42 results on '"Kylhammar, David"'
Search Results
2. Wall shear stress measured with 4D flow CMR correlates with biomarkers of inflammation and collagen synthesis in mild-to-moderate ascending aortic dilation and tricuspid aortic valves
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Hammaréus, Filip, Trenti, Chiara, Bjorck, Hanna M., Engvall, Jan, Lekedal, Hanna, Krzynska-Trzebiatowska, Aleksandra, Kylhammar, David, Lindenberger, Marcus, Lundberg, Anna, Nilsson, Fredrik, Nilsson, Lennart, Swahn, Eva, Jonasson, Lena, Dyverfeldt, Petter, Hammaréus, Filip, Trenti, Chiara, Bjorck, Hanna M., Engvall, Jan, Lekedal, Hanna, Krzynska-Trzebiatowska, Aleksandra, Kylhammar, David, Lindenberger, Marcus, Lundberg, Anna, Nilsson, Fredrik, Nilsson, Lennart, Swahn, Eva, Jonasson, Lena, and Dyverfeldt, Petter
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Aims Understanding the mechanisms underlying ascending aortic dilation is imperative for refined risk stratification of these patients, particularly among incidentally identified patients, most commonly presenting with tricuspid valves. The aim of this study was to explore associations between ascending aortic haemodynamics, assessed using four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR), and circulating biomarkers in aortic dilation. Methods and results Forty-seven cases with aortic dilation (diameter >= 40 mm) and 50 sex-and age-matched controls (diameter < 40 mm), all with tricuspid aortic valves, underwent 4D flow CMR and venous blood sampling. Associations between flow displacement, wall shear stress (WSS), and oscillatory shear index in the ascending aorta derived from 4D flow CMR, and biomarkers including interleukin-6, collagen type I alpha 1 chain, metalloproteinases (MMPs), and inhibitors of MMPs derived from blood plasma, were investigated. Cases with dilation exhibited lower peak systolic WSS, higher flow displacement, and higher mean oscillatory shear index compared with controls without dilation. No significant differences in biomarkers were observed between the groups. Correlations between haemodynamics and biomarkers were observed, particularly between maximum time-averaged WSS and interleukin-6 (r = 0.539, P < 0.001), and maximum oscillatory shear index and collagen type I alpha 1 chain (r = -0.575, P < 0.001 in cases). Conclusion Significant associations were discovered between 4D flow CMR derived whole-cardiac cycle WSS and circulating biomarkers representing inflammation and collagen synthesis, suggesting an intricate interplay between haemodynamics and the processes of inflammation and collagen synthesis in patients with early aortic dilation and tricuspid aortic valves., Funding Agencies|ALF Grants; Medical Faculty at Linkping University; Futurum-Academy for Health and Care, Region Jnkping [NT-2021-03716]; Swedish Research Council
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- 2024
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3. TCT-687 Prevalence and Characteristics of Aortic Valve Calcification in the General Population
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Adeli, Athena, primary, Östgren, Carl, additional, Jernberg, Tomas, additional, Swahn, Eva, additional, Engvall, Jan E., additional, Kylhammar, David, additional, Freyland, Sara, additional, Kara, Pinar, additional, Söderberg, Stefan, additional, Blomberg, Anders, additional, Settergren, Magnus, additional, and Shahim, Bahira, additional
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- 2023
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4. TCT-583 Prevalence and Predictors of Thoracic Aortic Dilatation in the Swedish Cardiopulmonary BioImage Study
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Shahim, Angiza, primary, Shahim, Bahira, additional, Lodin, Klara, additional, Östgren, Carl, additional, Jernberg, Tomas, additional, Swahn, Eva, additional, Engvall, Jan E., additional, Kylhammar, David, additional, Freyland, Sara, additional, Söderberg, Stefan, additional, Blomberg, Anders, additional, Olsson, Christian, additional, and Settergren, Magnus, additional
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- 2023
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5. TCT-690 Sex Differences in the Prevalence of Aortic Valve Calcification in the General Population
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Adeli, Athena, primary, Östgren, Carl, additional, Jernberg, Tomas, additional, Swahn, Eva, additional, Engvall, Jan E., additional, Kylhammar, David, additional, Freyland, Sara, additional, Kara, Pinar, additional, Söderberg, Stefan, additional, Blomberg, Anders, additional, Settergren, Magnus, additional, and Shahim, Bahira, additional
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- 2023
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6. TCT-692 Prevalence and Characteristics of Bicuspid Aortic Valve in the General Population
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Adeli, Athena, primary, Shahim, Bahira, additional, Östgren, Carl, additional, Jernberg, Tomas, additional, Swahn, Eva, additional, Engvall, Jan E., additional, Kylhammar, David, additional, Freyland, Sara, additional, Kara, Pinar, additional, Söderberg, Stefan, additional, Blomberg, Anders, additional, and Settergren, Magnus, additional
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- 2023
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7. Consequences of Using Post- or Pre-Bronchodilator Reference Values in Interpreting Spirometry.
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Malinovschi, Andrei, Zhou, Xingwu, Andersson, Anders, Backman, Helena, Bake, Björn, Blomberg, Anders, Caidahl, Kenneth, Eriksson, Maria J, Eriksson Ström, Jonas, Hamrefors, Viktor, Hjelmgren, Ola, Janson, Christer, Karimi, Reza, Kylhammar, David, Lindberg, Anne, Lindberg, Eva, Liv, Per, Olin, Anna-Carin, Shalabi, Adel, Sköld, C Magnus, Sundström, Johan, Tanash, Hanan, Torén, Kjell, Wollmer, Per, Zaigham, Suneela, Östgren, Carl Johan, Engvall, Jan E, Malinovschi, Andrei, Zhou, Xingwu, Andersson, Anders, Backman, Helena, Bake, Björn, Blomberg, Anders, Caidahl, Kenneth, Eriksson, Maria J, Eriksson Ström, Jonas, Hamrefors, Viktor, Hjelmgren, Ola, Janson, Christer, Karimi, Reza, Kylhammar, David, Lindberg, Anne, Lindberg, Eva, Liv, Per, Olin, Anna-Carin, Shalabi, Adel, Sköld, C Magnus, Sundström, Johan, Tanash, Hanan, Torén, Kjell, Wollmer, Per, Zaigham, Suneela, Östgren, Carl Johan, and Engvall, Jan E
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RATIONALE: Post-bronchodilator (BD) spirometry is used for diagnosis of chronic obstructive pulmonary disease (COPD). However, pre-BD reference values are used for spirometry interpretation. OBJECTIVES: To compare the resulting prevalence rates of abnormal spirometry and study the consequences of using pre- or post-BD reference values generated within the Swedish CArdioPulmonary bioImage Study (SCAPIS) when interpreting post-BD spirometry in a general population. METHODS: SCAPIS reference values for post-BD and pre-BD spirometry were based on 10,156 and 1,498 never-smoking, healthy participants, respectively. We studied the associations of abnormal spirometry, defined by using pre- or post-BD reference values, with respiratory burden in the SCAPIS general population (28,851 individuals). MEASUREMENTS AND MAIN RESULTS: Bronchodilation resulted in higher predicted median and lower limit of normal (LLN) for FEV1/FVC ratio. The prevalence of post-BD FEV1/FVC < pre-bronchodilator LLN was 4.8% and that of post-BD FEV1/FVC < post-bronchodilator LLN was 9.9% for the general population. An additional 5.1% was identified as having an abnormal post-BD FEV1/FVC ratio and this group had more respiratory symptoms, emphysema (13.5% vs. 4.1%, p<0.001) and self-reported physician-diagnosed COPD (2.8% vs. 0.5%, p<0.001) than subjects with post-BD FEV1/FVC ratio > LLN for both pre- and post-bronchodilation). CONCLUSIONS: Pre- and post-bronchodilator spirometry reference values differ with regard to FEV1/FVC ratio. Use of post-bronchodilator reference values doubled the population prevalence of airflow obstruction; this was related to a higher respiratory burden. Using post-bronchodilator reference values when interpreting post-bronchodilator spirometry might enable identification of individuals with mild disease and be clinically relevant.
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- 2023
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8. Plasma l-arginine levels distinguish pulmonary arterial hypertension from left ventricular systolic dysfunction
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Sandqvist, Anna, Schneede, Jörn, Kylhammar, David, Henrohn, Dan, Lundgren, Jakob, Hedeland, Mikael, Bondesson, Ulf, Rådegran, Göran, and Wikström, Gerhard
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- 2018
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9. Consequences of Using Post- or Prebronchodilator Reference Values in Interpreting Spirometry.
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Malinovschi, Andrei, Zhou, Xingwu, Andersson, Anders, Backman, Helena, Bake, Björn, Blomberg, Anders, Caidahl, Kenneth, Eriksson, Maria J., Ström, Jonas Eriksson, Hamrefors, Viktor, Hjelmgren, Ola, Janson, Christer, Karimi, Reza, Kylhammar, David, Lindberg, Anne, Lindberg, Eva, Liv, Per, Olin, Anna-Carin, Shalabi, Adel, and Sköld, C. Magnus
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REFERENCE values ,SPIROMETRY ,CHRONIC obstructive pulmonary disease - Abstract
Rationale: Postbronchodilator spirometry is used for the diagnosis of chronic obstructive pulmonary disease. However, prebronchodilator reference values are used for spirometry interpretation. Objectives: To compare the resulting prevalence rates of abnormal spirometry and study the consequences of using preor postbronchodilator reference values generated within SCAPIS (Swedish CArdioPulmonary bioImage Study) when interpreting postbronchodilator spirometry in a general population. Methods: SCAPIS reference values for postbronchodilator and prebronchodilator spirometry were based on 10,156 and 1,498 never-smoking, healthy participants, respectively. We studied the associations of abnormal spirometry, defined by using pre- or postbronchodilator reference values, with respiratory burden in the SCAPIS general population (28,851 individuals). Measurements and Main Results: Bronchodilation resulted in higher predicted medians and lower limits of normal (LLNs) for FEV
1 /FVC ratios. The prevalence of postbronchodilator FEV1 /FVC ratio lower than the prebronchodilator LLN was 4.8%, and that of postbronchodilator FEV1 /FVC lower than the postbronchodilator LLN was 9.9%, for the general population. An additional 5.1% were identified as having an abnormal postbronchodilator FEV1 /FVC ratio, and this group hadmore respiratory symptoms, emphysema (13.5% vs. 4.1%; P,0.001), and self-reported physician-diagnosed chronic obstructive pulmonary disease (2.8% vs. 0.5%, P,0.001) than subjects with a postbronchodilator FEV1 /FVC ratio greater than the LLN for both pre- and postbronchodilation. Conclusions: Pre- and postbronchodilator spirometry reference values differ with regard to FEV1 /FVC ratio. Use of postbronchodilator reference values doubled the population prevalence of airflow obstruction; this was related to a higher respiratory burden. Using postbronchodilator reference values when interpreting postbronchodilator spirometry might enable the identification of individuals with mild disease and be clinically relevant. [ABSTRACT FROM AUTHOR]- Published
- 2023
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10. DYSGLYCEMIA AND AORTIC VALVE CALCIFICATION IN THE GENERAL POPULATION
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Wang, Anne, Östgren, Carl Johan, Norhammar, Anna, Kylhammar, David, Jernberg, Tomas, Swahn, Eva, Engvall, Jan Edvin, Spaak, Jonas, Löfmark, Henrik, Freyland, Sara, Shahim, Angiza, olsson, christian, Lind, Lars, Söderberg, Stefan, Blomberg, Anders, Engström, Gunnar, Bergström, Göran, Settergren, Magnus, and Shahim, Bahira
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- 2024
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11. P2Y1 and P2Y12 receptors in hypoxia- and adenosine diphosphate-induced pulmonary vasoconstriction in vivo in the pig
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Kylhammar, David, Bune, Laurids T., and Rådegran, Göran
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- 2014
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12. The ratio FEV1/FVC and its association to respiratory symptoms-A Swedish general population study
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Toren, Kjell, Schioler, Linus, Lindberg, Anne, Andersson, Anders, Behndig, Annelie F., Bergstrom, Goran, Blomberg, Anders, Caidahl, Kenneth, Engvall, Jan, Eriksson, Maria J., Hamrefors, Viktor, Janson, Christer, Kylhammar, David, Lindberg, Eva, Linden, Anders, Malinovschi, Andrei, Persson, Lennart, Sandelin, Martin, Eriksson Strom, Jonas, Tanash, Hanan, Vikgren, Jenny, Östgren, Carl Johan, Wollmer, Per, Skold, C. Magnus, Toren, Kjell, Schioler, Linus, Lindberg, Anne, Andersson, Anders, Behndig, Annelie F., Bergstrom, Goran, Blomberg, Anders, Caidahl, Kenneth, Engvall, Jan, Eriksson, Maria J., Hamrefors, Viktor, Janson, Christer, Kylhammar, David, Lindberg, Eva, Linden, Anders, Malinovschi, Andrei, Persson, Lennart, Sandelin, Martin, Eriksson Strom, Jonas, Tanash, Hanan, Vikgren, Jenny, Östgren, Carl Johan, Wollmer, Per, and Skold, C. Magnus
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Chronic airflow limitation (CAL) can be defined as fixed ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) any respiratory symptom. In a cross-sectional general population study, 15,128 adults (50-64 years of age), 7,120 never-smokers and 8,008 ever-smokers completed a respiratory questionnaire and performed FEV1 and FVC after bronchodilation. We calculated different ratios of FEV1/FVC from 0.40 to 1.0 using 0.70 as reference category. We analysed odds ratios (OR) between different ratios and any respiratory symptom using adjusted multivariable logistic regression. Among all subjects, regardless of smoking habits, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.82, OR 0.48 (95% CI 0.41-0.56). Among never-smokers, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.81, OR 0.53 (95% CI 0.41-0.70). Among ever-smokers, the odds for any respiratory symptom was lowest at FEV1/FVC = 0.81, OR 0.43 (95% CI 0.16-1.19), although the rate of inclining in odds was small in the upper part, that is FEV1/FVC = 0.85 showed similar odds, OR 0.45 (95% CI 0.38-0.55). We concluded that the odds for any respiratory symptoms continuously decreased with higher FEV1/FVC ratios and reached a minimum around 0.80-0.85, with similar results among never-smokers. These results indicate that the optimal threshold associated with respiratory symptoms may be higher than 0.70 and this should be further investigated in prospective longitudinal studies., Funding Agencies|Knut och Alice Wallenbergs StiftelseKnut & Alice Wallenberg Foundation; Forskningsradet om Halsa, Arbetsliv och Valfard; VetenskapsradetSwedish Research Council; Hjart-Lungfonden; Swedish State ALF Agreement; VINNOVAVinnova
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- 2021
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13. Risk stratification in chronic thromboembolic pulmonary hypertension predicts survival
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Sandqvist, Anna, Kylhammar, David, Bartfay, Sven-Erik, Hesselstrand, Roger, Hjalmarsson, Clara, Kavianipour, Mohammad, Nisell, Magnus, Rådegran, Göran, Wikström, Gerhard, Kjellström, Barbro, Söderberg, Stefan, Sandqvist, Anna, Kylhammar, David, Bartfay, Sven-Erik, Hesselstrand, Roger, Hjalmarsson, Clara, Kavianipour, Mohammad, Nisell, Magnus, Rådegran, Göran, Wikström, Gerhard, Kjellström, Barbro, and Söderberg, Stefan
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Objectives: To investigate if the pulmonary arterial hypertension (PAH) risk assessment tool presented in the 2015 ESC/ERS guidelines is valid for patients with chronic thromboembolic pulmonary hypertension (CTEPH) when taking pulmonary endarterectomy (PEA) into account. Design. Incident CTEPH patients registered in the Swedish PAH Registry (SPAHR) between 2008 and 2016 were included. Risk stratification performed at baseline and follow-up classified the patients as low-, intermediate-, or high-risk using the proposed ESC/ERS risk algorithm. Results: There were 250 CTEPH patients with median age (interquartile range) 70 (14) years, and 53% were male. Thirty-two percent underwent PEA within 5 (6) months. In a multivariable model adjusting for age, sex, and pharmacological treatment, patients with intermediate-risk or high-risk profiles at baseline displayed an increased mortality risk (Hazard Ratio [95% confidence interval]: 1.64 [0.69–3.90] and 5.39 [2.13–13.59], respectively) compared to those with a low-risk profile, whereas PEA was associated with better survival (0.38 [0.18–0.82]). Similar impact of risk profile and PEA was seen at follow-up. Conclusion: The ESC/ERS risk assessment tool identifies CTEPH patients with reduced survival. Furthermore, PEA improves survival markedly independently of risk group and age., on behalf of SveFPH and SPAHR
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- 2021
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14. Early risk prediction in idiopathic versus connective tissue disease-associated pulmonary arterial hypertension : call for a refined assessment
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Hjalmarsson, Clara, Kjellström, Barbro, Jansson, Kjell, Nisell, Magnus, Kylhammar, David, Kavianipour, Mohammad, Rådegran, Goran, Söderberg, Stefan, Wikström, Gerhard, Wuttge, Dirk M., Hesselstrand, Roger, Hjalmarsson, Clara, Kjellström, Barbro, Jansson, Kjell, Nisell, Magnus, Kylhammar, David, Kavianipour, Mohammad, Rådegran, Goran, Söderberg, Stefan, Wikström, Gerhard, Wuttge, Dirk M., and Hesselstrand, Roger
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Despite systematic screening and improved treatment strategies, the prognosis remains worse in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) compared to patients with idiopathic/hereditary pulmonary arterial hypertension (IPAH). We aimed to investigate differences in clinical characteristics, outcome and performance of the European Society of Cardiology (ESC)/ European Respiratory Society (ERS) risk stratification tool in these patient groups. This retrospective analysis included incident patients with CTD-PAH (n=197, of which 64 had interstitial lung disease, ILD) or IPAH (n=305) enrolled in the Swedish PAH Register (SPAHR) 2008-2019. Patients were classified as low, intermediate or high risk at baseline, according to the "SPAHR-equation". One-year survival, stratified by type of PAH, was investigated by Cox proportional regression. At baseline, CTD-PAH patients had lower diffusing capacity for carbon monoxide and lower haemoglobin but, at the same time, lower N-terminal prohormone-brain natriuretic peptide, longer 6 min walk distance, better haemodynamics and more often a low-risk profile. No difference in age, World Health Organisation functional class (WHO-FC) or renal function between groups was found. One-year survival rates were 75, 82 and 83% in patients with CTD-PAH with ILD, CTD-PAH without ILD and IPAH, respectively. The 1-year mortality rates for low-, intermediate- and high-risk groups in the whole cohort were 0, 18 and 34% (p<0.001), respectively. Corresponding percentages for CTD-PAH with ILD, CTD-PAH without ILD and IPAH patients were: 0, 26, 67% (p=0.008); 0, 19, 39% (p=0.004); and 0, 16, 29% (p=0.001), respectively. The ESC/ERS risk assessment tool accurately identified low-risk patients but underestimated the 1-year mortality rate of CTD-PAH and IPAH patients assessed as having intermediate risk at diagnosis.
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- 2021
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15. Predicting mortality during long-term follow-up in pulmonary arterial hypertension
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Kylhammar, David, Hjalmarsson, Clara, Hesselstrand, Roger, Jansson, Kjell, Kavianipour, Mohammad, Kjellström, Barbro, Nisell, Magnus, Söderberg, Stefan, Rådegran, Göran, Kylhammar, David, Hjalmarsson, Clara, Hesselstrand, Roger, Jansson, Kjell, Kavianipour, Mohammad, Kjellström, Barbro, Nisell, Magnus, Söderberg, Stefan, and Rådegran, Göran
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The European Society of Cardiology (ESC) and European Respiratory Society (ERS) guideline recommendation of comprehensive risk assessments, which classify patients with pulmonary arterial hypertension (PAH) as having low, intermediate or high mortality risk, has not been evaluated during long-term follow-up in a "real-life" clinical setting. We therefore aimed to investigate the utility of risk assessment in a clinical setting for up to 5 years post diagnosis. 386 patients with PAH from the Swedish PAH Registry were included. Risk group (low/intermediate/ high) and proportion of low-risk variables were investigated at 3-, 4- and 5-year follow-ups after time of diagnosis. In an exploratory analysis, survival rates of patients with low-intermediate or high-intermediate risk scores were compared. A low-risk profile was in multivariate Cox proportional hazards regressions found to be a strong, independent predictor of longer transplant-free survival (p<0.001) at the 3-, 4- and 5-year follow-ups. Also, for the 3-, 4- and 5-year follow-ups, survival rates significantly differed (p<0.001) between the three risk groups. Patients with a greater proportion of low-risk variables had better (p<0.001) survival rates. Patients with a high-intermediate risk score had worse survival rates (p<0.001) than those with a low-intermediate risk score. Results were similar when excluding patients with >= 3 risk factors for heart failure with preserved ejection fraction, atrial fibrillation and/or age >75 years at diagnosis. Our findings suggest that the ESC/ERS guideline strategy for comprehensive risk assessments in PAH is valid also during long-term follow-up in a "real-life" clinical setting.
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- 2021
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16. Early risk prediction in idiopathic versus connective tissue disease-associated pulmonary arterial hypertension: call for a refined assessment
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Hjalmarsson, Clara, primary, Kjellström, Barbro, additional, Jansson, Kjell, additional, Nisell, Magnus, additional, Kylhammar, David, additional, Kavianipour, Mohammad, additional, Rådegran, Göran, additional, Söderberg, Stefan, additional, Wikström, Gerhard, additional, Wuttge, Dirk M., additional, and Hesselstrand, Roger, additional
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- 2021
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17. Predicting mortality during long-term follow-up in pulmonary arterial hypertension
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Kylhammar, David, primary, Hjalmarsson, Clara, additional, Hesselstrand, Roger, additional, Jansson, Kjell, additional, Kavianipour, Mohammad, additional, Kjellström, Barbro, additional, Nisell, Magnus, additional, Söderberg, Stefan, additional, and Rådegran, Göran, additional
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- 2021
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18. Chronic airflow limitation and its relation to respiratory symptoms among ever-smokers and never-smokers : a cross-sectional study
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Toren, Kjell, Schioler, Linus, Lindberg, Anne, Andersson, Anders, Behndig, Annelie F., Bergstrom, Goran, Blomberg, Anders, Caidahl, Kenneth, Engvall, Jan, Eriksson, Maria, Hamrefors, Viktor, Janson, Christer, Kylhammar, David, Lindberg, Eva, Linden, Anders, Malinovschi, Andrei, Persson, Hans Lennart, Sandelin, Martin, Strom, Jonas Eriksson, Tanash, Hanan A., Vikgren, Jenny, Ostgren, Carl Johan, Wollmer, Per, Skold, C. Magnus, Toren, Kjell, Schioler, Linus, Lindberg, Anne, Andersson, Anders, Behndig, Annelie F., Bergstrom, Goran, Blomberg, Anders, Caidahl, Kenneth, Engvall, Jan, Eriksson, Maria, Hamrefors, Viktor, Janson, Christer, Kylhammar, David, Lindberg, Eva, Linden, Anders, Malinovschi, Andrei, Persson, Hans Lennart, Sandelin, Martin, Strom, Jonas Eriksson, Tanash, Hanan A., Vikgren, Jenny, Ostgren, Carl Johan, Wollmer, Per, and Skold, C. Magnus
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Background The diagnosis of chronic obstructive pulmonary disease is based on the presence of persistent respiratory symptoms and chronic airflow limitation (CAL). CAL is based on the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1:FVC) after bronchodilation, and FEV1:FVC less than the fifth percentile is often used as a cut-off for CAL. The aim was to investigate if increasing percentiles of FEV1:FVC were associated withany respiratory symptom(cough with phlegm, dyspnoea or wheezing) in a general population sample of never-smokers and ever-smokers. Methods In a cross-sectional study comprising 15 128 adults (50-64 years), 7120 never-smokers and 8008 ever-smokers completed a respiratory questionnaire and performed FEV(1)and FVC after bronchodilation. We calculated theirz-scores for FEV1:FVC and defined the fifth percentile using the Global Lung Function Initiative (GLI) reference value, GLI(5)and increasing percentiles up to GLI(25). We analysed the associations between different strata of percentiles and prevalence ofany respiratory symptomusing multivariable logistic regression for estimation of OR. Results Among all subjects, regardless of smoking habits, the odds ofany respiratory symptomwere elevated up to the GLI(15-20)strata. Among never-smokers, the odds ofany respiratory symptomwere elevated at GLI(<5)(OR 3.57, 95% CI 2.43 to 5.23) and at GLI(5-10)(OR 2.57, 95% CI 1.69 to 3.91), but not at higher percentiles. Among ever-smokers, the odds ofany respiratory symptomwere elevated from GLI(<5)(OR 4.64, 95% CI 3.79 to 5.68) up to GLI(>= 25)(OR 1.33, 95% CI 1.00 to 1.75). Conclusions The association between percentages of FEV1:FVC and respiratory symptoms differed depending on smoking history. Our results support a higher percentile cut-off for FEV1:FVC for never-smokers and, in particular, for ever-smokers.
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- 2020
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19. The ratio FEV 1 /FVC and its association to respiratory symptoms—A Swedish general population study
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Torén, Kjell, primary, Schiöler, Linus, additional, Lindberg, Anne, additional, Andersson, Anders, additional, Behndig, Annelie F., additional, Bergström, Göran, additional, Blomberg, Anders, additional, Caidahl, Kenneth, additional, Engvall, Jan E., additional, Eriksson, Maria J., additional, Hamrefors, Viktor, additional, Janson, Christer, additional, Kylhammar, David, additional, Lindberg, Eva, additional, Lindén, Anders, additional, Malinovschi, Andrei, additional, Lennart Persson, Hans, additional, Sandelin, Martin, additional, Eriksson Ström, Jonas, additional, Tanash, Hanan, additional, Vikgren, Jenny, additional, Johan Östgren, Carl, additional, Wollmer, Per, additional, and Sköld, C. Magnus, additional
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- 2020
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20. Chronic airflow limitation and its relation to respiratory symptoms among ever-smokers and never-smokers: a cross-sectional study
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Toren, Kjell, primary, Schiöler, Linus, additional, Lindberg, Anne, additional, Andersson, Anders, additional, Behndig, Annelie F, additional, Bergström, Göran, additional, Blomberg, Anders, additional, Caidahl, Kenneth, additional, Engvall, Jan, additional, Eriksson, Maria, additional, Hamrefors, Viktor, additional, Janson, Christer, additional, Kylhammar, David, additional, Lindberg, Eva, additional, Lindén, Anders, additional, Malinovschi, Andrei, additional, Persson, Hans Lennart, additional, Sandelin, Martin, additional, Eriksson Ström, Jonas, additional, Tanash, Hanan A, additional, Vikgren, Jenny, additional, Östgren, Carl Johan, additional, Wollmer, Per, additional, and Sköld, C. Magnus, additional
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- 2020
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21. Risk stratification in chronic thromboembolic pulmonary hypertension predicts survival
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Sandqvist, Anna, primary, Kylhammar, David, additional, Bartfay, Sven-Erik, additional, Hesselstrand, Roger, additional, Hjalmarsson, Clara, additional, Kavianipour, Mohammad, additional, Nisell, Magnus, additional, Rådegran, Göran, additional, Wikström, Gerhard, additional, Kjellström, Barbro, additional, and Söderberg, Stefan, additional
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- 2020
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22. Sex-specific differences and survival in patients with idiopathic pulmonary arterial hypertension 2008-2016
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Kjellström, Barbro, Nisell, Magnus, Kylhammar, David, Bartfay, Sven-Erik, Ivarsson, Bodil, Rådegran, Göran, Hjalmarsson, Clara, Kjellström, Barbro, Nisell, Magnus, Kylhammar, David, Bartfay, Sven-Erik, Ivarsson, Bodil, Rådegran, Göran, and Hjalmarsson, Clara
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Background Women with idiopathic pulmonary arterial hypertension (IPAH) have been found to have a worse haemodynamic status at diagnosis, but better survival than men. Over the past decade, demographics have changed and new treatments have become available. The objective of this study was to investigate sex differences in an incident IPAH population diagnosed between 2008 and 2016. Methods Differences in clinical characteristics of patients included in the Swedish Pulmonary Arterial Hypertension Register (SPAHR) were analysed at the time of diagnosis. Survival by sex was investigated using Cox proportional hazard regression and Kaplan–Meier curves. Results The study included 271 patients diagnosed with IPAH, median age was 68 (1st–3rd quartiles 54–74) years and 56% were women. At diagnosis, women were younger, had lower pulmonary vascular resistance and fewer comorbidities and more often received a combination of PAH-targeted therapies than men. Men had worse survival rates than women (hazard ratio 1.49; CI 1.02–2.18; p=0.038), but this difference did not remain after adjustment for age (hazard ratio 1.30; CI 0.89–1.90; p=0.178). Conclusions Men with incident IPAH have worse crude survival than women. This is due to women being younger with a less pronounced comorbidity burden than men at the time of diagnosis.
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- 2019
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23. Editorial Material: Pulmonary arterial hypertension : assessing risk to improve prognosis
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Kjellström, Barbro, Hjalmarsson, Clara, Kylhammar, David, Radegran, Göran, Kjellström, Barbro, Hjalmarsson, Clara, Kylhammar, David, and Radegran, Göran
- Published
- 2019
- Full Text
- View/download PDF
24. Sex-specific differences and survival in patients with idiopathic pulmonary arterial hypertension 2008–2016
- Author
-
Kjellström, Barbro, primary, Nisell, Magnus, additional, Kylhammar, David, additional, Bartfay, Sven-Erik, additional, Ivarsson, Bodil, additional, Rådegran, Göran, additional, and Hjalmarsson, Clara, additional
- Published
- 2019
- Full Text
- View/download PDF
25. Pulmonary arterial hypertension: assessing risk to improve prognosis
- Author
-
Kjellström, Barbro, primary, Hjalmarsson, Clara, additional, Kylhammar, David, additional, and Rådegran, Göran, additional
- Published
- 2018
- Full Text
- View/download PDF
26. The ratio FEV1/FVC and its association to respiratory symptoms—A Swedish general population study.
- Author
-
Torén, Kjell, Schiöler, Linus, Lindberg, Anne, Andersson, Anders, Behndig, Annelie F., Bergström, Göran, Blomberg, Anders, Caidahl, Kenneth, Engvall, Jan E., Eriksson, Maria J., Hamrefors, Viktor, Janson, Christer, Kylhammar, David, Lindberg, Eva, Lindén, Anders, Malinovschi, Andrei, Lennart Persson, Hans, Sandelin, Martin, Eriksson Ström, Jonas, and Tanash, Hanan
- Subjects
SYMPTOMS ,SMOKING ,LOGISTIC regression analysis ,ODDS ratio ,AIR flow - Abstract
Chronic airflow limitation (CAL) can be defined as fixed ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 0.70 after bronchodilation. It is unclear which is the most optimal ratio in relation to respiratory morbidity. The aim was to investigate to what extent different ratios of FEV1/FVC were associated with any respiratory symptom. In a cross‐sectional general population study, 15,128 adults (50–64 years of age), 7,120 never‐smokers and 8,008 ever‐smokers completed a respiratory questionnaire and performed FEV1 and FVC after bronchodilation. We calculated different ratios of FEV1/FVC from 0.40 to 1.0 using 0.70 as reference category. We analysed odds ratios (OR) between different ratios and any respiratory symptom using adjusted multivariable logistic regression. Among all subjects, regardless of smoking habits, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.82, OR 0.48 (95% CI 0.41–0.56). Among never‐smokers, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.81, OR 0.53 (95% CI 0.41–0.70). Among ever‐smokers, the odds for any respiratory symptom was lowest at FEV1/FVC = 0.81, OR 0.43 (95% CI 0.16–1.19), although the rate of inclining in odds was small in the upper part, that is FEV1/FVC = 0.85 showed similar odds, OR 0.45 (95% CI 0.38–0.55). We concluded that the odds for any respiratory symptoms continuously decreased with higher FEV1/FVC ratios and reached a minimum around 0.80–0.85, with similar results among never‐smokers. These results indicate that the optimal threshold associated with respiratory symptoms may be higher than 0.70 and this should be further investigated in prospective longitudinal studies. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
27. A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension
- Author
-
Kylhammar, David, Kjellström, Barbro, Hjalmarsson, Clara, Jansson, Kjell, Nisell, Magnus, Söderberg, Stefan, Wikström, Gerhard, Rådegran, Göran, Kylhammar, David, Kjellström, Barbro, Hjalmarsson, Clara, Jansson, Kjell, Nisell, Magnus, Söderberg, Stefan, Wikström, Gerhard, and Rådegran, Göran
- Abstract
Aims: Guidelines recommend a goal-oriented treatment approach in pulmonary arterial hypertension (PAH). The aim is to reach a low-risk profile, as determined by a risk assessment instrument. This strategy is incompletely validated. We aimed to investigate the bearing of such risk assessment and the benefit of reaching a low-risk profile. Methods and results: Five hundred and thirty PAH patients were included. Follow-up assessments performed after a median of 4 (interquartile range 3–5) months were available for 383 subjects. Patients were classified as ‘Low’, ‘Intermediate’, or ‘High risk’ and the benefit of reaching the ‘Low risk’ group was estimated. Survival differed (P < 0.001) between the risk groups at baseline and at follow-up. Survival was similar for patients who remained in or improved to the ‘Low risk’ group. Survival was similar for patients who remained in or worsened to the ‘Intermediate risk’ or ‘High risk’ groups. Irrespective of follow-up risk group, survival was better (P < 0.001) for patients with a higher proportion of variables at low risk. Results were unchanged after excluding patients with idiopathic PAH >65 years at diagnosis, and when patients with idiopathic or connective tissue disease-associated PAH were analysed separately. Patients in the ‘Low risk’ group at follow-up exhibited a reduced mortality risk (hazard ratio 0.2, 95% confidence interval 0.1–0.4 in multivariable analysis adjusted for age, sex and PAH subset), as compared to patients in the ‘Intermediate risk’ or ‘High risk’ groups. Conclusion: These findings suggest that comprehensive risk assessments and the aim of reaching a low-risk profile are valid in PAH.
- Published
- 2018
- Full Text
- View/download PDF
28. Impact of age and comorbidity on risk stratification in idiopathic pulmonary arterial hypertension
- Author
-
Hjalmarsson, Clara, Radegran, Goran, Kylhammar, David, Rundqvist, Bengt, Multing, Jonas, Nisell, Magnus D., Kjellstrom, Barbro, Hjalmarsson, Clara, Radegran, Goran, Kylhammar, David, Rundqvist, Bengt, Multing, Jonas, Nisell, Magnus D., and Kjellstrom, Barbro
- Abstract
Recent reports from worldwide pulmonary hypertension registries show a new demographic picture for patients with idiopathic pulmonary arterial hypertension (IPAH), with an increasing prevalence among the elderly. We aimed to investigate the effects of age and comorbidity on risk stratification and outcome of patients with incident IPAH. The study population (n=264) was categorised into four age groups: 18-45, 46-64, 65-74 and amp;gt;= 75 years. Individual risk profiles were determined according to a risk assessment instrument, based on the European Society of Cardiology and the European Respiratory Society guidelines. The change in risk group from baseline to follow-up (median 5 months) and survival were compared across age groups. In the two youngest age groups, a significant number of patients improved (18-45 years, Z=-4.613, pamp;lt; 0.001; 46-64 years, Z=-2.125, p=0.034), but no significant improvement was found in the older patient groups. 5-year survival was highest in patients aged 18-45 years (88%), while the survival rates were 63%, 56% and 36% for patients in the groups 46-64, 65-74 and. 75 years, respectively (pamp;lt; 0.001). Ischaemic heart disease and kidney dysfunction independently predicted survival. These findings highlight the importance of age and specific comorbidities as prognostic markers of outcome in addition to established risk assessment algorithms., Funding Agencies|Actelion Pharmaceuticals Sweden AB; Bayer Health Care; Eli Lilly Sweden; GlaxoSmithKline; NordicInfu Care; Pfizer; Swedish Association of Local Authorities and Regions
- Published
- 2018
- Full Text
- View/download PDF
29. Impact of age and comorbidity on risk stratification in idiopathic pulmonary arterial hypertension
- Author
-
Hjalmarsson, Clara, primary, Rådegran, Göran, additional, Kylhammar, David, additional, Rundqvist, Bengt, additional, Multing, Jonas, additional, Nisell, Magnus D., additional, and Kjellström, Barbro, additional
- Published
- 2018
- Full Text
- View/download PDF
30. Plasma l-arginine levels distinguish pulmonary arterial hypertension from left ventricular systolic dysfunction
- Author
-
Sandqvist, Anna, primary, Schneede, Jörn, additional, Kylhammar, David, additional, Henrohn, Dan, additional, Lundgren, Jakob, additional, Hedeland, Mikael, additional, Bondesson, Ulf, additional, Rådegran, Göran, additional, and Wikström, Gerhard, additional
- Published
- 2017
- Full Text
- View/download PDF
31. Pulmonell hypertension vanligt vid kronisk lungsjukdom - Europeiska riktlinjer kring utredning och behandling
- Author
-
Kylhammar, David, Rådegran, Göran, Kylhammar, David, and Rådegran, Göran
- Abstract
Pulmonary hypertension due to lung diseases In 2015 the European Society of Cardiology and European Respiratory Society published new guidelines on the diagnosis and treatment of pulmonary hypertension (PH). PH due to lung diseases and/or hypoxia was classified as a separate entity. PH is common in lung diseases, but seldom severe. Nevertheless, the presence of PH in a patient with lung disease is associated with worse outcome. If there is clinical suspicion of PH in a patient with lung disease, echocardiography is recommended, and if there are signs of severe PH and/or severe right ventricular dysfunction the patient should be referred to a PH expert centre. Patients may have lung disease and e.g. pulmonary arterial hypertension or chronic thromboembolic PH simultaneously, and targeted treatments are available in such cases. PH-targeted drugs should, however, not be used to treat PH due to lung diseases, since there are no robust data speaking for their benefit and a risk of impaired arterial oxygenation due to inhibition of hypoxic pulmonary vasoconstriction. Instead, the underlying lung disease should be optimally treated, including long-term oxygen therapy in case of chronic hypoxemia.
- Published
- 2017
32. Modulators of hypoxic pulmonary vasoconstriction and pulmonary hypertension. Implications for new treatment strategies
- Author
-
KYLHAMMAR, DAVID
- Subjects
Physiology ,Cardiac and Cardiovascular Systems - Published
- 2016
33. A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension
- Author
-
Kylhammar, David, primary, Kjellström, Barbro, additional, Hjalmarsson, Clara, additional, Jansson, Kjell, additional, Nisell, Magnus, additional, Söderberg, Stefan, additional, Wikström, Gerhard, additional, and Rådegran, Göran, additional
- Published
- 2017
- Full Text
- View/download PDF
34. Prognosis and response to first-line single and combination therapy in pulmonary arterial hypertension
- Author
-
Kylhammar, David, primary, Persson, Liselotte, additional, Hesselstrand, Roger, additional, and Rådegran, Göran, additional
- Published
- 2014
- Full Text
- View/download PDF
35. Levosimendan Attenuates Hypoxia-Induced Pulmonary Hypertension in a Porcine Model
- Author
-
Wiklund, Annaeva, primary, Kylhammar, David, additional, and Rådegran, Göran, additional
- Published
- 2012
- Full Text
- View/download PDF
36. Pulmonary arterial hypertension: assessing risk to improve prognosis.
- Author
-
Kjellström, Barbro, Hjalmarsson, Clara, Kylhammar, David, and Rådegran, Göran
- Published
- 2019
- Full Text
- View/download PDF
37. Differences in plasma L-arginine and dimethylarginines in diagnosis and treatment of pulmonary arterial hypertension: a prospective observational study
- Author
-
Sandqvist, Anna, Schneede, Jörn, Henrohn, Dan, Kylhammar, David, Lundgren, Jakob, Hedeland, Mikael, Bondesson, Ulf, Rådegran, Göran, Wikström, Gerhard, Sandqvist, Anna, Schneede, Jörn, Henrohn, Dan, Kylhammar, David, Lundgren, Jakob, Hedeland, Mikael, Bondesson, Ulf, Rådegran, Göran, and Wikström, Gerhard
- Abstract
Introduction Pulmonary arterial hypertension (PAH) is a life-threatening condition, characterized by an imbalance in vasoactive substances and remodelling of pulmonary vasculature. Asymmetric dimethylarginine (ADMA) inhibits the enzyme nitric oxide synthase, which generates nitric oxide (NO), a molecule causing smooth muscle cell relaxation. Our aim was to investigate the plasma concentrations of ADMA, symmetrical dimethylarginine (SDMA), L-arginine, L-ornithine and L- citrulline at diagnosis and during PAH-specific treatment in patients with PAH compared to patients with left heart failure (LVHF) and healthy subjects. Methods This is an observational, prospective multicentre study of 21 PAH patients. For comparison 14 patients with LVHF and 27 healthy subjects were investigated. Blood samples were collected and ADMA, SDMA, L-arginine, L-ornithine and L-citrulline were analysed with liquid chromatography – tandem mass spectrometry (LC-MS/MS). Results Baseline plasma concentrations of ADMA and SDMA were higher whereas the L-arginine concentrations and L-arginine/ADMA ratio were lower in PAH patients compared to healthy subjects (p<0.001). Patients with PAH had lower L-arginine concentration than patients with LVHF (p<0.05). WHO functional class and six minutes walking distance (6MWD) correlated to L-arginine and L- arginine/ADMA in PAH at baseline (p<0.05). At follow-up, patients on mono- or combination therapy with endothelin receptor antagonists (ERA) had lower ADMA levels than patients without ERA (p<0.05). In contrast, patients on phosphodiesterase type-5 inhibitors (PDE5-inhibitors) had higher ADMA levels compared to patients without PDE5-inhibitor treatment (p<0.05). Conclusion Concentrations of L-arginine were decreased and dimethylarginines were increased in PAH compared to healthy subjects. L-arginine was decreased in PAH compared to LVHF. L- arginine/ADMA ratio correlated to WHO functional class and L-arginine and L-arginine/ADMA ratio correl
38. Chronic Airflow Limitation, Emphysema and Impaired Diffusing Capacity in Relation to Smoking Habits in a Swedish Middle-Aged Population.
- Author
-
Blomberg A, Torén K, Liv P, Granåsen G, Andersson A, Behndig A, Bergström G, Brandberg J, Caidahl K, Cederlund K, Egesten A, Ekström M, Eriksson MJ, Hagström E, Janson C, Jernberg T, Kylhammar D, Lind L, Lindberg A, Lindberg E, Löfdahl CG, Malinovschi A, Mannila M, Nilsson LT, Olin AC, Persson A, Persson HL, Rosengren A, Sundström J, Swahn E, Söderberg S, Vikgren J, Wollmer P, Östgren CJ, Engvall J, and Sköld CM
- Abstract
Rationale: Chronic obstructive pulmonary disease (COPD) includes respiratory symptoms and chronic airflow limitation (CAL). In some cases, emphysema and impaired diffusing capacity for carbon monoxide (DLCO) are present, but characteristics and symptoms vary with smoking exposure., Objectives: To study the prevalence of CAL, emphysema and impaired DLCO in relation to smoking and respiratory symptoms in a middle-aged population., Methods: We investigated 28,746 randomly invited individuals (52% women) aged 50-64 years across six Swedish sites. We performed spirometry, DLCO, high-resolution computed tomography (HRCT) and asked for smoking habits and respiratory symptoms. CAL was defined as post-bronchodilator forced expiratory volume in 1 second divided by forced expiratory volume (FEV1/FVC)<0.7., Results: The overall prevalence was for CAL 8.8%, for impaired DLCO (DLCO
- Published
- 2024
- Full Text
- View/download PDF
39. Restrictive Spirometric Pattern and Preserved Ratio Impaired Spirometry in a Population 50-64 Years.
- Author
-
Torén K, Blomberg A, Schiöler L, Malinovschi A, Backman H, Caidahl K, Carlhäll CJ, Ekbom E, Ekström M, Engström G, Engvall J, Eriksson MJ, Hamrefors V, Janson C, Johnson Å, Khalil M, Kylhammar D, Lindberg A, Nilsson U, Olin AC, Pesonen I, Sjölund J, Sköld CM, Svartengren M, Östgren CJ, and Wollmer P
- Abstract
Rationale: Knowledge regarding prevalence and shared and unique characteristics of Restrictive spirometric pattern (RSP) and Preserved ratio impaired spirometry (PRISm) is lacking for a general population investigated with post-bronchodilator spirometry and computed tomography of the lungs., Objectives: To investigate shared and unique features for RSP and PRISm., Methods: In the Swedish CArdioPulmonary bioImage Study (SCAPIS), a general population sample of 28,555 people aged 50 - 64 years (including 14,558 never-smokers) was assessed. The participants answered a questionnaire and underwent computed tomography of the lungs, post-bronchodilator spirometry, and coronary artery calcification score (CACS). Odds ratios (OR) with 95% confidence intervals (CI) were calculated using adjusted logistic regression. RSP was defined as FEV
1 /FVC≥0.70 and FVC<80%. PRISm was defined as FEV1 /FVC≥0.70 and FEV1 <80%. A local reference equation was applied., Measurements and Results: The prevalence of RSP and PRISm were 5.1% (95% CI 4.9 - 5.4) and 5.1% (95% CI 4.8 - 5.3), respectively, with similar values seen in never-smokers. For RSP and PRISm, shared features were current smoking, dyspnea, chronic bronchitis, rheumatic disease, diabetes, ischemic heart disease (IHD), bronchial wall thickening, interstitial lung abnormalities (ILA), and bronchiectasis. Emphysema was uniquely linked to PRISm (OR 1.69, 1.36-2.10) vs 1.10 (0.84-1.43) for RSP. CACS≥300 was related to PRISm, but not among among never-smokers., Conclusions: PRISm and RSP have respiratory, cardiovascular, and metabolic conditions as shared features. Emphysema is only associated with PRISm. Coronary atherosclerosis may be associated with PRISm. Our results indicate that RSP and PRISm may share more features than not. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).- Published
- 2024
- Full Text
- View/download PDF
40. The ratio FEV 1 /FVC and its association to respiratory symptoms-A Swedish general population study.
- Author
-
Torén K, Schiöler L, Lindberg A, Andersson A, Behndig AF, Bergström G, Blomberg A, Caidahl K, Engvall JE, Eriksson MJ, Hamrefors V, Janson C, Kylhammar D, Lindberg E, Lindén A, Malinovschi A, Lennart Persson H, Sandelin M, Eriksson Ström J, Tanash H, Vikgren J, Johan Östgren C, Wollmer P, and Sköld CM
- Subjects
- Adult, Child, Forced Expiratory Volume, Humans, Prospective Studies, Sweden epidemiology, Vital Capacity, Cross-Sectional Studies
- Abstract
Chronic airflow limitation (CAL) can be defined as fixed ratio of forced expiratory volume in 1 s (FEV
1 )/forced vital capacity (FVC) < 0.70 after bronchodilation. It is unclear which is the most optimal ratio in relation to respiratory morbidity. The aim was to investigate to what extent different ratios of FEV1 /FVC were associated with any respiratory symptom. In a cross-sectional general population study, 15,128 adults (50-64 years of age), 7,120 never-smokers and 8,008 ever-smokers completed a respiratory questionnaire and performed FEV1 and FVC after bronchodilation. We calculated different ratios of FEV1 /FVC from 0.40 to 1.0 using 0.70 as reference category. We analysed odds ratios (OR) between different ratios and any respiratory symptom using adjusted multivariable logistic regression. Among all subjects, regardless of smoking habits, the lowest odds for any respiratory symptom was at FEV1 /FVC = 0.82, OR 0.48 (95% CI 0.41-0.56). Among never-smokers, the lowest odds for any respiratory symptom was at FEV1 /FVC = 0.81, OR 0.53 (95% CI 0.41-0.70). Among ever-smokers, the odds for any respiratory symptom was lowest at FEV1 /FVC = 0.81, OR 0.43 (95% CI 0.16-1.19), although the rate of inclining in odds was small in the upper part, that is FEV1 /FVC = 0.85 showed similar odds, OR 0.45 (95% CI 0.38-0.55). We concluded that the odds for any respiratory symptoms continuously decreased with higher FEV1 /FVC ratios and reached a minimum around 0.80-0.85, with similar results among never-smokers. These results indicate that the optimal threshold associated with respiratory symptoms may be higher than 0.70 and this should be further investigated in prospective longitudinal studies., (© 2020 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.)- Published
- 2021
- Full Text
- View/download PDF
41. A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension.
- Author
-
Kylhammar D, Kjellström B, Hjalmarsson C, Jansson K, Nisell M, Söderberg S, Wikström G, and Rådegran G
- Subjects
- Adult, Aged, Exercise Test, Female, Follow-Up Studies, Humans, Hypertension, Pulmonary diagnosis, Hypertension, Pulmonary physiopathology, Incidence, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Survival Rate trends, Sweden epidemiology, Hypertension, Pulmonary epidemiology, Pulmonary Wedge Pressure physiology, Registries, Risk Assessment methods, Ventricular Function, Right physiology
- Abstract
Aims: Guidelines recommend a goal-oriented treatment approach in pulmonary arterial hypertension (PAH). The aim is to reach a low-risk profile, as determined by a risk assessment instrument. This strategy is incompletely validated. We aimed to investigate the bearing of such risk assessment and the benefit of reaching a low-risk profile., Methods and Results: Five hundred and thirty PAH patients were included. Follow-up assessments performed after a median of 4 (interquartile range 3-5) months were available for 383 subjects. Patients were classified as 'Low', 'Intermediate', or 'High risk' and the benefit of reaching the 'Low risk' group was estimated. Survival differed (P < 0.001) between the risk groups at baseline and at follow-up. Survival was similar for patients who remained in or improved to the 'Low risk' group. Survival was similar for patients who remained in or worsened to the 'Intermediate risk' or 'High risk' groups. Irrespective of follow-up risk group, survival was better (P < 0.001) for patients with a higher proportion of variables at low risk. Results were unchanged after excluding patients with idiopathic PAH >65 years at diagnosis, and when patients with idiopathic or connective tissue disease-associated PAH were analysed separately. Patients in the 'Low risk' group at follow-up exhibited a reduced mortality risk (hazard ratio 0.2, 95% confidence interval 0.1-0.4 in multivariable analysis adjusted for age, sex and PAH subset), as compared to patients in the 'Intermediate risk' or 'High risk' groups., Conclusion: These findings suggest that comprehensive risk assessments and the aim of reaching a low-risk profile are valid in PAH.
- Published
- 2018
- Full Text
- View/download PDF
42. [Pulmonary hypertension due to lung diseases].
- Author
-
Kylhammar D and Rådegran G
- Subjects
- Critical Pathways, Europe, Humans, Practice Guidelines as Topic, Hypertension, Pulmonary complications, Hypertension, Pulmonary diagnosis, Hypertension, Pulmonary physiopathology, Hypertension, Pulmonary therapy, Lung Diseases complications
- Abstract
Pulmonary hypertension due to lung diseases In 2015 the European Society of Cardiology and European Respiratory Society published new guidelines on the diagnosis and treatment of pulmonary hypertension (PH). PH due to lung diseases and/or hypoxia was classified as a separate entity. PH is common in lung diseases, but seldom severe. Nevertheless, the presence of PH in a patient with lung disease is associated with worse outcome. If there is clinical suspicion of PH in a patient with lung disease, echocardiography is recommended, and if there are signs of severe PH and/or severe right ventricular dysfunction the patient should be referred to a PH expert centre. Patients may have lung disease and e.g. pulmonary arterial hypertension or chronic thromboembolic PH simultaneously, and targeted treatments are available in such cases. PH-targeted drugs should, however, not be used to treat PH due to lung diseases, since there are no robust data speaking for their benefit and a risk of impaired arterial oxygenation due to inhibition of hypoxic pulmonary vasoconstriction. Instead, the underlying lung disease should be optimally treated, including long-term oxygen therapy in case of chronic hypoxemia.
- Published
- 2017
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