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101. AMBULATORY BLOOD PRESSURE MONITORING: A NEW DIAGNOSTIC APPROACH FOR DETECTION OF HYPOTENSION IN REFLEX SYNCOPE (SYNABPM 1 STUDY)

Author

Rivasi, Giulia, primary, Groppelli, Antonella, additional, Brignole, Michele, additional, Soranna, Davide, additional, Zambon, Antonella, additional, Bilo, Grzegorz, additional, Pengo, Martino, additional, Sharad, Bashaaer, additional, Hamrefors, Viktor, additional, Rafanelli, Martina, additional, Testa, Giuseppe Dario, additional, Rice, Ciara, additional, Kenny, Rose Anne, additional, Sutton, Richard, additional, Ungar, Andrea, additional, Fedorowski, Artur, additional, and Parati, Gianfranco, additional

Published
2022
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104. Cardiovagal Function Measured by the Deep Breathing Test: Relationships With Coronary Atherosclerosis

Author

Engström, Gunnar, primary, Hamrefors, Viktor, additional, Fedorowski, Artur, additional, Persson, Anders, additional, Johansson, Maria E., additional, Ostenfeld, Ellen, additional, Goncalves, Isabel, additional, Markstad, Hanna, additional, Johnson, Linda S. B., additional, Persson, Margaretha, additional, Carlson, Jonas, additional, and Platonov, Pyotr G., additional

Published
2022
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109. RETRACTED: PO-04-037 ARTIFICIAL INTELLIGENCE FOR ANALYSIS OF MOBILE CARDIAC TELEMETRY

Author

Johnson, Linda S., Zadrozniak, Piotr, Jasina, Grzegorz, Grotek, Agnieszka, Benz, Alexander P., MAZUECOS, JUAN BENEZET, Andrade, Jason G., Bhavnani, Sanjeev, Brandes, Axel, Diederichsen, Søren Zöga, Fedorowski, Artur, Glotzer, Taya V., Iakobishvili, Zaza, Krisai, Philipp, Laish-Farkash, Avishag, Ljungstrom, Erik, McIntyre, William F., Platonov, Pyotr G., Stavrakis, Stavros, Svennberg, Emma, Weclawski, Jakub, van Vreeswijk, Nick L., Engström, Gunnar, and Healey, Jeffrey S.

Published
2024
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113. Prevalence of asystole during tilt test-induced vasovagal syncope may depend on test methodology.

Author

Russo, Vincenzo, Parente, Erika, Groppelli, Antonella, Rivasi, Giulia, Tomaino, Marco, Gargaro, Alessio, Giacopelli, Daniele, Ungar, Andrea, Parati, Gianfranco, Fedorowski, Artur, Sutton, Richard, Dijk, J Gert van, and Brignole, Michele

Abstract

This review addresses tilt-testing methodology by searching the literature which reports timing of asystole and loss of consciousness (LOC). Despite the Italian protocol being the most widely adopted, its stipulations are not always followed to the letter of the European Society of Cardiology guidelines. The discrepancies permit reassessment of the incidence of asystole when tilt-down is early, impending syncope, compared with late, established LOC. Asystole is uncommon with early tilt down and diminishes with increasing age. However, if LOC is established as test-end, asystole is more common, and it is age-independent. Thus, the implications are that asystole is commonly under-diagnosed by early tilt-down. The prevalence of asystolic responses observed using the Italian protocol with a rigorous tilt down time is numerically close to that observed during spontaneous attacks by electrocardiogram loop recorder. Recently, tilt-testing has been questioned as to its validity but, in selection of pacemaker therapy in older highly symptomatic vasovagal syncope patients, the occurrence of asystole has been shown to be an effective guide for treatment. The use of head-up tilt test as an indication for cardiac pacing therapy requires pursuing the test until complete LOC. This review offers explanations for the findings and their applicability to practice. A novel interpretation is offered to explain why pacing induced earlier may combat vasodepression by raising the heart rate when sufficient blood remains in the heart. [ABSTRACT FROM AUTHOR]

Published
2023
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114. Familial risk of dilated and hypertrophic cardiomyopathy: a national family study in Sweden.

Author

Ricci, Fabrizio, Banihashemi, Behzad, Pirouzifard, Mirnabi, Sundquist, Jan, Sundquist, Kristina, Sutton, Richard, Fedorowski, Artur, and Zöller, Bengt

Subjects
HYPERTROPHIC cardiomyopathy, DILATED cardiomyopathy, MYOCARDIUM, FAMILIES, ODDS ratio
Abstract

Aims: This study aims to determine the familial incidence of dilated (DCM) and hypertrophic cardiomyopathy (HCM) in first‐degree, second‐degree, and third‐degree relatives of affected individuals. Methods and results: In this population‐based multigenerational cohort study, full‐siblings, half‐siblings, and cousin pairs born to Swedish parents between 1932 and 2015 were included, and register‐based DCM and HCM diagnoses among relatives were ascertained. Adjusted odds ratios (ORs) for DCM and HCM were calculated for relatives of individuals with DCM and HCM compared with relatives of individuals without DCM and HCM for reference. Total study population included 6 334 979 subjects and consisted of 5 577 449 full‐siblings, 1 321 414 half‐siblings, and 3 952 137 cousins. Overall, 10 272 (0.16%) unique individuals were diagnosed with DCM and 3769 (0.06%) with HCM. Of these, 7716 (75.12%) and 2375 (63.01%) were males, respectively. Familial risk ORs for DCM were 5.35 [95% confidence intervals (CI): 4.85–5.90] for full‐siblings, 2.68 (95% CI:1.86–3.87) for half‐siblings, and 1.72 (95% CI:1.12–2.64) for cousins of affected individuals. The ORs for HCM were 42.44 (95% CI:37.66–47.82) for full‐siblings, 32.70 (95% CI:21.32–50.15) for half‐siblings, and 36.96 (95% CI:29.50–46.31) for cousins of affected individuals. In sex‐stratified analysis, relatives of affected females were found more likely to be affected than were relatives of affected males, with stronger aggregation observed for HCM. Conclusions: Familial risk of HCM and DCM is high and associated with genetic resemblance, with strongest aggregations observed in relatives of affected females with HCM, whereas this association was distinctly attenuated for DCM. The finding of a Carter effect, more pronounced in HCM, suggests a multifactorial threshold model of inheritance. [ABSTRACT FROM AUTHOR]

Published
2023
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115. Malmö POTS symptom score: Assessing symptom burden in postural orthostatic tachycardia syndrome.

Author

Spahic, Jasmina Medic, Hamrefors, Viktor, Johansson, Madeleine, Ricci, Fabrizio, Melander, Olle, Sutton, Richard, and Fedorowski, Artur

Subjects
ORTHOSTATIC intolerance, POSTURAL orthostatic tachycardia syndrome, SYSTOLIC blood pressure, SYMPTOMS
Abstract

Background: Postural orthostatic tachycardia syndrome (POTS) is a common cardiovascular autonomic disorder characterized by excessive heart rate (HR) increase on standing and symptoms of orthostatic intolerance, posing significant limitations on functional capacity. No objective tool exists to classify symptom burden in POTS. Methods: We conducted a case–control study in 62 POTS patients and 50 healthy controls to compare symptom burden between groups using the newly developed, self‐rating, 12‐item, Malmö POTS Score (MAPS; 0–10 per item, total range 0–120) based on patients own perception of symptoms through visual analogue scale assessment. We have also explored correlations between symptom severity assessed by MAPS, basic clinical parameters and postural haemodynamic changes. Results: POTS patients showed significantly higher total MAPS score (78 ± 20 vs. 14 ± 12, p < 0.001), higher baseline systolic blood pressure (BP), diastolic BP and HR (p < 0.001) compared with healthy controls. The most prominent symptoms in POTS were palpitations, fatigue and concentration difficulties. Haemodynamic parameters on standing were significantly correlated with palpitations in POTS after adjustment for age and sex (lower systolic and diastolic BP, and higher HR) (p < 0.001 for all). Orthostatic HR was significantly associated with concentration difficulties and total MAPS score. The optimal cut‐point value of MAPS to differentiate POTS and healthy controls was ≥42 (sensitivity, 97%; specificity, 98%). Conclusions: Symptom severity, as assessed by MAPS score, is fivefold higher in POTS compared with healthy individuals. The new MAPS score can be useful as a semiquantitative system to assess symptom burden, monitor disease progression and evaluate pre‐test likelihood of disease. [ABSTRACT FROM AUTHOR]

Published
2023
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117. Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1

Author

Vernino, Steven, primary, Bourne, Kate M., additional, Stiles, Lauren E., additional, Grubb, Blair P., additional, Fedorowski, Artur, additional, Stewart, Julian M., additional, Arnold, Amy C., additional, Pace, Laura A., additional, Axelsson, Jonas, additional, Boris, Jeffrey R., additional, Moak, Jeffrey P., additional, Goodman, Brent P., additional, Chémali, Kamal R., additional, Chung, Tae H., additional, Goldstein, David S., additional, Diedrich, Andre, additional, Miglis, Mitchell G., additional, Cortez, Melissa M., additional, Miller, Amanda J., additional, Freeman, Roy, additional, Biaggioni, Italo, additional, Rowe, Peter C., additional, Sheldon, Robert S., additional, Shibao, Cyndya A., additional, Systrom, David M., additional, Cook, Glen A., additional, Doherty, Taylor A., additional, Abdallah, Hasan I., additional, Darbari, Anil, additional, and Raj, Satish R., additional

Published
2021
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118. Postural orthostatic tachycardia syndrome (POTS): Priorities for POTS care and research from a 2019 National Institutes of Health Expert Consensus Meeting – Part 2

Author

Raj, Satish R., primary, Bourne, Kate M., additional, Stiles, Lauren E., additional, Miglis, Mitchell G., additional, Cortez, Melissa M., additional, Miller, Amanda J., additional, Freeman, Roy, additional, Biaggioni, Italo, additional, Rowe, Peter C., additional, Sheldon, Robert S., additional, Shibao, Cyndya A., additional, Diedrich, Andre, additional, Systrom, David M., additional, Cook, Glen A., additional, Doherty, Taylor A., additional, Abdallah, Hasan I., additional, Grubb, Blair P., additional, Fedorowski, Artur, additional, Stewart, Julian M., additional, Arnold, Amy C., additional, Pace, Laura A., additional, Axelsson, Jonas, additional, Boris, Jeffrey R., additional, Moak, Jeffrey P., additional, Goodman, Brent P., additional, Chémali, Kamal R., additional, Chung, Tae H., additional, Goldstein, David S., additional, Darbari, Anil, additional, and Vernino, Steven, additional

Published
2021
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121. Underlying hemodynamic differences are associated with responses to tilt testing

Author

Fedorowski, Artur, primary, Rivasi, Giulia, additional, Torabi, Parisa, additional, Johansson, Madeleine, additional, Rafanelli, Martina, additional, Marozzi, Irene, additional, Ceccofiglio, Alice, additional, Casini, Niccolò, additional, Hamrefors, Viktor, additional, Ungar, Andrea, additional, Olshansky, Brian, additional, Sutton, Richard, additional, Brignole, Michele, additional, and Parati, Gianfranco, additional

Published
2021
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123. Syncope Unit: rationale and requirement – the European Heart Rhythm Association position statement endorsed by the Heart Rhythm Society

Author

Kenny, Rose Anne, Brignole, Michele, Dan, Gheorghe-Andrei, Deharo, Jean Claude, van Dijk, J. Gert, Doherty, Colin, Hamdan, Mohamed, Moya, Angel, Parry, Steve W., Sutton, Richard, Ungar, Andrea, Wieling, Wouter, Asgari, Mehran, Baron-Esquivias, Gonzalo, Blanc, Jean-Jacques, Casagranda, Ivo, Cunnigham, Conal, Fedorowski, Artur, Furlan, Raffello, Gall, Nicholas, De Lange, Frederik J., Mcmahon, Geraldine, Mitro, Peter, Pietrucha, Artur, Podoleanu, Cristian, Raviele, Antonio, Benditt, David, Krahn, Andrew, Morillo, Carlos Arturo, Olshansky, Brian, Raj, Satish, Sheldon, Robert, Shen, Win Kuang, Sun, Benjamin, Hachul, Denise, Abe, Haruhiko, Furukawa, Toshyuki, Gorenek, Bulent, Lip, Gregory Y. H., Glikson, Michael, Ritter, Philippe, Hurwitz, Jodie, Macfadyen, Robert, Rankin, Andrew, Mont, Luis, Svendsen, Jesper, Kusumoto, Fred, Cohen, Mitchell, and Savelieva, Irene

Published
2015
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127. Cardiovascular risk factors and autonomic indices in relation to fatal and non-fatal coronary events

Author

Zambach, Christian, Fedorowski, Artur, Borné, Yan, Johnson, Linda S B, Gerward, Sofia, Hamrefors, Viktor, and Engström, Gunnar

Subjects
Adult, Sweden, Blood Pressure, Coronary Artery Disease, Middle Aged, Cardiac Risk Factors and Prevention, acute coronary syndrome, Survival Rate, Cardiovascular Diseases, Heart Disease Risk Factors, Risk Factors, Cause of Death, Humans, Follow-Up Studies, Retrospective Studies
Abstract

Objective Mortality caused by coronary artery disease has markedly decreased in recent years. However, a substantial proportion of patients suffering a coronary event (CE) die within the first day, most of them out of hospital. We aimed to investigate how established cardiovascular (CV) risk factors and CV autonomic indices associate with fatal versus non-fatal CEs in the population. Methods 33 057 individuals (mean age; 45.6 years; 10 773 women) free of coronary artery disease at baseline were included. Baseline examination, including assessment of traditional CV risk factors and autonomic indices such as heart rate and orthostatic reaction, was performed during 1974–1992, after which the subjects were monitored for incident CV disease. The Lunn-McNeil competing risks approach with a prespecified multivariable model was used to assess differences in risks for fatal and non-fatal CEs in relation to baseline CV risk factors. Results During follow-up period of 29.7 years, 5494 subjects (6.10/1000 person-years) had first CE; 1554 of these were fatal. Age, male gender, smoking, body mass index (BMI), blood pressure, pulse pressure and resting heart rate had stronger relationships with fatal CE than with non-fatal events. The effects of diabetes, serum cholesterol, antihypertensive treatment and orthostatic blood pressure responses were similar for fatal and non-fatal CE. Conclusions Several cardiovascular risk factors, such as smoking, high BMI, blood pressure and high resting heart rate, were preferentially associated with fatal compared with non-fatal CEs. These observations may require special attention in the overall efforts to further reduce coronary artery disease mortality.

Published
2021

128. Long-Haul Post–COVID-19 Symptoms Presenting as a Variant of Postural Orthostatic Tachycardia Syndrome

Author

Johansson, Madeleine, Ståhlberg, Marcus, Runold, Michael, Nygren-Bonnier, Malin, Nilsson, Jan, Olshansky, Brian, Bruchfeld, Judith, and Fedorowski, Artur

Subjects
BP, blood pressure, complications, COVID-19, coronavirus disease-2019, HR, heart rate, autonomic dysfunction, SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2, Case Report, orthostatic intolerance, Clinical Case Series, postural orthostatic tachycardia syndrome, POTS, postural orthostatic tachycardia syndrome, COVID-19 infection
Abstract

Major clinical centers in Sweden have witnessed an inflow of patients with chronic symptoms following initial outpatient care for coronavirus disease-2019 (COVID-19) infection, suggestive of postural orthostatic tachycardia syndrome. This report presents the first case series of 3 Swedish patients diagnosed with postural orthostatic tachycardia syndrome more than 3 months after the primary COVID-2019 infections. (Level of Difficulty: Beginner.), Graphical abstract

Published
2021

129. Network Physiology in Aging and Frailty: The Grand Challenge of Physiological Reserve in Older Adults

Author

Romero-Ortuño, Román, primary, Martínez-Velilla, Nicolás, additional, Sutton, Richard, additional, Ungar, Andrea, additional, Fedorowski, Artur, additional, Galvin, Rose, additional, Theou, Olga, additional, Davies, Andrew, additional, Reilly, Richard B, additional, Claassen, Jurgen, additional, Kelly, Áine M, additional, and Ivanov, Plamen Ch., additional

Published
2021
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131. Additional file 1 of Risk of incident fractures in individuals hospitalised due to unexplained syncope and orthostatic hypotension

Author

Johansson, Madeleine, Rogmark, Cecilia, Sutton, Richard, Fedorowski, Artur, and Hamrefors, Viktor

Abstract

Additional file 1: Table S1. Baseline characteristics of the study population (n=30,399) stratified according to hospitalisations due to orthostatic hypotension and unexplained syncope. P-values for differences all

Published
2021
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133. PO-04-037 ARTIFICIAL INTELLIGENCE FOR ANALYSIS OF MOBILE CARDIAC TELEMETRY.

Author

Johnson, Linda S., Zadrozniak, Piotr, Jasina, Grzegorz, Grotek, Agnieszka, Benz, Alexander P., MAZUECOS, JUAN BENEZET, Andrade, Jason G., Bhavnani, Sanjeev, Brandes, Axel, Diederichsen, Søren Zöga, Fedorowski, Artur, Glotzer, Taya V., Iakobishvili, Zaza, Krisai, Philipp, Laish-Farkash, Avishag, Ljungstrom, Erik, McIntyre, William F., Platonov, Pyotr G., Stavrakis, Stavros, and Svennberg, Emma

Published
2024
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143. The orthostatic hypotension questionnaire in Swedish tested in patients with parkinsonism

Author

Olsson, Andreas, Olsson, Mia, Fedorowski, Artur, Hagell, Peter, Wictorin, Klas, Olsson, Andreas, Olsson, Mia, Fedorowski, Artur, Hagell, Peter, and Wictorin, Klas

Abstract

BACKGROUND: Orthostatic hypotension (OH) is common among older people and in particular in conditions like Parkinson's disease (PD). The OH Questionnaire (OHQ) has been proposed as a useful patient-reported assessment tool consisting of the OH Symptom Assessment (OHSA), OH Daily Activity Scale (OHDAS), and a composite score. AIMS OF THE STUDY: To translate the OHQ into Swedish and assess its psychometric properties. METHODS: Following forward-backward translation, the Swedish OHQ was field-tested (n = 6) for relevance, comprehensibility, and respondent burden. It was then tested regarding scaling assumptions, targeting, reliability, and construct validity in persons with PD (n = 27) and multiple system atrophy (n = 2). RESULTS: The Swedish OHQ was considered relevant and easy to use, with a mean completion time of 5.3 min. Scaling assumptions were acceptable for OHSA and OHDAS (corrected item-total correlations, .30-.67) but not for the total score (.12-.69). Floor/ceiling effects were ≤3.4% and reliability was >.64. Construct validity was supported by expected correlations with the SCOPA-AUT, RAND-36, and blood pressure measurements. CONCLUSIONS: The Swedish OHQ was well received, and psychometric results suggest that the OHQ (particularly the OHDAS) is a useful tool for OH assessment in parkinsonian disorders. Further testing in larger samples is needed.

Published
2020
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144. Cognitive test results are associated with mortality and rehospitalization in heart failure: Swedish prospective cohort study

Author

Holm, Hannes, Bachus, Erasmus, Jujic, Amra, Nilsson, Erik D., Wadstrom, Benjamin, Molvin, John, Minthon, Lennart, Fedorowski, Artur, Nägga, Katarina, Magnusson, Martin, Holm, Hannes, Bachus, Erasmus, Jujic, Amra, Nilsson, Erik D., Wadstrom, Benjamin, Molvin, John, Minthon, Lennart, Fedorowski, Artur, Nägga, Katarina, and Magnusson, Martin

Abstract

Aims We aimed to search for associations between cognitive test results with mortality and rehospitalization in a Swedish prospective heart failure (HF) patient cohort. Methods and results Two hundred and eighty-one patients hospitalized for HF (mean age, 74 years; 32% women) were assessed using cognitive tests: Montreal Cognitive Assessment (MoCA), A Quick Test of Cognitive speed, Trail Making Test A, and Symbol Digit Modalities Test. The mean follow-up time censored at rehospitalization or death was 13 months (interquartile range, 14) and 28 months (interquartile range, 29), respectively. Relations between cognitive test results, mortality, and rehospitalization risk were analysed using multivariable Cox regression model adjusted for age, sex, body mass index, systolic blood pressure, atrial fibrillation, diabetes, smoking, educational level, New York Heart Association class, and prior cardiovascular disease. A total of 80 patients (29%) had signs of cognitive impairment (MoCA score < 23 points). In the fully adjusted Cox regression model using standardized values per 1 SD change of each cognitive test, lower score on MoCA [hazard ratio (HR), 0.75; confidence interval (CI), 0.60-0.95;P = 0.016] and Symbol Digit Modalities Test (HR, 0.66; CI, 0.48-0.90;P = 0.008) yielded significant associations with increased mortality. Rehospitalization risk (n = 173; 62%) was significantly associated with lower MoCA score (HR, 0.84; CI, 0.71-0.99;P = 0.033). Conclusions Two included cognitive tests were associated with mortality in hospitalized HF patients, independently of traditional risk factors. In addition, worse cognitive test scores on MoCA heralded increased risk of rehospitalization., Funding Agencies|Medical Faculty of Lund University; Skane University Hospital; Crafoord Foundation; Ernhold Lundstroms Research Foundation; Region Skane; Hulda and Conrad Mossfelt Foundation; Southwest Skanes Diabetes Foundation; Kockska Foundation; Research Funds of Region Skane; Swedish Heart and Lung FoundationSwedish Heart-Lung Foundation; Wallenberg Center for Molecular Medicine, Lund University

Published
2020
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145. Cognitive test results are associated with mortality and rehospitalization in heart failure: Swedish prospective cohort study

Author

Holm, Hannes, Bachus, Erasmus, Jujic, Amra, Nilsson, Erik D., Wadstrom, Benjamin, Molvin, John, Minthon, Lennart, Fedorowski, Artur, Nägga, Katarina, and Magnusson, Martin

Subjects
Heart Failure, Male, Sweden, Kardiologi, Cognitive dysfunction, Heart failure, Mortality, Rehospitalization, Neuropsychological Tests, Cohort Studies, RC666-701, Diseases of the circulatory (Cardiovascular) system, Humans, Cardiac and Cardiovascular Systems, Female, Prospective Studies, Aged
Abstract

Aims We aimed to search for associations between cognitive test results with mortality and rehospitalization in a Swedish prospective heart failure (HF) patient cohort. Methods and results Two hundred and eighty-one patients hospitalized for HF (mean age, 74 years; 32% women) were assessed using cognitive tests: Montreal Cognitive Assessment (MoCA), A Quick Test of Cognitive speed, Trail Making Test A, and Symbol Digit Modalities Test. The mean follow-up time censored at rehospitalization or death was 13 months (interquartile range, 14) and 28 months (interquartile range, 29), respectively. Relations between cognitive test results, mortality, and rehospitalization risk were analysed using multivariable Cox regression model adjusted for age, sex, body mass index, systolic blood pressure, atrial fibrillation, diabetes, smoking, educational level, New York Heart Association class, and prior cardiovascular disease. A total of 80 patients (29%) had signs of cognitive impairment (MoCA score < 23 points). In the fully adjusted Cox regression model using standardized values per 1 SD change of each cognitive test, lower score on MoCA [hazard ratio (HR), 0.75; confidence interval (CI), 0.60-0.95;P = 0.016] and Symbol Digit Modalities Test (HR, 0.66; CI, 0.48-0.90;P = 0.008) yielded significant associations with increased mortality. Rehospitalization risk (n = 173; 62%) was significantly associated with lower MoCA score (HR, 0.84; CI, 0.71-0.99;P = 0.033). Conclusions Two included cognitive tests were associated with mortality in hospitalized HF patients, independently of traditional risk factors. In addition, worse cognitive test scores on MoCA heralded increased risk of rehospitalization. Funding Agencies|Medical Faculty of Lund University; Skane University Hospital; Crafoord Foundation; Ernhold Lundstroms Research Foundation; Region Skane; Hulda and Conrad Mossfelt Foundation; Southwest Skanes Diabetes Foundation; Kockska Foundation; Research Funds of Region Skane; Swedish Heart and Lung FoundationSwedish Heart-Lung Foundation; Wallenberg Center for Molecular Medicine, Lund University

Published
2019

146. TEMPORARY REMOVAL: IgM anti-malondialdehyde low density lipoprotein antibody levels indicate coronary heart disease and necrotic core characteristics in the Nordic Diltiazem (NORDIL) study and the Integrated Imaging and Biomarker Study 3 (IBIS-3)

Author

van den Berg, Victor J., Haskard, Dorian O., Fedorowski, Artur, Hartley, Adam, Kardys, Isabella, Caga-Anan, Mikhail, Martijn Akkerhuis, K., Oemrawsingh, Rohit M., van Geuns, Robert Jan, de Jaegere, Peter, van Mieghem, Nicolas, Regar, Evelyn, Ligthart, Jurgen M.R., Umans, Victor A.W.M., Serruys, Patrick W., Melander, Olle, Boersma, Eric, and Khamis, Ramzi Y.

Subjects
Male, Research paper, Coronary Artery Disease, Middle Aged, Atherosclerosis, Lipoproteins, LDL, Necrosis, Immunoglobulin M, Malondialdehyde, Humans, Female, Prospective Studies, Biomarkers, Aged
Abstract

Certain immunoglobulins (Ig) are proposed to have protective functions in atherosclerosis.We tested whether serum levels of IgG and IgM autoantibodies against malondialdehyde low density lipoprotein (MDA-LDL) are associated with clinical coronary heart disease (CHD) and unfavorable plaque characteristics.NORDIL was a prospective study investigating adverse cardiovascular outcomes in hypertensive patients. IBIS-3 analyzed lesions in a non-culprit coronary artery with50% stenosis using radiofrequency intravascular ultrasound (RF-IVUS) and near-infrared spectroscopy (NIRS). Imaging was repeated after a median of 386?days on rosuvastatin. Associations of antibodies with incident CHD and imaging parameters were assessed in the two sub-studies respectively.From 10,881 NORDIL patients, 87 had serum sampled at baseline and developed CHD over 4.5 years, matched to 227 controls. Higher titers of IgM anti-MDA-LDL had a protective effect on adverse outcomes, with odds ratio 0.29 (0.11, 0.76; p=0.012; p=0.016 for trend). Therefore, the effect was explored at the lesional level in IBIS-3. 143 patients had blood samples and RF-IVUS measurements available, and NIRS was performed in 90 of these. At baseline, IgM anti-MDA-LDL levels had a strong independent inverse relationship with lesional necrotic core volume (p=0.027) and percentage of plaque occupied by necrotic core (p=0.011), as well as lipid core burden index (p=0.024) in the worst 4 mm segment.Our study supports the hypothesis that lower circulating levels of IgM anti-MDA-LDL are associated with clinical CHD development, and for the first time relates these findings to atherosclerotic plaque characteristics that are linked to vulnerability.

Published
2018

147. Tilt testing remains a valuable asset

Author

Sutton, Richard, primary, Fedorowski, Artur, additional, Olshansky, Brian, additional, Gert van Dijk, J, additional, Abe, Haruhiko, additional, Brignole, Michele, additional, de Lange, Frederik, additional, Kenny, Rose Anne, additional, Lim, Phang Boon, additional, Moya, Angel, additional, Rosen, Stuart D, additional, Russo, Vincenzo, additional, Stewart, Julian M, additional, Thijs, Roland D, additional, and Benditt, David G, additional

Published
2021
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149. Low-blood pressure phenotype underpins the tendency to reflex syncope

Author

Brignole, Michele, primary, Rivasi, Giulia, additional, Sutton, Richard, additional, Kenny, Rose Anne, additional, Morillo, Carlos A., additional, Sheldon, Robert, additional, Raj, Satish R., additional, Ungar, Andrea, additional, Furlan, Raffaello, additional, van Dijk, Gert, additional, Hamdan, Mohamed, additional, Hamrefors, Viktor, additional, Engström, Gunnar, additional, Park, Chloe, additional, Soranna, Davide, additional, Zambon, Antonella, additional, Parati, Gianfranco, additional, and Fedorowski, Artur, additional

Published
2021
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