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K Forfang

Publications and source records attributed to K Forfang.

At least 19 recordsLinked to original sources
PubMed1999

[Current use of beta-blockers in coronary artery disease].

This article presents the results of a retrospective analysis of the use of beta-blockers and current dosing of these agents in patients with coronary artery disease. While 70 to 78% of patients admitted to Norwegian university hospitals during 1990-1997 for angiographic evaluation of chest pain used beta-blockers, only 43-60% of patients with stable coronary artery disease enrolled in the 4S study in Norway received such treatment. High risk groups such as diabetics and patients with peripheral artery disease were less likely to receive beta-blockers during the early period, but were not treated differentially compared to low risk patients during recent years. Only 15% of patients with congestive heart failure received oral beta-blockers, and only 10.5% intravenous beta-blockade during acute myocardial infarction. The dosing of the most common beta-blockers were low, approximately 50% of doses shown to improve survival after acute myocardial infarction.

Adrenergic beta-Antagonists↗
PubMed1998

Effect of percutaneous transluminal coronary angioplasty on exercise in patients with and without previous myocardial infarction.

Improvement in exercise capacity is an important clinical effect of percutaneous transluminal coronary angioplasty (PTCA), and was assessed in patients with and without previous myocardial infarction (MI) undergoing PTCA. We prospectively followed patients with exercise testing before and 2 weeks after angioplasty in 415 patients, 170 (41%) of whom had a previous MI. A third exercise test was performed 20 +/- 2 weeks after PTCA in 403 patients. From left ventricular angiography obtained before PTCA, regional dyskinesia was classified into anterior or posterior locations. Both patients with and without previous MI had a significant increase in exercise capacity from before to 2 and 20 weeks after PTCA (previous MI: 31.9% and 29.3%; no MI: 50.7% and 38.2%; p <0.0001 [analysis of variance]). In patients with MI and anterior dyskinesia, in whom lesions on the left anterior descending artery were dilated or posterior dyskinesia in whom lesions on the right coronary artery were dilated, exercise capacity increased significantly from before to 2 and 20 weeks after PTCA (left anterior descending artery: 53.1% and 39.7%, p <0.0001; right coronary artery: 16.9% and 27.6%, p = 0.01 [analysis of variance]). Multivariate regression analysis revealed that male sex, no previous MI, and dilation of left anterior descending artery were significantly associated with increased exercise capacity after angioplasty adjusted for age and smoking habits, whereas left ventricular ejection fraction and end-diastolic pressure were not associated with increased exercise capacity.

Angioplasty, Balloon, Coronary↗
PubMed1998

Attenuated physical exercise capacity in smokers compared with non-smokers after coronary angioplasty despite similar luminal diameters.

AIMS: To study the impact of smoking on the change in exercise capacity in patients treated with coronary angioplasty. METHODS: Three hundred and sixty-eight men below 70 years of age eligible for percutaneous transluminal coronary angioplasty without previous coronary interventions were consecutively enrolled. Of the 334 patients (90.8%) who completed the study 77 (23.1%) were current smokers. Exercise tests were performed before percutaneous transluminal coronary angioplasty, 2 and 19 +/- 2.4 weeks after percutaneous transluminal coronary angioplasty. Coronary angiography was done in 333 patients (99.7%) (at mean 19 +/- 2.4 weeks). The angiograms were analysed quantitatively. RESULTS: There were no differences in the clinical and angiographic characteristics among the groups except for age. The non-smokers were older than the smokers (55.7 vs 52.4 years (P = 0.001)). Exercise capacity was equal before percutaneous transluminal coronary angioplasty in both groups (17.6 vs 16.5 W x min-1 x kg-1). Non-smokers had a significantly higher increase in exercise capacity than smokers from baseline to 2 weeks after percutaneous transluminal coronary angioplasty (mean difference 4.3 W x min-1 x kg-1 (95% CI: 2.3 to 6.2; P < 0.001)), and from baseline to 19 weeks after percutaneous transluminal coronary angioplasty (mean difference 3.9 W x min-1 x kg-1 (95% CI: 1.6 to 6.2; P < 0.001). CONCLUSION: A clinical benefit from percutaneous transluminal coronary angioplasty was seen in both groups as judged from exercise testing. Smokers had a substantially lower increase in exercise capacity than non-smokers, indicating an attenuated benefit from percutaneous transluminal coronary angioplasty among smokers.

Adult↗
PubMed1998

Governmental steering of highly specialized medical services.

In Norway, highly specialized medicine has been under governmental steering since 1991. The Social and Health Department decides at which hospitals certain medical functions should be offered. In the field of cardiovascular medicine this has been experienced as mainly positive. The quality of the work has improved, and cooperation between hospitals has been stimulated.

Health Services Administration↗
PubMed1997

Post-transplant hyperlipidaemia: low-dose lovastatin lowers atherogenic lipids without plasma accumulation of lovastatin.

OBJECTIVES: The purpose of the present study was twofold. First, to determine the frequency of hyperlipidaemia after heart transplantation (Tx) in relation to values obtained before Tx. Secondly, to examine the effect of low-dose lovastatin on possible antiatherogenic mechanisms and test the hypothesis that the side-effects are dose-dependent. SUBJECTS AND DESIGN: Retrospective study of the frequency of hyperlipidaemia disturbances in heart transplant patients. In addition, in a prospective study, the safety and efficacy of incremental low doses of lovastatin up to 20 mg day-1 were studied, with measurements of its plasma concentration in 24 cyclosporin A treated heart (n = 14) and kidney (n = 10) recipients with total cholesterol > 7.5 mmol L-1. RESULTS: Cholesterol increased markedly after heart transplantation from a pretransplant value of 5.3 (5.0,5.6) mmol L-1 to 6.7 (6.4,7.0) mmol L-1 after 1 year and then remained constant, but this increase was largely due to a 'normalization' since cholesterol decreased significantly during increasing heart failure before transplantation. Treatment with lovastatin decreased total cholesterol by 19% (P < 0.001), primarily by an effect on LDL cholesterol. HDL cholesterol increased by 15% (P < 0.05), whereas triglycerides remained unchanged. Lovastatin also caused a significant reduction in apolipoprotein B of 16%, and lipid peroxidation of 40%, whereas apolipoprotein A-I, fibrinogen, and glycerol were unchanged. Plasma concentration of lovastatin was significantly higher in transplant recipients compared with controls, but there was no accumulation during incremental dosing of lovastatin. The drug was well tolerated without significant symptoms or evidence of myopathy. CONCLUSIONS: Hyperlipidaemia is common after cardiac transplantation. Treatment with low dose lovastatin is well tolerated and has a favourable effect on atherogenic lipids.

Adult↗
PubMed1997

Effect of bolus injection versus continuous infusion of furosemide on diuresis and neurohormonal activation in patients with severe congestive heart failure.

Previous studies have demonstrated that continuous infusion of furosemide results in increased diuresis and natriuresis compared with bolus administration of the drug in patients with severe heart failure. We reasoned that continuous infusion of furosemide caused less activation of neurohumoral mechanisms, since other studies have shown that bolus administration of furosemide may activate this system. We therefore tested the hypothesis that continuous administration of furosemide would increase water and sodium excretion due to less activation of neurohormones. Eight patients with severe heart failure were studied during continuous infusion over 24 h and bolus injections of furosemide twice daily in a randomized cross-over study. Bolus administration of furosemide increased diuresis and natriuresis significantly in the first 4 h after administration compared with continuous administration, but this was later reversed, resulting in similar 24 h total output. The neurohormones measured at baseline were all markedly elevated. Neither regimens of furosemide caused any further significant changes in neurohumoral response except that pro-ANF decreased more during the first 8 h after bolus administration compared to continuous infusion. This study has demonstrated that bolus administration of furosemide in conventional doses is equally effective as continuous intravenous infusion in patients with severe heart failure. This may be due to maximal neurohormonal activation in severe heart failure (NYHA III-IV) which could not be further activated by bolus administration.

Atrial Natriuretic Factor↗
PubMed1996

[Restenosis and arterial remodelling after coronary angioplasty].

Restenosis after coronary angioplasty (PTCA) is a complex process and is still the major problem, despite improvements in equipment and technique. Thrombus formation and intimal hyperplasia have been considered to be the main causes of the development of restenosis after primary successful angioplasty. As yet, pharmacological trials to prevent restenosis have failed to prevent it, despite the fact that the therapy has been aimed at reducing thrombus formation and intimal hyperplasia. Several new angioplasty devices have been developed. Series of observations and a few controlled trials have demonstrated restenosis rates similar to those obtained with conventional balloon angioplasty, except in the case of stent implantation, which appears to be promising. Intravascular ultrasound studies have provided new insight and a more complete understanding of the process leading to restenosis. Vascular remodeling is now considered as an important pathogenetic factor. It consists of a change in the cross-sectional vessel area and may involve an actual constriction of the artery. This may lead to lumen-narrowing and finally restenosis with minimal neointimal formation. In this review we summarise the literature on the restenosis process and the current status of the clinical trials aimed at preventing restenosis.

Angioplasty, Balloon, Coronary↗
PubMed1996

Cardiopulmonary sequelae after treatment for Hodgkin's disease: increased risk in females?

BACKGROUND: The treatment of Hodgkin's disease (HD) involves irradiation and chemotherapy. Both modalities may cause heart and lung injury. We aimed to assess 1) the occurrence of such injury, 2) the extent to which combined versus single-organ-affection resulted in disability, and 3) whether determinants for cardiopulmonary injury could be identified. PATIENTS AND METHODS: A national cohort (n = 116) of HD patients (mean age 37 +/- 7 (SD) years, 67 males) was examined by interview, echocardiography, bicycle exercise test and lung function tests, 5-13 years after mediastinal irradiation with or without chemotherapy. RESULTS: Cardiac, pulmonary or combined sequelae occurred, respectively, in 21%, 15% and 19% of the patients affecting 75% of the females versus 41% of the males (P < 0.001). Of the patients with combined sequelae, 27% were disabled versus 4% of the rest (P < 0.05). Combined sequelae was associated with dyspnoea (P < 0.001) and reduced maximal exercise heart rate (P < 0.05). Compared to males, females had an increased risk of heart valve regurgitation (46% versus 16%, P < 0.001), pericardial thickening (22% versus 10%, P = 0.07) and reduced gas transfer (41% versus 22%, P = 0.03). Female gender was a significant risk factor for cardiac and/or pulmonary sequelae (OR 6.1, 95% CI 2.4-15.7), whereas age, follow-up period, smoking habits, histology, bulky mediastinal disease, radiation dose and chemotherapy were not. Mean exercise work capacity and O2-saturation were within normal limits. CONCLUSIONS: Although cardiac and/or pulmonary sequelae were detected in more than half of the patients, only combined injury was associated with disability, dyspnoea and reduced performance. Females had an increased risk of cardiopulmonary sequelae, which could not be explained by treatment-related differences between the genders.

Adult↗
PubMed1996

Increased risk of heart valve regurgitation after mediastinal radiation for Hodgkin's disease: an echocardiographic study.

OBJECTIVE: To assess by echocardiography the occurrence and degree of late cardiac sequelae after treatment for Hodgkin's disease by radiation and chemotherapy. PATIENTS AND METHODS: In Norway from 1980 to 1988, 129 patients < 50 years old with Hodgkin's disease had curative treatment with mediastinal radiation, with or without chemotherapy. 116 (90%) of these patients (mean (SD) age 37 (7) years, 67 males) were examined by echocardiography 5-13 years after treatment. 40 healthy individuals (mean (SD) age 40 (11), 20 males) were examined as controls. All those examined were in regular sinus rhythm. RESULTS: Grade > 1 (scale 0-3) aortic and/or mitral valvar regurgitation was found in 24% of the patients (15% aortic, 7% mitral, and 2% aortic+mitral), affecting 46% of the females v 16% of the males (P < 0.001). Female gender was a significant risk factor for aortic and mitral regurgitation (odds ratio 4.7, 95% confidence interval 2.0 to 11.2), whereas age, period of follow up, radiation dose, and chemotherapy were not. Thickened pericardium was diagnosed in 15% of the patients. No risk factors were identified. No cases of pericardial thickening or valvar regurgitation grade > 1 were recorded in the control group. Mean values for measured and calculated indices of systolic and diastolic function were within the normal range for patients and controls. The patients had reduced E/A ratio compared with the healthy controls (E/A 1.1 v 2.0, P < 0.001). CONCLUSIONS: Abnormal left sided valvar regurgitation was detected in one fourth of the patients, affecting the aortic valve in more than half of the cases. Females had an increased risk of valvar regurgitation. Echocardiographic screening after high-dose mediastinal radiation is recommended.

Adult↗
PubMed1995

[Drug therapy of angina pectoris. Are the possibilities exploited well enough?].

A retrospective comparative study of the use of antianginal drugs in 1987 and 1992/93 has been carried out in unselected series of patients admitted for angiographic evaluation. Compared with the patients in 1987 the patients in 1992/93 were treated with approximately 50% of the doses of beta-blockers and isosorbide dinitrate. There was also a considerable reduction of the proportion of patients who received doses of beta-blockers of a similar level as used in large multicentre studies showing improved survival after myocardial infarction. The explanation of this change in therapy may be due, at least partly, to a general fear of side-effects.

Adrenergic beta-Antagonists↗
PubMed1995

[Intermittent claudication and beta-blockaders. An unfortunate combination?].

beta-adrenergic blockers have been considered relatively contraindicated in patients with peripheral arterial disease because of reports claiming that these drugs may worsen intermittent claudication. The authors review the published randomized controlled trials and discuss the results of comparisons of this treatment with treatment with alternative drugs. None of the studies of beta-blockade in patients with intermittent claudication showed a reduction of walking distance or impairment of peripheral flow compared with patients given placebo, except one study using a beta-blocker with intrinsic sympathomimetic activity. Alternative drugs are included in only few trials and do not seem to be beneficial. There is a lack of evidence to suggest that beta-blockers adversely effect walking capacity or worsen symptoms in mild to moderate intermittent claudication. beta-blockers should not be avoided if considered in other respects to be the optimal therapy for associated atherosclerotic disease.

Adrenergic beta-Antagonists↗
PubMed1995

[Treatment of terminal heart failure].

Heart transplantation is one treatment for terminal heart failure. To assure a good result it is important to give optimal treatment while waiting for a suitable donor organ. We review the treatment received by patients on the waiting list for heart transplantation at our hospital from 1983 to 1994. On the basis of our experience from 183 patients, we discuss the routine and intensive care of severe heart failure, as well as the practice of anticoagulation and antiarrhythmic treatment.

Adolescent↗
PubMed1995

[Hypercholesterolemia--a clinical problem in heart transplantation. A therapeutic trial with low-dose lovastatin].

One year after heart transplantation, serum total cholesterol had increased by 24% in 103 recipients on prednisolon, cyclosporin A, and azathioprin immuno-suppression, and was above 5.2 mmol/l in 84 of them. Incremental small dose lovastatin treatment up to 20 mg per day safely reduced total cholesterol by 19% and LDL-cholesterol by 24% in 14 patients with serum cholesterol above 7.5 mmol/l. Serum concentration of lovastatin did not increase further after three weeks treatment with 20 mg. It is concluded that hypercholesterolaemia in heart recipients treated with cyclosporin A can be treated safely with small dose lovastatin. Drug therapy should be individualized and conducted by physicians experienced in transplantation medicine.

Adult↗
PubMed1995

Lung function impairment in long-term survivors of Hodgkin's disease.

BACKGROUND: Treatment of Hodgkin's disease (HD) involves radiation and chemotherapy, modalities known to cause lung injury. PATIENTS AND METHODS: In Norway, between 1980 and 1988, 129 patients aged less than 50 years at the time of diagnosis, had curative treatment with thoracic radiation alone or combined-modality therapy for supradiaphragmatic HD. We have examined 116 (90%) of these patients by interview, chest X-ray and lung function tests, 5-13 years after treatment. RESULTS: Nearly 30% of the patients had dyspnoea on exertion and associated reductions in total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and gas transfer (TLCO) (p < 0.05). Radiographic evidence of no, slight or moderate fibrosis occurred in 32%, 54% and 14% of the patients, respectively. Moderate fibrosis was associated with reductions in FVC, FEV1 and TLCO (p < 0.05). Radiation plus chemotherapy containing bleomycin-anthracyclines (median cumulative bleomycin dose 120 mg) was associated with decreases in FVC and TLCO (p < 0.05). In the multivariate analysis, chemotherapy with bleomycin-anthracyclines was the only significant predictor for lung function impairment. CONCLUSION: More than five years after therapy, respiratory symptoms and reduction in lung function were diagnosed in nearly one-third of otherwise healthy HD survivors.

Adolescent↗
PubMed1992

Differential effect of selective beta 1 and nonselective beta-adrenoceptor blockade on epinephrine and atropine response in normal humans.

Sympathetic stimulation with epinephrine (EPI) combined with parasympathetic blockade with atropine was studied in 10 healthy volunteers premedicated with placebo or three different beta-adrenoceptor blockers: atenolol (62.5 micrograms/kg, beta 1-selective), propranolol (62.5 micrograms/kg, nonselective), and pindolol (7.5 micrograms/kg, nonselective with intrinsic sympathomimetic activity, ISA). EPI infusion (0.06 microgram/kg/min) after placebo increased heart rate (HR) and systolic blood pressure (SBP) and decreased diastolic BP (DBP). Pretreatment with atenolol reduced the HR increase, and caused similar changes in BP. In contrast, pretreatment with propranolol and pindolol decreased HR and increased BP. Combined EPI and atropine (15 micrograms/kg) after placebo increased HR by 40% without causing BP changes. Similar HR changes were observed after administration of all beta-adrenoceptor blockers, but whereas a marked pressor response was observed after propranolol and pindolol a blunted response was observed after atenolol. Propranolol and pindolol reduced myocardial oxygen demand estimated by the HR x BP product after EPI, but this response was abolished by atropine. Serum potassium decreased from 3.9 +/- 0.2 to 3.2 +/- 0.3 mM after EPi and atropine. This effect was less after atenolol, and potassium increased after premedication with propranolol and pindolol. Our results show that nonselective beta-adrenoceptor blockade has a favorable effect on potassium homeostasis and oxygen demand parameters during EPI infusion but causes a marked pressor response, contrary to a beta 1-selective agent, during combined sympathetic stimulation and parasympathetic blockade. They also highlight the importance of the vasodilator cholinergic system as a defense mechanism in such situations.

Adrenergic beta-Antagonists↗
PubMed1991

[Results of 6 1/2 years of heart transplantation at Rikshospitalet].

We discuss our experience from 6 1/2 years of orthotopic heart transplantation at Rikshospitalet (the National Hospital). 112 grafts were performed on 109 patients (19 women and 90 men), mean age 47 years (range 14-63). In the first nine patients the immunosuppressive regimen consisted of cyclosporine A and prednisolone, and in the last 100 azathioprine was added (triple medication). There was no operative mortality. 21 patients died, giving an 81% cumulative survival, with a significantly better prognosis among those who received triple immunosuppressive regimen. The main complications were rejection, infection and arrhythmia. Since our main problem was rejection it is concluded that careful supervision, concentrated on as few cardiologists as possible, and a liberal indication for myocardial biopsy, are decisive for the prognosis.

Adolescent↗