46 results on '"Waldenborg, A."'
Search Results
2. Freeze-dried bilberry (Vaccinium myrtillus) dietary supplement improves walking distance and lipids after myocardial infarction: an open-label randomized clinical trial
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Arevström, Lilith, Bergh, Cecilia, Landberg, Rikard, Wu, Huaxing, Rodriguez-Mateos, Ana, Waldenborg, Micael, Magnuson, Anders, Blanc, Stepháne, and Fröbert, Ole
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- 2019
- Full Text
- View/download PDF
3. Skrivgruppen
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Karin Borge Renberg, Annelie Hägglund, Sara Johansson, and Kristina Waldenborg
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Language and Literature - Abstract
–
- Published
- 2021
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- View/download PDF
4. “IF HE COULD DO BETTER,HE WOULD HAVE CHOSEN TO DO SO” : A qualitative study to investigate staff members’ perception of controllability,responsibility, and police reporting of violence in residential care settings forpeople with intellectual disability.
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Waldenborg, Therese and Waldenborg, Therese
- Abstract
Acts of violence towards staff committed by people with intellectual disabilities in residential care settings are common. In the Swedish legal system, the requirement for criminal intent is the same for everyone over 15 years. This creates a gap between the law and the perceived ability to take criminal responsibility in this group since the consequences of the intellectual disability can be functioning on a lower level than your chronological age. This study aims to explore the factors in reasoning about controllability, responsibility and police reporting in violent situations, with a focus on staff members working in residential care settings for people with intellectual disabilities. The method for this was 7 semi-structured interviews with staff members working in care settings where violence and threats were occurring. The thematic analysis of the interviews revealed that experience of violence was common and that communication problems are perceived as a common cause. Responsibility in violent situations was perceived as something that needs to be shared between the person displaying it and the staff involved. The reasoning around police reporting of violence shows that staff takes both the person’s ability to take responsibility and level of understanding into account and in most cases this reasoning led to the decision not to file a police report. Another factor considered in staff reasoning is the legal process and the consequences of entering it for a person with intellectual disability. This implies that staff is trying to take responsibility in practice for the gap between the law and their perception of responsibility in the person they support. The study concludes that there is a need for addressing this on a governmental level as well as on a practical level in care settings, to improve the work environment and strengthen the legal certainty for people with intellectual disabilities.
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- 2022
5. Building Efficient Regular Expression Matchers Through GA Optimization With ML Surrogates
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Johan Garcia, Anders Waldenborg, and Jonathan Hillblom
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Finite-state machine ,Optimization problem ,Matching (graph theory) ,Computer science ,business.industry ,Intrusion detection system ,Evaluation function ,Machine learning ,computer.software_genre ,Set (abstract data type) ,Traffic classification ,Artificial intelligence ,Regular expression ,business ,computer - Abstract
Important network functions such as traffic classification and intrusion detection often depend on high-throughput regular expression matching. To achieve high performance, regular expressions can be represented as state machines, which are then merged. However, determining which individual state machines should ideally be merged together is a challenging optimization problem. We address this problem by using genetic algorithms with novel problem-specific operators. To allow large scale evaluation of the new operators, we devise two ML-based surrogate models for the expensive fitness evaluation function. Our results from a set of production scale regular expressions show that using the most appropriate operations provides large gains over a naive baseline, but also that no universal best combination of operators exist. We provide some insights into which operators perform best for different objectives, and show the variation between TCP- and UDP-specific regular expressions.
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- 2021
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6. Diastolic function improves after resolution of takotsubo cardiomyopathy
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Kumar, Sanjay, Waldenborg, Micael, Bhumireddy, Priya, Ramkissoon, Keshwar, Loiske, Karin, Innasimuthu, Antony L., Grodman, Richard S., Heitner, John F., Emilsson, Kent, and Lazar, Jason M.
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- 2016
- Full Text
- View/download PDF
7. Building Efficient Regular Expression Matchers Through GA Optimization With ML Surrogates
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Hillblom, Jonathan, primary, Garcia, Johan, additional, and Waldenborg, Anders, additional
- Published
- 2021
- Full Text
- View/download PDF
8. Building Efficient Regular Expression Matchers Through GA Optimization with ML Surrogates
- Author
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Hillblom, J., Garcia, Johan, Waldenborg, A., Hillblom, J., Garcia, Johan, and Waldenborg, A.
- Abstract
Important network functions such as traffic classification and intrusion detection often depend on high-throughput regular expression matching. To achieve high performance, regular expressions can be represented as state machines, which are then merged. However, determining which individual state machines should ideally be merged together is a challenging optimization problem. We address this problem by using genetic algorithms with novel problem-specific operators. To allow large scale evaluation of the new operators, we devise two ML-based surrogate models for the expensive fitness evaluation function. Our results from a set of production scale regular expressions show that using the most appropriate operations provides large gains over a naive baseline, but also that no universal best combination of operators exist. We provide some insights into which operators perform best for different objectives, and show the variation between TCP- and UDP-specific regular expressions.
- Published
- 2021
- Full Text
- View/download PDF
9. Chronic nicotine effects on left ventricular function in healthy middle-aged people: an echocardiographic study
- Author
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Sundström, D., Waldenborg, M., Magnuson, A., and Emilsson, K.
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- 2013
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10. Acute effects on the ventricular function in Swedish snuffers: an echocardiographic study
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Sundström, D., Waldenborg, M., and Emilsson, K.
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- 2012
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11. Left and right ventricular systolic long-axis function and diastolic function in patients with takotsubo cardiomyopathy
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Loiske, K., Waldenborg, M., Fröbert, O., Rask, P., and Emilsson, K.
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- 2011
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12. Multidisciplinary assessment of tako tsubo cardiomyopathy: a prospective case study
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Emilsson Kent, Kähäri Anders, Soholat Mona, Waldenborg Micael, and Fröbert Ole
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background The cause of tako tsubo cardiomyopathy remains unclear. We used a multidisciplinary approach to investigate if a common pathophysiological denominator could be outlined. Methods Within 3 days following symptom presentation and again after 3 months we investigated all patients coming to our institution and diagnosed with tako-tsubo cardiomyopathy. Patients underwent extensive biochemical screening. Left ventricular function was evaluated by echocardiography and contrast-enhanced cardiac magnetic resonance imaging. Cardiac autonomic function was studied by heart rate variability and signal-averaged electrocardiogram and posttraumatic stress and depression were investigated by questionnaires (the Posttraumatic Stress Syndrome 10-Questions Inventory, PTSS-10 and the Montgomery-Åsberg depression rating scale, self rated version, MADRS-S). Results During 2 years, 13 consecutive patients were included. Markers of myocardial damage and heart failure were slightly to moderately elevated and ejection fraction (echocardiography and MRi) was moderately reduced at hospitalization and improved to normal values in all patients. Signal averaged ECG demonstrated a statistically significant shorter duration of the filtered QRS complex in the acute phase as compared to follow-up. In heart rate variability analysis, SDNN and SDANN were shorter acutely compared to follow-up. Two patients fulfilled criteria for posttraumatic stress syndrome while 7 patients were in the borderline zone. There was a statistically significant inverse correlation between PTSS-10 score and QRS duration in the signal-averaged ECG (r = -0.66, P = 0.01). Conclusions Patients with tako tsubo cardiomyopathy have altered cardiac autonomic function and a high incidence rate of borderline or definite posttraumatic stress syndrome acutely. This is in line with findings in patients with myocardial infarction and does not allow conclusions on cause and effect.
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- 2011
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13. Determination of Right Ventricular Volume by Combining Echocardiographic Distance Measurements
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Stina Jorstig, Per Thunberg, Mats Lidén, Maciej Wodecki, and Micael Waldenborg
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Sternum ,Heart Ventricles ,Echocardiography, Three-Dimensional ,030204 cardiovascular system & hematology ,Sensitivity and Specificity ,030218 nuclear medicine & medical imaging ,Free wall ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Internal medicine ,Image Interpretation, Computer-Assisted ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Aged ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Stroke Volume ,Organ Size ,Stroke volume ,Middle Aged ,Image enhancement ,Image Enhancement ,body regions ,medicine.anatomical_structure ,Ventricle ,Cardiology ,Ventricular volume ,Female ,Anatomic Landmarks ,Cardiology and Cardiovascular Medicine ,business - Abstract
The position of the right ventricle (RV), often partly behind the sternum, implies difficulties to image the RV free wall using transthoracic echocardiography (TTE) and consequently limits the possibilities of stroke volume calculations. The aim of this study was to evaluate whether the volume of the right ventricle (RV) can be determined by combining TTE distance measurements that do not need the RV free wall to be fully visualized.The RV volume was approximated by an ellipsoid composed of three distances. Distance measurements, modeled RV stroke volumes (RVSV), and RV ejection fraction (RVEF) were compared to reference values obtained from cardiac magnetic resonance (CMR) imaging for 12 healthy volunteers.Inter-modality comparisons showed that distance measurements were significantly underestimated in TTE compared to CMR. The modeled RV volumes using TTE distance measurements were underestimated compared to reference CMR volumes. There was, however, for TTE an agreement between modeled RVSV and left ventricular stroke volumes determined by biplane Simpson's rule. Similar agreement was shown between modeled RVSV based on CMR distance measurements and the CMR reference. Regarding RVEF, further studies including patients with a wider range of RVEF are needed to evaluate the method.In conclusion, the ellipsoid model of the RV provides good estimates of RVSVs, but volumes based on distance measurements from different modalities cannot be used interchangeably.
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- 2016
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14. Poster session 6
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Per Thunberg, Maciej Wodecki, Micael Waldenborg, Kent Emilsson, Mats Lidén, and Stina Jorstig
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medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Right atrial ,Area measurement ,body regions ,medicine.anatomical_structure ,Cardiac magnetic resonance imaging ,Ventricle ,cardiovascular system ,medicine ,Right atrium ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Cardiac magnetic resonance ,Stroke - Abstract
Purpose: It has previously been shown that stroke volumes measured by transthoracic echocardiography (TTE) are underestimated, compared to cardiac magnetic resonance (CMR) imaging. The purpose of this study was to evaluate differences in distance and area measurements of the right atrium (RA) and the right ventricle (RV) by TTE and CMR.Methods: TTE examinations and CMR examinations were subsequently performed in 12 healthy volunteers. Three distances (RAL - right atrial length, RVIT3 - right ventricular inflow tract, RVLAX - right ventricular long axis) and one area (RVA - right ventricular area) were measured in TTE and CMR. Stroke volumes were also calculated using conventional methods available on each modality. Both intramodality and intermodality comparisons were performed based on measurements from three observers. One of the observers performed measurements in both TTE and CMR.Results: Intermodality comparisons showed that all distance and area measurements were significantly smaller using TTE (Table 1). Two of the measurements, RVIT3 and RVA, differed at about 50%. Calculated stroke volumes showed, consistent with previous results, that the TTE stroke volumes are substantially underestimated compared to CMR volumes. Intramodality variations of distance and area measurements were considerably smaller (Table 1).Conclusions: Our results show that RV distances and areas measured by TTE are smaller compared to CMR, probably due to differences in defining the endocardial borders. These differences subsequently result in smaller stroke volumes when using TTE. Caution should be taken when comparing distances, areas and volumes measured by TTE and CMR.
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- 2015
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15. How to improve an organization's desorptive capacity to facilitate knowledge transfer : A single case study at a multinational organization operating in transfer projects
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Persson, Erik and Waldenborg, Emil
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transfer projects ,Teknik och teknologier ,Engineering and Technology ,Desorptive capacity ,knowledge transfer - Abstract
Purpose - The purpose of this study is to describe how to improve an organization’s desorptive capacity to facilitate knowledge transfer in transfer projects. Method - This research was conducted as a single case study, with an abductive approach, were the unit of analysis has been transfer projects. The empirical data collection has been qualitative and was conducted through 20 semi-structured interviews. The interviews were held at the case company with project managers, sub-project managers and project members to widen the experience of everyone involved in transfer projects. A thematic analysis was utilized to possess the empirical data. Result - We found that it is essential to evaluate critical factors in the identification of a transfer project and utilize managerial tools to facilitate the application of the knowledge transferred to the recipient. We have created a framework that show the correlations between the evaluation of the critical factors and the utilization of the managerial tools, categorized in organizational practices. Depending on the evaluation of the critical factors, resources need to be allocated to specific organizational practices. This will result in an improvement of an organization’s desorptive capacity. Theoretical contribution - This report contributes to the literature by filling the gap regarding how to improve organizations’ desorptive capacity to facilitate knowledge transfer in transfer projects. We have identified the critical aspects of desorptive capacity andcontributed with a framework that can be adapted by organizationsto improve their desorptive capacity. Managerial implications - The findings in this study have potential to increase the awareness among organizations about the initial phase of transfer projects and contribute to an increased understanding of how an organization can improve their desorptive capacity. It is recommended to utilize the presented framework in this report to take advantages of the correlations found between the critical factors and the organizational practices.
- Published
- 2018
16. Effect on left ventricular mass and geometry in patients with takotsubo cardiomyopathy
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Mats Lidén, Anders Kähäri, Kent Emilsson, and Micael Waldenborg
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medicine.medical_specialty ,Time Factors ,Heart Ventricles ,Cardiomyopathy ,Magnetic Resonance Imaging, Cine ,Geometry ,Ventricular Function, Left ,Left ventricular mass ,Predictive Value of Tests ,Takotsubo Cardiomyopathy ,Internal medicine ,Humans ,Medicine ,In patient ,cardiovascular diseases ,Aged ,Retrospective Studies ,Observer Variation ,business.industry ,Two dimensional echocardiography ,Apical Ballooning Syndrome ,Reproducibility of Results ,Prognosis ,medicine.disease ,Myocardial Contraction ,Echocardiography, Doppler ,Cardiology ,Stress induced cardiomyopathy ,Female ,Cardiology and Cardiovascular Medicine ,business ,Recovery phase - Abstract
Takotsubo cardiomyopathy (TTC) is a condition of transient left ventricular (LV) dysfunction. The effects on LV mass (LVM) and geometry have not been studied enough in TTC. Retrospectively, we analyzed our TTC cohort both by transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI), for comparative purposes.Thirteen women undergoing TTE and MRI, at onset and three months later, were included. LVM was estimated by MRI, and two TTE methods. Segmental wall thickness (SWT) was measured, while radial strain was assessed by TTE. Data analysis included Wilcoxon's test (between phases), Mann-Whitney U test and McNemar's test (between and within groups). Bland-Altman analyses were used for intertechnique coherence, while interactions regarding TTE were tested using Spearman's coefficient.LVM decreased during recovery (p0.05), by MRI and one of the TTE methods; truncated ellipsoid formula (TEF), which also showed relatively better coherence compared with MRI. SWT decreased in two of three sites, by both modalities, but with ambiguous coherence there between. The TEF data interacted partially with a demonstrated increase in radial strain.TTC associates with acute increase in LVM, which appears to be an apical effect, tending to follow the changes in concentric wall motion. MRI and TTE show adequate coherence; primarily for the TEF method regarding LVM.
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- 2015
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17. Chronic nicotine effects on left ventricular function in healthy middle-aged people: an echocardiographic study
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Anders Magnuson, Daniel Sundström, Micael Waldenborg, and Kent Emilsson
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Male ,Nicotine ,medicine.medical_specialty ,Time Factors ,Tobacco, Smokeless ,Physiology ,Heart Ventricles ,Diastole ,macromolecular substances ,Ventricular Function, Left ,Ventricular Dysfunction, Left ,Predictive Value of Tests ,Physiology (medical) ,Internal medicine ,Humans ,Medicine ,Nicotinic Agonists ,Snuff ,Echocardiography, Doppler, Pulsed ,Ventricular function ,business.industry ,Smoking ,Case-control study ,General Medicine ,Middle Aged ,Nicotinic agonist ,Chronic nicotine ,Case-Control Studies ,Predictive value of tests ,Linear Models ,Cardiology ,Female ,business ,medicine.drug - Abstract
Cigarettes and Swedish snuff influence the cardiovascular system in many ways. Cigarette and snuff usage have been linked with an acute impairment in several diastolic cardiac parameters during intake. The aim of this study is to investigate whether long-term usage of Swedish snuff or cigarettes also causes a more permanent impairment of systolic and/or diastolic cardiac parameters in the left ventricle in otherwise healthy middle-aged snuffers and smokers.Eighty-seven age-matched volunteers were included and examined with echocardiography. The volunteers were divided into three subgroups; one group with non-tobacco users, one group with long-term smokers and finally one group with long-term snuffers. The smokers and snuffers were instructed not to use these products for at least 5 h before the examination. The systolic and diastolic cardiac parameters were collected at one time. Most of the systolic parameters measured were unaltered between the tobacco subgroups and non-tobacco users, and therefore, no alteration of significance was found in systolic parameters. Also, almost all of the diastolic parameters measured were not significantly impaired in the tobacco subgroups compared with non-tobacco users. However, the deceleration time (DT) was slightly prolonged (P0·05) and thus statistically significant in the tobacco subgroups. This finding is somewhat difficult to interpret but may be seen as random.This study reveals that most systolic- and diastolic cardiac parameters are not chronically significantly altered in middle-aged long-term tobacco users compared with age-matched non-tobacco users.
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- 2013
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18. Acute effects on the ventricular function in Swedish snuffers: an echocardiographic study
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Kent Emilsson, Daniel Sundström, and Micael Waldenborg
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Acute effects ,medicine.medical_specialty ,Ventricular function ,medicine.diagnostic_test ,Physiology ,business.industry ,Diastole ,General Medicine ,Stroke volume ,Doppler echocardiography ,Blood pressure ,Physiology (medical) ,Internal medicine ,Heart rate ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,Systole ,business - Abstract
Acute cardiac effects on the ventricular function in Swedish snuffers : an echocardiographic study
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- 2011
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19. Left and right ventricular systolic long-axis function and diastolic function in patients with takotsubo cardiomyopathy
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Ole Fröbert, Karin Loiske, Micael Waldenborg, Kent Emilsson, and Peter Rask
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medicine.medical_specialty ,Physiology ,business.industry ,Diastole ,Cardiomyopathy ,General Medicine ,Disease ,medicine.disease ,Text mining ,Physiology (medical) ,Internal medicine ,Cardiology ,Medicine ,cardiovascular diseases ,Differential diagnosis ,Systole ,business ,Prospective cohort study ,Pathological - Abstract
Takotsubo cardiomyopathy (TTC) is a disease characterized by transient left ventricular (LV) dysfunction and typical wall motion abnormalities in apical parts, without obvious signs of coronary influence. Due to its elusive natural cause and the lack of clarified pathology, further studies are needed. Thirteen patients presented with an episode of TTC, and referred to Orebro University Hospital (USO), were prospectively included and investigated by comparisons made at onset (acute phase) against at follow-up three months later (recovery phase). Including echocardiographic measurements, focused on biventricular systolic long-axis function and conventional diastolic function (DF) variables. Systolic improvement was shown, while most DF data were unchanged, suggesting that TTC is mainly a systolic disease affecting both ventricles.Diagnosis should include multidisciplinary engagement, as TTC associates both with emotional stress and pathological markers of physiological stress. In this thesis, such approach was offered to the aforementioned patients; to see if a common denominator could be found, thus, contributing to better handling. Emotional state was assessed, along with an array of cardiac investigations in addition to echocardiography. Acutely, imbalance in the autonomic cardiac control was shown, as well as a trend toward posttraumatic stress, but specific findings allowing conclusions on differential diagnosis could not be demonstrated.By adding another 15 TTC patients (i.e. 28 in total), through collaboration with observers from USA, a retrospective echocardiographic analysis could be done to further study DF; concluding that TTC associates with impairment of conventional DF variables which tends to parallel the systolic recovery, in contrary to the initial result but in line with other causesof LV dysfunction.Magnetic resonance imaging (MRI) is another method of choice at TTC. The USO patients had cardiac MRI, thus, a retrospective analysis was done to investigate the effect on LV geometry, both echocardiographic and by MRI; suggesting that TTC is consistently associated with increased LV mass, due to a local impact that seems to follow the change in LVconcentric wall motion.
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- 2010
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20. To capture life in a few words : Kristin Lavransdotter through Alice Munroä's eyes - the possibilities and limits of the short story
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Edin Waldenborg, Kristina
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Skapande svenska ,Sigrid Undset ,Alice Munro ,Novell - Abstract
Uppsatsen ingår i kursen Skapande svenska C, 30 hp, inom ämnet Litteraturvetenskap vid Umeå universitet
- Published
- 2016
21. Right ventricular ejection fraction measurements using two-dimensional transthoracic echocardiography by applying an ellipsoid model
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Jorstig, Stina, primary, Waldenborg, Micael, additional, Lidén, Mats, additional, and Thunberg, Per, additional
- Published
- 2017
- Full Text
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22. Right ventricular ejection fraction measurements using two-dimensional transthoracic echocardiography by applying an ellipsoid model
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Jorstig, Stina, Waldenborg, Micael, Lidén, Mats, Thunberg, Per, Jorstig, Stina, Waldenborg, Micael, Lidén, Mats, and Thunberg, Per
- Abstract
Background: There is today no established approach to estimate right ventricular ejection fraction (RVEF) using 2D transthoracic echocardiography (TTE). The aim of this study was to evaluate a new method for RVEF calculations using 2D TTE and compare the results with cardiac magnetic resonance (CMR) imaging and tricuspid annular plane systolic excursion (TAPSE). Methods: A total of 37 subjects, 25 retrospectively included patients and twelve healthy volunteers, were included to give a wide range of RVEF. The right ventricle (RV) was modeled as a part of an ellipsoid enabling calculation of the RV volume by combining three distance measurements. RVEF calculated according to the model, RVEFTTE, were compared with reference CMR-derived RVEF, RVEFCMR. Further, TAPSE was measured in the TTE images and the correlations were calculated between RVEFTTE, TAPSE and RVEFCMR. Results: The mean values were RVEFCMR = 43 +/- 12% (range 20-66%) and RVEFTTE = 50 +/- 9% (range 34-65%). There was a high correlation (r = 0.80, p < 0.001) between RVEFTTE and RVEFCMR. Bland-Altman analysis showed a mean difference between RVEFCMR and RVEFTTE of 6 percentage points (ppt) with limits of agreement from -11 to 23 ppt. The mean value for TAPSE was 19 +/- 5 mm and the correlation between TAPSE and RVEFCMR was moderate (r = 0.54, p < 0.001). The correlation between RVEFTTE and RVEFCMR was significantly higher (p < 0.05) than the correlation between TAPSE and RVEFCMR. Conclusions: The ellipsoid model shows promise for RVEF calculations using 2D TTE for a wide range of RVEF, providing RVEF estimates that were significantly better correlated to RVEF obtained from CMR compared to TAPSE., Funding Agency:Research Committee of Region Orebro County OLL-573211
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- 2017
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23. Diastolic function improves after resolution of takotsubo cardiomyopathy
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Richard S. Grodman, Keshwar Ramkissoon, Sanjay Kumar, Antony Leslie Innasimuthu, Kent Emilsson, John F. Heitner, Micael Waldenborg, Priya Bhumireddy, Karin Loiske, and Jason Lazar
- Subjects
Male ,medicine.medical_specialty ,Physiology ,Cardiomyopathy ,030204 cardiovascular system & hematology ,Sensitivity and Specificity ,Broken heart syndrome ,03 medical and health sciences ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Takotsubo Cardiomyopathy ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Diastolic function ,cardiovascular diseases ,030212 general & internal medicine ,Retrospective Studies ,business.industry ,Reproducibility of Results ,Stroke Volume ,General Medicine ,Recovery of Function ,Middle Aged ,medicine.disease ,Treatment Outcome ,Echocardiography ,Cardiology ,Stress induced cardiomyopathy ,Female ,business - Abstract
Takotsubo cardiomyopathy (TTC) is a condition of reversible left ventricular (LV) systolic dysfunction. However, the diastolic function (DF) manifestations of TTC have not been widely investigated. We performed a bicentric study with retrospective analysis of DF in patients with TTC, during onset and at follow-up.Twenty-eight patients with TTC (64 ± 10 years, F 24) were included. All underwent echocardiograms acutely and at the recovery phase (average three months later). Diastolic and systolic function parameters were recorded, including E-wave velocity (E), A-wave velocity, E/A ratio, relaxation (e') and contractility (S') based on tissue Doppler velocities of the mitral annuli, ejection fraction (EF), left atrial (LA) size and DF stages.Recovery, including the mean difference with 95% confidence interval, was associated with tending improvement (i.e. uncorrected significance) in E [13 cm s(-1) (-24, -2·3), P = 0·02] and in E/A ratio [0·2 (-0·41, -0·02), P = 0·04], as well as significant improvement (after multiple comparison correction) in mean e' [2·0 cm s(-1) (-3·3, -1·2), P0·001] and in A-wave duration [29 ms (-46·7, -12·7), P = 0·002]. LA area tended to decrease during recovery [-2 cm² (0·33, 2·4), P = 0·01]. Improvement in DF stages was significant between the phases (21% versus 58% defined as normal DF, P = 0·016). Improvement in LVEF correlated with improvement in mean e' (r = 0·52, P = 0·02).TTC is associated with an acute impairment of conventional DF variables, which improves during recovery. DF recovery seems to occur in parallel with systolic recovery in patients with TTC.
- Published
- 2014
24. Att fånga livet med få ord : Kristin Lavransdotter genom Alice Munros ögon - novellens möjligheter och begränsningar
- Author
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Edin Waldenborg, Kristina and Edin Waldenborg, Kristina
- Abstract
Uppsatsen ingår i kursen Skapande svenska C, 30 hp, inom ämnet Litteraturvetenskap vid Umeå universitet
- Published
- 2016
25. Determination of Right Ventricular Volume by Combining Echocardiographic Distance Measurements
- Author
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Hellstrandh Jorstig, Stina, Waldenborg, Micael, Lidén, Mats, Wodecki, Maciej, Thunberg, Per, Hellstrandh Jorstig, Stina, Waldenborg, Micael, Lidén, Mats, Wodecki, Maciej, and Thunberg, Per
- Abstract
Background: The position of the right ventricle (RV), often partly behind the sternum, implies difficulties to image the RV free wall using transthoracic echocardiography (TTE) and consequently limits the possibilities of stroke volume calculations. The aim of this study was to evaluate whether the volume of the right ventricle (RV) can be determined by combining TTE distance measurements that do not need the RV free wall to be fully visualized. Methods: The RV volume was approximated by an ellipsoid composed of three distances. Distance measurements, modeled RV stroke volumes (RVSV), and RV ejection fraction (RVEF) were compared to reference values obtained from cardiac magnetic resonance (CMR) imaging for 12 healthy volunteers. Results: Inter-modality comparisons showed that distance measurements were significantly underestimated in TTE compared to CMR. The modeled RV volumes using TTE distance measurements were underestimated compared to reference CMR volumes. There was, however, for TTE an agreement between modeled RVSV and left ventricular stroke volumes determined by biplane Simpson's rule. Similar agreement was shown between modeled RVSV based on CMR distance measurements and the CMR reference. Regarding RVEF, further studies including patients with a wider range of RVEF are needed to evaluate the method. Conclusion: In conclusion, the ellipsoid model of the RV provides good estimates of RVSVs, but volumes based on distance measurements from different modalities cannot be used interchangeably., Funding Agency:Örebro County Council
- Published
- 2016
- Full Text
- View/download PDF
26. Distance and area measurement of the right atrium and ventricle by echocardiography and cardiac magnetic resonance imaging : do we measure the same thing?
- Author
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Jorstig, Stina, Emilsson, Kent, Waldenborg, Micael, Lidén, Mats, Wodecki, M., Thunberg, Per, Jorstig, Stina, Emilsson, Kent, Waldenborg, Micael, Lidén, Mats, Wodecki, M., and Thunberg, Per
- Abstract
Purpose: It has previously been shown that stroke volumes measured by transthoracic echocardiography (TTE) are underestimated, compared to cardiac magnetic resonance (CMR) imaging. The purpose of this study was to evaluate differences in distance and area measurements of the right atrium (RA) and the right ventricle (RV) by TTE and CMR. Methods: TTE examinations and CMR examinations were subsequently performed in 12 healthy volunteers. Three distances (RAL - right atrial length, RVIT3 - right ventricular inflow tract, RVLAX - right ventricular long axis) and one area (RVA - right ventricular area) were measured in TTE and CMR. Stroke volumes were also calculated using conventional methods available on each modality. Both intramodality and intermodality comparisons were performed based on measurements from three observers. One of the observers performed measurements in both TTE and CMR. Results: Intermodality comparisons showed that all distance and area measurements were significantly smaller using TTE (Table 1). Two of the measurements, RVIT3 and RVA, differed at about 50%. Calculated stroke volumes showed, consistent with previous results, that the TTE stroke volumes are substantially underestimated compared to CMR volumes. Intramodality variations of distance and area measurements were considerably smaller (Table 1). Conclusions: Our results show that RV distances and areas measured by TTE are smaller compared to CMR, probably due to differences in defining the endocardial borders. These differences subsequently result in smaller stroke volumes when using TTE. Caution should be taken when comparing distances, areas and volumes measured by TTE and CMR.
- Published
- 2016
- Full Text
- View/download PDF
27. BILBERRY AS A DIETARY SUPPLEMENT AFTER MYOCARDIAL INFARCTION: THE BEAR SMART TRIAL
- Author
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Arevström, Lilith, primary, Landberg, Rikard, additional, Waldenborg, Micael, additional, Blanc, Stepháne, additional, and Fröbert, Ole, additional
- Published
- 2016
- Full Text
- View/download PDF
28. Echocardiographic measurements at Takotsubo cardiomyopathy : transient left ventricular dysfunction
- Author
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Waldenborg, Micael
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diastolic ,ventricular mass ,broken heart ,Annan medicinsk grundvetenskap ,Echocardiography ,cardiovascular diseases ,takotsubo ,cardiac autonomic function ,Other Basic Medicine ,concentric wall motion ,annulus motion - Abstract
Takotsubo cardiomyopathy (TTC) is a disease characterized by transient left ventricular (LV) dysfunction and typical wall motion abnormalities in apical parts, without obvious signs of coronary influence. Due to its elusive natural cause and the lack of clarified pathology, further studies are needed. Thirteen patients presented with an episode of TTC, and referred to Örebro University Hospital (USÖ), were prospectively included and investigated by comparisons made at onset (acute phase) against at follow-up three months later (recovery phase). Including echocardiographic measurements, focused on biventricular systolic long-axis function and conventional diastolic function (DF) variables. Systolic improvement was shown, while most DF data were unchanged, suggesting that TTC is mainly a systolic disease affecting both ventricles. Diagnosis should include multidisciplinary engagement, as TTC associates both with emotional stress and pathological markers of physiological stress. In this thesis, such approach was offered to the aforementioned patients; to see if a common denominator could be found, thus, contributing to better handling. Emotional state was assessed, along with an array of cardiac investigations in addition to echocardiography. Acutely, imbalance in the autonomic cardiac control was shown, as well as a trend toward posttraumatic stress, but specific findings allowing conclusions on differential diagnosis could not be demonstrated. By adding another 15 TTC patients (i.e. 28 in total), through collaboration with observers from USA, a retrospective echocardiographic analysis could be done to further study DF; concluding that TTC associates with impairment of conventional DF variables which tends to parallel the systolic recovery, in contrary to the initial result but in line with other causesof LV dysfunction. Magnetic resonance imaging (MRI) is another method of choice at TTC. The USÖ patients had cardiac MRI, thus, a retrospective analysis was done to investigate the effect on LV geometry, both echocardiographic and by MRI; suggesting that TTC is consistently associated with increased LV mass, due to a local impact that seems to follow the change in LVconcentric wall motion.
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- 2014
29. BILBERRY AS A DIETARY SUPPLEMENT AFTER MYOCARDIAL INFARCTION: THE BEAR SMART TRIAL
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Lilith Arevström, Rikard Landberg, Ole Fröbert, Micael Waldenborg, and Stepháne Blanc
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Veterinary medicine ,Bilberry ,Traditional medicine ,biology ,business.industry ,Dietary supplement ,medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,Vaccinium myrtillus ,biology.organism_classification ,medicine.disease ,business - Abstract
Animal studies have shown a cardioprotective effect of blueberries after acute myocardial infarction (AMI). Bilberries (Vaccinium myrtillus), so-called Nordic blueberries, have a much higher content and diversity of anthocyanins compared to blueberries. To determine whether bilberries could have a
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- 2016
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30. Acute effects on the ventricular function in Swedish snuffers: an echocardiographic study
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D, Sundström, M, Waldenborg, and K, Emilsson
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Adult ,Echocardiography, Doppler, Pulsed ,Male ,Sweden ,Analysis of Variance ,Time Factors ,Tobacco, Smokeless ,Systole ,Ventricular Dysfunction, Right ,Blood Pressure ,Stroke Volume ,Middle Aged ,Echocardiography, Doppler ,Ventricular Function, Left ,Echocardiography, Doppler, Color ,Ventricular Dysfunction, Left ,Young Adult ,Diastole ,Heart Rate ,Predictive Value of Tests ,Ventricular Function, Right ,Humans ,Female - Abstract
Cigarettes and Swedish snuff contain nicotine, which influence the cardiovascular system. Cigarette smoke has been shown to give an acute impairment in diastolic heart parameters. The systolic and diastolic heart function in snuff users is not thoroughly enough investigated. The aim of this study was to investigate if Swedish snuff will give an acute decrease in systolic and diastolic heart parameters in the left and right ventricles in healthy Swedish snuffers.Thirty healthy volunteers were examined with echocardiography. The study involved recordings from four different times: before snuff intake, 5 and 30 min after intake and finally 30 min after snuff withdrawal. The systolic and diastolic heart parameters were collected with conventional echocardiographic methods. In addition, the heart frequency and blood pressure response were measured. The pulse and blood pressure response were significantly altered (P0.01) during the test. Left ventricular ejection fraction and the amplitudes of mitral and tricuspid annulus motion did not alter significantly. The main finding in the study was the significant decrease (P0.05) in several diastolic heart parameters for both the left and right ventricles.This study shows that snuff intake causes a significant decrease in E/A ratio and a delay in ventricular relaxation and therefore a decrease in diastolic heart function in the left and right ventricles. The mechanism behind these alterations is probably very complex, but a combination of nicotine effects and loading conditions is probably the main factor.
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- 2012
31. Determination of Right Ventricular Volume by Combining Echocardiographic Distance Measurements
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Jorstig, Stina, primary, Waldenborg, Micael, additional, Lidén, Mats, additional, Wodecki, Maciej, additional, and Thunberg, Per, additional
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- 2016
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32. Effect on left ventricular mass and geometry in patients with takotsubo cardiomyopathy
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Waldenborg, Micael, Lidén, Mats, Kähäri, Anders, Emilsson, Kent, Waldenborg, Micael, Lidén, Mats, Kähäri, Anders, and Emilsson, Kent
- Abstract
Objectives: Takotsubo cardiomyopathy (TTC) is a condition of transient left ventricular (LV) dysfunction. The effects on LV mass (LVM) and geometry have not been studied enough in TTC. Retrospectively, we analyzed our TTC cohort both by transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI), for comparative purposes. Design: Thirteen women undergoing TTE and MRI, at onset and three months later, were included. LVM was estimated by MRI, and two TTE-methods. Segmental wall thickness (SWT) was measured, whilst radial strain was assessed by TTE. Data analysis included Wilcoxon's test (between phases), Mann Whitney U- and McNemar's tests (between and within groups). Bland-Altman analyzes were used for intertechnique coherence, whilst interactions regarding TTE were tested using Spearman's coefficient. Results: LVM decreased during recovery (p<0.05), by MRI and one of the TTE-methods; truncated ellipsoid formula (TEF), which also showed relatively better coherence compared to MRI. SWT decreased in two of three sites, by both modalities, but with ambiguous coherence therebetween. The TEF-data interacted partially with a demonstrated increase in radial strain. Conclusions: TTC associates with acute increase in LVM, which appears to be an apical effect, tending to follow the changes in concentric wall motion. MRI and TTE show adequate coherence; primarily for the TEF-method regarding LVM.
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- 2015
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33. Left and right ventricular systolic long-axis function and diastolic function in patients with takotsubo cardiomyopathy
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K, Loiske, M, Waldenborg, O, Fröbert, P, Rask, and K, Emilsson
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Echocardiography, Doppler, Pulsed ,Male ,Time Factors ,Systole ,Middle Aged ,Coronary Angiography ,Ventricular Function, Left ,Diastole ,Takotsubo Cardiomyopathy ,Ventricular Function, Right ,Humans ,Female ,Prospective Studies ,Aged - Abstract
Takotsubo cardiomyopathy is characterized by apical wall motion abnormalities without coronary stenosis. Limited information is available on the genesis of the underlying reversible contractile disorder. Our objective in this prospective study was to investigate biventricular changes in systolic long-axis function and diastolic parameters in the acute phase and after recovery. Thirteen consecutive patients were examined by echocardiography and coronary angiography at admission and again by echocardiography after 3 months. Amplitudes, systolic and diastolic velocities of the mitral and tricuspid annuli and conventional diastolic parameters were measured. Systolic long-axis shortening of the left ventricle (LV) and right ventricle (RV) improved from 9.6 ± 2.2 mm to 11.2 ± 1.9 mm (P = 0.02) and from 21.3 ± 3.6 mm to 24.1 ± 2.8 mm (P = 0·02), respectively. LV systolic, early and late diastolic velocities measured by pulsed-wave tissue Doppler also improved, while additional conventional diastolic parameters of the LV and RV diastolic function were unchanged. Takotsubo cardiomyopathy temporarily affects systolic LV and RV function, while most diastolic parameters remain unchanged.
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- 2010
34. Effect on left ventricular mass and geometry in patients with takotsubo cardiomyopathy
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Waldenborg, Micael, primary, Lidén, Mats, additional, Kähäri, Anders, additional, and Emilsson, Kent, additional
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- 2015
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35. Diastolic function improves after resolution of takotsubo cardiomyopathy
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Kumar, Sanjay, primary, Waldenborg, Micael, additional, Bhumireddy, Priya, additional, Ramkissoon, Keshwar, additional, Loiske, Karin, additional, Innasimuthu, Antony L., additional, Grodman, Richard S., additional, Heitner, John F., additional, Emilsson, Kent, additional, and Lazar, Jason M., additional
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- 2014
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36. Chronic nicotine effects on left ventricular function in healthy middle-aged people : an echocardiographic study
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Sundström, Daniel, Waldenborg, Micael, Magnuson, Anders, Emilsson, Kent, Sundström, Daniel, Waldenborg, Micael, Magnuson, Anders, and Emilsson, Kent
- Abstract
Aims Cigarettes and Swedish snuff influence the cardiovascular system in many ways. Cigarette and snuff usage have been linked with an acute impairment in several diastolic cardiac parameters during intake. The aim of this study is to investigate whether long-term usage of Swedish snuff or cigarettes also causes a more permanent impairment of systolic and/or diastolic cardiac parameters in the left ventricle in otherwise healthy middle-aged snuffers and smokers. Methods and results Eighty-seven age-matched volunteers were included and examined with echocardiography. The volunteers were divided into three subgroups; one group with non-tobacco users, one group with long-term smokers and finally one group with long-term snuffers. The smokers and snuffers were instructed not to use these products for at least 5h before the examination. The systolic and diastolic cardiac parameters were collected at one time. Most of the systolic parameters measured were unaltered between the tobacco subgroups and non-tobacco users, and therefore, no alteration of significance was found in systolic parameters. Also, almost all of the diastolic parameters measured were not significantly impaired in the tobacco subgroups compared with non-tobacco users. However, the deceleration time (DT) was slightly prolonged (P<0 center dot 05) and thus statistically significant in the tobacco subgroups. This finding is somewhat difficult to interpret but may be seen as random. Conclusions This study reveals that most systolic- and diastolic cardiac parameters are not chronically significantly altered in middle-aged long-term tobacco users compared with age-matched non-tobacco users.
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- 2013
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37. Diastolic function improves after resolution of takotsubo cardiomyopathy
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Kumar, Sanyay, Waldenborg, Micael, Bhumireddy, P., Ramkissoon, K., Innasimuthu, A. L., Loiske, K., Emilsson, Kent, Lazar, J. M., Kumar, Sanyay, Waldenborg, Micael, Bhumireddy, P., Ramkissoon, K., Innasimuthu, A. L., Loiske, K., Emilsson, Kent, and Lazar, J. M.
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- 2012
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38. Acute effects on the ventricular function in Swedish snuffers : an echocardiographic study
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Sundström, Daniel, Waldenborg, Micael, Emilsson, Kent, Sundström, Daniel, Waldenborg, Micael, and Emilsson, Kent
- Abstract
Aims: Cigarettes and Swedish snuff contain nicotine, which influence the cardiovascular system. Cigarette smoke has been shown to give an acute impairment in diastolic heart parameters. The systolic and diastolic heart function in snuff users is not thoroughly enough investigated. The aim of this study was to investigate if Swedish snuff will give an acute decrease in systolic and diastolic heart parameters in the left and right ventricles in healthy Swedish snuffers. Methods and results: Thirty healthy volunteers were examined with echocardiography. The study involved recordings from four different times: before snuff intake, 5 and 30 min after intake and finally 30 min after snuff withdrawal. The systolic and diastolic heart parameters were collected with conventional echocardiographic methods. In addition, the heart frequency and blood pressure response were measured. The pulse and blood pressure response were significantly altered (P<0Æ01) during the test. Left ventricular ejection fraction and the amplitudes of mitral and tricuspid annulus motion did not alter significantly. The main finding in the study was the significant decrease (P<0Æ05) in several diastolic heart parameters for both the left and right ventricles. Conclusions: This study shows that snuff intake causes a significant decrease in E ⁄ A ratio and a delay in ventricular relaxation and therefore a decrease in diastolic heart function in the left and right ventricles. The mechanism behind these alterations is probably very complex, but a combination of nicotine effects and loading conditions is probably the main factor., © 2011 The AuthorsClinical Physiology and Functional Imaging 2011 Scandinavian Society of Clinical Physiology and Nuclear Medicine 32, 2, 106–113
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- 2012
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39. Left and right ventricular systolic long-axis function and diastolic function in patients with takotsubo cardiomyopathy
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Loiske, Karin, Waldenborg, Micael, Fröbert, Ole, Rask, Peter, Emilsson, Kent, Loiske, Karin, Waldenborg, Micael, Fröbert, Ole, Rask, Peter, and Emilsson, Kent
- Abstract
Aims: Takotsubo cardiomyopathy is characterized by apical wall motion abnormalities without coronary stenosis. Limited information is available on the genesis of the underlying reversible contractile disorder. Our objective in this prospective study was to investigate biventricular changes in systolic long-axis function and diastolic parameters in the acute phase and after recovery. Methods and results: Thirteen consecutive patients were examined by echocardiography and coronary angiography at admission and again by echocardiography after 3 months. Amplitudes, systolic and diastolic velocities of the mitral and tricuspid annuli and conventional diastolic parameters were measured. Systolic long-axis shortening of the left ventricle (LV) and right ventricle (RV) improved from 9·6 ± 2·2 mm to 11·2 ± 1·9 mm (P = 0·02) and from 21·3 ± 3·6 mm to 24·1 ± 2·8 mm (P = 0·02), respectively. LV systolic, early and late diastolic velocities measured by pulsed-wave tissue Doppler also improved, while additional conventional diastolic parameters of the LV and RV diastolic function were unchanged.Conclusions: Takotsubo cardiomyopathy temporarily affects systolic LV and RV function, while most diastolic parameters remain unchanged
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- 2011
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40. Multidisciplinary assessment of takotsubo cardiomyopathy : a prospective case study
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Waldenborg, Micael, Soholat, Mona, Kähäri, Anders, Emilsson, Kent, Fröbert, Ole, Waldenborg, Micael, Soholat, Mona, Kähäri, Anders, Emilsson, Kent, and Fröbert, Ole
- Abstract
Background: The cause of tako tsubo cardiomyopathy remains unclear. We used a multidisciplinary approach to investigate if a common pathophysiological denominator could be outlined. Methods: Within 3 days following symptom presentation and again after 3 months we investigated all patients coming to our institution and diagnosed with tako-tsubo cardiomyopathy. Patients underwent extensive biochemical screening. Left ventricular function was evaluated by echocardiography and contrast-enhanced cardiac magnetic resonance imaging. Cardiac autonomic function was studied by heart rate variability and signal-averaged electrocardiogram and posttraumatic stress and depression were investigated by questionnaires (the Posttraumatic Stress Syndrome 10-Questions Inventory, PTSS-10 and the Montgomery-Asberg depression rating scale, self rated version, MADRS-S). Results: During 2 years, 13 consecutive patients were included. Markers of myocardial damage and heart failure were slightly to moderately elevated and ejection fraction (echocardiography and MRi) was moderately reduced at hospitalization and improved to normal values in all patients. Signal averaged ECG demonstrated a statistically significant shorter duration of the filtered QRS complex in the acute phase as compared to follow-up. In heart rate variability analysis, SDNN and SDANN were shorter acutely compared to follow-up. Two patients fulfilled criteria for posttraumatic stress syndrome while 7 patients were in the borderline zone. There was a statistically significant inverse correlation between PTSS-10 score and QRS duration in the signal-averaged ECG (r = -0.66, P = 0.01). Conclusions: Patients with tako tsubo cardiomyopathy have altered cardiac autonomic function and a high incidence rate of borderline or definite posttraumatic stress syndrome acutely. This is in line with findings in patients with myocardial infarction and does not allow conclusions on cause and effect., This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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- 2011
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41. Acute effects on the ventricular function in Swedish snuffers: an echocardiographic study
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Sundström, D., primary, Waldenborg, M., additional, and Emilsson, K., additional
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- 2011
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42. Multidisciplinary assessment of tako tsubo cardiomyopathy: a prospective case study
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Waldenborg, Micael, primary, Soholat, Mona, additional, Kähäri, Anders, additional, Emilsson, Kent, additional, and Fröbert, Ole, additional
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- 2011
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43. Left and right ventricular systolic long-axis function and diastolic function in patients with takotsubo cardiomyopathy
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Loiske, K., primary, Waldenborg, M., additional, Fröbert, O., additional, Rask, P., additional, and Emilsson, K., additional
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- 2010
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44. Effect on left ventricular mass and geometry in patients with takotsubo cardiomyopathy
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Waldenborg, Micael, Lidén, Mats, Kähäri, Anders, Emilsson, Kent, Waldenborg, Micael, Lidén, Mats, Kähäri, Anders, and Emilsson, Kent
- Abstract
Aims: Takotsubo cardiomyopathy (TTC) is a condition of reversible left ventricular (LV) dysfunction. The effects, from acute to recovery phase, on LV mass (LVM) and the LV geometry are not thoroughly enough studied at TTC, which were the main aims of the present study. Retrospectively, we analyzed our cohort of TTC-patients, both with transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI), to further investigate these changes, including intertechnique comparison. Methods: We studied 13 female TTC-patients, undergoing TTE and MRI acutely, and three months later at follow-up. LVM was measured with MRI- and five different TTE-methods. Segmental wall thickness (SWT) was assessed, and used for LV hypertrophy (LVH) geometry categorization. Radial strain was measured at TTE. Data analysis included Wilcoxon signed-test (between phases), Mann Whitney U- and McNemar’s tests (between and within groups). Spearman’s coefficient was used for intertechnique coherence (with BlandAltman plots) and for correlations of simultaneous TTE changes. Results: LVM decreased significantly between phases (p<0.05), by MRI and with two TTE-methods. Two of three SWT-sites became significantly thinner, with adequate correlation (rs≥0.69) between techniques, while LVH categories remained unchanged. Relatively better consistency, compared with MRI, was shown for one of the TTE-methods used to estimate LVM (truncated ellipsoid (TE)). Radial strain improved significantly, with partial correlation towards the TE-method. Conclusions: TTC associates with acute increase in LVM, which seems to be a local effect, tending to occur in parallel with changes in concentric wall motion. MRI and TTE shows adequate consistency, primarily for the TE-method regarding LVM.
45. Right ventricular ejection fraction measurements using twodimensional echocardiography
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Jorstig, Stina, Waldenborg, Micael, Lidén, Mats, Thunberg, Per, Jorstig, Stina, Waldenborg, Micael, Lidén, Mats, and Thunberg, Per
46. Poster session 6
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Lofmark, H, Winter, R, Moukarzel, JA, Filipuzzi, JM, Vaisbuj, F, Salmo, F, Guevara, E, Barbier, P, Savioli, G, Keramida, K, Kouris, N, Dawson, D, Olympios, CD, Nihoyannopoulos, P, Meel, R, Peters, F, Libhaber, E, Nel, S, Goncalves, R, Essop, MR, Dinis, P G, Teixeira, R, Madeira, M, Cachulo, MC, Goncalves, L, Jorstig, S, Emilsson, K, Waldenborg, M, Liden, M, Wodecki, M, Thunberg, P, Perez, Valverde, Sotelo, J, Beerbaum, P, Grotenhuis, H, Greil, G, Razavi, R, Uribe, S, Figueroa, A, Zemedkun, M, Wang, Z, Asch, FM, Gizzi, G, Fabiani, D, Lavorgna, A, Napoletano, C, Saha, S K, Muthukumar, L, Englund, E, Toole, R, Gopal, AS, Di Salvo, G, Issa, Z, Moiduddin, N, Siblini, G, Bulbul, Z, Yurdakul, SELEN, Ercan, G, Tekkesin, ILKER, Sahin, ST, Cengiz, B, Celik, G, Demircan, SABRI, Aytekin, SAIDE, Chumarnaya, T, Alueva, Y, Kochmasheva, VV, Solovyova, O, Tuset, L, Maceira Gonzalez, A M, Igual, B, Bruin De- Bon, HACM, Cocchieri, R, Wagner, GS, Eberl, S, Brink Van Den, RBA, Bouma, BJ, Onishi, T, Kawai, H, Tanaka, H, Fujiwara, S, Hirata, K, Marketou, M, Parthenakis, F, Kontaraki, J, Patrianakos, A, Nakou, H, Maragkoudakis, S, Vougia, D, Logakis, J, Roufas, K, Vardas, P, Bayuga, MT, Ramboyong, RE, Johansson, M C, Wallentin Guron, C, Thurin, A, Wessling, N, Almodares, Q, Fu, M, Mandour Ali, M, Mohamed, LA, Abd Al-Rahman, T, Maghraby, HM, Kora, IM, Abdel-Hameed, FR, Ali, MN, King, GJ, Byrne, D, Bennett, K, Norris, K, Daly, C, Murphy, RT, Marti, G, Degiovanni, A, Di Ruocco, MV, Sartori, C, Devecchi, P, Marino, P, Angelis, A, Aggeli, K, Ioakeimidis, N, Felekos, I, Aznaouridis, K, Rokas, K, Abdelrasoul, M, Terentes, D, Vlachopoulos, C, Tousoulis, D, Spinelli, L, Stabile, E, Santoro, M, Morisco, C, Giudice, C A, Esposito, G, Trimarco, B, Dragoi Galrinho, R, Ciobanu, AO, Rimbas, RC, Manole, GC, Marinescu, B, Vinereanu, D, Krljanac, G, Trifunovic, D, Savic, L, Asanin, M, Lasica, R, Aleksandric, S, Zlatic, N, Petrovic, M, Jovanovic, LJ, Mrdovic, I, Zahidova, K, aethiology, Chronic heart failure of ishemic, anemia, Trifunovic, D, Krljanac, G, Sobic Saranovic, D, Asanin, M, Grozdic Milojevic, I, Savic, L, Vasiljevic, Z, Aleksandric, S, Srdic, M, Mrdovic, I, Mateescu, AD, Calin, A, Rosca, M, Beladan, CC, Enache, R, Gurzun, MM, Varga, P, Calin, C, Ginghina, C, Popescu, BA, Melissopoulou, M, Nguyen, V, Mathieu, T, Attias, D, Dreyfus, J, Codogno, I, Vahanian, A, Messika-Zeitoun, D, study, The COFRASA/GENERAC, Stefanidis, A, Komatanou, E, Anagnostou, E, Armatas, G, Samiotou, D, Papaspyropoulos, A, Philippou, P, Korlou, P, Tzerefos, S, Kranidis, A, Kammerer, I, Wiedemann, M, Sack, FU, Koyama, T, Fukuhara, K, Imai, K, Yamada, R, Kume, T, Neishi, Y, Uemura, S, Pergola, V, Di Salvo, G, Fadel, B, Aladmawi, M, Shahid, M, Alamri, M, Bulbul, Z, Issa, Z, Alhalees, Z, Rafael De La Espriella Juan, RDLE, Rafael Paya-Serrano, RPS, Jose-Leando Perez-Bosca, JLPB, Francisco Ridocci-Soriano, FRS, Oscar Fabregat-Andres, OFA, Cristina Albiach-Montanana, CAM, Natalia Chacon-Hernandez, NCH, Laura Higueras-Ortega, LHO, Blanca Trejo-Velasco, BTV, Salvador Morell-Cabedo, SMC, Bech-Hanssen, O, Polte, CL, Johnsson, AA, Cederbom, U, Lagerstrand, K, Gao, SA, Cho, E J, Hwang, J W, Park, S J, Yun, H R, Lee, S C, Park, S W, Poilane, M, Cueff, C, Jaafar, P, Jobbe Duval, A, Guijarro, D, Le Tourneau, T, Vaturi, M, Kotler, T, Shapira, Y, Weisenberg, D, Monakier, D, Kazum, S, Sagie, A, Valuckiene, Z, Ovsianas, J, Jurgaityte, J, Jasiskyte, V, Jurkevicius, R, Jenei, C, Muraru, D, Aruta, P, Miglioranza, M H, Cavalli, G, Romeo, G, Peluso, D, Cucchini, U, Iliceto, S, Badano, L P, Yesin, M, Kalcik, M, Gursoy, MO, Gunduz, S, Astarcioglu, MA, Karakoyun, S, Bayam, E, Cersit, S, Ozkan, M, Galuszka, O M, Reinthaler, M, Rutschow, S, Gross, M, Landmesser, U, Kasner, M, Caggegi, A M, Scandura, S, Capranzano, P, Mangiafico, S, Ronsivalle, G, Cannata, S, Farruggio, S, Giaquinta, S, Grasso, C, Tamburino, C, Merchan Cuenda, M, Fuentes Canamero, M E, Bengla Limpo, B, Chacon Pinero, A, Millan Nunez, M V, Nogales 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Jinjolia, NJ, and Abuladze, GA
- Abstract
Purpose: To explore the cost effectiveness of expert hand-held echo (HHE) upstream as an alternative to referral for a complete transthoracic echo (TTE) in clinical routine. We hypothized that an upstream HHE approach would prove adequate and cost effective in terms of - Decrease the numbers of required TTE - Fewer revisits to the outpatient unit - Shorten the length of admission - Increase the number of higly specialized echoes, i.e. stress echo, transesophageal echoes - Shorten the time to final diagnosis and decrease the concerns for the patient who is forced to wait for survey and results at complete TTE. Methods: In this study, a HHE scanner (V-scan, GE Health care) was kept available for the senior consultants with level 3 TTE certification, for use in patients where a TTE was indicated. HHE was performed in different clinical scenarios such in the emergency room, during consultation of inpatients or in the clinic of outpatients. The results of HHE was documented in the patient record under a heading and can directly be found upon request. The length of hospital stay during a representative week, is compared between patients who have not undergone HHE with patients undergoing HHE. Results: Out of a total of 94 patients examined with HHE, 71 patients were not in need of a complete TTE. Additional 11 patients received a more rapid investigation i.e stress-echo, transesophageal echocardiography or other investigations that would otherwise have been delayed because of waiting for the complete TTE. 12 patients were in need of a complete TTE for a more precise analysis. In the heart clinic of Danderyds hospital approximately 18 inpatients were examined with a complete TTE every ordinary week and that postpone the day of submission from hospital among approximately 6 patients a week. Every day of care in hospital cost 445 € in an ordinary ward and 981 € in the heart intensive care unit. This means there is a cost benefit of approximately 3741 € every week if it is possible to prevent this postponing of submission. Conclusions: Upstream HHE in clinical routine was in the setting of this study highly cost-effective, decreasing the need of TTE to a great extent, and leading to quicker diagnosis, shorter hospital stays and less anxiety in patients during the waiting time for a complete TTE and before a response is received.
- Published
- 2015
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