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Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

In order to identify patients with severe coronary artery disease (CAD) and at a higher risk of future cardiac events after uncomplicated myocardial infarction, 105 consecutive patients were studied prospectively. There were 93 men and 12 women with a mean age of 56 +/- 8.2 years. Treadmill testing, exercise radionuclide ventriculography, thallium-201 myocardial imaging and selective coronary arteriography were performed 6-8 weeks after infarction. Patients were grouped into those who had single and multiple vessel disease. Multiple regression analysis of 18 noninvasive indices was carried out using generalized linear interactive modelling (GLIM) and the results were compared with the severity of underlying CAD and the clinical outcome after a mean follow-up period of 18.8 +/- 3. 4 months. At the end of the follow-up period, patients were categorized into those who had no cardiac events, minor and major cardiac events. Multivariate analysis produced an algorithm from three factors found to be most predictive of the severity of CAD. These included ST-segment depression on exercise, total score of rest and exercise regional wall motion and the presence of significant redistribution on thallium-201 imaging. The sensitivity of this algorithm for predicting multiple vessel disease was 42%, with a specificity of 94%, and a predictive accuracy of 69%. However, the total score of regional wall motion abnormalities was the single most predictive factor of major cardiac events with a sensitivity of 94%, a specificity of 57%, and predictive accuracy of 63%. None of the other factors produced additional prognostic information. Therefore, exercise radionuclide ventriculography appears to be the investigation of choice in assessing prognosis after myocardial infarction.

Atrial fibrillation (AF) is one of the most frequent complications following coronary artery bypass grafting (CABG), occurring in up to 40% of patients. This thesis investigates the utility of non-invasive markers of left ventricular filling pressure in predicting AF in this setting, and assesses a novel marker of inflammation in the same role. Given the haemodynamic changes occurring peri-operatively it was hypothesised that acute changes in left ventricular filling pressure (LVFP), and resulting atrial stretch, might predispose to post-operative AF. Levels of the natriuretic peptides, BNP and NT-proBNP, were measured pre-operatively in 275 patients undergoing non-emergency CABG, and detailed echocardiographic examination performed. The natriuretic peptides were higher in patients who developed AF, and both were independently predictive of post-operative AF in multivariable analysis. However, their clinical utility appears modest in this role. The only significant echocardiographic predictors of AF were the transmitral E to A-wave ratio and the early mitral annulus velocity. None of the echocardiographic parameters remained independently predictive in multivariable analysis. The strongest echocardiographic correlate of both BNP and NT-proBNP was the left atrial volume index (LAVi), a marker of chronic LV filling pressure. Patients undergoing CABG are subject to a significant peri-operative inflammatory response. This was investigated in the same cohort by means of the neutrophil/lymphocyte (N/L) ratio. Patients who developed AF had greater pre- and post-operative N/L ratios, with no preoperative differences observed in other white blood cell parameters or C-reactive protein. In multivariate models, a greater post-operative N/L ratio was independently associated with the incidence of AF. In patients undergoing CABG, AF remains difficult to predict from pre-operative variables, although age appears to be a consistent factor. Difficulties in the prediction of AF in this setting are likely to reflect the heterogeneity of influences on the development of the arrhythmia in this setting.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2001. / Härtill 5 uppsatser.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2006. / Härtill 4 uppsatser.

Thesis (Geaggregeerde voor het Hoger Onderwijs)--Catholic University of Leuven, 1988. / Includes bibliographical references (p. 118-129).

Thesis (Geaggregeerde voor het Hoger Onderwijs)--Catholic University of Leuven, 1988. / Includes bibliographical references (p. 118-129).