The primary myocardial disease idiopathic dilated cardiomyopathy (IDCM) is not clearly defined in the literature. The description is both morphologic and etiologic. We examined consecutive patients with congestive heart failure (CHF) of unknown cause to identify possible cases of IDCM and to give a detailed description of echocardiographic data and possible diastolic dysfunction in this group. The hospital records of patients aged 16 to 65 years hospitalized due to CHF or IDCM during a 6-year period (N = 2,711) were evaluated in a defined region of western Sweden. Twenty-two percent (584/2,711) of these records contained no plausible cause of CHF or IDCM, and among patients being alive, obvious cause was lacking in 411 of 1,516 (27%). These 411 patients were offered a diagnostic investigation, including echocardiography, and they were compared with a randomly selected control group (n = 103) from the general population. Of 411 patients, 293 accepted investigation. From the control group, we defined the reference level for left ventricular (LV) dilatation to be > 32 mm/m2, and reduced ejection fraction according to Teichholz formula to be
Department of Molecular Medicine and Surgery, Division of Clinical Physiology, Karolinska Institutet, (L1:00), SE-171 76, Stockholm, Sweden. anna.damlin@ki.se.
The diagnosis of infective endocarditis (IE) is based on microbiological analyses and diagnostic imaging of cardiac manifestations. Echocardiography (ECHO) is preferred for visualization of IE-induced cardiac manifestations. We investigated associations between bacterial infections and IE manifestations diagnosed by ECHO.
In this cohort study, data from patients aged 18?years or above, with definite IE admitted at the Karolinska University Hospital between 2008 and 2017 were obtained from Swedish National Registry of Endocarditis. Bacteria registered as pathogen were primarily selected from positive blood culture and for patients with negative blood culture, bacteria found in culture or PCR from postoperative material was registered as pathogen. Patients with negative results from culture or PCR, and patients who did not undergo ECHO during hospital stay, were excluded. IE manifestations diagnosed by ECHO were obtained from the registry. Chi-squared test and two-sided Fisher's exact test was used for comparisons between categorical variables, and student's t test was used for continuous numerical variables. Multivariable analyses were performed using logistic regression. Secular trend analyses were performed using linear regression. Associations and the strength between the variables were estimated using odds ratios (ORs) with 95% confidence intervals (CIs). P
Dyspnoea is one of the earliest symptoms in several conditions, such as heart disease and airway obstruction. However, the early phases of these two conditions are hard to distinguish in a reproducible way. In a population study of the natural history and epidemiology of congestive heart failure a scoring test to differentiate the two conditions was developed. In this report the test is presented and evaluated against various clinical and laboratory measures in 644 men sampled from the general population. The test provides a 'cardiac score' and a 'pulmonary score', both based on history and findings at the physical examination. Men who had pulmonary scores (indicating a pulmonary cause of the dyspnoea) had significantly lower values of spirometry variables but no significant pulmonary congestion at X-ray compared to a reference group (no dyspnoea, no pulmonary scores). Men with cardiac scores had significantly larger hearts and more congestion but no significant change of variables measuring airways obstruction compared to the reference group (no dyspnoea, no cardiac scores). Even though there was a moderate overlap of impaired cardiac and pulmonary function in the dyspnoea group, perhaps due to smoking being a common causal agent, the test appears to differentiate the causes of dyspnoea in a manner similar to clinical evaluation but, in contrast to the latter, in a defined and therefore reproducible way.
Death, mode of death, morbidity and requirement for rehospitalization during 2 years after coronary artery bypass grafting in relation to preoperative ejection fraction.
OBJECTIVE: To describe the impact of ejection fraction on the prognosis during 2 years after coronary artery bypass grafting (CABG). PATIENTS: All patients in western Sweden who underwent CABG without concomitant valve surgery between June 1988 and June 1991. RESULTS: In all, 2121 patients were operated upon and information on ejection fraction was available for 1961 patients (92%). Of these patients, 178 (9%) had an ejection fraction or = 60%. In these groups the mortalities during the first 30 days after CABG were 5.1, 4.3 and 2.2%, respectively (P
OBJECTIVE: To identify determinants of an inferior quality of life (QoL) five years after coronary artery bypass grafting (CABG). SETTING: University hospital. PARTICIPANTS: Patients from western Sweden who underwent CABG between 1988 and 1991. MAIN OUTCOME MEASURES: Questionnaires for evaluating QoL before CABG and five years after operation. Three different instruments were used: the Nottingham health profile (NHP), the psychological general wellbeing index (PGWI), and the physical activity score (PAS). RESULTS: 2121 patients underwent CABG, of whom 310 died during five years' follow up. Information on QoL after five years was available in 1431 survivors (79%). There were three independent predictors for an inferior QoL with all three instruments: female sex, a history of diabetes mellitus, and a history of chronic obstructive pulmonary disease. Multivariate analysis showed that a poor preoperative QoL was a strong independent predictor for an impaired QoL five years after CABG. An impaired QoL was also predicted by previous disease. CONCLUSIONS: Female sex, an impaired QoL before surgery, and other diseases such as diabetes mellitus are independent predictors for an impaired QoL after CABG in survivors five years after operation.
The relation between dyspnoea of presumed cardiac origin and disturbed left ventricular systolic function was studied in a group of 67 year old men from the general population of Gothenburg, Sweden. Forty two men with cardiac dyspnoea were identified and 45 controls were randomly selected from a screened cohort of 644 men. Dyspnoea was graded according to the World Health Organisation standard, and M mode echocardiography, carotid pulse tracing, an apex cardiogram, and phonocardiography were used to evaluate the grade of dyspnoea and its relation to systolic time intervals, left ventricular ejection indices, and wall stress. The dyspnoea grade was significantly related to the left ventricular end systolic dimension, to septal and posterior wall fractional thickening, and to ejection indices such as fractional shortening. The dyspnoea grade was also significantly correlated with the ratio of end systolic wall stress to end systolic volume index. There was a close relation between end systolic wall stress and mean velocity of circumferential fibre shortening adjusted for heart rate. This relation did not clearly show reduced inotropy in the dyspnoeic men. There was no relation between the degree of dyspnoea and the systolic time intervals. Among the systolic variables obtained by echocardiography the only abnormal finding in mild to moderate dyspnoea was an increased end systolic dimension. The grade of cardiac dyspnoea seemed to be related to the degree of systolic left ventricular dysfunction, which was considerably impaired in severe dyspnoea. In population studies left ventricular end systolic dimension and fractional shortening may provide sufficient information on systolic function without the need to assess variables that are independent of load.
The relation of cardiac dyspnoea to diastolic left ventricular dysfunction was examined in a sample of 67 year old men from the general population of Gothenburg, Sweden. Forty two men with cardiac dyspnoea and 45 controls were selected from the screened cohort of 644 men. M mode echocardiography, apexcardiography, and phonocardiography were used to evaluate heart sounds, diastolic time intervals, aortic root motion (atrial emptying index); peak rate of change in left ventricular dimension, left atrial and ventricular size; and left ventricular mass. There was a significant relation between dyspnoea grade and left ventricular mass and posterior wall thickness. Dyspnoea grade also correlated significantly with the amplitude of the rapid filling wave and the third heart sound, atrial emptying index and left atrial size, the pulmonary component of the second heart sound, and the dimension of the right ventricle. In mild to moderate dyspnoea fractional shortening was normal, but posterior wall thickness and left atrial dimension were increased. The time from the second heart sound to the O point of the apexcardiogram, adjusted for heart rate, was significantly prolonged in mild to moderate dyspnoea, but not in severe dyspnoea. There was a significant decrease of rate adjusted isovolumic relaxation time, probably secondary to altered loading conditions, in severe dyspnoea, but not in mild to moderate dyspnoea. When the effect of systolic function was excluded multivariate analyses showed that the relation between dyspnoea grade and left atrial dimension persisted. The finding that diastolic abnormalities of the heart contributed to the generation of cardiac dyspnoea may have implications for treatment.
A cross-sectional analysis of characteristics possibly associated with congestive heart failure (CHF) was performed among 644 men, all 67 years of age and randomly selected from the general population. A total of 13% had symptoms and signs of overt CHF. Another 10% had early or "latent" CHF. Among overt CHF cases, 46% had hypertension, 55% coronary heart disease and 79% any one of these conditions. Among "latent" CHF cases, the corresponding proportions were 52%, 25% and 65%. Simple indices of left ventricular diastolic function and filling pressure as well as of pulmonary artery pressure were closer related to the CHF stage, than were measures of systolic left ventricular function. Smoking habits, hypertension, blood lipids, weight and other measures of body fat, blood glucose, and serum insulin were all correlated to CHF stage. In a multivariate analysis, smoking habits, hypertension, body weight, and serum insulin were independently and significantly correlated to CHF stage.
Effects of Nordic walking on health-related quality of life in overweight individuals with Type 2 diabetes mellitus, impaired or normal glucose tolerance.
Center for Family and Community Medicine, Karolinska Institutet, Huddinge Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Aims To assess the effects of 4 months of increased physical activity on health-related quality of life in overweight individuals with Type 2 diabetes mellitus, normal or impaired glucose tolerance. Methods We included 212 individuals without severe physical or cardiovascular impairments aged 61 (57-64) years, with BMI of 29 (27.5-32) kg/m(2) . Numbers are median (25th-75th percentile). Subjects were stratified based on normal glucose tolerance (n = 128), impaired glucose tolerance (n = 34) or Type 2 diabetes mellitus (n = 50). They were randomized into either a control group (n = 125), who maintained unaltered habitual lifestyle, or an exercise intervention group (n = 87), who were directed to engage in Nordic walking with walking poles, 5 h per week over 4 months. Self-reported physical activity and health-related quality of life was assessed at the time of inclusion and after 4 months. Results Baseline health-related quality of life of this study cohort was similar to, or better than, an age- and sex-matched Swedish population sample, for 12 of 13 scales. Quality of sleep and BMI were improved for participants with normal glucose tolerance after 4 months of Nordic walking, with little or no musculoskeletal pain as compared with control subjects. No correlation was evident between improved quality of sleep and improved BMI. Conclusions Quality of sleep improved in the group with normal glucose tolerance following 4 months of Nordic walking. BMI reduction did not account for this improvement. Nordic walking can be introduced in a primary health care setting as a low-cost mode of exercise that promotes weight loss and improved health satisfaction.
OBJECTIVES: To evaluate the effect of different aspects of quality of life (QL) upon mortality during short-and long-term follow-up after coronary artery bypass grafting (CABG). DESIGN: Prospective evaluation. MATERIALS: Consecutive patients from western Sweden who during 3 years underwent CABG. METHODS: They answered a questionnaire at the time of coronary angiography prior to CABG. Quality of life was measured with questions from the Nottingham Health Profile (NHP) part I. RESULTS: In all, 1290 patients were included in the analyses. When accounting for various preoperative factors known to be independently associated with morality the NHP question "I feel lonely" was found to be associated with mortality, both at 30 days (RR 2.61; 95% CI 1.15-5.95; p = 0.02) and at 5 years (RR 1.78; 95% CI 1.17-2.71; p = 0.007) after the operation. Thirteen per cent reported they felt lonely. At 5 years was, in addition, the statement "I have difficulty climbing stairs" also independently associated with mortality (RR 1.50; 95% CI 1.02-2.22; p = 0.04). CONCLUSION: Among the 38 statements in NHP as a judgment of QL prior to CABG, one of them, "I feel lonely" was independently associated with survival both at 30 days and 5 years after CABG.
