Linn M.A. Kennedy

Left atrioventricular plane displacement but not left ventricular ejection fraction is influenced by the degree of aortic stenosis

Aims: To examine how left atrioventricular plane displacement (AVPD), a widely used measure of left ventricular (LV) function, is related to presence and degree of aortic stenosis. Methods and results: Cardiac dimensions, LV filling, left AVPD, LV ejection fraction (LVEF), and valve function were assessed by echocardiography/Doppler in 182 patients with various cardiac diseases (mean (SD) age 69 (12) years, 36% women), 49 consecutive with and 133 consecutive without aortic stenosis. In an analysis of covariance, neither left AVPD nor LVEF was independently correlated with the presence of aortic stenosis. However, looking separately at patients with aortic stenosis, left AVPD (p  =  0.03) but not LVEF correlated independently with degree of aortic stenosis in multiple linear regression analysis. In patients with aortic stenosis, an abnormal left AVPD had 94% sensitivity and 90% negative predictive value with regard to severe aortic stenosis, compared with 56% and 62%, respectively, for LVEF. Conclusion: In patients with cardiac disease, neither left AVPD nor LVEF correlated independently with presence of aortic stenosis. However, in patients with aortic stenosis, left AVPD but not LVEF correlated with the degree of aortic valve obstruction and left AVPD but not LVEF had high sensitivity and negative predictive value with regard to severe aortic stenosis. Compared with LVEF, left AVPD is an earlier and more sensitive marker of LV haemodynamic load in patients with aortic stenosis.

Evaluation of pre-arrest morbidity score and prognosis after resuscitation score and other clinical variables associated with in-hospital cardiac arrest in southern Sweden

OBJECTIVE To evaluate pre-arrest morbidity score (PAM), prognosis after resuscitation score (PAR) and to identify additional clinical variables associated with survival after in-hospital cardiac arrest (IHCA) treated with cardiopulmonary resuscitation (CPR). METHODS A retrospective observational study involving all cases of IHCA at Skåne University Hospital Malmö 2007-2010. RESULTS Two-hundred-eighty-seven cases of IHCA were identified (61.3% male; mean age 70 years) of whom 20.2% survived until discharge. The odds ratio (95% confidence interval) for death prior to discharge was 6.49 (1.50-28.19) (p=0.013) for PAM>6 and 3.88 (1.95-7.73) (p<0.001) for PAR>4. At PAM- and PAR-scores >5, specificity exceeded 90%, while sensitivity was only 20-30%. The odds ratio for in-hospital mortality was 0.38 (0.20-0.72) (p=0.003) for patients with cardiac monitoring, 9.86 (5.08-19.12) (p<0.001) for non-shockable vs shockable rhythm, 0.32 (0.15-0.69) (p=0.004) for presence of ST-elevation myocardial infarction (STEMI), 0.27 (0.09-0.78) (p=0.016) for patients with independent Activities of Daily Life (ADL) and 13.86 (1.86-103.46) (p=0.010) for patients with malignancies. Heart rate (HR) on admission (per bpm) [1.024 (1.009-1.040) (p=0.002)] and sodium plasma concentration on admission (per mmoll(-1)) [0.92 (0.85-0.99) (p=0.023)] were significantly associated with in-hospital mortality. CONCLUSION PAM- and PAR-scores do not sufficiently discriminate between in-hospital death and survival after IHCA to be used as clinical tools guiding CPR decisions. We confirm that malignancy is associated with increased in-hospital mortality, and cardiac monitoring, shockable rhythm, STEMI and independent ADL, with decreased in-hospital mortality. Interestingly, our results suggest that HR and plasma sodium concentration upon admission may represent new tools for risk stratification.

Gender differences in variables related to B-natriuretic peptide, left ventricular ejection fraction and mass, and peak oxygen consumption, in patients with heart failure.

AIM AND METHODS We assessed gender differences in variables related to B-natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), peak oxygen consumption (peak-VO2), and LV mass (LVM), among patients recently hospitalized for suspected heart failure (HF). RESULTS Of 930 consecutive patients, 409 accepted follow-up after discharge, 221 of these had definite HF (90 women, mean age 74.5 [9.8]years). In 141 HF patients (61 women) with BNP data, women had lower BNP than men (43.9 [38.1] versus 76.3 [88.9]pmol/L, P=0.0193). LVEF (all HF patients) was higher in women (49.8 [13.4] versus 42.4 [13.9]%, P=0.0004). Peak-VO2 (147 HF patients, 48 women) was lower in women (13.9 [4.3] versus 16.3 [4.2]mL/kg/min, P=0.0093). LVM index (200 HF patients, 78 women) was lower in women (130.4 [46.5] versus 171.7 [57.6]g/m(2), P<0.0001). Among HF patients, variables independently related to BNP were body mass index (BMI) and peak-VO2 exclusively among men, mitral regurgitation, respiratory disease and angiotensin receptor blocker treatment only among women. Variables independently related to LVEF were resting heart rate, acetylic salicylic acid use and BNP exclusively among men. No variable was exclusive for women. Variables independently related to peak-VO2 were right ventricular size, BNP, resting and peak heart rate solely among men, BMI and stable angina pectoris exclusively among women. Variables independently related to LVM were left atrial diameter only among men, BMI exclusively among women. CONCLUSION Among elderly HF patients, there were some important gender differences in BNP, LVEF, peak-VO2 and LVM, and in variables independently related to these factors.

Gender Differences in Predictors of Heart Failure Morbidity and Mortality in an Urban Swedish Population: The Malmo Preventive Project

Objective/Background: Reports on heart failure (HF) predictors are scarce. We assessed gender-specific HF predictors. Design: Preventive case-finding programme, register study. Setting: City population-based sample. Methods: We examined 33,342 HF-free subjects, 32.7% women, included in Malmo Preventive Project. Mean inclusion age was 49.7±7.4 years for women and 43.7±6.6 years for men. Results: During 21.7±4.3 years of average follow-up, 764 (2.3%) subjects were diagnosed with HF, 120 (1.1%) women and 644 (2.9%) men. Following bootstrap analysis, the only strong independent predictor of HF among women was smoking. Independent predictors of HF among men were diastolic blood pressure (BP), fasting blood-glucose, smoking, family history of myocardial infarction, and previous cardiovascular disease (CVD). During follow-up, 5,370 (16.1%) subjects died, 978 (9.0%) women and 4,392 (19.6%) men. Among both women and men, strong independent predictors of combined HF or all-cause death were high serum-triglycerides, fasting blood-glucose and estimated glomerular filtration rate, smoking, and previous CVD. Among men, also underweight, high BMI, and systolic and diastolic BP, were strong independent predictors of HF or death. Conclusions: Although women and men shared many predictors of HF, there were several important differences between sexes. (Less)

Midlife risk factor exposure and incidence of cardiac arrest depending on cardiac or non-cardiac origin

OBJECTIVE Little is known about midlife risk factors of future cardiac arrest. Our objective was to evaluate cardiovascular risk factors in midlife in relation to the risk of cardiac arrest (CA) of cardiac and non-cardiac origin later in life. METHODS We cross-matched individuals of the population based Malmö Diet and Cancer study (n=30,447) with the local CA registry of the city of Malmö. Baseline exposures were related to incident CA. RESULTS During a mean follow-up of 17.6±4.6years, 378 CA occurred, of whom 17.2% survived to discharge. Independent midlife risk factors for CA of cardiac origin included coronary artery disease {HR 2.84 (1.86-4.34) (p<0.001)}, diabetes mellitus {HR 2.37 (1.61-3.51) (p<0.001)} and smoking {HR 1.95 (1.49-2.55) (p<0.001)}. Dyslipidemia and history of stroke were also significantly associated with an elevated risk for CA of cardiac origin. Independent midlife risk factors for CA of non-cardiac origin included obesity (BMI>30kg/m2) {HR 2.37 (1.51-3.71) (p<0.001)}, smoking {HR 2.05 (1.33-3.15) (p<0.001)} and being on antihypertensive treatment {HR 2.25 (1.46-3.46) (p<0.001)}. CONCLUSION Apart from smoking, which increases the risk of CA in general, the midlife risk factor pattern differs between CA of cardiac and non-cardiac origin. Whereas CA of cardiac origin is predicted by history of cardiovascular disease, dyslipidemia and diabetes mellitus, the main risk factors for CA of non-cardiac origin are obesity and hypertension. In addition to control of classical cardiovascular risk factors for prevention of CA, our results suggest that prevention of midlife obesity may reduce the risk of CA of non-cardiac origin.