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The ability of an electrocardiogram to predict fatal and non-fatal cardiac events in asymptomatic middle-aged subjects.

https://arctichealth.org/en/permalink/ahliterature283977
Source
Ann Med. 2016 Nov;48(7):525-531
Publication Type
Article
Date
Nov-2016
Author
Henri K Terho
Jani T Tikkanen
Tuomas V Kenttä
M Juhani Junttila
Aapo L Aro
Olli Anttonen
Tuomas Kerola
Harri A Rissanen
Paul Knekt
Antti Reunanen
Heikki V Huikuri
Source
Ann Med. 2016 Nov;48(7):525-531
Date
Nov-2016
Language
English
Publication Type
Article
Keywords
Adult
Cardiovascular Diseases - mortality - physiopathology
Electrocardiography - methods
Female
Finland
Humans
Male
Middle Aged
Predictive value of tests
Prognosis
Registries
Risk factors
Abstract
The long-term prognostic value of a standard 12-lead electrocardiogram (ECG) for predicting cardiac events in apparently healthy middle-aged subjects is not well defined.
A total of 9511 middle-aged subjects (mean age 43?±?8.2 years, 52% males) without a known cardiac disease and with a follow-up 40 years were included in the study. Fatal and non-fatal cardiac events were collected from the national registries. The predictive value of ECG was separately analyzed for 10 and 30 years. Major ECG abnormalities were classified according to the Minnesota code.
Subjects with major ECG abnormalities (N?=?1131) had an increased risk of cardiac death after 10-years (adjusted hazard ratio [HR] 1.7; 95% confidence interval [95% CI], 1.1-2.5, p?=?0.009) and 30-years of follow-up (HR 1.3, 95% CI, 1.1-1.5, p?
PubMed ID
27684209 View in PubMed
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Ambulatory Blood Pressure Characteristics and Long-Term Risk for Atrial Fibrillation.

https://arctichealth.org/en/permalink/ahliterature289822
Source
Am J Hypertens. 2017 Mar 01; 30(3):264-270
Publication Type
Journal Article
Date
Mar-01-2017
Author
Juha S Perkiömäki
Santeri Nortamo
Antti Ylitalo
Antero Kesäniemi
Olavi Ukkola
Heikki V Huikuri
Author Affiliation
Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
Source
Am J Hypertens. 2017 Mar 01; 30(3):264-270
Date
Mar-01-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Atrial Fibrillation - epidemiology
Blood pressure
Blood Pressure Monitoring, Ambulatory
Emergencies - epidemiology
Female
Finland - epidemiology
Follow-Up Studies
Humans
Hypertension - epidemiology - physiopathology
Male
Middle Aged
Predictive value of tests
Risk assessment
Risk factors
Abstract
We hypothesized that elevated nighttime systolic ambulatory blood pressure (ABP) yields additional information compared with daytime systolic ABP for the long-term risk of atrial fibrillation (AF) and perhaps should be taken into account in treatment strategies for preventing the increasing burden of AF during aging.
A total of 903 subjects with or without hypertension aged 40 to 59 years, who were recruited to the Oulu Project Elucidating Risk of Atherosclerosis (OPERA) study, underwent ABP monitoring, thorough clinical examinations and laboratory tests.
After an average of 16.4 ± 3.6 years of follow-up, 91 (10%) of the study subjects had experienced a new-onset AF requiring a hospital emergency room or hospital visit. Of the components of baseline ABP, the nighttime mean systolic blood pressure had the strongest univariable association with the occurrence of AF (120.8 ± 15.9 vs. 116.4 ± 14.1 mm Hg, P = 0.006, in subjects with vs. without the occurrence AF). When the univariable predictors of AF, such as age, sex, body mass index, height, smoking history, alanine aminotransferase, uric acid, and fasting plasma glucose, were entered in the multivariable Cox hazards model, age (P
PubMed ID
27852579 View in PubMed
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Ambulatory Blood Pressure Characteristics and Long-Term Risk for Atrial Fibrillation.

https://arctichealth.org/en/permalink/ahliterature277774
Source
Am J Hypertens. 2016 Nov 15;
Publication Type
Article
Date
Nov-15-2016
Author
Juha S Perkiömäki
Santeri Nortamo
Antti Ylitalo
Antero Kesäniemi
Olavi Ukkola
Heikki V Huikuri
Source
Am J Hypertens. 2016 Nov 15;
Date
Nov-15-2016
Language
English
Publication Type
Article
Abstract
We hypothesized that elevated nighttime systolic ambulatory blood pressure (ABP) yields additional information compared with daytime systolic ABP for the long-term risk of atrial fibrillation (AF) and perhaps should be taken into account in treatment strategies for preventing the increasing burden of AF during aging.
A total of 903 subjects with or without hypertension aged 40 to 59 years, who were recruited to the Oulu Project Elucidating Risk of Atherosclerosis (OPERA) study, underwent ABP monitoring, thorough clinical examinations and laboratory tests.
After an average of 16.4 ± 3.6 years of follow-up, 91 (10%) of the study subjects had experienced a new-onset AF requiring a hospital emergency room or hospital visit. Of the components of baseline ABP, the nighttime mean systolic blood pressure had the strongest univariable association with the occurrence of AF (120.8 ± 15.9 vs. 116.4 ± 14.1 mm Hg, P = 0.006, in subjects with vs. without the occurrence AF). When the univariable predictors of AF, such as age, sex, body mass index, height, smoking history, alanine aminotransferase, uric acid, and fasting plasma glucose, were entered in the multivariable Cox hazards model, age (P
PubMed ID
27852579 View in PubMed
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Ambulatory Pulse Pressure Predicts the Development of Left Ventricular Diastolic Dysfunction in Over 20 Years of Follow-up.

https://arctichealth.org/en/permalink/ahliterature296701
Source
Am J Hypertens. 2017 Oct 01; 30(10):985-992
Publication Type
Journal Article
Date
Oct-01-2017
Author
Tero J W Pääkkö
Reko J Renko
Juha S Perkiömäki
Y Antero Kesäniemi
Antti S Ylitalo
Jarmo A Lumme
Heikki V Huikuri
Heikki Ruskoaho
Olli Vuolteenaho
Olavi H Ukkola
Author Affiliation
Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland.
Source
Am J Hypertens. 2017 Oct 01; 30(10):985-992
Date
Oct-01-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Blood pressure
Blood Pressure Monitoring, Ambulatory
Echocardiography, Doppler, Pulsed
Female
Finland - epidemiology
Follow-Up Studies
Humans
Male
Middle Aged
Predictive value of tests
Prognosis
Prospective Studies
Risk factors
Time Factors
Ventricular Dysfunction, Left - diagnostic imaging - epidemiology - physiopathology
Ventricular Function, Left
Abstract
Ambulatory blood pressure (ABP) has been shown to have an association with left ventricular diastolic dysfunction (LVDD) in cross-sectional assessments. We evaluated the association between ABP measurement (ABPM) and the development of LVDD during over 20 years of follow up in 414 middle-aged subjects from OPERA cohort.
ABPM, clinical, and anthropometric measurements were performed in baseline. Echocardiographic measurements were performed at baseline and during follow-up and E/E' =15 was considered indicating significant LVDD.
Several baseline clinical characteristics (age, female gender, short stature, body mass index, prevalence of diabetes, in-office systolic BP (SBP), in-office pulse pressure (PP), N-terminal pro-atrial natriuretic peptide, and the use of antihypertensive therapy) were associated with the development of LVDD. Baseline 24-hour mean, daytime mean or nighttime mean SBP or diastolic BP were not associated with the development of LVDD, neither were different circadian BP profiles. Instead 24-hour mean, daytime mean and nighttime mean PP showed significant association with the development of LVDD (P from
PubMed ID
28911024 View in PubMed
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Antiepileptic medications and the risk for sudden cardiac death caused by an acute coronary event: a prospective case-control study.

https://arctichealth.org/en/permalink/ahliterature278965
Source
Ann Med. 2016;48(1-2):111-7
Publication Type
Article
Date
2016
Author
Eeva Hookana
Hanna Ansakorpi
Marja-Leena Kortelainen
M Juhani Junttila
Kari S Kaikkonen
Juha Perkiömäki
Heikki V Huikuri
Source
Ann Med. 2016;48(1-2):111-7
Date
2016
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - mortality
Aged
Anticonvulsants - administration & dosage - adverse effects
Autopsy
Case-Control Studies
Death, Sudden, Cardiac - epidemiology - etiology
Epilepsy - drug therapy - mortality
Female
Finland - epidemiology
Humans
Male
Middle Aged
Prospective Studies
Abstract
Epilepsy is associated with sudden death, but the reasons for this association are not well known. Objective We studied the role of antiepileptic drugs (AEDs) as a factor contributing to sudden cardiac death (SCD) in The Finnish Study of the Genotype and Phenotype Characteristics of Sudden Cardiac Death (FinGesture).
The FinGesture study compares the characteristics of victims of SCD caused by an autopsy-verified acute coronary event (cases) vs. survivors of an acute coronary event (ACS) (controls). The study population comprised 3737 cases (mean age 64?±?12 y) and 3081 controls (mean age 66?±?12 y). The use of AED was obtained from death certificates, autopsy/hospital records, national drug imbursement register, and interviews with the relatives. AEDs were more commonly used by the victims of SCD vs. controls (5.5% vs. 2.2%, adjusted odds ratio 2.7, 95% CI; 1.9-3.9; p?
PubMed ID
26838936 View in PubMed
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Association of early repolarization and sudden cardiac death during an acute coronary event.

https://arctichealth.org/en/permalink/ahliterature123138
Source
Circ Arrhythm Electrophysiol. 2012 Aug 1;5(4):714-8
Publication Type
Article
Date
Aug-1-2012
Author
Jani T Tikkanen
Viktor Wichmann
M Juhani Junttila
Meri Rainio
Eeva Hookana
Olli-Pekka Lappi
Marja-Leena Kortelainen
Olli Anttonen
Heikki V Huikuri
Author Affiliation
Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Oulu, Finland. jani.tikkanen@oulu.fi
Source
Circ Arrhythm Electrophysiol. 2012 Aug 1;5(4):714-8
Date
Aug-1-2012
Language
English
Publication Type
Article
Keywords
Acute Disease
Aged
Aged, 80 and over
Chi-Square Distribution
Death, Sudden, Cardiac - etiology
Electrocardiography
Female
Finland
Heart Conduction System - physiopathology
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Myocardial Ischemia - complications - diagnosis - mortality - physiopathology
Odds Ratio
Predictive value of tests
Retrospective Studies
Risk assessment
Risk factors
Survival Analysis
Abstract
Electrocardiographic early repolarization (ER) pattern has been previously associated with arrhythmic mortality and with an increased risk of ventricular fibrillation. We hypothesized that there is an association between ER and sudden cardiac death (SCD) during an acute coronary event.
The present study included 432 consecutive victims of SCD because of acute coronary event and 532 survivors of such an event, in whom 12-lead ECGs recorded before and unrelated to the event could be evaluated. SCDs were verified by medicolegal autopsy to be because of acute coronary event. ER was defined as an elevation of the QRS-ST junction in at least 2 inferior or lateral leads, manifested as QRS notching or slurring. The prevalence of ER pattern =0.1 mV was more common in cases (62/432; 14.4%) than controls (42/532; 7.9%) (P=0.001). The victims of SCD were younger, were more commonly men and smokers, had lower body mass index, had elevated heart rate, had prolonged QRS complex, and had lower prevalence of history of prior cardiovascular disease than controls. After adjustments for baseline differences, the odds ratio for J waves without ST-segment elevation in the SCD group was 2.15 (95% CI, 1.20-3.85; P=0.01).
Higher prevalence of ER in a standard 12-lead ECG in victims of SCD than in survivors of an acute coronary event suggests that the presence of ER increases the vulnerability to fatal arrhythmia during acute myocardial ischemia and provides a plausible mechanistic link between this ECG pattern and higher arrhythmic mortality of middle-aged/elderly subjects.
Notes
Comment In: Circ Arrhythm Electrophysiol. 2012 Dec;5(6):e116; author reply e117-823250559
PubMed ID
22730409 View in PubMed
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Association of initial recorded rhythm and underlying cardiac disease in sudden cardiac arrest.

https://arctichealth.org/en/permalink/ahliterature287156
Source
Resuscitation. 2017 Nov 27;122:76-78
Publication Type
Article
Date
Nov-27-2017
Author
Janna P Kauppila
Antti Hantula
Marja-Leena Kortelainen
Lasse Pakanen
Juha Perkiömäki
Matti Martikainen
Heikki V Huikuri
M Juhani Junttila
Source
Resuscitation. 2017 Nov 27;122:76-78
Date
Nov-27-2017
Language
English
Publication Type
Article
Abstract
Asystole (ASY) and pulseless electrical activity (PEA) are increasing and ventricular fibrillation (VF) or ventricular tachycardia (VT) declining as presenting rhythms of sudden cardiac arrest (SCA). Since there is limited information on possible differences in the etiology of underlying structural heart disease, we analyzed the clinical and/or autopsy findings of victims with ASY, PEA or VT/VF.
All SCA cases with recorded ASY, PEA or VT/VF occurring after onset of witnessed collapse were analyzed by the emergency personnel between the years 2007-2012 within the Oulu University Hospital area. Underlying structural heart disease was diagnosed by medico-legal autopsy or by clinical investigation (echocardiography, angiography). Of a total number of 659 subjects with a documented rhythm at the time of SCA, 300 were determined to be due to cardiac disease at autopsy or as a result of clinical investigation. Delay was less than 30min from collapse to rhythm recording in 274 subjects (mean age 65±14 yrs; 214 males, 78.1%).
The presenting rhythm was ASY in 87 (31.8%) PEA in 38 (13.9%) and VT/VF in 149 subjects (54.4%). There was no significant difference in the delay from the onset of collapse to the rhythm recording between ASY (11±8min) and VT/VF (9±6min, p=0.06) or PEA (6±8min) and VT/VF (p=0.334). The majority of SCA subjects had an ischemic cause for the event (n=216, 78.8%). Non-ischemic cause for SCA was associated with non-shockable rhythm (Non-ischemic: ASY 46.6% PEA 17.2% VT/VF 36.2% v. Ischemic: ASY 27.8% PEA 13.0% VT/VF 59.3%) even when adjusted for gender, age and delay from collapse to rhythm recording (ASY/PEA v. VT/VF, OR 3.2 95%CI: 1.67-6.50, p=0.001).
Asystole and PEA are a more common presenting rhythm than VT/VF at the time of SCA in non-ischemic cardiac disease. The decreasing trend of ischemic heart disease as a cause of SCA may partly explain the increasing trend of ASY/PEA.
PubMed ID
29191702 View in PubMed
Less detail

Association of initial recorded rhythm and underlying cardiac disease in sudden cardiac arrest.

https://arctichealth.org/en/permalink/ahliterature293463
Source
Resuscitation. 2018 01; 122:76-78
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
01-2018
Author
Janna P Kauppila
Antti Hantula
Marja-Leena Kortelainen
Lasse Pakanen
Juha Perkiömäki
Matti Martikainen
Heikki V Huikuri
M Juhani Junttila
Author Affiliation
Research Unit of Internal Medicine, Medical Research Center Oulu, University Hospital of Oulu and University of Oulu, Finland.
Source
Resuscitation. 2018 01; 122:76-78
Date
01-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Cardiopulmonary Resuscitation - methods
Death, Sudden, Cardiac - etiology
Female
Heart rate
Humans
Male
Middle Aged
Myocardial Ischemia - complications
Tachycardia, Ventricular - complications
Time-to-Treatment
Ventricular Fibrillation - complications
Abstract
Asystole (ASY) and pulseless electrical activity (PEA) are increasing and ventricular fibrillation (VF) or ventricular tachycardia (VT) declining as presenting rhythms of sudden cardiac arrest (SCA). Since there is limited information on possible differences in the etiology of underlying structural heart disease, we analyzed the clinical and/or autopsy findings of victims with ASY, PEA or VT/VF.
All SCA cases with recorded ASY, PEA or VT/VF occurring after onset of witnessed collapse were analyzed by the emergency personnel between the years 2007-2012 within the Oulu University Hospital area. Underlying structural heart disease was diagnosed by medico-legal autopsy or by clinical investigation (echocardiography, angiography). Of a total number of 659 subjects with a documented rhythm at the time of SCA, 300 were determined to be due to cardiac disease at autopsy or as a result of clinical investigation. Delay was less than 30min from collapse to rhythm recording in 274 subjects (mean age 65±14 yrs; 214 males, 78.1%).
The presenting rhythm was ASY in 87 (31.8%) PEA in 38 (13.9%) and VT/VF in 149 subjects (54.4%). There was no significant difference in the delay from the onset of collapse to the rhythm recording between ASY (11±8min) and VT/VF (9±6min, p=0.06) or PEA (6±8min) and VT/VF (p=0.334). The majority of SCA subjects had an ischemic cause for the event (n=216, 78.8%). Non-ischemic cause for SCA was associated with non-shockable rhythm (Non-ischemic: ASY 46.6% PEA 17.2% VT/VF 36.2% v. Ischemic: ASY 27.8% PEA 13.0% VT/VF 59.3%) even when adjusted for gender, age and delay from collapse to rhythm recording (ASY/PEA v. VT/VF, OR 3.2 95%CI: 1.67-6.50, p=0.001).
Asystole and PEA are a more common presenting rhythm than VT/VF at the time of SCA in non-ischemic cardiac disease. The decreasing trend of ischemic heart disease as a cause of SCA may partly explain the increasing trend of ASY/PEA.
PubMed ID
29191702 View in PubMed
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Association of non-shockable initial rhythm and psychotropic medication in sudden cardiac arrest.

https://arctichealth.org/en/permalink/ahliterature306124
Source
Int J Cardiol Heart Vasc. 2020 Jun; 28:100518
Publication Type
Journal Article
Date
Jun-2020
Author
Janna P Kauppila
Antti Hantula
Lasse Pakanen
Juha S Perkiömäki
Matti Martikainen
Heikki V Huikuri
M Juhani Junttila
Author Affiliation
Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland.
Source
Int J Cardiol Heart Vasc. 2020 Jun; 28:100518
Date
Jun-2020
Language
English
Publication Type
Journal Article
Abstract
Asystole (ASY) and pulseless electrical activity (PEA) have a poor outcome during sudden cardiac arrest (SCA). Psychotropic medication has been associated with a risk for sudden cardiac death (SCD). Our aim was to study the association of psychotropic medication with ASY/PEA during SCA.
A total of 659 SCA subjects were derived from the emergency data of Oulu University Hospital (2007-2012). Subjects with non-cardiac origin of SCA and over 30-minute delay to rhythm recording were excluded. Population included 222 subjects after exclusions (mean age 64 ± 14 years, 78% males). Initial rhythm was ventricular fibrillation (VF) or ventricular tachycardia (VT) in 123 (55%), ASY in 67 (30%) and PEA in 32 (14%) subjects. The delay (collapse to rhythm recording) was similar in VF/VT and ASY/PEA subjects (median 8 min [1st-3rd quartile 3-12 min] versus 10 [0-14] minutes, p = 0.780). Among VF/VT subjects underlying cardiac disease was more often ischemic compared to ASY/PEA subjects (85% versus 68%, p = 0.003). Psychotropic medication was associated with ASY/PEA rhythm (OR 3.18, 95%CI 1.40-7.23, p = 0.006) after adjustment for gender, age and underlying cardiac disease. Subsequently, antipsychotics (OR 4.27, 95%CI 1.28-14.25, p = 0.018) were more common in the ASY/PEA group. Benzodiazepines and antidepressants were not associated with ASY/PEA.
Psychotropic medication and especially antipsychotics are associated with non-shockable rhythm during SCA and may lower the possibility of survival from the event. This might partly explain the risk of SCD related to psychotropic medication.
PubMed ID
32346603 View in PubMed
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Associations of fitness and physical activity with orthostatic responses of heart rate and blood pressure at midlife.

https://arctichealth.org/en/permalink/ahliterature300456
Source
Scand J Med Sci Sports. 2019 Jun; 29(6):874-885
Publication Type
Journal Article
Date
Jun-2019
Author
Päivi Oksanen
Mikko P Tulppo
Juha Auvinen
Maisa Niemelä
Timo Jämsä
Katri Puukka
Heikki V Huikuri
Raija Korpelainen
Mika Venojärvi
Antti M Kiviniemi
Author Affiliation
Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland.
Source
Scand J Med Sci Sports. 2019 Jun; 29(6):874-885
Date
Jun-2019
Language
English
Publication Type
Journal Article
Keywords
Blood pressure
Cardiorespiratory fitness
Exercise
Exercise Test
Female
Finland
Heart rate
Humans
Male
Middle Aged
Abstract
Cardiorespiratory fitness (CRF) and physical activity (PA) are associated with autonomic function, but their associations to orthostatic autonomic responses are unclear in epidemiological setting. We hypothesized that higher CRF and PA would associate with higher immediate vagal responses and lower incidence of adverse findings during orthostatic test. At age of 46, 787 men and 938 women without cardiorespiratory diseases and diabetes underwent an orthostatic test (3-minutes sitting, 3-minutes standing) with recording of RR intervals (RRi) and blood pressure (BP) by finger plethysmography. Acute responses of RRi (30:15 ratio) and BP were calculated. CRF was measured by a submaximal step test and daily amount of moderate-to-vigorous PA (MVPA) for 2 weeks by wrist-worn accelerometer. Lifelong PA was based on questionnaires at ages of 14, 31, and 46. High CRF was significantly associated with higher RRi 30:15 ratio (adjusted standardized ß = 0.17, P 
PubMed ID
30697819 View in PubMed
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103 records – page 1 of 11.