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Biomedical subjects

E Sivertssen

Publications and source records attributed to E Sivertssen.

At least 19 recordsLinked to original sources
PubMed1998

Acute myocardial infarction mortality related to use of calcium antagonists before admission to hospital.

We investigated whether prior use of calcium antagonists in 80 (16.8%) out of 477 patients (64% males) admitted with acute myocardial infarction (MI) had any impact on in-hospital mortality. Patients using calcium antagonists were slightly older (74 years vs. 72 years, 2P = 0.039) than those not taking them and fewer were male patients. Previous MI, diabetes mellitus, and prior use of aspirin, beta-blockers, and long-acting nitrates were more frequent in patients on calcium antagonists. In contrast, fewer patients on calcium antagonists prior to symptoms received thrombolytic treatment (21.3% vs. 34.8%, 2P = 0.018). The study had an observational exposed/nonexposed design, and we looked for both crude and adjusted effects. Of the 83 patients (17.4%) who died during hospitalization, 18 patients were in the calcium antagonist group (22.5%). The odds ratio (OR) for these patients to die in the hospital was 1.48 and the 95% confidence interval (CI) 0.78-2.78; 2P = 0.19. When adjusting for confounders (gender, age, smoking habit, previous MI, and diabetes mellitus, as well as prior use of aspirin, beta-blockers, long-acting nitrates, and thrombolytic treatment at entry) OR was 1.08 and 95% CI 0.57-2.05; 2P = 0.85. Thus, we found no excess in-hospital mortality in patients with acute MI using calcium antagonists prior to the onset of symptoms.

Acute Disease↗
PubMed1998

Has hospital mortality from acute myocardial infarction been markedly reduced since the introduction of thrombolytics and aspirin? European Secondary Prevention Study Group.

OBJECTIVES: There are conflicting views on how hospital mortality with respect to acute myocardial infarction (AMI) has changed since the introduction of thrombolytics and aspirin. Our purpose therefore was to explain this by studying hospital mortality in a nonselected AMI population. and then assess how patients allocated to different treatment groups contribute to overall mortality. DESIGN: Extensive data were collected on all AMI patients admitted to the 10 hospitals in health region 1 (population 850,000) in Norway during a 2 month period. A protocol approved by the European Secondary Prevention Study Group was used. RESULTS: Of the 487 patients, 32% received thrombolytics, 72% aspirin and 22%) none of the treatments. Average in-hospital mortality was 18%. Mortality within the different groups was as follows: no thrombolytics nor aspirin group 35.0% (39/111), aspirin group 13.7%, (30/218), thrombolytics group 17.3% (4/23), and thrombolytics plus aspirin group 11.0% (15/135). The characteristics of the nontreated group compared to the aspirin and aspirin plus thrombolytics groups were more females, older, increased frequency of previous AMI, left ventricular failure, cardiopulmonary resuscitation, history of stroke and peptic ulcer, and electrocardiogram (ECG) findings other than ST elevation. CONCLUSION: In a nonselected AMI population, a patient group receiving neither thrombolytics nor aspirin contributed most significantly to an overall high mortality. This indicates a modest reduction in total AMI mortality after the new therapies were introduced, as the mortality for this group, with a high risk profile, has presumably remained unchanged.

Aged↗
PubMed1997

[The heart bridge. A follow-up study of cardiac patients from the health region 1 operated abroad during the period 1985-87].

During the years 1985 to 1987 a total number of 388 patients from the Norwegian health region 1 were transferred from Ullevål Hospital to heart centres abroad for heart operation because of the low operating capacity in our own hospital. The operative mortality in pure coronary bypass operations was 6.0%. Six out of 34 patients (17.6%) died postoperatively following valvular replacements. A questionnaire was sent to all survivors in November, 1989 and July, 1996. The clinical condition was judged to be very good or good by 95% and 83% of the patients, respectively. A self-evaluation of quality of life on a visual analog scale indicated a significant improvement after the operation.

Adult↗
PubMed1996

[Long term results of the use of Björk-Shiley convex-concave heart valves. Ullevol hospital 1978-83].

In recent years, Björk-Shiley CC-valves have become the object of suspicion after several reports of strut fracture with embolization of the tilting disk and acute heart failure. At Ullevål Hospital Björk-Shiley CC-valves were used in 341 patients during the period October 1978 to March 1983. Strut fracture occurred in four cases, three of the patients died and one survived an emergency heart operation with replacement of the valve. In four patients, prophylactic replacement of the valves was performed. During the observation period concluded in September 1995 a total of 187 patients died. These included 26 operative deaths (7.6%). Of the late deaths, 40% were due to heart failure and 21% were sudden deaths. Strut fracture was the cause of death in 2% of the late deaths.

Aortic Valve↗
PubMed1996

[The failing heart valve. History of the Björk-Shiley convex-concave heart valve].

Strut fracture with embolization of the valve disk has been reported worldwide in about 550 cases out of a total of 86,000 implanted Björk-Shiley convexo-concave disk valves. 320 of the patients died. In Norway six cases of strut fracture are reported, with five deaths. The highest risk is reported for valves with a 70 degree opening of the disk. Other risk factors are large valves in the mitral position, valves produced in the year 1981 and early 1982, and valves welded by inexperienced welders. A joint lawsuit which was started in January 1992 on behalf of all living patients with a CC-valve has been concluded and has resulted in a legal settlement between the parties.

Heart Valve Prosthesis↗
PubMed1994

[Is top level athletic performance dangerous? A 25-year follow-up study of 24 elite cross-country skiers].

In the years 1964-68, the Norwegian troop of elite cross-country skiers comprised 27 skiers (15 men and 12 women). We present the results of a follow-up study 25 years after the troop's active competing period. One of the male skiers died suddenly of acute myocardial infarction in 1986, one was unable to participate in the study because of other disease, and one female refused to participate. The follow-up study thus comprises 24 athletes (13 men and 11 women). The results show that the group has managed to keep in physically good condition after concluding the active period. Two of the participants had paroxystic atrial fibrillation. Apart from this no cardiovascular disease was found which could be attributed to the hard physical training as top athletes.

Adult↗
PubMed1991

[Cardiopulmonary resuscitation attempts at Ullevål hospital during January 1989-July 1990].

During the period January 1989 to July 1990, 68 in-hospital cardiopulmonary resuscitations were attempted in 65 patients at Ullevål Hospital. The total number of deaths during the same period was 2,166. 21 patients survived initially (32%). Nine patients died later, and 12 patients (18%) were discharged from hospital without major cerebral disability. Six patients were alive at follow-up 13-25 months after cardiopulmonary resuscitation. No differences in survival were found between males and females, or between patients under and over 70 years of age.

Adult↗
PubMed1991

Degree of coronary artery disease predicted by exercise testing.

The ability of exercise testing to predict the extent of coronary artery disease was examined in 268 male patients undergoing both coronary angiography and bicycle testing with electrocardiography before coronary artery bypass surgery. When maximal ST-depressions limited by symptoms increased from 0 to 4 mm or more, the percentage of patients with 'serious' coronary disease, defined as either triple vessel disease or left main stem stenosis, increased from 50% to 80% (P = 0.0001). The patients in the lowest third of physical work capacity showed only a slightly increased risk of serious disease. This tendency was abolished in patients who were using beta-blockers, whereas the relationship between ST-depression and disease was not affected by this medication. The probability of finding left main stem stenosis in a patient increased from 5 to 30% with increasing ST-depression: beta-blockers did not affect this relationship, but there was no additional predictive effect of implicating the level of physical work capacity. It is concluded that traditional electrocardiography during exercise is of value when selecting patients for angiography, but that the physical work level obtained during the test does not predict the degree of coronary pathology.

Adrenergic beta-Antagonists↗
PubMed1990

Risk factors for morbidity and mortality in mitral valve replacement.

Risk factors of operative mortality and long term survival were identified in 219 patients who underwent mitral valve replacement (MVR) using Bjørk-Shiley mechanical prostheses. Early mortality was 7.3%. The accumulated follow-up time was 1134 patient-years, and the 5-year survival for the total cohort was 78 +/- 3%. Independent prognostic factors of early mortality were poor NYHA class, which carried a relative risk (RR) of 3.2, and ischaemic aetiology, with a RR of 2.2. Ischaemic aetiology was the sole predictor of heart pump failure requiring intra-aortic balloon pump support (RR = 2.7). Independent risk factors of total mortality (early and late) were male sex (RR = 2.3), NYHA class III-IV (RR = 2.4), presence of mitral regurgitation (RR = 3.2) and relative heart volume (RR = 1.6 for a 800 ml/m2 size compared to a heart of 550 ml/m2). Our results underline the importance of patient-related factors in MVR, and indicate that care is needed in comparing the quality of MVR from different institutions with respect to mortality and morbidity. The results of MVR are palliative rather than curative except in female patients with NYHA class II function and mitral stenosis, in whom cure was attained.

Adolescent↗
PubMed1989

Surgical treatment of left ventricular aneurysm. Analysis of risk factors, morbidity and mortality in 205 cases.

Left ventricular aneurysm was surgically treated in 205 patients during the decade 1975-1984. The patients had had one to five myocardial infarctions, the latest days to years (mean 32 months) preoperatively and 92% were in NYHA functional class III or IV. The main indications for surgery were angina (47%), congestive heart failure (38%) and arrhythmia (15%). The 176 anterior, 23 posterior and six combined aneurysms were treated with resection (130 cases) or plication (75). The early mortality was 5%. Univariate analysis identified arrhythmia, concomitant valve replacement and need for intra-aortic balloon pumping (IABP) as significant risk factors, and multivariate analysis revealed the indication for surgery and need for IABP as the only independent predictors of total mortality. The survival rates 5 and 10 years postoperatively were respectively, 74% and 60%. At follow-up after 1/2-10 years, almost 90% of the surviving patients had improved functional status. Left ventricular aneurysm thus can be surgically treated with low mortality rate and good functional result.

Adult↗
PubMed1987

Blood donor selection can prevent cytomegalovirus infection after open heart surgery.

Thirty-four patients without IgG antibodies against cytomegalovirus (CMV) prior to open heart surgery were studied. The patients were randomized to receive blood either from unselected donors, or from donors without detectable CMV antibodies. Fresh whole blood was mainly used. Eleven patients received CMV seronegative blood only. All had an uneventful convalescence period and remained seronegative. Ten of the 23 patients who received blood from unselected donors had typical CMV disease with the onset of symptoms in the third or fourth postoperative week, and fever lasting for two to three weeks. They all had liver enzyme release and later seroconversion against CMV. Four patients were hospitalized during this period. The incidence of symptomatic CMV infection after open heart surgery was higher than usually reported among the CMV seronegative patients. Selection of blood donors who lack antibodies against CMV may be an adequate protective measure. Avoidance of fresh blood and reduced use of blood products are presumably also of importance.

Antibodies, Viral↗
PubMed1987

Haemodynamics during repeated exercise tests with special reference to the 'warm-up' phenomenon in patients with angina pectoris.

The haemodynamic effect of two successive supine exercise tests 20 min apart was examined in 12 patients with angina pectoris. All the patients had coronary artery disease verified by angiography and were accepted for coronary bypass surgery. They exercised 20-40 W and all of them had angina during the first exercise test. Half the patients did not experience angina during the second of the two exercise tests ('warm-up' responders). In these patients left ventricular filling pressure (LVFP) was reduced by 40% (P less than 0.01) in the second compared to the first exercise test. The non-responders showed no significant change in LVFP. The heart rate pressure product (RPP) and thus myocardial oxygen demand were unchanged in responders and non-responders. In another 10 patients with angina and coronary artery disease, also accepted for coronary bypass surgery, atropine (1.5-2.0 mg) was given intravenously. Ten minutes after administration of atropine, these patients followed exactly the same investigation programme including two successive supine exercise tests as in the group not given atropine. In the group given atropine, four 'warm-up' responders and six non-responders showed the same pattern of response in LVFP as in the group not given atropine. In the 'warm-up' responders a smaller increase in RPP was observed during the second exercise test compared to the first. The present study indicates that cholinergic mechanisms are probably not involved in the 'warm-up' phenomenon. Due to the difference in haemodynamic response, the 'warm-up' phenomenon has to be taken into account when evaluating results from haemodynamic studies of cardiovascular drugs.

Adult↗
PubMed1986

Hemodynamic effects at rest and during exercise in long-term treatment with prazosin in chronic congestive heart failure.

The long-term effects of prazosin in chronic congestive heart failure were studied in 10 patients (New York Heart Association class III-IV) in a double-blind cross-over study. Patients with systolic blood pressure greater than 120 mmHg and left ventricular filling pressure greater than 15 mmHg were included. Prazosin lowered the arteriovenous oxygen difference both at rest and during exercise (p less than 0.05), increased cardiac index (p less than 0.01) and reduced right atrial pressure and systemic vascular resistance (p less than 0.05) during exercise. Left ventricular filling pressure was also reduced, but not significantly, during exercise. Our data show that prazosin has beneficial long-term effects during exercise in patients with chronic congestive heart failure.

Adult↗
PubMed1985

Ventricular septal rupture diagnosed by simultaneous cross-sectional echocardiography and Doppler ultrasound.

Thirteen patients with intraventricular septal rupture in the course of acute myocardial infarction (AMI) have been examined with simultaneous cross-sectional echocardiography (CSE) and Doppler ultrasound. Visualization of the rupture was achieved in six patients by CSE alone. The simultaneous technique identified the rupture in all patients. Eight patients were operated upon; seven of them are still alive. We conclude that simultaneous CSE and Doppler ultrasound is a sensitive, rapid and safe technique for diagnosing ventricular septal rupture (VSR) after AMI.

Aged↗
PubMed1985

Primary cytomegalovirus infection following open heart surgery.

Among 674 patients undergoing open heart surgery in 1981-82, 86 (13%) were cytomegalovirus (CMV) antibody-negative when tested by an enzyme-linked immunosorbent assay prior to operation. At follow-up, 54 (67%) of 80 patients restudied had seroconverted after the operation, and 35 of the 54 seroconvertants had been ill with fever and elevated liver enzymes. Among the latter 35 patients, 26 demonstrated a significant rise in CMV antibody titre, most often detected in the third week following the onset of illness. The older patients were more susceptible to illness and seroconversion, and there was a positive correlation between age and the number of blood units given. Thus, at least one third of the seronegative patients developed symptomatic CMV illness after open heart surgery. This is a much higher incidence than earlier reported.

Adolescent↗