As the occurrence of obesity increases amongst young people, so increases the risk of more people suffering from heart failure as early as during middle age. The aim is to describe the life experiences of middle aged persons living with chronic heart failure. The literature study is based on twelve published, qualitative, and scientifically proved articles derived from MedLine and Cinahl using queries representing the subject, as well as from manual searching in ScienceDirect and LIBRIS. These articles have been analyzed from a life world perspective. Four main themes and four sub themes were identified from the articles' results. The main themes are "The social life", "Quality of life", "Body failing", and "the Economical impact of chronic heart failure". These represent the main areas where the patients feel the greatest loss due to their condition. The discussion reveals the importance of informing the patients of the common prevalence of the feelings described in this study. Also, the nurse should function as a coach for self-care with continuous follow-ups. The result of this study will hopefully increase the understanding of the heart diseased patients' life situations. / I takt med att förekomsten av kraftig övervikt ökar bland unga, ökar även risken för att fler personer drabbas av hjärtsvikt redan i medelåldern. Syftet är att utifrån befintlig forskning beskriva medelålders personers upplevelser av hur det är att leva med kronisk hjärtsvikt. Litteraturstudien baseras på 12 publicerade, kvalitativa och vetenskapliga artiklar efter sökning i MedLine och Cinahl med specifika sökord som representerade ämnet. Manuella sökningar utfördes i ScienceDirect och LIBRIS. Artiklarna har analyserats utifrån ett livsvärldsperspektiv. Ur artiklarnas resultat identifierades fyra teman och sex subteman. Huvudteman är ”Det sociala livet”, ”Livskvalitet”, ”Kroppen sviker” och ”Ekonomiska aspekter”. Huvudteman skildrar patienternas upplevdelser av att leva med kronisk hjärtsvikt. I diskussionen framkommer att det är viktigt för en patient med kronisk hjärtsvikt att få bekräftat att upplevda känslor är vanligt förekommande. Vidare bör sjuksköterskan fungera som en vägledare för egenvård med kontinuerliga uppföljningar. Förhoppningen är att resultatet från denna studie ska öka förståelsen för hjärtsjuka patienter inom ramen för hälso- och sjukvård.

Heart failure is a common disorder and a major cause of illness and death in the population, creating an enormous health-care burden. It is a complex condition, representing the end-point of many cardiovascular diseases. In general heart failure progresses slowly over time and once it is diagnosed it has a poor prognosis which is comparable with that of many types of cancer. The heart has an ability to adapt in response to long lasting increases in hemodynamic demand; the heart conforms its shape and size in order to maintain adequate cardiac output. This process is called remodeling and can be triggered by pathologies such as hypertension or valvular disease. When the myocardial remodeling is maintained chronically it becomes maladaptive and is associated with an increased risk of heart failure. In many cases, heart failure is associated with left bundle branch block (LBBB). This electrical disturbance leads to dyssynchronous left ventricular (LV) contraction and relaxation which may contribute to cardiac dysfunction and ultimately heart failure. Mechanical dyssynchrony can be treated with cardiac resynchronization therapy (CRT). However, many heart failure patients do not demonstrate clinical improvement despite CRT. Blood flow plays an important role in the normal development of the fetal heart. However, flow-induced forces may also induce changes in the heart cells that could lead to pathological remodeling in the adult heart. Until recently, measurement tools have been inadequate in describing the complex three-dimensional and time-varying characteristics of blood flow within the beating heart. 4D (3D + time) flow cardiovascular magnetic resonance (CMR) enables acquisition of three-dimensional, three-directional, time-resolved velocity data from which visualization and quantification of the blood flow patterns over a complete cardiac cycle can be performed. In this thesis, novel 4D Flow CMR based methods are used to study the intraventricular blood flow in healthy subjects and heart failure patients with and without ventricular dyssynchrony in order to gain new knowledge of the ventricular function. Different flow components were assessed in normal heart ventricles. It was found that inflowing blood that passes directly to outflow during the same heartbeat (the Direct Flow component) was larger and possessed more kinetic energy (KE) than other flow components. Diastolic flow through the normal heart appears to create favorable conditions for effective systolic ejection. This organized blood flow pattern within the normal LV is altered in heart failure patients and is associated with decreased preservation of KE which might be unfavorable for efficient LV ejection. Inefficient flow of blood through the heart may influence diastolic wall stress, and thus contribute to pathological myocardial remodeling. In dyssynchronous LVs of heart failure patients with LBBB, Direct Flow showed even more reduced preservation of KE compared to similarly remodeled LVs without LBBB. Furthermore, in LBBB patients, LV filling hemodynamic forces, acting on the myocardium, were more orthogonal to the main flow direction compared to patients without LBBB. Deviation of LV flow forces and reduction of KE preservation and may reflect impairment of LV diastolic function and less efficient ensuing ejection related to dyssynchrony in these failing ventricles. Blood flow patterns were also studied with respect to fluctuations of the velocity of the flow (turbulent flow) in normal and failing LVs. In failing hearts, turbulent kinetic energy (TKE) was higher during diastole than in healthy subjects. TKE is a cause of energy loss and can thus be seen as a measure of flow inefficiency. Elucidating the transit of multidimensional blood flow through the heart chambers is fundamental in understanding the physiology of the heart and to detect abnormalities in cardiac function. The 4D Flow CMR parameters presented in this thesis can be utilized to detect altered intracardiac blood flow and may be used as markers of deteriorating cardiac function, pathological remodeling and mechanical dyssynchrony in heart failure.

Background High blood pressure is associated with an increased risk of cardiovascular disease and premature death. The shape of association between blood pressure and the risk of cardiovascular events is debated. Some researchers suggest that the association is linear or log-linear, whereas others suggest it is J-shaped. Randomized controlled trials of antihypertensive treatment have been successful in hypertension, but ambiguous in the high normal blood pressure range. Previous systematic reviews have not found any interaction between baseline systolic blood pressure and treatment effect, with beneficial effects at systolic blood pressure levels well below what is currently recommended. These reviews, however, use a method to standardize treatment effects and study weights according to within-trial blood pressure differences that may introduce bias. Methods We performed two systematic reviews to assess the effect of antihypertensive treatment on cardiovascular disease and mortality at different blood pressure levels. The first review was limited to people with diabetes mellitus. The second review included all patient categories except those with heart failure and acute myocardial infarction. Both reviews were designed with guidance from Cochrane Collaborations Handbook for Systematic Reviews of Interventions, and are reported according to PRISMA guidelines. We included randomized controlled trials assessing any antihypertensive agent against placebo or any blood pressure targets against each other. Results were combined in random-effects meta-analyses, stratified by baseline systolic blood pressure. Non-stratified analyses were performed for coronary heart disease trials and post-stroke trials. Interaction between blood pressure level and treatment effect was assessed with Cochran’s Q in the first review, and multivariable-adjusted metaregression in the second review. The third paper builds on data from the second paper, and assesses the effect of standardization according to within-trial blood pressure differences on the results of meta-analyses. We performed non-standardized analyses, analyses with standardized treatment effects, and analyses with standardized treatment effects and standard errors. We compared treatment effect measures and heterogeneity across different methods of standardization. We also compared treatment effect estimates between fixed-effects and random-effects meta-analyses within each method of standardization. Lastly, we assessed the association between number of events and study weights, using linear regression. Results Forty-nine trials assessed the effect of antihypertensive treatment in people with diabetes mellitus. Treatment effect on cardiovascular mortality and myocardial infarction decreased with lower baseline systolic blood pressure. Treatment reduced the risk of death and cardiovascular disease if baseline systolic blood pressure was 140 mm Hg or higher. If baseline systolic blood pressure was below 140 mm Hg, however, treatment increased the risk of cardiovascular death by 15 % (0-32 %). Fifty-one trials assessed the effect of antihypertensive treatment in primary prevention. Treatment effect on cardiovascular mortality, major cardiovascular events, and heart failure decreased with lower baseline systolic blood pressure. If baseline systolic blood pressure was 160 mm Hg or higher treatment reduced the risk of major cardiovascular events by 22 % (95 % confidence interval 13-30 %). If systolic blood pressure was 140-159 mm Hg treatment reduced the risk by 12 % (4-20 %), whereas if systolic blood pressure was below 140 mm Hg, treatment effect was neutral (4 % increase to 10 % reduction). All-cause mortality was reduced if systolic blood pressure was 140 mm Hg or higher, with neutral effect at lower levels. Twelve trials compared antihypertensive treatment against placebo in people with coronary heart disease. Mean baseline systolic blood pressure was 138 mm Hg. Treatment reduced the risk of major cardiovascular events by 10 % (3-16 %), whereas the effect on mortality was neutral (7 % increase to 11 % reduction). Standardization of treatment effects resulted in more extreme effect estimates for individual trials. This caused increased between-study heterogeneity, and different results with fixed- and random-effects model. Standardization of standard errors shifted weights from trials with many events to trials with large blood pressure differences. This caused biased overall effect estimates. Standardization of standard errors also resulted in wider confidence intervals, masking the previously increased heterogeneity. This reduced the possibility to find different treatment effects at different blood pressure levels. Conclusion The effect of antihypertensive treatment depends on blood pressure level before treatment. Treatment reduces the risk of death and cardiovascular disease if baseline systolic blood pressure is 140 mm Hg or higher. Below this level, treatment is potentially harmful in people with diabetes, has neutral effect in primary prevention, but might offer additional protection in people with coronary heart disease. Standardization should generally be avoided in meta-analyses of antihypertensive treatment. Previous meta-analyses using standardized methods should be interpreted with caution. / Hjärt-kärlsjukdomar leder till fler dödsfall och fler förlorade levnadsår än någon annan sjukdomsgrupp. Den enskilt viktigaste riskfaktorn som bidrar till hjärtkärlsjukdomar ur ett befolkningsperspektiv är högt blodtryck. Risken att drabbas av hjärt-kärlsjukdomar minskar om man behandlar högt blodtryck men till vilken nivå blodtrycket skall behandlas är kontroversiellt. Denna avhandling innefattar två systematiska översikter och meta-analyser samt ett arbete som jämför olika sätt att hantera skillnader mellan studier i meta-analyser. De systematiska översikterna sammanställer data från randomiserade kontrollerade studier av blodtryckssänkande behandling. Vår övergripande frågeställning var om effekten av behandling påverkas av blodtrycksnivån innan behandling. Mer specifikt studerades hur behandling påverkade risken att dö eller drabbas av hjärt-kärlsjukdom vid olika blodtrycksnivåer. Det första arbetet fokuserade på personer med diabetes. För dessa fann vi att blodtryckssänkande behandling minskar risken att dö eller drabbas av hjärtkärlsjukdom vid nivåer ≥ 140 mmHg. Vi fann ingen nytta, men möjligen en skadlig effekt av behandling, vid lägre blodtrycksnivåer. Det andra arbetet inkluderade studier oberoende av vilka sjukdomar deltagarna hade. Vi fann att den förebyggande effekten av blodtryckssänkande behandling berodde på blodtrycksnivån. Vid blodtryck > 160 mmHg minskade risken att drabbas av hjärt-kärlsjukdomar med 22 % hos de som erhöll behandling. Om blodtrycket var 140-160 mmHg minskade risken med 12 %, men om blodtrycket var < 140 mmHg sågs ingen behandlingseffekt. Hos personer med känd kranskärlssjukdom, och ett medelblodtryck på 138 mmHg, fann vi en något minskad risk för hjärt-kärlhändelser med ytterligare behandling. I det tredje arbetet fann vi att skillnader i resultat mellan olika studier inte kan antas bero endast på olika grad av blodtryckssänkning i studierna. När resultaten standardiserades, som om alla studier hade sänkt blodtrycket lika mycket, ökade nämligen skillnaderna mellan studierna. Detta resulterade i sin tur i snedvridning av resultaten från meta-analyser av standardiserade värden. Sammanfattningsvis minskar blodtryckssänkande behandling risken att dö eller drabbas av hjärt-kärlsjukdomar om blodtrycket är 140 mmHg eller högre. Vid lägre nivåer är nyttan med behandling osäker samtidigt som det finns potentiella risker. Standardisering bör inte användas rutinmässigt vid metaanalyser av blodtrycksstudier. Tidigare meta-analyser som använt denna metod bör tolkas med försiktighet.

Ekokardiologiska undersökningar erbjuder en lätt, snabb och icke-invasiv metod för diagnostik av vänster förmaksvolym (LAV). I dagsläget är hjärt-magnetresonanstomografi (CMR) referensmetod för mätningen. Dock är CMR både tid- och kostnadskrävande, vilket leder till att tvådimensionell ekokardiografi (2DE) istället används. Den relativt nya metoden tredimensionell ekokardiografi (3DE) erbjuder en intressant valmöjlighet vid bedömning av förmaksvolym. Det är studiens syfte att ställa 2DE mot 3DE, gällande modaliteternas korrelation av vänster förmaksvolym, med CMR som referensmetod. Studien undersöker även förhållandet för modaliteternas intra- och inter-bedömar variation. Studien har använt databaserna Pubmed och Medline där systematiska litteratursökningar genomförts under april månad år 2020. Flera inklusions och exklusions kriterier har använts, studien har endast använt artiklar publicerade från 2010 och framåt. 3DE uppvisar en högre korrelation mot CMR vid volymbestämning av LAV. Resultatet visade även att 3DE har en lägre variation mellan både intra- och inter-bedömare än 2DE. 3DE har både en starkare korrelation mot CMR och en lägre bedömarvariation än 2DE, dock lider denna modalitet av begränsningar i dagsläget. Begränsningarna är: tid, personalens erfarenhet, brist på referensvärden samt kostnad för klinikerna. Författarna rekommenderar användning av 3DE för säkrare bedömning av LAV. Fortsatt kunskap som ger adekvata referensvärden och standardiserade mjukvarusystem behövs. / Echocardiological examinations offer an easy, quick, and non-invasive method for diagnosing the left atrium volume (LAV). Cardiac magnetic resonance imaging (CMR) is currently the golden-standard method. However, CMR is time-consuming and costly. Instead two-dimensional echocardiography (2DE) modality is used. The relatively new three-dimensional echocardiography (3DE) method offers an interesting choice when assessing LAV. It’s the purpose of this study to plot 2DE against 3DE regarding LAV correlation and with CMR as reference. The study will examine the relationship between modalities intra- and interobserver variation. Pubmed and Medline databases were used, and systematic literature searches were carried out during April 2020. Inclusion and exclusion criterias have been adopted; the study has only used articles published from 2010 onwards. 3DE shows a higher correlation with CMR in assessment of LAV. The result also showed that 3DE has a lower variation between both intra- and interobserver. 3DE has a stronger correlation to CMR and a lower variation than 2DE, however, 3DE suffers from limitations. These limitations are time, staff experience, lack of reference values and cost to clinics. The authors recommend 3DE for more accurate LAV assessment. Further research for more adequate reference-values and software systems is needed.

Bakgrund: Hjärtinfarkt är en sjukdom som globalt drabbar många personer och räknas som den största dödsorsaken. Hjärtinfarkt är för de flesta en traumatisk upplevelse som påverkar livet kraftigt. Fysiska följder som trötthet och hjärtsvikt, psykiska följder i form av ångest och depression, samt psykosociala följder är vanligt förekommande. Patienters känsla av sammanhang kan vara en avgörande faktor för att bibehålla hälsan efter hjärtinfarkt, samt i patienters hantering efter hjärtinfarkten. Syfte: Syftet var att beskriva patienters upplevelser som nyligen genomgått en hjärtinfarkt. Metod: En litteraturöversikt med kvalitativ metod och induktiv ansats har genomförts, där 13 vetenskapliga artiklar analyserades. Resultat: Resultatet innehöll tre huvudteman. Att inte känna igen sin kropp med subtema fysisk trötthet och fatigue samt misstro till sin kropp. Nya tankar och känslor med subtema psykiska upplevelser av trötthet, stress, rädsla och ångest samt tacksamhet och ny mening. Begränsning i vardagslivet med subtema skam och skuld, att inte passa in, svårigheter med förändringar samt behov av stöd. Slutsats: Patienter upplevde fysisk, psykisk och psykosocial påverkan på livet efter genomgången hjärtinfarkt. Hjärtinfarkten hade påverkan på patienters liv i både positiva och negativa aspekter. / Title: Patients' experiences after a myocardial infarction - A literature review. Background: Myocardial infarction was a disease which affected a lot of humans globally and was countable as the largest cause of death. Myocardial infarction was a traumatic experience and affected patient’s life considerably. Physical consequences as tiredness, heart failure, psychological consequences as anxiety and depression and psychosocial consequences were common. To maintain health and cope with myocardial infarction was the sense of coherence. Aim: The aim was to describe patients´ experiences of having recently had a myocardial infarction. Method: A literature review with a qualitative method and an inductive approach was used, where 13 scientific articles were analyzed. Results: The result contained three main themes. Not recognizing his body with subtheme physical fatigue and fatigue as well as distrust of his body. New thoughts and feelings with sub-themes mental experiences of tiredness, stress, fear and anxiety as well as gratitude & new meaning. Limitations in everyday life with subtheme shame and guilt, not fitting in, difficulties with changes and the need for support. Conclusion: Patients experienced physical, psychological and psychosocial consequences after myocardial infarction. Myocardial infarction had an impact on patients’ daily life in both positive and negative aspects.

Pulmonell hypertension (PH) är en sjukdom med flera olika etiologier som bidrar till ett förhöjt tryck i lungkretsloppet. PH definieras som ett medelartärtryck i lungpulsådern   25mm Hg i vila uppmätt vid högersidig hjärtkateterisering (RHC). De olika orsakerna till PH delas in i fem grupper. Denna studie fokuserar på grupp I, som utgörs av pulmonell arteriell hypertension (PAH). PAH bidrar till en tryckbelastning av högerkammaren där högerkammaren måste arbeta mot ett högre tryck. Detta leder till en nedsatt högerkammarfunktion. I nuläget används right ventricular stroke work index (RVSWI) inom RHC, för att mäta högerkammarens arbete. Syftet med studien var att jämföra RVSWI beräknat med ekokardiografi och RHC. Detta för att finna ytterligare ett mått vid bedömning av högerkammarfunktion med ekokardiografi hos patienter med PAH. RVSWI beräknades med två ekokardiografiska metoder (RVSWIEKO1= 90 - (0,62 x pulmonalisflödets accelerationstid (PAT) x slagvolymindex (SVIEKO)), RVSWIEKO2= ((0,61 x maximala gradienten över tricuspidalisinsufficiensen (TRmaxPG)) + medeltrycket i höger förmak (mRAP) + 2) x SVIEKO). Båda metoderna påvisade statistisk signifikant skillnad (p <0,001) i absoluta värden mot RVSWI erhållet med RHC.  En av metoderna (RVSWI EKO2) påvisade en måttlig korrelation mot RHC, medan RVSWI EKO1 hade en försumbar korrelation mot RHC. Studien visade att ekokardiografiskt beräknat RVSWI kan användas, som ett ytterligare mått vid bedömning av högerkammarens funktion. Det krävs dock fler studier för att parametern ska kunna användas kliniskt. / Pulmonary hypertension (PH) is a disease with many different etiologies contributing to an increased pressure in the pulmonary circulation. PH is defined as a mean arterial pressure in the pulmonary artery ≥ 25mm Hg at rest measured by right heart catheterization (RHC). The different causes of PH are divided into five groups. This study focuses on group I, which consists of pulmonary arterial hypertension (PAH). PAH contributes to a pressure overload of the right ventricle. The right ventricle must work at a higher pressure, which leads to a reduced right ventricular function. Currently, right ventricular stroke work index (RVSWI) by right heart catheterization (RHC) is a measure of right ventricular workload. The purpose of the study was to compare RVSWI calculated with echocardiography to RVSWI by RHC. And to find an additional measure for assessing right ventricular function by echocardiography in patients with PAH.  RVSWI was evaluated with two echocardiographic methods (RVSWIEKO1= 90 - (0,62 x pulmonary acceleration time (PAT) x stroke volume index (SVIEKO)), RVSWIEKO2= ((0,61 x tricuspid regurgitant maximum pressure gradient (TRmaxPG)) + mean right atrial pressure (mRAP) + 2) x SVIEKO). Both the echocardiographic methods showed a statistically significant difference (p <0.001) in absolute values ​​compared to RVSWI by RHC. One of the echocardiographic methods (RVSWI EKO2) showed a moderate correlation with RHC, while RVSWIEKO1 showed a negligible with RHC. The study has shown that RVSWI evaluated with echocardiography can be used as an additional measure, when assessing right ventricular function. However, more studies are needed until the parameter can be used clinically.

Bakgrund: Hjärtsvikt betraktas som en av våra folksjukdomar och är en av de vanligaste hjärt- och kärlsjukdomarna. Att leva med hjärtsvikt påverkar personens vardagliga liv negativt både fysiskt och psykiskt. Genom egenvård där personen får god information och patientundervisning kan livskvalitén påverkas i en positiv riktning. Syfte: Att beskriva personers upplevelser av egenvård vid hjärtsvikt. Metod: En litteraturöversikt med kvalitativ metod och induktiv ansats. Artikelsökningen utfördes i databaserna Cinahl och Medline. Tolv artiklar inkluderades i litteraturöversiktens resultat och analyserades genom Fribergs femstegsmodell.   Resultat: Resultatet baseras på personers upplevelser av egenvård och i litteraturöversikten framkom det att stöd och individuella strategier främjade en god följsamhet till egenvård vid hjärtsvikt. I resultatet framkom även begränsningar till egenvården som bland annat var brist på stöd och brist på information. Slutsatser: Litteraturöversiktens resultat visar vad som är betydelsefullt för personer med hjärtsvikt när de ska utföra sin egenvård. Även aspekter som hindrar egenvården framkom i resultatet. För sjuksköterskan är det betydelsefullt att förstå personernas upplevelser för att kunna individanpassa vården efter personens behov och önskemål. / Background: Heart failure is one of the most common cardiovascular diseases. To live with heart failure affects the persons daily life negatively both physical and psychological. Through self-care where the person gets good information, their quality of life improves.  Aim: To describe the experiences of self-care in people with heart failure.  Method: A literature review with qualitative method and an inductive design. Articles were found I the databases Cinahl and Medline. Twelve articles were included in the result and were analyzed based on Friberg´s five step model. Result: The result is based on the experiences of self-care, and it emerged that support and individual strategies promoted good compliance for the self-care in heart failure. The limitations to self-care were among others lack of support and lack of information.  Conclusion: The result in this literature review shows what is important for persons with heart failure when they are performing self-care. There are also aspects on what prevent people from performing self-care found in the result. It is important for the nurse to understand the person’s experiences to be able to individually adapt the care after the person’s needs and wishes.

Hypertrophic cardiomyopathy is a heart disease that is characterized by an enlarged heart muscle. Mutations to sarcomere proteins in the muscle fibers give rise to the disease, and this review aims to compile the mechanisms by which the mutations cause the disease phenotype. β-myosin heavy chain mutants affect the thick filament structure and contraction velocity of the muscle. Mutations to the myosin-binding protein C produces truncated proteins with decreased expression in the cells. Troponin T mutants cause myofibrillar disarray, alters affinity to α-tropomyosin, and are linked to a higher risk of sudden death. Troponin I is an unpredictable mutant that needs to be further researched but is thought to cause regulatory problems. Mutations to α-tropomyosin and the regulatory myosin light chain both affect the Ca2+-affinity of the proteins and leads to contractile problems. Hypercontractility as a result of the mutations seems to be the primary cause of the disease. Hypertrophic cardiomyopathy is linked to sudden death, and factors such as a family history of sudden death, multiple simultaneous mutations, unexplained syncope, non-sustained ventricular tachycardia, abnormal blood pressure response and extreme hypertrophy (>30 mm) heightens the risk of a sudden death. An increased knowledge about the disease will aid in the mission to better the treatments for the affected, but further investigation of pathological pathways needs to be performed.

Pulmonary arterial hypertension (PAH) is an uncommon but serious disease that causes increased pressure in the pulmonary vessels and increased pulmonary vascular resistance (PVR), which in turn leads to right heart failure. At diagnosis, mean pulmonary artery pressure (mPAP) must be >20 mmHg, pulmonary artery wedge pressure (PAWP) ≤15 mmHg and PVR >2 Wood units (WU). Calculation of cardiac output (CO) is an important hemodynamic parameter to be measured and assessed in these patients during a right heart catheterization (RHC). Prevailing ESC guidelines recommend using direct Fick's principle (dFp), which is considered the gold standard, or thermodilution when calculating CO. The aim of this study was to compare these two methods to see if there is a significant difference in the calculation of CO in patients with PAH. The aim was also to see if calculated cardiac index (CI) and PVR differ significantly depending on which of the methods for calculating CO is used. A retrospective study was conducted in which 34 patients who underwent RHC at the University Hospital in Örebro were included. The result showed a significant difference between dFp and thermodilution (p<0,05), where dFp on average measures higher volumes compared to thermodilution. It also showed a low agreement between the two methods. A significant difference was seen between CI and PVR (p<0,05) depending on which of the methods is used. Therefore, dFp and thermodilution cannot be said to have a good agreement in this patient group. It is important to use the same method for follow-up examinations as the assessment of PVR and CI is used as a predictor of whether the disease progresses or remains stable.

During interventional cardiology (IC), medical staff are exposed to scattered ionizing radiation from the patient, potentially leading to various radiation-induced health effects. Therefore, shielding devices are routinely used to reduce occupational exposure during IC procedures. This study explores how the positioning of shielding devices impacts radiation protection efficiency in clinical scenarios. The study aims to determine optimal setups and potential pitfalls that might significantly reduce the efficiency of the shielding devices. It also explores the relationship between DICOM-based production data, clinical observations, and phantom-based measurements to add knowledge to the research field of radiation protection in IC. Clinical DICOM-based production data from 4976 procedures were analyzed to identify C-arm projection angles used during different procedure types. This data and the results of an observational study were used to determine a scattered radiation measurement setup. A survey meter was used to measure air kerma at seven heights in the operator position while an anthropomorphic phantom was irradiated. The measurements were distributed over seven projections with 56 position combinations of the shielding devices. A total of 3171 measurements were performed. The measurements suggest significant variations in the operator dose depending on the projection and how the shielding devices are positioned. The most optimal combination of shielding devices was achieved when placing the table-mounted shield along the table, the ceiling-suspended shield caudal close to the phantom, and without the patient drape. Conversely, the least optimal combination was achieved when placing the table-mounted shield flared out, the ceiling-suspended shield cranial 10 cm above the phantom, and without the patient drape. The air kerma rate for these two shielding setups with the LAO25/CAUD30 projection was reduced from 0.19 μGy/s to 0.05 μGy/s at 110 cm from the floor. This height was shown to be the hardest to properly shield. Despite the implementation of the most optimal shielding combination, it is evident that certain heights present difficulties in effectively protecting the operator from scattered radiation.