years was 7.8 and 3.6%, respectively (P < 0.01). During 2 years of follow-up, a history of diabetes appeared to be a significant independent predictor of death. Whereas the development of MI after discharge from the hospital did not significantly differ between the two groups; 6.3% of diabetic patients developed stroke versus 2.5% in nondiabetic patients (P < 0.001). CONCLUSIONS: Diabetic patients have a mortality rate during the 2-year period after CABG that is about twice that of nondiabetic patients during both the early and late phase after the operation.

Age Factors↗

Relationship between quality of life and exercise test findings after coronary artery bypass surgery.

We studied the correlation between quality of life and exercise testing in 554 patients 2 years after coronary artery bypass surgery. Quality of life constitutes a person's perceptions of physical and mental functional capacity, health and symptoms. Traditionally, evaluations after coronary bypass surgery have focused on physical performance, medication and anginal symptoms, which cannot be said to represent quality of life. We used the Physical Activity Score, the Nottingham Health Profile and the Psychological General Well-being Index for evaluation of quality of life. Significant correlations were found between quality of life and exercise capacity (P < 0.0001), and quality of life and chest pain at exercise for all questionnaires (P < 0.0001). Significant correlations, although of small or moderate magnitude, were found between exercise capacity, chest pain and most subscales of quality of life, with the highest correlation coefficients for dimensions reflecting physical abilities and pain. We conclude that quality of life correlates significantly with exercise capacity and chest pain during exercise 2 years after coronary bypass surgery. However, only dimensions of pain and physical performance are reasonably well correlated with exercise test results. Several aspects of quality of life are only weakly related to exercise test results and may escape identification in an exercise test.

Activities of Daily Living↗

Assessment of coronary artery stenosis during PTCA by measurement of the trans-stenotic pressure gradient. Comparison with quantitative coronary angiography.

A fibreoptic pressure sensor mounted on an 0.018 inch guidewire (Pressure Guide, RadiMedical Systems, Uppsala, Sweden) was used to measure the trans-stenotic pressure gradient in 20 patients admitted for percutaneous transluminal coronary angioplasty (PTCA) of a single, discrete stenosis. Pressure measurements were made both at rest and during maximal vasodilatation induced by intracoronary injection of papaverine. From the ratio of distal coronary pressure divided by the proximal pressure, the relative coronary flow reserve was calculated. The aim of the study was to compare the different pressure-derived parameters by correlating them to stenosis geometry estimated by quantitative coronary angiography. There was a moderate correlation between baseline pressure gradient and percent area stenosis; r = 0.64, P < 0.001 and minimal cross-sectional area; r = 0.45, P < 0.005. A higher correlation was found between hyperaemic pressure gradient and area stenosis (r = 0.80, P < 0.001) and minimal cross-sectional areas, respectively (r = 0.55, P < 0.005). The best correlation was found between relative coronary flow reserve and area stenosis (r = 0.86, P < 0.001) and minimal cross-sectional area (r = 0.70, P < 0.001). In conclusion, pressure measurement using a pressure guidewire is useful as a complement to angiography in evaluation of coronary stenoses during PTCA. Pressures should be measured during maximal vasodilatation. Relative coronary flow reserve calculated from the pressure measurements provides additional information about the fraction of normal maximal flow possible in the presence of a stenosis.

Aged↗

Spinal cord stimulation in angina pectoris with normal coronary arteriograms.

BACKGROUND: Patients with angina pectoris with normal coronary arteriograms, also known as Syndrome X (typical exercise-induced angina pectoris, positive exercise testing, and normal coronary arteriograms), are often difficult to treat with conventional forms of medical therapy. Spinal cord stimulation has been used in recent years for the treatment of severe angina pectoris refractory to conventional medical and surgical therapy in coronary artery disease. The aim of this study was to investigate the effects of spinal cord stimulation on angina pectoris with normal coronary arteriograms. METHODS: Twelve patients underwent five bicycle exercise tests, three tests without (control), and two tests with spinal cord stimulation treatment. RESULTS: The exercise tolerance of the patients increased (108 +/- 22 W versus 96 +/- 21 W; P < 0.001), the magnitude of ST-segment depression at comparable work load decreased (1.0 +/- 0.6 mm versus 1.5 +/- 0.9 mm; P < 0.01), time to angina increased (5.4 +/- 2.2 min versus 2.7 +/- 1.9 min; P < 0.01), and time to the appearance of ST-segment depression increased (3.5 +/- 1.9 min versus 2.4 +/- 1.6 min; P < 0.01). The rate-pressure product at maximum work load during treatment increased, compared with the maximum work load during the control session (28,038 +/- 6124 mmHg x bpm versus 25,222 +/- 4519 mmHg x bpm; P < 0.05) and the comparable work load during treatment (28,038 +/- th 6124 mmHg x bpm versus 24,795 +/- 5022 mmHg x bpm; P < 0.01). CONCLUSIONS: Spinal cord stimulation has beneficial effects in angina pectoris with normal coronary arteriograms in terms of relief of symptoms of angina pectoris and improvement of exercise tolerance. These effects may be associated with a reduction in myocardial ischemia.

Aged↗

Adenosine infusion to patients with ischaemic heart disease may provoke left ventricular dysfunction detected by echocardiography.

Infusion of the endogenous vasodilator adenosine to patients with ischaemic heart disease (IHD) frequently provokes myocardial ischaemia, possibly caused by a coronary steal. The aim of this study was to detect the occurrence and incidence of disturbances in left ventricular (LV) wall motion and Doppler indices of altered LV function during infusion of adenosine. Thirty-seven patients (six female) aged 37-74 years with IHD, verified by coronary angiography, were given up to 200 micrograms kg-1 min-1 (mean 155 +/- 5) adenosine i.v. for 18 +/- 1 min. LV wall motion was monitored by two-dimensional echocardiography (2D-echo). Doppler spectral signal was obtained from the mitral blood flow. All but six of the patients experienced angina pectoris of habitual character in connection with the adenosine infusion. Heart rate increased by 22 +/- 1 beats min-1, systolic blood pressure was unchanged, but diastolic blood pressure decreased slightly. 2D-echo revealed severe regional LV wall motion disturbances already in the basal state in 17 patients. During infusion of adenosine, these abnormalities were aggravated and disturbances also occurred in another 15 patients. Thus, adenosine increased the sensitivity for IHD in this selected material from 49 to 89%. In all, the mean index of wall motion abnormalities increased from 5.1 +/- 1.1 to 10.1 +/- 1.4 (P less than 0.001). The diastolic LV filling characteristics, as evaluated by the Doppler A/E ratios, were of limited value for determination of IHD grade. It is concluded that infusion of adenosine to patients with IHD frequently elicits myocardial ischaemia with disturbances in LV function, and offers an alternative to exercise for stress echocardiography.

Adenosine↗

Early thrombolytic therapy in suspected acute myocardial infarction--role of the electrocardiogram: results from the TEAHAT Study.

In a placebo-controlled trial in which rt-PA was administered to patients within 2 h and 45 min after the onset of symptoms indicative of acute myocardial infarction (AMI), 352 patients were randomized. Standard 12-lead electrocardiograms (ECGs) were recorded at inclusion and repeatedly during admission and at follow-up after 1 month and 1 year. In patients who presented with ST-segment elevation, the infarction rate was high (88%), whereas in patients without ST-elevation the infarction rate was low (21%), and infarct size, as assessed by serum enzyme activities, was small in this group. There were only minor differences between rt-PA- and placebo-treated patients with regard to ST-segment changes and Q-wave development, whereas the R-wave amplitude was higher after 1 month in patients who were given rt-PA. The infarction rate was not altered by rt-PA, but there was a shift towards a reduction in Q-wave infarction in patients who were treated with rt-PA. When a score system, as suggested by Palmeri et al., intended to reflect the ultimate infarct size, was applied, a significantly lower score was found in infarction patients who were treated with rt-PA as compared to placebo (3.95 +/- 0.35 vs. 2.95 +/- 0.29, P = 0.03), indicating limitation of infarct size. In summary, early treatment with rt-PA resulted in less frequent Q-wave infarction and a reduction in the electrocardiographically estimated infarct size.

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