OBJECTIVES:Rivaroxaban 2.5mg twice daily with aspirin 100mg daily was superior to aspirin 100mg daily in the COMPASS trial but the cost-effectiveness in Scandinavia is unknown. DESIGN:Mean lifetime costs (USDs) and quality-adjusted life-years were determined from a Scandinavian perspective using a 2-state Markov model with US mortality data. Subgroup and sensitivity analyses were performed. RESULTS:Over a lifetime adding rivaroxaban to aspirin had lower costs (-$3791USD/-23675DKK/-27410NOK/-29200SEK) and gained 1.17 QALYs versus ASA alone. CONCLUSION:Rivaroxaban 2.5mg twice daily with aspirin is a dominant strategy compared to aspirin alone in COMPASS participants from a Scandinavian perspective.
To evaluate whether image fusion guidance reduces contrast media consumption and radiation exposure during endovascular embolization of pulmonary arteriovenous malformations (PAVM). A retrospective analysis was performed on 38 endovascular embolization procedures conducted for PAVMs at a tertiary care university hospital between 2009 and 2022. Image fusion guidance was employed in 22 procedures, while the remaining 16 procedures served as a control group. Key metrics for comparison included contrast media usage and radiation exposure, the latter measured indirectly by dose-area product (DAP) and fluoroscopy time. Significant reductions in both contrast media use and radiation exposure were observed with the implementation of image fusion guidance. The median contrast dose was 0.18 g I/kg in the image fusion group compared to 0.62 g I/kg in the control group (p = 0.001). Similarly, the DAP was 22.4 Gy·cm2 versus 86.6 Gy·cm2 (p = 0.04), and fluoroscopy time was 31.2 min compared to 55.7 min (p = 0.04). In this observational study, image fusion guidance was associated with reduced contrast media usage and radiation exposure during endovascular embolization of PAVMs, without compromising procedural outcomes. These findings provide supportive rather than definitive evidence and warrant confirmation in prospective studies.
OBJECTIVES:Constrictive pericarditis can cause heart failure from restricted diastolic relaxation due to pericardial fibrosis. Pericardiectomy is the only curative treatment. However, evidence regarding factors associated with variation in outcomes after pericardiectomy remains limited. Therefore, we explored short- and long-term outcomes after pericardiectomy for constrictive pericarditis. DESIGN:This nation-wide study included all pericardiectomy procedures for constrictive pericarditis in Sweden 1997-2020 (median follow-up 5.8 (IQR 2.5-10.1) years). Data were collected from the SWEDEHEART registry and two mandatory registries. Short- and long-term survival was analyzed. Long-term mortality was compared with an age and sex matched control group from the Swedish general population (n = 630). RESULTS:We included 175 patients (mean age 59 ± 15 years). Extracorporeal circulation was common (47% of cases), and 26% of patients underwent concomitant cardiac surgery. In the pericardiectomy cohort, 30-day mortality was 5.1%, associated with older age at surgery (p = 0.008). During follow-up, 22% of patients were readmitted because of heart failure, associated with higher age at surgery (p = 0.02) and preoperative atrial fibrillation (p < 0.001). The long-term survival for pericardiectomy patients was poorer compared to the Swedish population controls in univariable analysis (HR 2.55, 95% CI 1.86-3.48). However, after multivariable adjustment for concomitant comorbidities, this association was attenuated (aHR 1.40, 95% CI 0.96-2.05). CONCLUSIONS:Pericardiectomy for constrictive pericarditis is a rare procedure and risk of early mortality cannot be overlooked. However, only a low proportion of patients are rehospitalized due to heart failure during follow-up. Pericardiectomy patients show a high frequency of preoperative comorbidities, which appear to play a certain role in the postoperative period.
BACKGROUND:Exercise capacity (EC) is a key prognostic indicator in adults with congenital heart disease (ACHD), closely associated with all-cause mortality. Thus, EC may serve a valuable tool for risk-stratification in ACHD. We propose a novel risk score incorporating EC, age, and lesion complexity to improve mortality risk prediction in ACHD. METHODS:This observational study utilized data from the Swedish National Register of Congenital Heart Disease. Adults aged 18 to 60 years who had completed at least one bicycle ergometer exercise test were included. EC was classified according to percentage of predicted capacity (% ECpred): normal (>70%), moderately impaired (50-70%), severely impaired (<50%). Patients were followed for ten years or until death. Odds ratios for mortality were used to derive a 5-point risk-score to estimate 10-year mortality, with the following point allocation: % ECpred 50-70 = 1 point, <50% = 2 points; age 25-40 years = 1 point, 40-60 years = 2 points; moderate/severe lesion complexity = 1 point. Internal validation of risk score resulted in a median AUC of 0.72 for training data, and 0.70 for test data. RESULTS:In total, 1,525 patients (mean age 31.1 ± 11.8 years; 44% women) were included, where 104 deaths occurred during follow-up. Risk scores ranged from 0 to 5, corresponding to 10-year mortality rates of 1%, 3%, 5%, 10%, 18%, and 34%, respectively. CONCLUSION:A simple risk score incorporating exercise capacity, age, and congenital heart lesion complexity can effectively stratify ACHD patients to 10-year risk of all-cause mortality following an exercise test.
Objectives. Data quality is a prerequisite for the use of registries. National Registry for Ablation and Electrophysiology in Norway (AblaNor) is a nationwide medical quality register of Norwegian patients undergoing electrophysiology (EP) examination and ablation. The aim of this study is to assess the coverage of registrations and completeness and reliability variables in AblaNor. Design. National coverage was assessed by comparing EP patients registered in the Norwegian Patient Registry (NPR) and AblaNor in 2021. Completeness of AblaNor registrations was calculated by examining fraction of missing data in key variables. To study reliability, 13 dummy patients were invented and distributed to electrophysiologists in all five EP-centres in Norway. Interrater reliability between the five ratings was assessed for categorical variables by calculating observed percent agreement (PA), Gwet's agreement coefficient (AC1, AC2) and Krippendorff's alpha (K alpha) coefficient. The intraclass correlation coefficient (ICC) was calculated for continuous variables. Results. National coverage was high (93%) with excellent variable completeness (99%). Most variables showed almost perfect (AC1 0.8) or substantial (AC1 0.61-0.80) reliability. Conclusions. Data in AblaNor shows very good national coverage and completeness of data, with a high degree of reliability for most variables.
Objectives. Larger body size is associated with larger thoracic aortic diameter, a risk factor for thoracic aortic disease (TAD). Studies of body size-indexed aortic diameters suggest wider aortas may be less harmful in large people, but the association between body size and TAD events is unknown. This study aims to assess if body size is associated with TAD events. Methods. Swedish 18-year-olds attending mandatory military conscription 1969-1997 were included. Body size was assessed as height, weight, body surface area (BSA) and body mass index (BMI) stratified into quartiles. A composite endpoint of dissection, rupture, surgery of the ascending aorta, or death from TAD was constructed, linking data from the Swedish Inpatient Register and the Cause of Death Register. Cox regression analyses, adjusted for diabetes mellitus and blood pressure at conscription, socioeconomic factors, and Marfan's syndrome, bicuspid aortic valve, and coronary artery by-pass surgery before endpoint or censoring, were performed. Results. During a median follow-up of 36 years (48,404,276 person-years), the composite endpoint occurred in 3,355 out of 1.4 million individuals, 99.7% male. The adjusted hazard ratio (95% confidence interval) for the highest versus lowest quartile of body size was 1.58 (1.43-1.73) for height, 1.90 (1.73-2.09) for weight, 1.87 (1.70-2.07) for BSA, and 1.55 (1.41-1.71) for BMI. Results were robust when surgery was excluded from the composite endpoint. Conclusions. Larger body size is associated with increased risk for TAD, regardless of the category of body size. Further studies including women, and also analyzing aortic diameter are warranted.
OBJECTIVES:Jehovah's Witnesses categorically refuse allogenic blood transfusions on religious grounds, a major challenge if intervention for heart disease is required. We retrospectively analyzed outcome after open-heart surgery in 26 Jehovah's Witnesses. METHODS:Jehovah's Witnesses undergoing open heart surgery between 2010 and June 2025 were compared to matched patients operated at our clinic by year of surgery, age, gender and type of surgical procedure. RESULTS:Seven of the Jehovah's Witnesses (27%) were not accepted for open-heart surgery at other clinics because of an assumed high risk, three of whom were admitted from abroad. Two patients were operated on for acute aortic dissection. Six of the Jehovah's Witnesses (23%) had previously undergone open-heart surgery, two of whom required reoperation for prosthetic valve endocarditis. There was one early death (4%) among the Jehovah's Witnesses from renal failure and septicaemia at haemoglobin 44 g/L. Cardiopulmonary bypass, aortic occlusion and total time of the operation, bleeding and hospital stay and postoperative complications did not differ significantly in Jehovah's Witnesses and matched patients. Eleven of the 26 matched patients (42%) received blood transfusion. Mean haemoglobin before the operation, lowest recorded level, and level at discharge from hospital and at follow-up one to three months after the operation did not differ significantly in the two groups. Haemoglobin level after the operation recovered within three months. CONCLUSIONS:Complex cardiac surgery can be performed with low risk in Jehovah's Witnesses. Blood conservation should be applied at all operations to avoid unnecessary blood transfusion.
BACKGROUND:Several aspects of acute type A aortic dissection (ATAAD) management remain debated. The strategies for arterial cannulation, cerebral protection, temperature management and extent of aortic resection are all contested. We aimed to explore and describe variations in the current management of patients with ATAAD in the Nordic countries, which form a limited geographic region with similar healthcare systems. METHODS:A 32-item questionnaire regarding the organizational and periprocedural aspects of care for patients with ATAAD was sent to 17 Nordic cardiac surgery units, prospective collaborators in the Nordic Consortium for Acute type A Aortic Dissection. Results were summarized using descriptive statistics. RESULTS:The response rate was 12/17 (71%). Fifty-eight per cent of centres used femoral artery cannulation, of which two centres (17%) used femoral artery cannulation in addition to another method. Nine centres (75%) used cerebral perfusion in most of surgical repairs requiring HCA, and among those using cerebral perfusion, 92% opted for antegrade cerebral perfusion. Five centres (42%) stated that total arch replacements were never performed. Valve sparing root replacements were performed by seven centres (58%). Regarding postoperative surveillance, all centres reported that CT-scans were performed at 6-12 months intervals. CONCLUSION:Although strategies for pre-, peri-, and postoperative management of patients with ATAAD could be expected to be reasonably similar, we found several differences in almost all aspects of management. The current survey may help identify relevant research questions that can be explored in the NORCAAD2 database, ultimately contributing to the development of consensus documents and guidelines.
Purpose. This study utilizes untargeted metabolomics to identify novel serum biomarkers and metabolic pathways linked to in-stent restenosis (ISR). Methods. This retrospective study included patients who underwent percutaneous coronary intervention (PCI) at the Chinese PLA General Hospital between February 2018 and December 2018. Serum metabolites were analyzed using gas chromatography-mass spectrometry (GC-MS). Multivariate analysis was used to identify differential metabolites, and pathway enrichment analysis was performed to explore their biological significance. Results. A total of 61 patients were enrolled, comprising 18 in the ISR group and 43 in the non-ISR group. The ISR group demonstrated a higher prevalence of smoking (50% vs. 21%, p = 0.023), a greater incidence of previous myocardial infarction (72% vs. 37%, p = 0.004), and a lower left ventricular ejection fraction (51% vs. 58%, p = 0.004) compared to the non-ISR group. Seven differential metabolites were identified, with five being upregulated (inosine, myo-inositol, 3-cyanoalanine, monostearin, and glutamine) and two downregulated (biuret and 3-methylcatechol). Pathway enrichment analysis revealed three major metabolic pathways associated with ISR: inositol phosphate metabolism, alanine-aspartate-glutamate metabolism, and the phosphatidylinositol signaling system. Receiver operating characteristic (ROC) analysis indicated that inosine had the highest diagnostic performance [The area under the curve (AUC) = 0.807], followed by myo-inositol (AUC = 0.705) and monostearin (AUC = 0.643). The combined biomarker panel significantly enhanced diagnostic accuracy, achieving an AUC of 0.925, indicating strong predictive potential for ISR. Conclusions. This study identified seven potential serum biomarkers and three metabolic pathways linked to ISR. These findings enhance our understanding of the metabolic mechanisms underlying ISR and could aid in the development of non-invasive diagnostic tools and therapeutic strategies.
OBJECTIVES:Primary dysmenorrhea is a common condition characterized by cramp-like menstrual pain in young women. Recently, its effects on the cardiovascular system have garnered attention. Endothelial dysfunction is an early indicator of cardiovascular risk; however, its relationship with primary dysmenorrhea remains unclear. This study aims to evaluate endothelial function in individuals with primary dysmenorrhea using post-ischemic flow-mediated dilation (FMD) and volumetric flow (VolFlow) methods, and to compare the results with healthy controls. DESIGN:This study included 31 women with a clinical diagnosis of primary dysmenorrhea and 31 healthy control women. Endothelial function was assessed using Flow-Mediated Dilation (FMD) and VolFlow methods. FMD measures the dilation of the brachial artery, while VolFlow evaluates arterial blood flow volume. Differences between the groups were analyzed using SPSS, and a p-value of < 0.05 was considered statistically significant. Normality was assessed using the Shapiro-Wilk test, and between-group comparisons were performed using appropriate parametric and non-parametric methods. FINDINGS:The FMD values were significantly lower in the dysmenorrhea group (5.97 ± 5.29 vs. 10.95 ± 3.78, p < 0.001), and the proportion of individuals with endothelial dysfunction was higher (%51.6 vs. %6.45, p < 0.001). In the dysmenorrhea group, the baseline VolFlow value was 77.4 ± 24.1 ml/min, which increased to 81.4 ± 25.1 ml/min after cuff inflation (p < 0.001). In healthy controls, the VolFlow increased from 69.8 ± 15.3 ml/min to 92.0 ± 15.3 ml/min, but this change was not statistically significant (p = 0.08). The change in VolFlow (ΔVF) was significantly lower in the dysmenorrhea group (p < 0.001). RESULTS:Our findings indicate a significant impairment of endothelial function in the primary dysmenorrhea group compared to the control group. Specifically, individuals with primary dysmenorrhea exhibited lower flow-mediated dilation (FMD) and Δ vascular function (ΔVF) values. To further investigate this relationship, large-scale studies are needed.
AIM:To examine sex differences in care-seeking when afflicted by an acute myocardial infarction (AMI). METHOD:This was a cross-sectional study in the region of Stockholm, Sweden. All patients from the Swedish national registry SWEDEHEART who were hospitalized due to an acute myocardial infarction in Stockholm, between March and June 2020, were asked to participate. A self-administered questionnaire Patients' appraisal, emotions, and action tendencies preceding care-seeking in acute myocardial infarction' (PA-AMI) including demographical questions, was sent out via mail, which was answered by a total of 326 participants. Additional variables for each participant were obtained from SWEDEHEART. RESULTS:There were no differences between women and men regarding patients' thoughts, feelings, and actions prior to care-seeking, as well as the time from symptom onset to care-seeking, both the patients' own assessed time, and the times reported to SWEDEHEART. However, the results shows that both women and men experience a high degree of uncertainty when afflicted by an AMI. CONCLUSIONS:Our results indicate that there are no significant sex differences in care-seeking patterns when afflicted by an AMI. Regardless of sex, AMI is associated with a high level of uncertainty among patients. To address this uncertainty and improve timely care, it is crucial to implement enhanced educational initiatives at both the individual and community levels. These efforts should focus on increasing awareness of the diverse symptom presentation of AMI and emphasize the critical importance of seeking immediate medical attention. Such interventions could help reduce delays in care and improve patient outcomes.
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. Invasive coronary angiography (ICA) is the gold standard in evaluating stent patency after percutaneous coronary intervention (PCI), but it carries a risk of potentially life-threatening complications. Third-generation coronary computed tomography angiography (CCTA) offers a non-invasive, safer follow-up method, but real-world data are lacking. This study evaluated the ability of CCTA to rule out in-stent restenosis (ISR) in long stents at long-term follow-up. Methods. This prospective, single-centre study (NCT06543641) included consecutive patients treated with PCI for coronary chronic total occlusion with long stents (left anterior descending coronary artery and right coronary artery ≥38 mm, left circumflex coronary artery ≥30 mm) in 2014-2019. All patients underwent third-generation dual-source CCTA. Patients with CCTA showing significant ISR, inconclusive results, or symptomatic native artery lesions underwent ICA. Results. The study included 45 patients (median age 67 (IQR 62-73) years, 87% males) with 47 stents (median length 51 mm, range 36-132 mm). CCTA ruled out significant ISR in 87% (n = 39) of the patients. CCTA indicated five ISRs and one inconclusive result in six (13%) patients, all of whom underwent ICA. Additionally, ICA was conducted for five patients due to a native artery lesion(s) on CCTA and angina. ICA showed significant stenosis in all six patients (100%) with ISR or inconclusive CCTA finding in the long stent. Conclusions. Third-generation CCTA could rule out significant ISR in a vast majority of cases (87%, n = 39) and without a risk of complications associated with ICA. CCTA provides a non-invasive, lower risk method for long-term revascularization follow-up.
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.
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.
