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Dive into the research topics where Eva Fernlund is active.

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Featured researches published by Eva Fernlund.


Annals of the Rheumatic Diseases | 2012

Development of heart block in children of SSA/SSB-autoantibody-positive women is associated with maternal age and displays a season-of-birth pattern

Aurélie Ambrosi; Stina Salomonsson; Håkan Eliasson; Elisabeth Zeffer; Amanda Skog; Vijole Dzikaite; Gunnar Bergman; Eva Fernlund; Joanna Tingström; Elke Theander; Annika Rydberg; Thomas Skogh; Annika Öhman; Ulla Lundström; Mats Mellander; Ola Winqvist; Michael Fored; Anders Ekbom; Lars Alfredsson; Henrik Källberg; Tomas Olsson; Fredrik Gadler; Anders Jonzon; Ingrid Kockum; Sven-Erik Sonesson; Marie Wahren-Herlenius

Objective Congenital heart block may develop in the fetuses of Ro/SSA-positive and La/SSB-positive mothers. Recurrence rates of only 10–20% despite persisting maternal antibodies indicate that additional factors are critical for the establishment of heart block. The authors investigated the influence of other maternal and fetal factors on heart block development in a Swedish population-based cohort. Methods The influence of fetal gender, maternal age, parity and time of birth on heart block development was analysed in 145 families, including Ro/La-positive (n=190) and Ro/La-negative (n=165) pregnancies. Results There was a recurrence rate of 12.1% in Ro/La-positive women, and no recurrence in Ro/La-negative women. Fetal gender and parity did not influence the development of heart block in either group. Maternal age in Ro/La-positive pregnancies with a child affected by heart block was, however, significantly higher than in pregnancies resulting in babies without heart block (p<0.05).Seasonal timing of pregnancy influenced the outcome. Gestational susceptibility weeks 18–24 occurring during January–March correlated with a higher proportion of children with heart block and lower vitamin D levels during the same period in a representative sample of Swedish women and a corresponding higher proportion of children with heart block born in the summer (p<0.02). Maternal age or seasonal timing of pregnancy did not affect the outcome in Ro/La-negative pregnancies. Conclusion This study identifies maternal age and seasonal timing of pregnancy as novel risk factors for heart block development in children of Ro/La-positive women. These observations may be useful for counselling when pregnancy is considered.


Scandinavian Journal of Immunology | 2011

A population-based investigation of the autoantibody profile in mothers of children with atrioventricular block.

Stina Salomonsson; Vijole Dzikaite; Elisabeth Zeffer; Håkan Eliasson; Aurélie Ambrosi; Gunnar Bergman; Eva Fernlund; Elke Theander; Annika Öhman; Annika Rydberg; Thomas Skogh; Solveig Wållberg-Jonsson; Åse Elfving; Michael Fored; Anders Ekbom; Ulla Lundström; Mats Mellander; Ola Winqvist; Sven-Erik Sonesson; Fredrik Gadler; Anders Jonzon; Marie Wahren-Herlenius

The objective of the study was to investigate the antigen specificity and occurrence of individual autoantibodies in mothers of children diagnosed with atrioventricular (AV) block in a nation‐wide setting. Patients with AV block detected before 15 years of age were identified using national quality registries as well as a network of pediatric and adult cardiologists and rheumatologists at the six university hospitals in Sweden. Patients with gross heart malformations, surgically or infectiously induced blocks were excluded. Blood samples were obtained from the mothers and maternal autoantibody profile, including the occurrence of antibodies against Ro52, Ro60, La, SmB, SmD, RNP‐70k, RNP‐A, RNP‐C, CENP‐C, Scl‐70, Jo‐1, ribosomal RNP and histones was investigated in 193 mothers of children with AV block by immunoblotting and ELISA. Autoantibody reactivity was detected in 48% (93/193) of the mothers of children with AV block. In autoantibody‐positive mothers, the vast majority, 95% (88/93), had antibodies against Ro52, while 63% (59/93) had autoantibodies to Ro60 and 58% (54/93) had autoantibodies to La. In addition, 13% (12/93) of the autoantibody‐positive mothers had antibodies to other investigated antigens besides Ro52, Ro60 and La, and of these anti‐histone antibodies were most commonly represented, detected in 8% (7/93) of the mothers. In conclusion, this Swedish population‐based study confirms that maternal autoantibodies may associate with heart block in the child. Further, our data demonstrate a dominant role of Ro52 antibodies in association with AV block.


American Journal of Medical Genetics Part A | 2012

Screening of congenital heart disease patients using multiplex ligation‐dependent probe amplification: Early diagnosis of syndromic patients

Karina SÕrensen; Milad El-Segaier; Eva Fernlund; Ab Errami; Patrice Bouvagnet; Nancy Nehme; Jesper Steensberg; Vibeke E. Hjortdal; Maria Soller; Mohaddeseh Behjati; Thomas Werge; Maria Kirchoff; Jan Schouten; Niels Tommerup; Paal Skytt Andersen; Lars Allan Larsen

Recurrent copy number variants (CNVs) are found in a significant proportion of patients with congenital heart disease (CHD) and some of these CNVs are associated with other developmental defects. In some syndromic patients, CHD may be the first presenting symptom, thus screening of patients with CHD for CNVs in specific genomic regions may lead to early diagnosis and awareness of extracardiac symptoms. We designed a multiplex ligation‐dependent probe amplification (MLPA) assay specifically for screening of CHD patients. The MLPA assay allows for simultaneous analysis of CNVs in 25 genomic regions previously associated with CHD. We screened blood samples from 402 CHD patients and identified 14 rare CNVs in 13 (3.2%) patients. Five CNVs were de novo and six where inherited from a healthy parent. The MLPA screen led to early syndrome diagnosis in two of these patients. We conclude that the MLPA assay detects clinically relevant CNVs and suggest that it could be used within pediatric cardiology as a first tier screen to detect clinically relevant CNVs and identify syndromic patients at an early stage.


Annals of the Rheumatic Diseases | 2011

Development of heart block in SSA/SSB autoantibody-positive pregnancies is associated with maternal age and display a season-of-birth pattern

Aurélie Ambrosi; Stina Salomonsson; Håkan Eliasson; Elisabeth Zeffer; Vijole Dzikaite; Gunnar Bergman; Eva Fernlund; Elke Theander; Annika Rydberg; Thomas Skogh; Solveig Wållberg-Jonsson; Annika Öhman; Ulla Lundström; Mats Mellander; Ola Winqvist; Michael Fored; Anders Ekbom; Lars Alfredsson; Henrik Källberg; Fredrik Gadler; Anders Jonzon; Sven-Erik Sonesson; Marie Wahren-Herlenius

Background and objectives Congenital heart block (CHB) may develop in the fetus of anti-Ro/SSA and anti-La/SSB positive mothers. Reported recurrence rates of only 10–20% despite persisting maternal antibodies indicate that additional factors are critical for establishment of the heart block. The authors therefore investigated the influence of other maternal and fetal factors on heart block development in a Swedish population-based cohort. Material and methods The influence of fetal gender, maternal age, parity and time of birth on heart block development was analysed in 145 families including Ro/La-positive (n= 190) and Ro/La-negative (n=165) pregnancies. Results The authors observed a recurrence rate for heart block of 12.1% in Ro/La-positive women, and no recurrence in Ro/La-negative women. Fetal gender and parity did not influence the development of heart block in either group. Maternal age in Ro/La-positive pregnancies with a child affected by heart block was however significantly higher than in pregnancies resulting in babies without heart block (p<0.01). Seasonal timing of pregnancy appeared to be an important factor in pregnancy outcome in Ro/La-positive women as the ratio of affected to healthy births in the summer (June–August) was significantly different from the rest of the year, corresponding to a higher proportion of children with heart block born in the summer compared to the rest of the year. This in turn corresponds to a higher proportion of affected pregnancies for which the susceptible gestational weeks 18–24 occur during the late winter (January–March). Maternal age or seasonal timing of pregnancy did not affect the outcome in Ro/La-negative pregnancies. Conclusions This study identifies maternal age and seasonal timing of pregnancy as novel risk factors for CHB development in Ro/La positive pregnancy. These observations will be important for counselling when a pregnancy is considered.


Open Heart; 4(2), no e000658 (2017) | 2017

Predictors of risk for sudden death in childhood hypertrophic cardiomyopathy: the importance of the ECG risk score

Ingegerd Östman-Smith; Gunnar Sjöberg; Annika Rydberg; Per H. Larsson; Eva Fernlund

Objective To establish which risk factors are predictive for sudden death in hypertrophic cardiomyopathy (HCM) diagnosed in childhood. Methods A Swedish national cohort of patients with HCM diagnosed <19 years of age was collected between 1972 and 2014, consisting of 155 patients with available ECGs, with average follow-up of 10.9±(SD 9.0) years, out of whom 32 had suffered sudden death or cardiac arrest (SD/CA group). Previously proposed risk factors and clinical features, ECG and ultrasound measures were compared between SD/CA group and patients surviving >2 years (n=100), and features significantly more common in SD/CA group were further analysed with univariate and multivariate Cox hazard regression in the total cohort. Results Ranked according to relative risk (RR) the ECG risk score >5 points had an RR of 46.5 (95% CI 6.6 to 331), sensitivity of 97% (83% to 100%) and specificity of 80% (71% to 88%) (p<0.0001), and was the best ECG predictor, predicting a 5-year risk of SD/CA of 30.6%. The following are other features with importantly raised RR: Detroit wall thickness Z-score >4.5: 9.9 (3.1 to 31.2); septal thickness ≥190% of upper limit of normal for age (septum in % of 95th centile for age (SEPPER) ≥190%): 7.9 (3.2 to 19.4); ventricular tachycardia: 9.1 (3.6 to 22.8); ventricular ectopics on exercise testing: 7.4 (2.7 to 20.2); and left ventricular outflow gradient (left ventricular outflow tract obstruction (LVOTO)) >50 mm Hg: 6.6 (4.0 to 11.0). Family history was non-significant. Multivariate Cox hazard analysis gives the following as early predictors: limb-lead QRS amplitude sum (p=0.020), SEPPER ≥190% (p<0.001) and LVOTO at rest (p=0.054); and for late predictors: last ECG risk score (p=0.002) and last Detroit Z-score (p=0.001). Both early (p=0.028) and late (p=0.037) beta-blocker doses reduced risk in the models. Conclusions ECG phenotype as assessed by ECG risk score is important for risk of sudden death and should be considered for inclusion in risk stratification of paediatric patients with HCM.


Journal of Cardiovascular Magnetic Resonance | 2015

Regional adenosine-induced hypoperfusion without hyperenhancement on LGE-MRI in young HCM patients : Comparison to subjects at risk of HCM and healthy volunteers

Robert Jablonowski; Eva Fernlund; Anthony H. Aletras; Henrik Engblom; Einar Heiberg; Petru Liuba; Håkan Arheden; Marcus Carlsson

Background The relation between hypoperfusion and fibrosis is not completely understood in hypertrophic cardiomyopathy (HCM). One hypothesis is that hypoperfusion is a primary cause of fibrosis. Therefore, the aim of this study was to use cardiac magnetic resonance (CMR) to 1) measure if regional perfusion is decreased in young patients with HCM and in subjects at risk of HCM compared to normal controls and 2) determine if regional myocardial perfusion is decreased in areas with left ventricular hypertrophy (LVH) without detectable fibrosis.


Journal of the American College of Cardiology | 2014

PERIPHERAL MICROVASCULAR FUNCTION IS ALTERED IN YOUNG INDIVIDUALS AT RISK FOR HYPERTROPHIC CARDIOMYOPATHY AND CORRELATES WITH DIASTOLIC MYOCARDIAL FUNCTION

Eva Fernlund; Todd T. Schlegel; Pyotr G. Platonov; Marcus Carlsson; Jonas Carlson; Petru Liuba

Hypertrophic cardiomyopathy (HCM) is the main cause of sudden cardiac death in the young. Adult patients with HCM appear to have functional abnormalities in the coronary circulation and also in the peripheral vessels. The aim of present study was to assess peripheral vascular function and myocardial


Journal of Cardiovascular Magnetic Resonance | 2014

Left ventricular myocardial perfusion in young patients evaluated for hypertrophic cardiomyopathy at rest and during adenosine hyperemia using cardiac magnetic resonance imaging

Tom Gyllenhammar; Eva Fernlund; Robert Jablonowski; Jonas Jögi; Henrik Engblom; Petru Liuba; Håkan Arheden; Marcus Carlsson

Methods Twelve controls (22.8 ± 4.5 years), fourteen subjects at risk (18.9 ± 3.8) and ten HCM patients (22.3 ± 6.4) were examined using echocardiography and cardiovascular magnetic resonance (CMR) at rest and during hyperemia (adenosine 140 μg/kg/min). Patients with left ventricular outflow tract obstruction were excluded from the study. Myocardial perfusion was calculated as the ratio of coronary sinus flow and left ventricular mass (LVM) from CMR. Myocardial fibrosis was assessed using late gadolinium enhancement. Diastolic function was quantified using both echocardiography and CMR. The Mann-Whitney test was used to compare the groups and results were considered significant if p < 0.05. Results are presented as mean ± SEM if not otherwise stated. The study was approved by the Ethical Board and informed consent was obtained. Results There was no significant difference in MP (ml/min/g) at rest in controls, subjects at risk and HCM patients (0.8 ± 0.1, 1.0 ± 0.1, 0.9 ± 0.1, respectively, p = ns). During hyperemia, MP was similar in controls and subjects at risk (3.9 ± 0.3 and 5.0 ± 0.5, p = 0.11, but lower in HCM patients (2.5 ± 0.4, p < 0.05 compared to both). Even when fibrosis was excluded from LVM the MP was lower in HCM patients compared to the other groups. Two subjects showed mild diastolic dysfunction (E/e’ = 16), otherwise none of the investigated subjects showed marked diastolic dysfunction (E/e’<15).


European Journal of Echocardiography | 2014

Young patients with hypertrophic cardiomyopathy, but not subjects at risk, show decreased myocardial perfusion reserve quantified with CMR

Tom Gyllenhammar; Eva Fernlund; Robert Jablonowski; Jonas Jögi; Henrik Engblom; Petru Liuba; Håkan Arheden; Marcus Carlsson


Pediatric Cardiology | 2015

Regional Stress-Induced Ischemia in Non-fibrotic Hypertrophied Myocardium in Young HCM Patients

Robert Jablonowski; Eva Fernlund; Anthony H. Aletras; Henrik Engblom; Einar Heiberg; Petru Liuba; Håkan Arheden; Marcus Carlsson

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