Arnljot Tveit

• Anjum, Mariam; Ariansen, Inger; Hjellvik, Vidar; Igland, Jannicke; Kjerpeseth, Lars Jøran & Kvalvaag, Elisabeth Myrset [Vis alle 12 forfattere av denne artikkelen] (2026). Trends in Incidence of Atrial Fibrillation–Related Stroke: The Norwegian AFNOR Study. Journal of the American Heart Association (JAHA). 15. doi: 10.1161/jaha.126.049696. Fulltekst i vitenarkiv Vis sammendrag

  Background The increasing prevalence of atrial fibrillation (AF), along with changes in cardiovascular risk factors, AF detection and oral anticoagulant use, may have altered the epidemiology of AF‐related stroke. However, population‐based data on long‐term trends remain limited. Methods Using mandatory nationwide registry data from the Atrial Fibrillation in Norway (AFNOR) study (2001–2021), we identified incident stroke cases defined as first hospitalization or death due to stroke in individuals aged ≥15 years. Age‐standardized incidence rates were calculated using direct standardization. Sex‐ and age‐adjusted incidence rate ratios (IRR) were estimated using negative binomial regression. Results Among 227 575 incident strokes, 66 795 (29.4%) were AF‐related, and increased from 22% to 31% during 2001–2021, with 69% of all AF‐related ischemic strokes occurring in non‐anticoagulated individuals. Incidence rate of AF‐related ischemic strokes remained stable overall (67.8 per 100 000 person‐years in 2001 to 68.4 in 2021; IRR=1.01; 95% CI, 1.00–1.03) but increased among individuals aged 15 to 64 years. Non‐AF ischemic strokes declined from 204.4 to 130.8 (IRR=0.98; 95% CI, 0.97–0.99). Incidence of AF‐related intracerebral hemorrhage in individuals aged ≥75 years increased, driven by anticoagulated patients. Incidence of non‐AF intracerebral hemorrhage decreased (IRR=0.98; 95% CI, 0.97–0.99). Conclusions The favorable decline in ischemic stroke incidence from 2001 to 2021 did not include AF‐related strokes. AF‐related ischemic strokes increased in younger age groups, whereas AF‐related intracerebral hemorrhage increased in the oldest age groups driven by anticoagulated patients. These findings underscore the need for improved strategies for AF detection and stroke prevention, particularly in younger populations, and greater attention towards management of bleeding risk among older, anticoagulated individuals.

• Wimalanathan, Thakshani; Sulkowska, Joanna; Melles, Woldegabriel A; Paus, Michael Fredrik; Skranes, Julia Brox & Berge, Trygve [Vis alle 11 forfattere av denne artikkelen] (2026). Myocardial fibrosis is associated with worse left ventricular strain and synchrony assessed by novel CMR imaging in the general population: data from the Akershus Cardiac examination 1950 study. The International Journal of Cardiovascular Imaging. ISSN 1569-5794. doi: 10.1007/s10554-026-03746-1. Fulltekst i vitenarkiv
• Sulkowska, Joanna; Skranes, Julia Brox; Berge, Trygve; Tveit, Arnljot; Røsjø, Helge Rørvik & Lyngbakken, Magnus Nakrem [Vis alle 9 forfattere av denne artikkelen] (2026). Mechanical signatures of left ventricular ejection fraction and mass index in a community cohort (ACE 1950). The International Journal of Cardiovascular Imaging. ISSN 1569-5794. doi: 10.1007/s10554-026-03697-7. Fulltekst i vitenarkiv
• Ihle-Hansen, Håkon; Walle-Hansen, Marte; Berge, Trygve; Ihle-Hansen, Hege Beate; Rønningen, Peter Selmer & Omland, Torbjørn [Vis alle 16 forfattere av denne artikkelen] (2026). Burden of atherosclerosis, cardiovascular risk factors and atrial fibrillation in individuals with covert brain infarcts in late midlife: the Akershus Cardiac Examination 1950 Study. BMJ Open. 16(3). doi: 10.1136/bmjopen-2025-114232. Fulltekst i vitenarkiv Vis sammendrag

  Background Current expert consensus statements generally suggest cardiovascular risk assessment, including atrial fibrillation (AF) screening, on detection of covert brain infarctions (CBIs). However, evidence to guide management of CBI remains limited. In the absence of randomised clinical trials specifically targeting CBI populations, observational studies comparing individuals with and without CBI can provide insights into the prevalence and burden of cardiovascular risk factors. Objectives We aimed to compare the burden of atherosclerosis and cardiovascular risk factors in participants with CBI to those without, and to explore the yield of AF screening in individuals with CBI. Design A prospective population-based birth cohort study including men and women born in 1950 and resident in Akershus County, Norway. Setting The two hospitals serving the population of Akershus county, Norway. Participants Participants included in the Akershus Cardiac Examination (ACE) 1950 study who also underwent a subsequent MRI examination were eligible for this study. Outcome measures Cardiovascular risk assessment was performed at study inclusion (2012–2015). Carotid ultrasound was used to quantify atherosclerosis through a carotid plaque score, and CHA₂DS₂-VA and Systematic COronary Risk Evaluation 2 (SCORE2) scores were calculated to estimate cardiovascular risk. Brain MRI was performed in a randomly selected, blood pressure-stratified subset of participants (2016–2024). CBI was defined as focal lesions consistent with ischaemia in the absence of clinical stroke. Participants with CBI were offered 72-hour ambulatory ECG monitoring for AF detection. Results MRI was performed in 414 of 3706 (11%) participants in the ACE 1950 Study. The mean age at the time of the MRI examination was 70.2±2.3 years, and 165 (41%) were women. CBI was identified in 54 participants (13%), of whom 45 (83%) completed 72-hour ambulatory ECG monitoring. There were no differences in mean carotid plaque score, SCORE2 or CHA₂DS₂-VA score between participants with CBI compared with those with normal MRI findings. AF was detected in one (2%) participant with CBI. Conclusions In this community-based cohort of individuals in late midlife, individuals with CBI did not have an increased cardiovascular risk compared with those without, as indicated by SCORE2, CHA₂DS₂-VA score, age-appropriate carotid plaque burden and a low prevalence of AF. Trial registration number URL: https://www.clinicaltrials.gov . Unique identifier: NCT01555411 .

• Bratholm, Åsmund Olaf; Ihle-Hansen, Håkon; Vigen, Thea; Lyngbakken, Magnus Nakrem; Omland, Torbjørn & Røsjø, Helge Rørvik [Vis alle 10 forfattere av denne artikkelen] (2026). Association between socioeconomic variables and carotid plaque in middle-aged adults: data from the Akershus Cardiac Examination (ACE) 1950 Study. Open heart. 13(1). doi: 10.1136/openhrt-2025-003865. Fulltekst i vitenarkiv
• Andersen, Elizabeth Lyster; Solberg, Magnar Gangås; Enger, Steve; Onarheim, Sophia; Olufsen, Mona & Berge, Trygve [Vis alle 12 forfattere av denne artikkelen] (2025). Circulating Biomarkers and Recurrence of Persistent Atrial Fibrillation After Electrical Cardioversion. Biomarker Insights. 20. doi: 10.1177/11772719251361306. Fulltekst i vitenarkiv Vis sammendrag

  Background: Rhythm control therapy is recommended for individuals with symptomatic atrial fibrillation (AF) to reduce symptoms and improve quality of life. Electrical cardioversion (ECV) is used to restore sinus rhythm (SR), but AF recurrence is common. Objective: We aimed to investigate if a selection of circulating biomarkers can predict rhythm outcomes in individuals with persistent AF treated with ECV. Design: This was an observational cohort study. Methods: We included 200 individuals aged ⩾ 18 years referred for ECV of AF from November 2017 to March 2022. We obtained blood samples 0 to 6 weeks before ECV. Plasminogen activator inhibitor type 1 (PAI-1) activity, soluble suppression of tumorigenicity 2 (sST2), galectin-3 (GAL-3), interleukin-6 (IL-6), matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), growth differentiation factor-15, (GDF-15), transforming growth factor-β-1 (TGF-β1), and fibroblast growth factor-23 (FGF-23) were analyzed by ELISA methods. The participants recorded thumb ECGs twice daily for 28 days after the ECV to detect AF recurrence. Results: A total of 188 individuals were eligible for the analyses. Twenty-four participants converted spontaneously to SR before ECV. Among the cardioverted, 74 maintained SR, whereas 90 experienced AF recurrence before hospital discharge (n = 15) or during the follow-up period of 28 days (n = 75). TIMP-1 was significantly higher in those with AF recurrence than in those who maintained SR, but overlapping distributions suggest limited predictive ability. PAI-1 activity, sST2, GAL-3, IL-6, MMP-9, GDF-15, TGF-β1, and FGF-23 did not differ among the participants who had ECV. Conclusion: TIMP-1 was higher in participants with recurrence of AF after ECV, but its predictive ability was limited. None of the other biomarkers were associated with AF recurrence. We do not recommend using these biomarkers for candidate selection for ECV of persistent AF.

• Anjum, Mariam; Ariansen, Inger; Myrstad, Marius; Kjerpeseth, Lars Jøran; Hjellvik, Vidar & Skovlund, Eva [Vis alle 9 forfattere av denne artikkelen] (2025). Timing of stroke risk reassessment in atrial fibrillation patients with a CHA2DS2-VA score of 0 or 1: the Norwegian AFNOR study. Europace. ISSN 1099-5129. 27(10). doi: 10.1093/europace/euaf145. Fulltekst i vitenarkiv Vis sammendrag

  Aims: Stroke risk in atrial fibrillation (AF) patients increases over time, but the optimal reassessment interval remains unclear. This study evaluated changes in the CHA2DS2-VA score in AF patients with low (score 0) or intermediate (score 1) stroke risk and explored appropriate reassessment intervals. Methods and results: Using Norwegian national registries (2011–18), 40 782 individuals with incident AF aged ≥18 years and a low or intermediate CHA2DS2-VA score were identified. Patients were followed from first AF diagnosis until an increase in the CHA2DS2-VA score, and the proportion with increased score was assessed across age groups. The number needed to reassess to detect one new CHA2DS2-VA risk factor was calculated at different time intervals after AF diagnosis. The CHA2DS2-VA score increased in 50% of patients after a median follow-up of 1.7 years. The proportion of patients with an increased CHA2DS2-VA score was 19% at 6 months, 25% at 1 year, and 40% at 3 years after AF diagnosis. At 1 year, the proportion of patients with a new risk factor was lower in those aged 18–44 years (8%) and 45–54 years (14%) compared to those aged >55 years (30%), with the number needed to reassess at 1 year being 12, 7, and 3 patients, respectively. Conclusion: New risk factors emerged in half of AF patients within 1.7 years. Age-specific differences underscore the need for tailored reassessment, suggesting a shorter interval of 6 months for patients ≥55 years and 1 year for those <55 years and routinely at age 65 and 75 years.

• Dypvik, Ragnhild; Fjukstad, Katrine Kveli; Lydersen, Stian; Berge, Trygve; Tveit, Arnljot & Røsjø, Helge Rørvik [Vis alle 9 forfattere av denne artikkelen] (2025). Associations Between Growth Differentiation Factor 15 and Anxiety and Depression in the General Population: The Akershus Cardiac Examination 1950 Study. Biopsychosocial Science and Medicine. ISSN 2998-8748. 87(2), s. 153–159. doi: 10.1097/psy.0000000000001365. Fulltekst i vitenarkiv Vis sammendrag

  Objective Several studies suggest a bidirectional association between inflammation, and anxiety and depression. Elevated inflammatory cytokines generate and aggravate neuroinflammation, which may play a part in developing psychological symptoms. Growth differentiation factor 15 (GDF-15) is a novel biomarker possibly reflecting fibrosis and inflammation. The aim of the current study was to investigate the associations between levels of GDF-15 and symptoms of anxiety and depression in the general population. Methods We measured GDF-15 in middle-aged persons participating in the Akershus Cardiac Examination 1950 Study. Symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), with HADS ≥8 denoting significant symptoms. We used multivariable regression analysis to assess the associations between GDF-15 and HADS, adjusting for levels of C-reactive protein (CRP), demographics, and comorbidities. Results A total of 3638 participants had valid assessment of HADS and measurements of GDF-15 and CRP. The mean age was 63.9 (SD 0.65) years, and 48.8% were women. In adjusted models, levels of GDF-15 were associated with the continuous HADS-D score ( β = 0.27, 95% confidence interval [CI] = 0.12 to 0.43) and HADS-D score ≥8 (odds ratio = 1.41, 95% CI = 1.12 to 1.78), but not with the continuous HADS-A score ( β = 0.06, 95% CI = −0.12 to 0.24) or HADS-A score ≥8 (odds ratio = 1.06, 95% CI = 0.88 to 1.27). Conclusions Levels of GDF-15 are independently associated with symptoms of depression in the general population. Our results reinforce the notion that inflammation may be a contributing factor for the development of clinical depression. Registration ClinicalTrials.gov identifier NCT01555411 (Akershus Cardiac Examination [ACE] 1950 Study), https://clinicaltrials.gov/study/NCT01555411

• Solberg, Magnar Gangås; Berge, Trygve; Rønningen, Peter Selmer; Enger, Steve; Pervez, Mohammad Osman & Orstad, Eivind Bjørkan [Vis alle 13 forfattere av denne artikkelen] (2025). Long-term impact of blood pressure in women and men in their early 40s on left atrial strain: data from the Akershus Cardiac Examination (ACE) 1950 Study. Open heart. 12(2). doi: 10.1136/openhrt-2025-003665. Fulltekst i vitenarkiv Vis sammendrag

  Background The life-long exposure of the left heart chambers to systemic blood pressures may be important to changes in left atrial (LA) function with age, but long-term follow-up studies are scarce. We aimed to assess the impact of blood pressure in mid-life on LA function assessed by echocardiographic reservoir (LASr) and contractile (LASct) strain two decades later, in men and women. Methods Echocardiography was performed at ages 62–65 in 3706 participants born in 1950 of the prospective observational Akershus Cardiac Examination (ACE) 1950 Study. Data was linked with blood pressure measurements from the Age 40 Programme, a national health survey performed when the participants were 40–43 years of age. Participants were categorised into three groups representing normal blood pressure, elevated blood pressure and hypertension, based on measurements at ages 40–43. Linear regression models were used to assess associations between blood pressure and echocardiographic LA strain analysis. Results A total of 2399 participants (51.6% women) had available LA strain analysis from the ACE 1950 Study (mean age 63.9±0.6 years) and blood pressure data from the Age 40 Programme (mean age 40.1±0.3 years). At ages 62–65, mean LASr was 35.1±9.2% and LASct was 17.7±5.6%. Adjusted regression models showed a significant association between blood pressure category increase at ages 40–43 and LASct (adjusted β 1.03% (95% CI 0.37% to 1.69%), p=0.002) at ages 62–65, but not with LASr. In women, no associations were evident between blood pressure at ages 40–43 and LA strain two decades later. Conclusions Increased blood pressure in the early 40s was associated with higher LA contractile strain two decades later in men, but not in women.

• Walle-Hansen, Marte; Hagberg, Guri; Myrstad, Marius; Berge, Trygve; Vigen, Thea & Ihle-Hansen, Hege Beate [Vis alle 14 forfattere av denne artikkelen] (2025). Blood pressure at age 40 and key features of cerebral small vessel disease at age 70: data from the ACE 1950 Study. BMC Cardiovascular Disorders. 25(1). doi: 10.1186/s12872-025-05140-6. Fulltekst i vitenarkiv Vis sammendrag

  Background The separate effects of systolic (SBP) and diastolic blood pressure (DBP) on cerebral small vessel disease (cSVD) development needs elucidation. We investigated the association between SBP and DBP at age 40 and two selected brain magnetic resonance imaging (MRI) features of cSVD (lacunes and white matter hyperintensities [WMHs]) at age 70 in a general Norwegian population cohort. Methods We included individuals from the Akershus Cardiac Examination (ACE) 1950 Study (2012–2015) who had previously participated in the Age 40 Program (1990–1993). A random subset of participants with SBP in the categories of non-elevated (< 120 mmHg), high elevated (130–139 mmHg) or hypertension (≥ 140 mmHg) at age 40 were invited to perform brain MRI for assessment of cSVD (lacunes and WMHs) at age 70 (2016–2024). DBP was categorized as non-elevated (< 70 mmHg), low elevated (70–79 mmHg), high elevated (80–89 mmHg) and hypertension (≥ 90 mmHg). Logistic and ordinal regressions assessed the association between SBP and DBP and lacunes and severity of WMHs (measured with Fazekas scale), adjusting for sex, total cholesterol, smoking, physical activity, diabetes, education, and age at MRI, with non-elevated BP as the reference category. Results A total of 414 participants (167 [40%] women) were included. Participants were 70.2 ± 2.3 years when undergoing brain MRI. Mean Fazekas scale was 1.3 ± 0.8, and 54 (13%) had lacunes. SBP and DPB were not associated with lacunes. DPB of 80–89 mmHg (adjusted OR [95% CI], 1.91 [1.01–3.62]) and ≥ 90 mmHg (2.11 [1.06–4.19]) at age 40 were associated with WMHs. Conclusions Elevated DBP (80–89 mmHg) and diastolic hypertension (> 90 mmHg) at age 40 were associated with WMH burden at age 70, suggesting a long-term association between midlife DBP and cerebrovascular health.

• Paus, Michael Fredrik; Lyngbakken, Magnus Nakrem; Tveit, Arnljot; Steine, Kjetil; Berge, Trygve & Skranes, Julia Brox [Vis alle 14 forfattere av denne artikkelen] (2025). Determinants of Cardiac Myosin Binding Protein C in the General Population. Clinical Chemistry. ISSN 0009-9147. 71(4), s. 484–496. doi: 10.1093/clinchem/hvaf013. Fulltekst i vitenarkiv Vis sammendrag

  Background: Cardiac myosin binding protein C (cMyC) is a novel, cardiac-specific biomarker with an early release profile after acute ischemic myocardial injury. Whether cMyC reflects chronic myocardial injury and left ventricular remodelling in the general population is unknown. The aims of the study were to test the hypotheses that cMyC concentrations are associated with cardiovascular risk factors, biomarkers of chronic myocardial injury, and imaging biomarkers of cardiac anatomy, function, and fibrosis. Methods: Circulating cMyC and cardiac troponin I and T concentrations were measured in 3672 individuals from the general population, born in 1950, who underwent echocardiography. One-hundred-ninety-nine participants with measured cMyC completed a cardiovascular magnetic resonance (CMR) examination for assessment of myocardial fibrosis. Results: Circulating cMyC was measurable in 99.6% of study participants and in 99.0% of CMR substudy participants. cMyC was positively associated with left ventricular mass and left atrial volume and inversely associated with renal function and indices of left ventricular systolic and diastolic function. In participants with available late gadolinium enhancement images for the assessment of focal fibrosis (n = 197), cMyC was positively associated with indices of focal myocardial fibrosis. Conclusions: In the general population, circulating cMyC concentrations are associated with cardiovascular risk factors, reflect left ventricular remodelling, including focal myocardial fibrosis, and systolic and diastolic dysfunction independently of traditional risk factors.

• Enge, Katrine; Ulimoen, Sara Reinvik; Enger, Steve; Onarheim, Sophia; Olufsen, Mona & Pripp, Are Hugo [Vis alle 10 forfattere av denne artikkelen] (2025). Effects of diltiazem and metoprolol on levels of high-sensitivity troponin I in patients with permanent atrial fibrillation: a randomized trial. BMC Cardiovascular Disorders. 25(1). doi: 10.1186/s12872-025-04574-2. Fulltekst i vitenarkiv Vis sammendrag

  Background High-sensitive (hs-) cardiac troponin assays provide prognostic information in atrial fibrillation (AF) patients. Few studies have explored the impact of long-term rate control therapy on levels of troponin in AF patients without coronary heart disease and heart failure. This substudy of the RATe control in Atrial Fibrillation (RATAF) II study aimed to compare the effects of six months’ treatment with diltiazem and metoprolol on hs-troponin I (TnI) levels both at rest and during exercise testing in patients with permanent AF. Methods This was a parallel-group, randomized, investigator-blinded clinical trial. The cohort consisted of 93 patients (28 women, mean age 71 ± 7 years) with symptomatic, permanent AF with preserved left ventricular systolic function and no coronary heart disease. Participants were randomized in a 1:1 ratio to receive either diltiazem 360 mg (n = 49) or metoprolol 100 mg (n = 44) once daily for six months. Blood tests were drawn at rest and during peak exercise testing at baseline, one month and six months’ treatment. This research has been supported by grants from the South-Eastern Norway Regional Health Authority and Vestre Viken Hospital Trust. Results Six months’ treatment with diltiazem and metoprolol significantly lowered the heart rate at rest and peak exercise. Both treatment groups exhibited a decrease in hs-TnI levels at rest (diltiazem p = 0.008, metoprolol p = 0.03) and peak exercise (diltiazem p < 0.001, metoprolol p = 0.004) at six months compared to baseline levels, with no significant differences observed between the groups. Conclusions In patients with permanent AF, six months of rate control therapy with diltiazem or metoprolol lowered levels of hs-TnI. Further research is warranted to determine whether this reduction translates into an improved prognosis.

• Apelland, Turid; Letnes, Jon Magne; Janssens, Kristel; Claessen, Guido; Tveit, Arnljot & Sellevold, Andreas Berg [Vis alle 16 forfattere av denne artikkelen] (2025). Arrhythmia burden, symptoms and quality of life in female and male endurance athletes with paroxysmal atrial fibrillation: a multicentre cohort study in Norway, Australia and Belgium. BMJ Open. 15(8). doi: 10.1136/bmjopen-2025-100496. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To assess atrial fibrillation (AF) burden, symptoms and quality of life (QoL) in endurance athletes with paroxysmal AF. Design Prospective cohort study. Setting and participants Otherwise healthy endurance athletes with paroxysmal AF in Norway, Australia and Belgium. The current study presents baseline measurements collected before the intervention of a randomised controlled trial on effects of individually tailored training adaptation. Methods AF burden (percentage time in AF) was measured by insertable cardiac monitors (Confirm Rx, Abbott). AF-related symptoms and QoL were assessed using the Atrial Fibrillation Effect on QualiTy-of-Life Questionnaire (AFEQT) with any score <80 defined as clinically relevant. Results 43 athletes (age 57±10 (mean±SD), range 33–75 years, 3 women) were included. The athletes were monitored for 50±18 days. Median AF burden was 0.18% (IQR 0%–2.6%). Out of 29 athletes with at least one AF episode, 21 (72%) had AF episodes >60 min. 13 athletes (30%) had AFEQT overall score <80, indicating reduced QoL, and 23 athletes (53%) had significant symptoms. AF burden above median, and episodes >60 min were associated with reduced QoL (mean AFEQT score 78 vs 90, p=0.001 and 78 vs 90, p=0.001, respectively). There were large individual variations between the athletes concerning AF burden, symptoms and QoL. Conclusions Although most athletes were still competing, more than half had troublesome symptoms. One-third had reduced QoL, which was associated with higher AF burden and longer duration of AF episodes. Variations between the athletes highlight the need for individually tailored AF management in athletes with paroxysmal AF.

• Ihle-Hansen, Håkon; Walle-Hansen, Marte; Hagberg, Guri; Berge, Trygve; Ihle-Hansen, Hege Beate & Rønningen, Peter Selmer [Vis alle 11 forfattere av denne artikkelen] (2025). Applying the 2024 European Society of Cardiology Guidelines for the management of elevated blood pressure and hypertension to a Norwegian general population cohort from age 40: data from the Akershus Cardiac Examination 1950 study. Heart. ISSN 1355-6037. 111(23), s. 1119–1123. doi: 10.1136/heartjnl-2025-325770. Fulltekst i vitenarkiv
• Vasstrand, Hilde Jæger; Raki, Melinda; Skrunes, Rannveig; Leh, Sabine; Thomsen, Janne & Gudmundsdottir, Helga [Vis alle 11 forfattere av denne artikkelen] (2025). Epidemiology and clinical presentation of kidney amyloidosis have changed over the past three decades: a nationwide population-based study. BMC Nephrology. 26. doi: 10.1186/s12882-025-04136-w. Fulltekst i vitenarkiv Vis sammendrag

  Background: Early diagnosis of kidney amyloidosis is essential for optimal treatment and improved outcomes. This large, nationwide cohort spanning three decades, explores the changing epidemiology and clinical presentation of kidney amyloidosis in Norway, aiming to raise amyloid awareness. Methods: In the 30-year period (1988–2017), we identified 479 patients with biopsy-confirmed kidney amyloidosis from national registries. Past medical records were reviewed for additional amyloid relevant data and cases were divided into groups of non-AA and AA amyloidosis. Results: Overall amyloid biopsy incidence in the registries was stable around 4%, but a shift in types occurred. The AL-dominated non-AA group increased from 1.9% to 2.8% (p = 0.014) while the AA group decreased from 2.6% to 1.3% (p < 0.001). The change in AA was related to less rheumatic disease, partly compensated by an increase in AA in people who inject drugs. The scope and accuracy of amyloid typing improved in the study period, significantly reducing undetermined cases (p < 0.001) and providing more robust diagnoses. Clinical presentation was diverse, but proteinuria was present in 94%. Non-AA patients more often than AA had nephrotic syndrome (70% vs 51%, p < 0.001) and better-preserved kidney-function (median (IQR) eGFR 53(55) vs 27(34) ml/min/1.73 m2, p < 0.001). AA patients were younger (p < 0.001) with higher prevalence of hypertension (53% vs 38%, p < 0.001). Notably, AA in people who inject drugs was more advanced and near half presented with end-stage kidney disease. In recent years, non-AA presented with significantly improved serum albumin (p = 0.002), haemoglobin (p = 0.020) and erythrocyte sedimentation ratio (p = 0.029). Additionally, the percentage of non-AA with end-stage kidney disease fell from 26.8% to 8.7% (p = 0.005), possibly indicating earlier diagnosis. Conclusion: The epidemiology of kidney amyloidosis has changed over the past 30 years. Biopsy incidence of non-AA is increased, and findings may suggest an earlier diagnosis. Amyloid typing has improved over time and is reflected in more precise amyloid diagnoses and reduced number of undetermined cases in recent years. Although AA related to rheumatic disease is declining, AA amyloidosis in people who inject drugs represents a growing challenge. The changing epidemiology of kidney amyloidosis may impact clinical presentation and future healthcare needs, emphasising the need for amyloid awareness.

• Roselli, Carolina; Surakka, Ida; Olesen, Morten S.; Sveinbjornsson, Gardar; Marston, Nicholas A. & Choi, Seung Hoan [Vis alle 156 forfattere av denne artikkelen] (2025). Meta-analysis of genome-wide associations and polygenic risk prediction for atrial fibrillation in more than 180,000 cases. Nature Genetics. ISSN 1061-4036. 57(3), s. 539–562. doi: 10.1038/s41588-024-02072-3. Fulltekst i vitenarkiv Vis sammendrag

  Atrial fibrillation (AF) is the most common heart rhythm abnormality and is a leading cause of heart failure and stroke. This large-scale meta-analysis of genome-wide association studies increased the power to detect single-nucleotide variant associations and found more than 350 AF-associated genetic loci. We identified candidate genes related to muscle contractility, cardiac muscle development and cell–cell communication at 139 loci. Furthermore, we assayed chromatin accessibility using assay for transposase-accessible chromatin with sequencing and histone H3 lysine 4 trimethylation in stem cell-derived atrial cardiomyocytes. We observed a marked increase in chromatin accessibility for our sentinel variants and prioritized genes in atrial cardiomyocytes. Finally, a polygenic risk score (PRS) based on our updated effect estimates improved AF risk prediction compared to the CHARGE-AF clinical risk score and a previously reported PRS for AF. The doubling of known risk loci will facilitate a greater understanding of the pathways underlying AF.

• Choi, Seung Hoan; Jurgens, Sean J.; Xiao, Ling; Hill, Matthew C.; Haggerty, Christopher M. & Sveinbjörnsson, Garðar [Vis alle 529 forfattere av denne artikkelen] (2025). Sequencing in over 50,000 cases identifies coding and structural variation underlying atrial fibrillation risk. Nature Genetics. ISSN 1061-4036. 57(3), s. 548–562. doi: 10.1038/s41588-025-02074-9. Fulltekst i vitenarkiv Vis sammendrag

  Atrial fibrillation (AF) is a prevalent and morbid abnormality of the heart rhythm with a strong genetic component. Here, we meta-analyzed genome and exome sequencing data from 36 studies that included 52,416 AF cases and 277,762 controls. In burden tests of rare coding variation, we identified novel associations between AF and the genes MYBPC3, LMNA, PKP2, FAM189A2 and KDM5B. We further identified associations between AF and rare structural variants owing to deletions in CTNNA3 and duplications of GATA4. We broadly replicated our findings in independent samples from MyCode, deCODE and UK Biobank. Finally, we found that CRISPR knockout of KDM5B in stem-cell-derived atrial cardiomyocytes led to a shortening of the action potential duration and widespread transcriptomic dysregulation of genes relevant to atrial homeostasis and conduction. Our results highlight the contribution of rare coding and structural variants to AF, including genetic links between AF and cardiomyopathies, and expand our understanding of the rare variant architecture for this common arrhythmia.

• Apelland, Turid; Sellevold, Andreas Berg; Letnes, Jon Magne; Onarheim, Sophia; Enger, Steve & Tveit, Arnljot [Vis alle 12 forfattere av denne artikkelen] (2025). Cardiac arrhythmia assessment with patch electrocardiogram versus insertable cardiac monitor: a cohort study in endurance athletes with atrial fibrillation. BMJ Open. 15. doi: 10.1136/bmjopen-2024-093250. Fulltekst i vitenarkiv Vis sammendrag

  Objectives The objective of this study was to assess the quality of ECG recordings and the concordance between the automatic detection of cardiac arrhythmia episodes by a patch ECG and an insertable cardiac monitor. Design Prospective cohort study. Setting and participants Endurance athletes diagnosed with paroxysmal atrial fibrillation (AF) and no other relevant comorbidities participating in a randomised controlled trial on the effects of training adaption. Methods A patch ECG (ECG247 Smart Heart Sensor) was sent to 29 non-elite endurance athletes with clinical paroxysmal AF. ECG247 continuously monitors, detects and categorises cardiac arrhythmias. The participants were simultaneously monitored with an insertable cardiac monitor (Confirm Rx, Abbott). ECG recording quality was assessed by an experienced physician. Training sessions were monitored using sports watches. Results Out of 29 invited athletes, 14 athletes (mean age 60.4 years, 2 women) made use of the patch ECG and were monitored for a total of 2987 hours and a median of 14 (range 1–17) days. During this period, the athletes performed a total of 112 training sessions. ECG quality varied between athletes and by type of exercise, with poor quality in 16% and 40% of recordings during cross-country skiing and running, respectively. In two athletes, the patch ECG detected AF episodes that were confirmed with insertable cardiac monitor recordings. One technical artefact was falsely classified as ventricular tachycardia by the ECG247 Smart Heart Sensor system. Conclusion Monitoring with patch ECG was feasible in endurance athletes, but ECG recording quality varied between athletes and by type of exercise.

• Tveit, Arnljot & Berge, Trygve (2024). Screening for atrieflimmer. Hjerteforum. ISSN 0802-1465. 37(3), s. 33–36. Fulltekst i vitenarkiv
• Kalstø, Silje Madeleine; Nygård, Ståle; Ariansen, Inger; Tveit, Arnljot & Christophersen, Ingrid E. (2024). Sex differences in early-onset atrial fibrillation in Norwegian primary care: a retrospective national database analysis. Open heart. 11(2). doi: 10.1136/openhrt-2024-002695. Fulltekst i vitenarkiv Vis sammendrag

  Background Individual variation in the need for healthcare constitutes knowledge gaps for young atrial fibrillation (AF) patients. We aimed to estimate the prevalence and primary care burden of early-onset AF in Norway, emphasising sex differences, in a nationwide healthcare database. Methods We used data from the Norwegian Control and Payment of Health Reimbursement database to identify all Norwegian residents ≥18 years of age registered with a primary care physician (PCP) in 2019, with onset of AF at ≤50 years of age (early-onset AF) in the period 2006–2019. From the accumulated number of early-onset AF cases among current residents, we calculated the prevalence in 2019. The group-level primary care burden was calculated as the total number of annual AF consultations divided by the annual number of AF patients (2014–2018), and individual burden as the mean number of consultations per AF patient per year within the study period. We analysed the distribution of AF consultations between PCP and primary care emergency room (ER) services in total and by sex. Results We identified 10 925 Norwegian residents with early-onset AF in 2019 (26.3% women, mean age 48.4 years). The prevalence of early-onset AF was 0.34% (women: 0.19%, men: 0.50%). The early-onset AF population had on average one annual primary care consultation for AF. The individual burden of annual AF consultations varied widely; <1: 66% of women and 54% of men, (1–5]: 25% of women and 36% of men, (5–10]: 6% of women and 8% of men, ≥10: 2% of women and 2% of men. A higher proportion of men (71%) than women (38%) attended both PCP and ER services due to AF. Conclusions The study confirmed a low prevalence of early-onset AF, with substantial sex differences and individual variation in primary healthcare needs. Our results signal a need for a higher resolution with regard to age groups in future research on burden and sex differences in early-onset AF.

• Wimalanathan, Thakshani; Paus, Michael Fredrik; Skranes, Julia Brox; Berge, Trygve; Tveit, Arnljot & Røsjø, Helge Rørvik [Vis alle 9 forfattere av denne artikkelen] (2024). Associations between Growth Differentiation Factor 15, Cardiac Troponin T, and N-terminal pro-B-type Natriuretic Peptide, and Future Myocardial Fibrosis Assessed by Cardiac Magnetic Resonance Imaging: Data from the Akershus Cardiac Examination 1950 Study. The Journal of Applied Laboratory Medicine (JALM). ISSN 2576-9456. 10(2), s. 392–405. doi: 10.1093/jalm/jfae145. Fulltekst i vitenarkiv Vis sammendrag

  Background Myocardial fibrosis is associated with a poor outcome for patients with cardiovascular disease (CVD). Growth differentiation factor 15 (GDF-15) concentrations predict the risk of death in patients with CVD, but the underlying pathophysiological mechanisms are poorly understood. We aimed to assess the associations between biomarkers of cellular stress and inflammation (GDF-15), cardiac injury (cardiac troponin T [cTnT]), and stretch (N-terminal pro-B-type natriuretic peptide [NT-proBNP]), and subsequent focal and diffuse myocardial fibrosis assessed by cardiac magnetic resonance (CMR) imaging. Methods We measured GDF-15, cTnT, and NT-proBNP in 200 study participants without known coronary artery disease or renal dysfunction from the population-based Akershus Cardiac Examination 1950 Study at baseline in 2012 to 2015. Focal myocardial scars and diffuse fibrosis were assessed by late gadolinium enhancement imaging and septal extracellular volume fraction (ECV) by CMR 4 to 7 years later. The relationships between cardiac biomarkers and CMR parameters were assessed by logistic regression analysis adjusted for common cardiovascular risk factors. Results The median age was 63.9 (interquartile range 63.4–64.5) years and 49% were women. GDF-15 (adjusted odds ratio [aOR] 4.40, 95% CI 1.09–17.72) and cTnT (aOR 1.59, 95% CI 1.01–2.50) were associated with nonischemic scars in the fully adjusted model. cTnT (aOR 2.45, 95% CI 1.41–4.25) and NT-proBNP (aOR 3.12, 95% CI 1.55–6.28) were associated with ischemic scars. None of the biomarkers were significantly associated with elevated ECV. Conclusions In a general population cohort, GDF-15, an emerging biomarker of cellular stress and inflammation, associates with nonischemic scars. Biomarkers of myocardial injury and stretch associate with ischemic scars, while no biomarker was associated with diffuse fibrosis as assessed by CMR.

• Sulkowska, Joanna; Melles, Woldegabriel A; Skranes, Julia Brox; Berge, Trygve; Tveit, Arnljot & Røsjø, Helge Rørvik [Vis alle 9 forfattere av denne artikkelen] (2024). Cardiac troponin T associates with left ventricular function and synchrony assessed by CMR in the general population: results from the Akershus Cardiac Examination 1950 Study. European Heart Journal – Imaging Methods and Practice (EHJ-IMP). 2(3). doi: 10.1093/ehjimp/qyae078. Fulltekst i vitenarkiv Vis sammendrag

  Background and aim Cardiac troponin T (cTnT) is a blood biomarker of myocardial injury that is associated with future adverse cardiovascular events in the general population. Left ventricular (LV) global longitudinal strain (GLS) and mechanical dispersion (MD) are metrics of systolic function and synchrony that can be obtained from cardiac imaging. Studies suggest an association between cTnT and echocardiographically assessed GLS and MD, but it is unknown whether cTnT relates to these metrics when assessed by cardiac magnetic resonance (CMR). We hypothesized that cTnT associates with GLS and with MD assessed by CMR feature tracking (CMR-FT) in the general population. Methods and results cTnT and CMR-FT measurements were performed in 186 community dwellers from the Akershus Cardiac Examination 1950 Study. The participants’ age ranged from 68 to 70 years. Median cTnT concentration was 7.0 ng/L (interquartile interval 5.0–12.6 ng/L), median absolute value of GLS was 17.3% (interquartile interval 15.7–18.8%), and median MD was 80.7 milliseconds (interquartile interval 61.8–105.0 milliseconds). In multivariable linear regression models adjusted for common clinical risk factors of cardiovascular disease, with GLS and MD as outcome and cTnT as the predictor variable of interest, log10 transformed cTnT was significantly associated with both absolute GLS [β-coefficient −1.65, confidence interval (−2.84, −0.46)] and MD [β-coefficient 28.56, confidence interval (12.14, 44.92)]. Conclusion In older adults from the general population, higher cTnT concentrations are associated with worse systolic function and synchrony assessed by CMR-FT LV GLS and MD, adding information about myocardial function to traditional risk factors.

• Ihle-Hansen, Hege Beate; Einvik, Gunnar; Hagberg, Guri; Thommessen, Bente; Rønning, Ole Morten & Vigen, Thea [Vis alle 11 forfattere av denne artikkelen] (2024). Sleep Duration and Cognitive Function: The Akershus Cardiac Examination 1950 Study. Dementia and Geriatric Cognitive Disorders. ISSN 1420-8008. 53(6), s. 338–344. doi: 10.1159/000540273. Fulltekst i vitenarkiv
• Enge, Katrine; Tveit, Arnljot; Enger, Steve; Onarheim, Sophia; Pripp, Are Hugo & Rønningen, Peter Selmer [Vis alle 14 forfattere av denne artikkelen] (2024). Diltiazem reduces levels of NT-proBNP and improves symptoms compared with metoprolol in patients with permanent atrial fibrillation. European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 10(6), s. 515–525. doi: 10.1093/ehjcvp/pvae032. Fulltekst i vitenarkiv
• Walle-Hansen, Marte; Hagberg, Guri; Myrstad, Marius; Berge, Trygve; Vigen, Thea & Ihle-Hansen, Hege Beate [Vis alle 13 forfattere av denne artikkelen] (2024). Systolic blood pressure at age 40 and 30-year stroke risk in men and women. Open heart. 11(2). doi: 10.1136/openhrt-2024-002805. Fulltekst i vitenarkiv Vis sammendrag

  Background American and European guidelines define hypertension differently and are sex agnostic. Our aim was to assess the impact of different hypertension thresholds at the age of 40 on 30-year stroke risk and to examine sex differences. Methods We included 2608 stroke-free individuals from the Akershus Cardiac Examination 1950 Study, a Norwegian regional study conducted in 2012–2015 of the 1950 birth cohort, who had previously participated in the Age 40 Program, a nationwide health examination study conducted in 1990–1993. We categorised participants by systolic blood pressure (SBP) at age 40 (<120 mm Hg (reference), 120–129 mm Hg, 130–139 mm Hg and ≥140 mm Hg) and compared stroke risk using Cox proportional hazard regressions adjusted for age, sex, smoking, cholesterol, physical activity, obesity and education. Fatal and non-fatal strokes were obtained from the Norwegian Cardiovascular Disease Registry from 1 January 2012 to 31 December 2020, in addition to self-reported strokes. Results The mean age was 40.1±0.3 years (50.4% women) and mean SBP was 128.3±13.5 mm Hg (mean±SD). Stroke occurred in 115 (4.4%) individuals (32 (28%) women and 83 (72%) men) during 29.4±2.9 years of follow-up. SBP between 130 and 139 mm Hg was not associated with stroke (adjusted HR 1.71, 95% CI 0.87 to 3.36) while SBP ≥140 mm Hg was associated with increased stroke risk (adjusted HR 3.11, 95% CI 1.62 to 6.00). The adjusted HR of stroke was 4.32 (95% CI 1.66 to 11.26) for women and 2.66 (95% CI 1.03 to 6.89) for men, with non-significant sex interactions. Conclusions SBP ≥140 mm Hg was significantly associated with 30-year stroke risk in both sexes. A small subgroup of women had SBP ≥140 mm Hg and systolic hypertension was a strong risk factor for stroke in these women.

• Solberg, Magnar Gangås; Enger, Steve; Berge, Trygve; Rønningen, Peter Selmer; Aagaard, Erika Nerdrum & Pervez, Mohammad Osman [Vis alle 12 forfattere av denne artikkelen] (2024). Left atrial function in middle-aged men and women with and without paroxysmal atrial fibrillation: Data from the Akershus Cardiac Examination (ACE) 1950 study. Echocardiography. ISSN 0742-2822. 41(6). doi: 10.1111/echo.15852. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To assess left atrial (LA) function in individuals with known paroxysmal atrial fibrillation (AF) compared with healthy and nonhealthy individuals without atrial fibrillation. Methods The Akershus Cardiac Examination 1950 Study included 3,706 individuals all born in 1950. LA strain assessment of reservoir (LASr), conduit (LAScd) and contractile (LASct) functions were performed in all participants by investigators blinded to clinical data. Participants with cardiovascular disease, obesity, diabetes, pulmonary or renal disease were defined as nonhealthy, and those without as healthy. Patients with paroxysmal AF were identified through medical history and ECG documentation. Results LA strain assessment was feasible in 3,229 (87%) of the participants (50% women). The healthy group (n = 758) had significantly higher LASr and LAScd than the nonhealthy (n = 2,376), but LASct was similar between the groups. Participants with paroxysmal AF had significantly lower values of all strain parameters than the other groups. Multivariable logistic regression showed a significantly reduced probability of having AF per standard deviation increase in LASr and LASct. A nonlinear restricted cubic spline model fitted better with the association of LASr with paroxysmal AF than the linear model, and LA strain values below the population mean associated with an increased probability of having AF, but for values above the population mean no such association was present. Conclusion Compared to participants without AF, those with known paroxysmal AF had significantly lower values of all LA strain parameters during sinus rhythm. Lower values of LA strain were associated with a significantly increased probability of having AF.

• Rønningen, Peter Selmer; Walle-Hansen, Marte; Ihle-Hansen, Håkon; Andersen, Elizabeth Lyster; Tveit, Arnljot & Myrstad, Marius (2023). Impact of frailty on the performance of the National Early Warning Score 2 to predict poor outcome in patients hospitalised due to COVID-19. BMC Geriatrics. 23(1). doi: 10.1186/s12877-023-03842-0. Fulltekst i vitenarkiv Vis sammendrag

  Background The National Early Warning Score 2 (NEWS2) is a scoring tool predictive of poor outcome in hospitalised patients. Older patients with COVID-19 have increased risk of poor outcome, but it is not known if frailty may impact the predictive performance of NEWS2. We aimed to investigate the impact of frailty on the performance of NEWS2 to predict in-hospital mortality in patients hospitalised due to COVID-19. Methods We included all patients admitted to a non-university Norwegian hospital due to COVID-19 from 9 March 2020 until 31 December 2021. NEWS2 was scored based on the first vital signs recorded upon hospital admission. Frailty was defined as a Clinical Frailty Scale score ≥ 4. The performance of a NEWS2 score ≥ 5 to predict in-hospital mortality was assessed with sensitivity, specificity and area under the receiver operating characteristic curve (AUROC) according to frailty status. Results Out of 412 patients, 70 were aged ≥ 65 years and with frailty. They presented less frequently with respiratory symptoms, and more often with acute functional decline or new-onset confusion. In-hospital mortality was 6% in patients without frailty, and 26% in patients with frailty. NEWS2 predicted in-hospital mortality with a sensitivity of 86%, 95% confidence interval (CI) 64%-97% and AUROC 0.73, 95% CI 0.65–0.81 in patients without frailty. In older patients with frailty, sensitivity was 61%, 95% CI 36%-83% and AUROC 0.61, 95% CI 0.48–0.75. Conclusion A single NEWS2 score at hospital admission performed poorly to predict in-hospital mortality in patients with frailty and COVID-19 and should be used with caution in this patient group. Graphical Abstract Graphical abstract summing up study design, results and conclusion

• Anjum, Mariam; Ariansen, Inger; Hjellvik, Vidar; Selmer, Randi Marie; Kjerpeseth, Lars Jøran & Skovlund, Eva [Vis alle 11 forfattere av denne artikkelen] (2023). Stroke and bleeding risk in atrial fibrillation with CHA2DS2-VASC risk score of one: the Norwegian AFNOR study. European Heart Journal. ISSN 0195-668X. 45(1), s. 57–66. doi: 10.1093/eurheartj/ehad659. Fulltekst i vitenarkiv Vis sammendrag

  Background and Aims The benefit of oral anticoagulant (OAC) therapy in atrial fibrillation (AF) and intermediate stroke risk is debated. In a nationwide Norwegian cohort with a non-sex CHA2DS2-VASc risk score of one, this study aimed to investigate (i) stroke and bleeding risk in AF patients with and without OAC treatment, and (ii) the risk of stroke in non-anticoagulated individuals with and without AF. Methods A total of 1 118 762 individuals including 34 460 AF patients were followed during 2011–18 until ischaemic stroke, intracranial haemorrhage, increased CHA2DS2-VASc score, or study end. One-year incidence rates (IRs) were calculated as events per 100 person-years (%/py). Cox regression models provided adjusted hazard ratios (aHRs [95% confidence intervals]). Results Among AF patients, the ischaemic stroke IR was 0.51%/py in OAC users and 1.05%/py in non-users (aHR 0.47 [0.37–0.59]). Intracranial haemorrhage IR was 0.28%/py in OAC users and 0.19%/py in non-users (aHR 1.23 [0.88–1.72]). Oral anticoagulant use was associated with an increased risk of major bleeding (aHR 1.37 [1.16–1.63]) but lower risk of the combined outcome of ischaemic stroke, major bleeding, and mortality (aHR 0.57 [0.51–0.63]). Non-anticoagulated individuals with AF had higher risk of ischaemic stroke compared to non-AF individuals with the same risk profile (aHR 2.47 [2.17–2.81]). Conclusions In AF patients at intermediate risk of stroke, OAC use was associated with overall favourable clinical outcomes. Non-anticoagulated AF patients had higher risk of ischaemic stroke compared to the general population without AF with the same risk profile.

• Andersen, Elizabeth Lyster; Solberg, Magnar Gangås; Walle-Hansen, Marte; Enger, Steve; Onarheim, Sophia & Olufsen, Mona [Vis alle 10 forfattere av denne artikkelen] (2023). Feasibility of Patient-Managed ECG Recordings to Detect the Time of Atrial Fibrillation Recurrence after Electrical Cardioversion: Results from the PRE-ELECTRIC Study. Cardiology. ISSN 0008-6312. 148(4), s. 347–352. doi: 10.1159/000530304. Fulltekst i vitenarkiv Vis sammendrag

  Background: Electrical cardioversion (ECV) is a common procedure to terminate persistent atrial fibrillation (AF). The recurrence rate is high, and the patients often fail to recognize AF recurrence. Objectives: The aim of the study was to evaluate the feasibility of patient-managed electrocardiography (ECG) to detect the time to AF recurrence after ECV. Methods: PRE-ELECTRIC (predictors for recurrence of atrial fibrillation after electrical cardioversion) is a prospective, observational study. Patients ≥18 years of age scheduled for ECV of persistent AF at Bærum Hospital were eligible for inclusion in the study. Time to recurrence of AF was detected by thumb ECG, recorded twice daily and whenever experiencing symptoms. The observation period was 28 days. We defined adherence as the observed number of days with ECG recordings divided by the expected number of days with ECG recordings. Study personnel contacted the participants by phone to assess their awareness of AF recurrence after a recurrence was detected in the thumb ECG. Results: The study enrolled 200 patients scheduled for ECV of persistent AF at Bærum Hospital between 2018 and 2022. The mean age was 66.2 ± 9.3 years, and 21.0% (42/200) were women. The most frequent comorbidities were hypertension (n = 94, 47.0%) and heart failure (n = 51, 25.5%). A total of 164 participants underwent ECV of AF. The procedure was initially successful in 90.9%, of which 50.3% had a recurrence of AF within 4 weeks. The median time to recurrence was 5 days. Among the cardioverted participants, 123 (75.0%) had no missing days of thumb ECG recording during the observation period, and 97.0% had ≤3 missing days. More than a third (37.3%) of the participants with AF recurrence were unaware of the recurrence at the time of contact. Women were older and more symptomatic than men but had similar outcomes after ECV. Conclusions: Recurrence of AF after ECV was common. Using patient-managed thumb ECG was a feasible method to detect AF recurrence following ECV. Further studies are needed to investigate whether patient-managed ECG after ECV can optimize AF treatment.

• Ihle-Hansen, Håkon; Vigen, Thea; Berge, Trygve; Walle-Hansen, Marte; Hagberg, Guri & Ihle-Hansen, Hege Beathe [Vis alle 12 forfattere av denne artikkelen] (2023). Carotid Plaque Score for Stroke and Cardiovascular Risk Prediction in a Middle-Aged Cohort From the General Population. Journal of the American Heart Association (JAHA). 12(17), s. 1–10. doi: 10.1161/JAHA.123.030739. Fulltekst i vitenarkiv Vis sammendrag

  Background We aimed to explore the predictive value of the carotid plaque score, compared with the Systematic Coronary Risk Evaluation 2 (SCORE2) risk prediction algorithm, on incident ischemic stroke and major adverse cardiovascular events and establish a prognostic cutoff of the carotid plaque score. Methods and Results In the prospective ACE 1950 (Akershus Cardiac Examination 1950 study), carotid plaque score was calculated with ultrasonography at inclusion in 2012 to 2015. The largest plaque diameter in each extracranial segment of the carotid artery on both sides was scored from 0 to 3 points. The sum of points in all segments provided the carotid plaque score. The cohort was followed up by linkage to national registries for incident ischemic stroke and major adverse cardiovascular events (nonfatal ischemic stroke, nonfatal myocardial infarction, and cardiovascular death) throughout 2020. Carotid plaque score was available in 3650 (98.5%) participants, with mean±SD age of 63.9±0.64 years at inclusion. Only 462 (12.7%) participants were free of plaque, and and 970 (26.6%) had a carotid plaque score of >3. Carotid plaque score predicted ischemic stroke (hazard ratio [HR], 1.25 [95% CI, 1.15–1.36]) and major adverse cardiovascular events (HR, 1.21 [95% CI, 1.14–1.27]) after adjustment for SCORE2 and provided strong incremental prognostic information to SCORE2. The best cutoff value of carotid plaque score for ischemic stroke was >3, with positive predictive value of 2.5% and negative predictive value of 99.3%. Conclusions The carotid plaque score is a strong predictor of ischemic stroke and major adverse cardiovascular events, and it provides incremental prognostic information to SCORE2 for risk prediction. A cutoff score of >3 seems to be suitable to discriminate high‐risk subjects.

• Warlo, Ellen Mathea Kirsch; Kalstad, Are; Myhre, Peder Langeland; Solheim, Svein; Arnesen, Harald & Tveit, Arnljot [Vis alle 9 forfattere av denne artikkelen] (2023). von Willebrand factor, ADAMTS-13, and thrombospondin 1 in relation to clinical outcomes in elderly patients with a recent myocardial infarction. Research and Practice in Thrombosis and Haemostasis (RPTH). 7(4). doi: 10.1016/j.rpth.2023.100164. Fulltekst i vitenarkiv Vis sammendrag

  Background von Willebrand factor (VWF) multimers are cleaved by A disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13 (ADAMTS-13) into less active fragments. Thrombospondin 1 (TSP-1) competes with VWF’s cleavage site, protecting it from degradation. Low ADAMTS-13 and high VWF have been associated with cardiovascular disease and atrial fibrillation (AF). Objectives We aimed to investigate whether VWF, ADAMTS-13, and TSP-1 are associated with clinical outcome. Methods Elderly patients with a recent myocardial infarction (MI) (n = 1027) were followed for 2 years. Blood was collected 2 to 8 weeks after the MI for ADAMTS-13, VWF, and TSP-1 measures. The primary endpoints (major adverse cardiovascular events; n = 210) included the first event of MI, stroke, heart failure hospitalization, coronary revascularization, and all-cause death. Total mortality was also registered (n = 56). The secondary endpoint was new-onset AF (n = 43). Results Concentrations of VWF, ADAMTS-13, and TSP-1 did not intercorrelate. The risk of major adverse cardiovascular events was altered in patients with VWF ≥ median (hazard ratio [HR], 1.4; 95% CI, 1.0-1.8; P = .03) and ADAMTS-13 ≥ median (HR, 0.7; 95% CI, 0.5-0.9; P = .02); however, it was not significant in adjusted models. VWF and ADAMTS-13 were significantly associated with total mortality, with a HR of 2.7 (95% CI, 1.6-4.6; P < .001) for VWF (Q4 vs. Q1-Q3) and HR of 0.3 (95% CI, 0.2-0.5; P < .001) for ADAMTS-13 (Q2-4 vs. Q1). The associations persisted in multivariable analysis, but the significance disappeared for VWF after correcting for high-sensitivity C-reactive protein. The risk of new-onset AF was lower in patients with VWF ≥ median (HR, 0.5; 95% CI, 0.3-1.0; P = .04]), and this was still significant after adjustments. Conclusion Although low ADAMTS-13 predicted death, the cardiovascular risk associated with VWF and ADAMTS-13 was weaker than previously reported. Low VWF is associated with new-onset AF and needs further research.

• Nilsen, Dennis WT; Myhre, Peder Langeland; Solheim, Svein; Tveit, Sjur Hansen; Kalstad, Are & Laake, Kristian [Vis alle 8 forfattere av denne artikkelen] (2023). Total Bilirubin Yields Prognostic Information Following a Myocardial Infarction in the Elderly. Antioxidants. 12(6). doi: 10.3390/antiox12061157. Fulltekst i vitenarkiv Vis sammendrag

  Total bilirubin consists of an unconjugated form, solubilized by its binding to albumin, and a conjugated form representing a minor part of the circulating bilirubin. As total bilirubin in physiological concentrations is a powerful antioxidant, its concentration gradient may reflect the health status of an individual, and serve as a prognostic indicator of outcome in primary and secondary cardiovascular disease prevention. The aim of this study was to assess the association between total bilirubin and incident cardiovascular events following a myocardial infarction. Total bilirubin in serum was measured at baseline 2–8 weeks after hospitalization for an MI in 881 patients, aged 70 to 82 years, included in the OMEMI (Omega-3 Fatty acids in Elderly with Myocardial Infarction) study, where patients were followed-up for up to 2 years. The first major adverse clinical event (MACE) was the primary endpoint and consisted of nonfatal MI, unscheduled coronary revascularization, stroke, hospitalization for heart failure or all-cause death. As total bilirubin was non-normally distributed, log-transformed values and quartiles of bilirubin were analyzed using Cox regression models. The median (Q1, and Q3) baseline concentration of bilirubin was 11 (9, and 14) µmol/L, and higher log-transformed concentrations were associated with male sex, lower New York Heart Association (NYHA) class and non-smoking. MACE occurred in 177 (20.1%) patients during the follow-up. Higher concentrations of bilirubin were associated with a lower risk of MACE: HR 0.67 (95%CI 0.47–0.97) per log-unit increase, p = 0.032. Patients in the lowest quartile of bilirubin (<9 µmol/L) had the highest risk with HR 1.61 (95%CI 1.19–2.18), p = 0.002, compared to quartiles 2–4. This association remained significant even after adjusting for age, sex, body mass index (BMI), smoking status, NYHA class and treatment allocation: HR 1.52 (1.21–2.09), p = 0.009. Low concentrations of bilirubin (<9 µmol/L) are associated with increased nonfatal cardiovascular events or death in elderly patients with a recent myocardial infarction.

• Vad, Oliver B.; Angeli, Elisavet; Liss, Martin; Ahlberg, Gustav; Andreasen, Laura & Christophersen, Ingrid E. [Vis alle 15 forfattere av denne artikkelen] (2023). Loss of Cardiac Splicing Regulator RBM20 Is Associated With Early-Onset Atrial Fibrillation. JACC: Basic to Translational Science. ISSN 2452-302X. 9(2), s. 163–180. doi: 10.1016/j.jacbts.2023.08.008. Fulltekst i vitenarkiv Vis sammendrag

  We showed an association between atrial fibrillation and rare loss-of-function (LOF) variants in the cardiac splicing regulator RBM20 in 2 independent cohorts. In a rat model with loss of RBM20, we demonstrated altered splicing of sarcomere genes (NEXN, TTN, TPM1, MYOM1, and LDB3), and differential expression in key cardiac genes. We identified altered sarcomere and mitochondrial structure on electron microscopy imaging and found compromised mitochondrial function. Finally, we demonstrated that 3 novel LOF variants in RBM20, identified in patients with atrial fibrillation, lead to significantly reduced splicing activity. Our results implicate alternative splicing as a novel proarrhythmic mechanism in the atria.

• Myhre, Peder Langeland; Berge, Trygve; Kalstad, Are; Tveit, Sjur Hansen; Laake, Kristian & Schmidt, Erik B. [Vis alle 10 forfattere av denne artikkelen] (2023). Omega-3 fatty acid supplements and risk of atrial fibrillation and ‘micro-atrial fibrillation’: A secondary analysis from the OMEMI trial. Clinical Nutrition. ISSN 0261-5614. 42(9), s. 1657–1660. doi: 10.1016/j.clnu.2023.07.002. Fulltekst i vitenarkiv Vis sammendrag

  Background & aims Recent randomized clinical trials have raised concerns regarding potential off target adverse effects from supplementation of n-3 polyunsaturated fatty acids (PUFA) on atrial fibrillation (AF) risk. We aimed to assess risk and potential mediators of AF and ‘micro-AF’ from n-3 PUFA in post-myocardial infarction (MI) patients. Methods In the OMEMI trial, 70–82 y. o. patients with a recent MI were randomized to 1.8 g/day of eicosapentaenoic-/docosahexaenoic acid (EPA/DHA) or placebo (corn oil) for two years. New-onset AF and ‘micro-AF’ was recorded by clinical detection and by screening with Zenicor thumb-ECG (adjudicated by blinded investigators). Serum EPA and DHA were measured at baseline and study end. Results At baseline, 759 of 1014 (75%) patients had no AF history. These patients were aged 75 ± 4 years and 71% were male. During follow-up, 43 patients developed new-onset AF (39 clinically-detected and 4 by thumb-ECG screening). In addition, 27 patients had episodes of micro-AF, yielding a total of 70 patients with new-onset AF or ‘micro-AF’. In the n-3 PUFA group 46 (11.9%) had AF/’micro-AF’ (28 AF, 18 ‘micro-AF’) and in the placebo group 24 (6.5%) had AF/micro-AF (15 AF, 9 micro-AF); HR 1.90 (95%CI 1.16–3.11), P = 0.011. Changes in serum EPA (but not DHA) mediated the effect from n-3 PUFA on AF risk, explaining 65% of the association. Conclusion Supplementation of n-3 PUFA post MI increases the risk of ‘micro-AF’ and AF, and increases in EPA seems to be an important mediator of the treatment effect from n-3 PUFA on the risk of AF.

• Berge, Trygve; Myhre, Peder Langeland; Kalstad, Are; Laake, Kristian; Tveit, Sjur Hansen & Onarheim, Sophia [Vis alle 10 forfattere av denne artikkelen] (2023). Screen-Detected Atrial Fibrillation and "micro-Atrial Fibrillation" and Risk of Cardiovascular Events after Myocardial Infarction in Elderly Patients. Cardiology. ISSN 0008-6312. 148(1), s. 72–77. doi: 10.1159/000528726. Fulltekst i vitenarkiv
• Sørensen, Eivind; Myrstad, Marius; Solberg, Magnar Gangås; Øie, Erik; Platonov, Pyotr G. & Carlson, Jonas [Vis alle 8 forfattere av denne artikkelen] (2023). Left atrial dyssynchrony in veteran endurance athletes with and without paroxysmal atrial fibrillation. Echocardiography. ISSN 0742-2822. doi: 10.1111/echo.15634. Fulltekst i vitenarkiv Vis sammendrag

  Background Prolonged endurance exercise increase the risk of atrial fibrillation (AF) in men. Functional parameters may help separate physiological from pathological atrial remodeling in athletes. LA mechanical dispersion (LA MD) is associated with AF in the general population, but the associations between prolonged exercise, LA MD and AF are not known. Purpose To describe LA MD in veteran athletes with and without paroxysmal AF (pAF) and to investigate LA MD's ability to identify veteran athletes with pAF. Methods Two hundred and ninety-three men, skiers with (n = 57) and without (n = 87) pAF, and controls with (n = 61) and without pAF (n = 88) underwent an echocardiographic exam in sinus rhythm. LA reservoir strain (LASr) was measured, and LA MD defined as the standard deviation of time-to-peak strain (SD-TPS). Results Skiers (mean age 70.7 ± 6.7 years) reported an average of 40–50 years of endurance exercise. LA volumes were associated with pAF and athletic status (p < .001). SD-TPS was associated with pAF (p < .001) but not athletic status (p = .173). We found no significant trend between years of exercise and SD-TPS in individuals without AF (p = .893). SD-TPS did not add incremental value in identifying athletes with pAF in addition to clinical markers, QRS width, LA volume, and LASr (p = .056). Conclusion LA MD was associated with pAF regardless of athletic status but not related to years of endurance exercise, suggesting LA MD could be a promising marker of pathological atrial remodeling in athletes. However, we found no incremental value of LA MD identifying athletes with pAF when LASr was included in the model.

• Aagaard, Erika Nerdrum; Lyngbakken, Magnus Nakrem; Kvisvik, Brede Alexander Havneraas; Berge, Trygve; Pervez, Mohammad Osman & Ariansen, Inger Kristine Holtermann [Vis alle 10 forfattere av denne artikkelen] (2022). Associations between cardiovascular risk factors, biomarkers, and left ventricular mechanical dispersion: insights from the ACE 1950 Study. European Heart Journal Open (EHJ Open). 2(2), s. 1–10. doi: 10.1093/ehjopen/oeac006. Fulltekst i vitenarkiv Vis sammendrag

  Aims Mechanical dispersion measures left ventricular contraction heterogeneity and is associated with the risk of sudden cardiac death. However, the associations between mechanical dispersion and cardiovascular risk factors in early mid-life, and established biomarkers of sub-clinical myocardial injury and dysfunction are not known. We aimed to examine this in the general population. Methods and results During 2012–15, we included 2527 Norwegian individuals from the general population born in 1950, with measurements of mechanical dispersion by 2D speckle tracking echocardiography and concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) available. Mechanical dispersion was calculated as the standard deviation of the contraction duration of 17 strain segments. We assessed the associations between mechanical dispersion, concentrations of hs-cTnT and NT-proBNP, and cardiovascular risk factors collected at a national health screening survey two decades earlier. At echocardiography baseline, median age was 64 (interquartile range 63.5–64.5) years, 49.8% were women, 59.1% had hypertension, and 5.9% reported established coronary artery disease. Median mechanical dispersion was 38.0 (29.5–47.0) ms, median hs-cTnT concentration 6 (4–8) ng/L, and the median NT-proBNP concentration 54 (34–93) ng/L. Mechanical dispersion was associated with both hs-cTnT and NT-proBNP concentrations in multivariable models adjusted for clinical and echocardiographic variables. High body mass index, serum triglyceride concentrations, and low resting heart rate at Age 40 were independently associated with increased mechanical dispersion two decades later. Conclusion Established risk factors at Age 40 are associated with mechanical dispersion two decades later, and mechanical dispersion is cross-sectionally associated with biomarkers of subclinical myocardial injury and dysfunction.

• Sørensen, Eivind; Myrstad, Marius; Solberg, Magnar Gangås; Øie, Erik; Tveit, Arnljot & Aarønæs, Marit (2022). Right Heart Structure and Function in Lifelong Recreational Endurance Athletes with and without Paroxysmal Atrial Fibrillation. Journal of the American Society of Echocardiography. ISSN 0894-7317. doi: 10.1016/j.echo.2022.06.008. Fulltekst i vitenarkiv
• Caspersen, Nina Faksvåg; Søyseth, Vidar; Lyngbakken, Magnus Nakrem; Berge, Trygve; Ariansen, Inger Kristine Holtermann & Tveit, Arnljot [Vis alle 8 forfattere av denne artikkelen] (2022). Treatable Traits in Misdiagnosed Chronic Obstructive Pulmonary Disease: Data from the Akershus Cardiac Examination 1950 Study. COPD: Journal of Chronic Obstructive Pulmonary Disease. ISSN 1541-2555. 9(2), s. 165–180. doi: 10.15326/jcopdf.2021.0265. Fulltekst i vitenarkiv
• Walle-Hansen, Marte; Berge, Trygve; Vigen, Thea; Myrstad, Marius; Hagberg, Guri & Ihle-Hansen, Hege Beathe [Vis alle 14 forfattere av denne artikkelen] (2022). Systolic blood pressure at age 40 and cognitive function 25 years later: The Akershus Cardiac Examination (ACE) 1950 Study. Journal of Hypertension. ISSN 0263-6352. 41(1), s. 132–139. doi: 10.1097/HJH.0000000000003312. Fulltekst i vitenarkiv
• Rønningen, Peter Selmer; Berge, Trygve; Solberg, Magnar Gangås; Enger, Steve; Pervez, Mohammad Osman & Orstad, Eivind Bjørkan [Vis alle 13 forfattere av denne artikkelen] (2022). Impact of Blood Pressure in the Early 40s on Left Atrial Volumes in the Mid-60s: Data From the ACE 1950 Study. Journal of the American Heart Association (JAHA). 11(11). doi: 10.1161/JAHA.121.023738. Fulltekst i vitenarkiv Vis sammendrag

  Background Echocardiographic measures of left atrial volumes are powerful predictors of cardiovascular events and important for assessing diastolic dysfunction. Despite this, there is limited knowledge of factors influencing left atrial remodeling. In particular, the impact of blood pressure in those in their early 40s on left atrial volumes later in life has not been sufficiently elucidated. Methods and Results We linked data from individuals born in 1950 who participated in the Age 40 Program, and the ACE (Akershus Cardiac Examination) 1950 Study. We divided the study population into quartiles of systolic blood pressure in their early 40s and assessed the proportion of individuals with an enlarged left atrium in their mid‐60s. The associations between blood pressure and left atrial volumes were assessed in linear regression analyses. Of the 2591 individuals included in this study, 1302 (50.3%) were women, and the mean age in the Age 40 Program was 40.1±0.3 years. Systolic blood pressure was 128.1±13.6 mm Hg and diastolic blood pressure was 78.3±9.5 mm Hg. Mean age in the ACE 1950 Study was 64.0±0.6 years. The proportion of individuals with an enlarged left atrium increased across the quartiles of systolic blood pressure (P=0.001). Systolic blood pressure was independently associated with left atrial volumes; the end‐systolic volume was 0.09 mL (95% CI, 0.04–0.14 mL) larger per 1‐mm Hg higher systolic blood pressure. Conclusions Our findings suggest that increased blood pressure in those in their early 40s is relevant for left atrial remodeling later in life.

• Myhre, Peder Langeland; Kalstad, Are; Tveit, Sjur Hansen; Laake, Kristian; Schmidt, Erik B. & Smith, Pål [Vis alle 11 forfattere av denne artikkelen] (2022). Changes in eicosapentaenoic acid and docosahexaenoic acid and risk of cardiovascular events and atrial fibrillation: A secondary analysis of the OMEMI trial. Journal of Internal Medicine. ISSN 0954-6820. 291(5), s. 637–647. doi: 10.1111/joim.13442. Fulltekst i vitenarkiv Vis sammendrag

  Background The cardiovascular benefit from n-3 polyunsaturated fatty acids (PUFAs) after acute myocardial infarction (AMI) is controversial, and the importance of serum eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) concentrations for clinical events is unclear. Objectives To assess changes in EPA and DHA serum concentrations during n-3 PUFA supplementation and their association with incident cardiovascular events. Methods In the OMEMI trial, elderly patients with a recent AMI were randomized to 1.8 g/day of EPA/DHA or control (corn oil) for 2 years. The primary outcome was a composite of AMI, coronary revascularization, stroke, heart failure hospitalization, or all-cause death (major adverse cardiovascular event [MACE]) and the secondary outcome was new-onset atrial fibrillation (AF). Results EPA and DHA measurements were available in 881 (92% of survivors) participants at randomization and study completion. EPA and DHA increased in the active treatment arm (n = 438) by a median of 87% and 16%, respectively. Greater on-treatment increases in EPA and DHA were associated with decreasing triglycerides, increasing high-density lipoprotein cholesterol, and lower baseline EPA and DHA concentrations. Greater on-treatment increases in EPA were associated with lower risk of MACE (adjusted hazard ratio 0.86 [95% confidence interval, CI, 0.75–0.99], p = 0.034), and higher risk of AF (adjusted hazard ratio (HR) 1.36 [95% CI 1.07–1.72], p = 0.011). Although there were similar tendencies for DHA changes and outcomes, these associations were not statistically significant (HR 0.84 [0.66–1.06] for MACE and 1.39 [0.90–2.13] for AF). Conclusion Greater on-treatment increases in EPA were associated with lower risk of MACE and higher risk of new-onset AF. These data suggest that the cardiovascular effects of increasing n-3 PUFA levels through supplements are complex, involving both potential benefits and harm.

• Lyngbakken, Magnus Nakrem; Kvisvik, Brede Alexander Havneraas; Berge, Trygve; Pervez, Mohammad Osman; Aagaard, Erika Nerdrum & Ariansen, Inger Kristine Holtermann [Vis alle 10 forfattere av denne artikkelen] (2022). Serial blood pressure measurements, left ventricular remodelling and cardiovascular outcomes. European Journal of Clinical Investigation. ISSN 0014-2972. 53(1). doi: 10.1111/eci.13876. Fulltekst i vitenarkiv Vis sammendrag

  Background Hypertension is a risk factor for the development of cardiovascular disease. Whether serial blood pressure (BP) measurements are more closely associated with subclinical left ventricular (LV) remodelling and better predict risk of cardiovascular events over individual BP measurements are not known. Methods We assessed systolic BP, diastolic BP and pulse pressure at several time points during adulthood in 1333 women and 1211 men participating in the Akershus Cardiac Examination 1950 Study. We defined serial BP measurements as the sum of averaged BPs from adjacent consecutive visits indexed to total exposure time between measurements. We assessed the associations between serial and individual BP measurements and (1) LV structure, function and volumes and (2) incident myocardial infarction, ischemic stroke, heart failure and cardiovascular death. Results All indices of higher serial BP measurements were associated with increased indexed LV mass, and the associations were stronger than those of individual BP measurements. Serial diastolic BP pressure was strongly and inversely associated with LV systolic function, while higher serial systolic BP was primarily associated with higher LV volumes. Both serial systolic (incidence rate ratio [IRR] 1.10, 95% CI 1.03 to 1.17) and diastolic BPs (IRR 1.14, 95% CI 1.02 to 1.27) were associated with increased incidence of clinical events. Conclusion In healthy community dwellers without established cardiovascular disease, different serial BP indices associate strongly with LV remodelling and cardiovascular outcomes. Whether the use of serial BP indices for guiding treatment is superior to individual measurements should be explored in additional prospective studies.

• Lyngbakken, Magnus Nakrem; Rønningen, Peter Selmer; Solberg, Magnar Gangås; Berge, Trygve; Brynildsen, Jon & Aagaard, Erika Nerdrum [Vis alle 11 forfattere av denne artikkelen] (2022). Prediction of incident atrial fibrillation with cardiac biomarkers and left atrial volumes. Heart. ISSN 1355-6037. doi: 10.1136/heartjnl-2022-321608. Fulltekst i vitenarkiv Vis sammendrag

  Objective Atrial fibrillation is a common arrhythmia associated with risk of stroke, heart failure and death. We aimed to elucidate the associations of cardiac biomarkers, echocardiographic left atrial volumetric indices and risk of prevalent and incident atrial fibrillation in the general population. Methods We assessed cardiac troponin T (cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), growth differentiation factor 15 (GDF-15), maximum (LAVi max ) and minimum (LAVi min ) indexed left atrial volumes and left atrial emptying fraction (LAEF) in subjects born in 1950 participating in the prospective observational cohort, Akershus Cardiac Examination 1950 Study. The Cohorts for Heart and Ageing Research in Genomic Epidemiology for Atrial Fibrillation risk score and sex was used to adjust for residual risk of atrial fibrillation. Results Out of 3487 subjects, 157 (4.5%) had prevalent and 123 (3.5%) had incident atrial fibrillation. Echocardiographic left atrial volumes and cardiac biomarkers associated with prevalent atrial fibrillation, but GDF-15 was non-significant in adjusted analysis. Incident atrial fibrillation was predicted by LAVi max (adjusted HR 1.51, 95% CI 1.30 to 1.75), LAVi min (adjusted HR 1.52, 95% CI 1.35 to 1.72), LAEF (adjusted HR 1.24, 95% CI 1.04 to 1.48) and NT-proBNP (adjusted HR 1.57, 95% CI 1.32 to 1.85). cTnT and NT-proBNP provided incremental prognostic information to left atrial volumes, but GDF-15 demonstrated no prognostic value for incident atrial fibrillation. Conclusions In the general population, echocardiographic left atrial volumetric indices and NT-proBNP, but not cTnT and GDF-15, associate with prevalent atrial fibrillation and with risk of incident atrial fibrillation. cTnT and NT-proBNP provide incremental prognostic information to echocardiography.

• Sørensen, Eivind; Myrstad, Marius; Solberg, Magnar Gangås; Øie, Erik; Tveit, Arnljot & Aarønæs, Marit (2022). Left atrial function in male veteran endurance athletes with paroxysmal atrial fibrillation. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 23(1), s. 137–146. doi: 10.1093/ehjci/jeab248. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Aims To assess left atrial (LA) function in sinus rhythm in veteran athletes with a history of paroxysmal atrial fibrillation (AF) exposed to prolonged endurance exercise compared with veteran athletes without AF and controls with and without paroxysmal AF from a non-athletic population. Methods and results Three hundred and two male participants from four groups, veteran recreational skiers with paroxysmal AF (n = 62), veteran skiers without AF (n = 89), and controls from a non-athletic population with (n = 62) and without paroxysmal AF (n = 89) underwent an echocardiographic examination in sinus rhythm to evaluate LA anatomy and function. The skiers (mean age 70.8±6.7 years) reported an average exposure to regular endurance exercise for 40–50 years. LA maximum and minimum volumes were larger in skiers (P &lt; 0.001). LA volumes differed within the athletic and non-athletic groups with larger volumes in the AF groups ( P &lt; 0.001). We observed a considerable overlap in LA volumes among non-athletes with AF and athletes without AF. LA reservoir strain (33.6% ± 4.8% vs. 28.3% ± 6.7% P &lt; 0.001) and contractile strain (18.3% ± 4.0% vs. 15.0% ± 5.2% P &lt; 0.001) were lower in both AF groups regardless of athletic status. LA reservoir strain was superior to volumetric measurements at identifying participants with AF (area under the curve 0.740 ±0.041). Conclusion Male veteran athletes had significantly larger LA volumes than non-athletes. In contrast, LA strain values were similar in athletes and non-athletes with paroxysmal AF, and significantly lower than in subjects without AF.

• Kalstad, Are; Myhre, Peder L.; Laake, Kristian; Opstad, Trine B.; Tveit, Arnljot & Solheim, Svein [Vis alle 8 forfattere av denne artikkelen] (2021). Biomarkers of ageing and cardiac remodeling are associated with atrial fibrillation. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 55(4), s. 213–219. doi: 10.1080/14017431.2021.1889653. Fulltekst i vitenarkiv Vis sammendrag

  Objectives. Ageing is one of the strongest risk factors for atrial fibrillation (AF), and additional risk factors are also closely related to ageing. Remodeling is part of the pathophysiology of AF, and a possible common denominator of ageing and other AF risk factors. The aim of this study was to investigate any association between the presence of AF and the ageing biomarkers, leukocyte telomere length (LTL) and sirtuin-1 (SIRT-1), and the cardiac remodeling biomarkers Galectin-3 and sST2 in elderly myocardial infarction (MI) patients. Design. Patients were included after admission for MI. Diagnosis of AF was retrieved from medical records and classified as either history of AF before MI or new onset from admission to study inclusion. SIRT-1, sST2 and Galectin-3 were analyzed by ELISAs and LTL by qPCR. Results. In total, 299 patients were included, median age 75 years, 70.2% male. A history of AF was recorded in 38 patients and 30 patients experienced new onset AF. Higher levels of SIRT-1 were associated with lower risk of having a history of AF (OR = 0.46 (95% CI 0.26, 0.81), p = 0.007), whereas higher sST2 levels were associated with higher risk of AF (OR = 4.13 (95% CI 1.69, 10.13), p = 0.002). Results remained significant after adjustment for other AF risk factors. No significant associations with AF were found for Galectin-3 or LTL. None of the biomarkers associated with new onset AF. Conclusion. In elderly patients with MI, higher ST2 and lower SIRT-2 levels were associated with higher prevalence of AF, possibly reflecting both ageing and the remodeling phenomena in AF.

• Myhre, Peder Langeland; Heck, Siri Lagethon; Skranes, Julia Brox; Prebensen, Christian Haugland; Jonassen, Christine M & Berge, Trygve [Vis alle 15 forfattere av denne artikkelen] (2021). Cardiac pathology 6 months after hospitalization for COVID-19 and association with the acute disease severity. American Heart Journal. ISSN 0002-8703. 242, s. 61–70. doi: 10.1016/j.ahj.2021.08.001. Fulltekst i vitenarkiv Vis sammendrag

  Background Coronavirus disease 2019 (COVID-19) may cause myocardial injury and myocarditis, and reports of persistent cardiac pathology after COVID-19 have raised concerns of long-term cardiac consequences. We aimed to assess the presence of abnormal cardiovascular resonance imaging (CMR) findings in patients recovered from moderate-to-severe COVID-19, and its association with markers of disease severity in the acute phase. Methods Fifty-eight (49%) survivors from the prospective COVID MECH study, underwent CMR median 175 [IQR 105-217] days after COVID-19 hospitalization. Abnormal CMR was defined as left ventricular ejection fraction (LVEF) <50% or myocardial scar by late gadolinium enhancement. CMR indices were compared to healthy controls (n = 32), and to circulating biomarkers measured during the index hospitalization. Results Abnormal CMR was present in 12 (21%) patients, of whom 3 were classified with major pathology (scar and LVEF <50% or LVEF <40%). There was no difference in the need of mechanical ventilation, length of hospital stay, and vital signs between patients with vs without abnormal CMR after 6 months. Severe acute respiratory syndrome coronavirus 2 viremia and concentrations of inflammatory biomarkers during the index hospitalization were not associated with persistent CMR pathology. Cardiac troponin T and N-terminal pro-B-type natriuretic peptide concentrations on admission, were higher in patients with CMR pathology, but these associations were not significant after adjusting for demographics and established cardiovascular disease. Conclusions CMR pathology 6 months after moderate-to-severe COVID-19 was present in 21% of patients and did not correlate with severity of the disease. Cardiovascular biomarkers during COVID-19 were higher in patients with CMR pathology, but with no significant association after adjusting for confounders. Trial Registration COVID MECH Study ClinicalTrials.gov Identifier: NCT04314232

• Myhre, Peder Langeland; Lyngbakken, Magnus Nakrem; Berge, Trygve; Røysland, Ragnhild; Aagaard, Erika Nerdrum & Pervez, Mohammad Osman [Vis alle 13 forfattere av denne artikkelen] (2021). Diagnostic Thresholds for Pre-Diabetes Mellitus and Diabetes Mellitus and Subclinical Cardiac Disease in the General Population: Data From the ACE 1950 Study. Journal of the American Heart Association (JAHA). 10(11). doi: 10.1161/JAHA.120.020447. Fulltekst i vitenarkiv Vis sammendrag

  Background Diabetes mellitus (DM) is associated with left ventricular remodeling and incident heart failure, but the association between glycated hemoglobin A1c (HbA1c) and subclinical cardiac disease is not established. We aimed to determine the associations between HbA1c and (1) echocardiographic measures of left ventricular structure and function, and (2) cardiovascular biomarkers: cardiac troponin T, NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), and CRP (C‐reactive protein). Methods and Results Participants (n=3688) born in 1950 from the population‐based ACE (Akershus Cardiac Examination) 1950 Study were classified as DM (HbA1c≥6.5% or self‐reported DM), pre‐DM (HbA1c 5.7%–6.5%), and no‐DM (HbA1c<5.7%). DM, pre‐DM, and no‐DM were classified in 380 (10%), 1630 (44%), and 1678 (46%) participants, respectively. Mean age was 63.9±0.7 years, mean body mass index was 27.2±4.4 kg/m2, and 49% were women. Higher HbA1c was associated with worse left ventricular systolic (ejection fraction and global longitudinal strain) and diastolic (E/e'‐ratio) function, myocardial injury (cardiac troponin T), inflammation (CRP), and impaired neurohormonal homeostasis (NT‐proBNP) (P<0.001 in unadjusted and P<0.01 in adjusted analysis for all). The associations between HbA1c and cardiovascular biomarkers were independent of the echocardiographic variables, and vice versa. Associations were nonlinear (P<0.05 for nonlinearity) and appeared stronger in the pre‐DM range of HbA1c than the no‐DM and DM range. Conclusions HbA1c was associated with indexes of subclinical cardiovascular disease, and this was more pronounced in pre‐DM. Our results suggest that cardiovascular preventive measures should be considered also in subjects with hyperglycemia and HbA1c below the established DM cutoff. Registration clinicaltrials.gov. Identifier: NCT01555411.

• Lyngbakken, Magnus; Vigen, Thea; Ihle-Hansen, Håkon; Brynildsen, Jon; Berge, Trygve & Rønning, Ole M. [Vis alle 9 forfattere av denne artikkelen] (2021). Cardiac troponin I measured with a very high sensitivity assay predicts subclinical carotid atherosclerosis: The Akershus Cardiac Examination 1950 Study. Clinical Biochemistry. ISSN 0009-9120. 93, s. 59–65. doi: 10.1016/j.clinbiochem.2021.04.005. Fulltekst i vitenarkiv Vis sammendrag

  Aims Concentrations of cardiac troponin I (cTnI) are associated with incident ischemic stroke and predict the presence and severity of coronary atherosclerosis. Accordingly, we hypothesized that concentrations of cTnI measured with a very high sensitivity (hs-) assay would be associated with subclinical stages of carotid atherosclerosis in the general population. Methods We measured hs-cTnI on the Singulex Clarity System in 1745 women and 1666 men participating in the prospective observational Akershus Cardiac Examination 1950 Study. All study participants were free from known coronary heart disease and underwent extensive cardiovascular phenotyping at baseline, including carotid ultrasound. We quantified carotid atherosclerosis by the carotid plaque score, carotid intima-media thickness (cIMT) and the presence of hypoechoic plaques. Results Concentrations of hs-cTnI were measurable in 99.8% of study participants and were significantly associated with increased carotid plaque score (odds ratio for quartile 4 of hs-cTnI 1.59, 95% CI 1.22 to 2.07, p for trend < 0.001) and cIMT (odds ratio for quartile 4 of hs-cTnI 1.57, 95% CI 1.02 to 2.42, p for trend = 0.036), but not with the presence of hypoechoic plaques. hs-cTnI concentrations significantly improved reclassification and discrimination models in predicting carotid plaques when added to cardiovascular risk factors, no improvements were evident in predicting cIMT or hypoechoic plaques. Conclusion Concentrations of cTnI measured with a very high sensitivity assay are predictive of carotid atherosclerotic burden, a phenomenon likely attributable to common risk factors of subclinical myocardial injury, coronary and carotid atherosclerosis.

• Myrstad, Marius; Rønningen, Peter Selmer; Tveita, Anders Aune; Rønning, Else Johanne; Ernø, Per Erik & Andersen, Elizabeth Lyster [Vis alle 13 forfattere av denne artikkelen] (2021). Tre bølger med covid-19 på et norsk lokalsykehus. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(2), s. 1–11. doi: 10.4045/tidsskr.21.0750. Fulltekst i vitenarkiv Vis sammendrag

  BAKGRUNN Formålet med artikkelen er å oppsummere sykdomsforløp og behandling for pasienter med covid-19 innlagt på Bærum sykehus siden starten av pandemien. MATERIALE OG METODE Vi presenterer data fra en prospektiv observasjonsstudie med mål om å systematisere kunnskap om pasienter innlagt på grunn av covid-19. Alle pasienter innlagt på Bærum sykehus til og med 28.6.2021 ble inkludert. Resultatene presenteres for tre bølger av sykehusinnleggelser: 9.3.–23.6.2020, 21.9.2020–28.2.2021 og 1.3.–28.6.2021. RESULTATER I alt 300 pasienter, fordelt på hhv. 77, 101 og 122 i de tre bølgene, var innlagt på grunn av covid-19. Antallet som døde under sykehusoppholdet i de tre bølgene, var hhv. 14 (18 %), 11 (11 %) og 5 (4 %). Gjennomsnittsalderen for innlagte var 67,6 år i første bølge og 53,3 år i tredje bølge. Totalt 204 pasienter (68 %) fikk oksygenbehandling eller ventilasjonsstøtte, og 31 av disse (10 % av alle pasientene) fikk invasiv ventilasjonsstøtte. Ikke-invasiv ventilasjonsstøtte ble brukt som høyeste nivå av behandling hos hhv. 4 (8 %), 9 (13 %) og 17 (20 %) pasienter med respirasjonssvikt i de tre bølgene. I andre og tredje bølge fikk 125 av 152 pasienter med respirasjonssvikt (82 %) behandling med deksametason. FORTOLKNING Forskjeller i pasientkarakteristika og endringer i behandling, som i bruk av deksametason og ikke-invasiv ventilasjonsstøtte, kan ha bidratt til at dødeligheten tilsynelatende sank fra første til tredje bølge. Forhold som ikke er registrert i studien, slik som vaksinasjonsstatus, kan også ha påvirket dødeligheten.

• Chandra, Anupam; Røsjø, Helge; Svensson, My Hanna Sofia; Vigen, Thea; Ihle-Hansen, Håkon & Orstad, Eivind Bjørkan [Vis alle 14 forfattere av denne artikkelen] (2020). Plasma linoleic acid levels and cardiovascular risk factors: results from the Norwegian ACE 1950 Study. European Journal of Clinical Nutrition. ISSN 0954-3007. doi: 10.1038/s41430-020-0641-4. Fulltekst i vitenarkiv Vis sammendrag

  Background A high intake of linoleic acid (LA), the major dietary polyunsaturated fatty acid (PUFA), has previously been associated with reduced cardiovascular (CV) morbidity and mortality in observational studies. However, recent secondary analyses from clinical trials of LA-rich diet suggest harmful effects of LA on CV health. Methods A total of 3706 participants, all born in 1950, were included in this cross-sectional study. We investigated associations between plasma phospholipid levels of LA and CV risk factors in a Norwegian general population, characterized by a relative low LA and high marine n-3 PUFA intake. The main statistical approach was multivariable linear regression. Results Plasma phospholipid LA levels ranged from 11.4 to 32.0 wt%, with a median level of 20.8 wt% (interquartile range 16.8–24.8 wt%). High plasma LA levels were associated with lower serum low-density lipoprotein cholesterol levels (standardized regression coefficient [Std. β-coeff.] −0.04, p = 0.02), serum triglycerides (Std. β-coeff. −0.10, p < 0.001), fasting plasma glucose (Std. β-coeff. −0.10, p < 0.001), body mass index (Std. β-coeff. −0.13, p < 0.001), systolic and diastolic blood pressure (Std. β-coeff. −0.04, p = 0.03 and Std. β-coeff. −0.02, p = 0.02, respectively) and estimated glomerular filtration rate (Std. β-coeff. −0.09, p < 0.001). We found no association between plasma LA levels and high-density lipoprotein cholesterol levels, glycated hemoglobin, carotid intima-media thickness, or C-reactive protein. Conclusion High plasma LA levels were favorably associated with several CV risk factors in this study of a Norwegian general population.

• Chandra, Anupam; Lyngbakken, Magnus; Eide, Ivar Anders; Røsjø, Helge; Vigen, Thea & Ihle-Hansen, Håkon [Vis alle 13 forfattere av denne artikkelen] (2020). Plasma trans fatty acid levels, cardiovascular risk factors and lifestyle: Results from the Akershus cardiac examination 1950 study. Nutrients. 12(5). doi: 10.3390/nu12051419. Fulltekst i vitenarkiv Vis sammendrag

  Intake of industrially produced trans fatty acids (iTFAs) has previously been associated with dyslipidemia, insulin resistance, hypertension and inflammation, as well as increased cardiovascular (CV) morbidity and mortality. iTFA intake declined in Norway after the introduction of legislative bans against iTFA consumption. However, the relationship between the current iTFA intake and CV health is unclear. The aim of the present study was to investigate the association between current iTFA intake, reflected by plasma iTFA levels, and established CV risk factors. We also examined the associations between plasma ruminant TFA levels and CV risk factors. In this cross-sectional study, we included 3706 participants from a Norwegian general population, born in 1950 and residing in Akershus County, Norway. The statistical method was multivariable linear regression. Plasma iTFA levels were inversely associated with serum triglycerides (p &lt; 0.001), fasting plasma glucose (p &lt; 0.001), body mass index (p &lt; 0.001), systolic and diastolic blood pressure (p = 0.001 and p = 0.03) and C-reactive protein (p = 0.001). Furthermore, high plasma iTFA levels were associated with higher education and less smoking and alcohol consumption. We found that plasma ruminant trans fatty acids (rTFA) levels were favorably associated with CV risk factors. Furthermore, plasma iTFA levels were inversely associated with CV risk factors. However, our results might have been driven by lifestyle factors. Overall, our findings suggest that the current low intake of iTFAs in Norway does not constitute a threat to CV health.

• Vad, Oliver Bundgaard; Paludan-Müller, Chrirstian; Ahlberg, Gustav; Kalstø, Silje Madeleine; Ghouse, Jonas & Andreasen, Laura [Vis alle 12 forfattere av denne artikkelen] (2020). Loss-of-Function Variants in Cytoskeletal Genes Are Associated with Early-Onset Atrial Fibrillation. Journal of Clinical Medicine. 9(2). doi: 10.3390/jcm9020372. Fulltekst i vitenarkiv Vis sammendrag

  Abstract: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and it is associated with an increased risk of heart failure, stroke, dementia, and death. Recently, titin-truncating variants (TTNtv), which are predominantly associated with dilated cardiomyopathy (DCM), were associated with early-onset AF. Furthermore, genome-wide association studies (GWAS) associated AF with other structural genes. In this study, we investigated whether early-onset AF was associated with loss-of-function variants in DCM-associated genes encoding cytoskeletal proteins. Using targeted sequencing, we examined a cohort of 527 Scandinavian individuals with early-onset AF and a control group of individuals free of AF (n = 383). The patients had onset of AF before 50 years of age, normal echocardiogram, and no other cardiovascular disease at onset of AF. We identified six individuals with rare loss-of-function variants in three different genes (dystrophin (DMD), actin-associated LIM protein (PDLIM3), and fukutin (FKTN)), of which two variants were novel. Loss-of-function variants in cytoskeletal genes were significantly associated with early-onset AF when patients were compared with controls (p = 0.044). Using publicly available GWAS data, we performed genetic correlation analyses between AF and 13 other traits, e.g., showing genetic correlation between AF and non-ischemic cardiomyopathy (p = 0.0003). Our data suggest that rare loss-of-function variants in cytoskeletal genes previously associated with DCM may have a role in early-onset AF, perhaps through the development of an atrial cardiomyopathy.

• Rønningen, Peter Selmer; Berge, Trygve; Solberg, Magnar Gangås; Enger, Steve; Nygård, Ståle & Pervez, Mohammad Osman [Vis alle 12 forfattere av denne artikkelen] (2020). Sex differences and higher upper normal limits for left atrial end-systolic volume in individuals in their mid-60s: data from the ACE 1950 Study. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 21(5), s. 501–507. doi: 10.1093/ehjci/jeaa004. Fulltekst i vitenarkiv
• Kalstad, Are; Myhre, Peder Langeland; Laake, Kristian; Tveit, Sjur Hansen; Schmidt, Erik Berg & Smith, Pål [Vis alle 12 forfattere av denne artikkelen] (2020). Effects of n-3 fatty acid supplementations in elderly patients after myocardial infarction: A randomized controlled trial. Circulation. ISSN 0009-7322. 143(6), s. 528–539. doi: 10.1161/CIRCULATIONAHA.120.052209. Fulltekst i vitenarkiv Vis sammendrag

  Background: High intake of marine n-3 polyunsaturated fatty acids (PUFA) has been associated with reduced risk of cardiovascular events; however, this has not been confirmed in patients with a recent acute myocardial infarction (AMI). Elderly patients are at particularly increased cardiovascular risk after myocardial infarction, but few trials address this group specifically. Omega-3 fatty acids hold the potential to reduce cardiovascular events with limited adverse effects in this vulnerable group. The hypothesis was that daily addition of 1.8g n-3 PUFA to standard of care secondary prophylaxis in elderly patients who have survived an AMI would reduce the risk of subsequent cardiovascular events during 2 years follow-up. Methods: The OMEMI trial (Omega-3 Fatty acids in Elderly with Myocardial Infarction) is an investigator-initiated, multicenter, randomized clinical trial adding 1.8 g n-3 PUFA (930 mg eicosapentaenoic acid and 660 mg docosohexaenoic acid) versus placebo (corn oil) daily to standard of care in patients aged 70 to 82 years with recent (2–8 weeks) AMI. The primary endpoint was a composite of nonfatal AMI, unscheduled revascularization, stroke, all-cause death, heart failure hospitalization after 2 years. The secondary outcome was new atrial fibrillation. The safety outcome was major bleeding. Serum fatty acids were measured as biomarkers of adherence. Results: In total, 1027 patients were randomized. Follow-up data were available for 1014 patients who were included in the intention-to-treat analysis. Mean±SD age was 75±3.6 years, 294 (29%) were female, and mean triglycerides were 111.4±61.9 mg/dL. The primary endpoint occurred in 108 (21.4%) patients on n-3 PUFA versus 102 (20.0%) on placebo (hazard ratio, 1.08 [95% CI, 0.82–1.41]; P=0.60). The secondary endpoint occurred in 28 (7.2%) patients on n-3 PUFA versus 15 (4.0%) on placebo (1.84 [0.98–3.45]; P=0.06). Median changes in eicosapentaenoic acid and docosahexaenoic acid were +87% and +16% for n-3 PUFA versus −13% and −8% for placebo. Major bleeding occurred in 54 (10.7%) and 56 (11.0%) in the n-3 PUFA and placebo groups, respectively (P=0.87). Similar results were found in per-protocol analysis (n=893). Conclusions: We could not detect reduction in clinical events in our elderly patients with recent AMI who were treated with 1.8 g n-3 PUFAs daily for 2 years.

• Ihle-Hansen, Håkon; Berge, Trygve; Ernø, Per Erik; Rønning, Else Johanne; Svendsen, Jan & Wien, Tale Norbye [Vis alle 11 forfattere av denne artikkelen] (2020). Komplikasjoner og dødelighet blant pasienter innlagt med covid-19. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140(11), s. 1–12. doi: 10.4045/tidsskr.20.0432. Fulltekst i vitenarkiv Vis sammendrag

  BAKGRUNN Sykdomsforløp, komplikasjoner og sykehusdødelighet blant pasienter med covid-19 innlagt ved norske sykehus er lite beskrevet. Formålet med denne studien var å kartlegge pasienter med covid-19 innlagt ved et lokalsykehus. MATERIALE OG METODE Dataene er hentet fra en prospektiv observasjonell kvalitetsstudie av alle pasienter innlagt med covid-19 på Bærum sykehus siden starten av koronavirusutbruddet. RESULTATER I alt 73 pasienter med covid-19 innlagt i perioden 9.3.2020–7.5.2020 ble inkludert. Gjennomsnittsalderen var 67,9 år, og 43 pasienter (59 %) var menn. Gjennomsnittlig antall liggedøgn på sykehus var 10,1. I alt hadde 19 pasienter (26 %) et svært alvorlig forløp, og 14 (19 %) døde under sykehusoppholdet. Gjennomsnittsalderen blant pasientene som døde, var 79,5 år. Totalt 49 pasienter (67 %) hadde hypoksemi og behov for oksygenbehandling i gjennomsnittlig 10,1 dager. Av disse fikk 9 pasienter invasiv respirasjonsstøtte i median 18 dager. Symptomer på delirium forekom hos 26 pasienter (36 %) og var den hyppigste ikke-respiratoriske komplikasjonen. FORTOLKNING De fleste pasientene innlagt på sykehus med covid-19 hadde behov for langvarig oksygenbehandling, og det var høy forekomst av alvorlige komplikasjoner.

• Lyngbakken, Magnus; Kvisvik, Brede Alexander; Aagaard, Erika Nerdrum; Berge, Trygve; Pervez, Mohammad Osman & Brynildsen, Jon [Vis alle 10 forfattere av denne artikkelen] (2020). B-Type Natriuretic Peptide Is Associated with Indices of Left Ventricular Dysfunction in Healtahy Subjects from the General Population: The Akershus Cardiac Examination 1950 Study. Clinical Chemistry. ISSN 0009-9147. doi: 10.1093/clinchem/hvaa257. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Concentrations of B-type natriuretic peptide (BNP) reflect myocardial distension and stress, and are associated with poor prognosis in patients with cardiovascular disease. Accordingly, we hypothesized that concentrations of BNP would be associated with indices of adverse left ventricular (LV) remodeling and early stages of LV systolic and diastolic dysfunction in healthy participants from the general population. Methods We measured BNP in 1757 women and 1677 men free from known coronary heart disease participating in the prospective observational Akershus Cardiac Examination 1950 Study. All study participants underwent extensive cardiovascular phenotyping at baseline, including detailed echocardiography with assessment of indexed LV mass (LVMI), diastolic [tissue Doppler e’, E/e’ ratio, indexed left atrial volume (LAVI), maximal tricuspid regurgitation velocity (TRVmax), and E/A ratio], and systolic [global longitudinal strain (GLS) and LV ejection fraction (LVEF)] function. Results Study participants with the highest BNP concentrations had higher GLS, LVMI, e’, E/e’ ratio, LAVI, TRVmax, and E/A ratio. In adjusted analyses, both GLS and LVEF exhibited significant nonlinear associations with BNP, with reduced LV systolic function observed in both the low and high concentration range of BNP. Conclusions In healthy participants recruited from the general population, concentrations of BNP exhibit nonlinear associations with LV systolic function, and both low and high concentrations are associated with reduced LV systolic function. This supports the notion that natriuretic peptides are beneficial and elicit cardioprotective effects, and may have important implications for the interpretation of BNP measurements in the general population.

• Myrstad, Marius; Ihle-Hansen, Håkon; Tveita, Anders Aune; Andersen, Elizabeth Lyster; Nygård, Ståle & Tveit, Arnljot [Vis alle 7 forfattere av denne artikkelen] (2020). National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19 - a prospective cohort study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 28(1). doi: 10.1186/s13049-020-00764-3. Fulltekst i vitenarkiv Vis sammendrag

  Background There is a need for validated clinical risk scores to identify patients at risk of severe disease and to guide decision-making during the covid-19 pandemic. The National Early Warning Score 2 (NEWS2) is widely used in emergency medicine, but so far, no studies have evaluated its use in patients with covid-19. We aimed to study the performance of NEWS2 and compare commonly used clinical risk stratification tools at admission to predict risk of severe disease and in-hospital mortality in patients with covid-19. Methods This was a prospective cohort study in a public non-university general hospital in the Oslo area, Norway, including a cohort of all 66 patients hospitalised with confirmed SARS-CoV-2 infection from the start of the pandemic; 13 who died during hospital stay and 53 who were discharged alive. Data were collected consecutively from March 9th to April 27th 2020. The main outcome was the ability of the NEWS2 score and other clinical risk scores at emergency department admission to predict severe disease and in-hospital mortality in covid-19 patients. We calculated sensitivity and specificity with 95% confidence intervals (CIs) for NEWS2 scores ≥5 and ≥ 6, quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2, ≥2 Systemic Inflammatory Response Syndrome (SIRS) criteria, and CRB-65 score ≥ 2. Areas under the curve (AUCs) for the clinical risk scores were compared using DeLong’s test. Results In total, 66 patients (mean age 67.9 years) were included. Of these, 23% developed severe disease. In-hospital mortality was 20%. Tachypnoea, hypoxemia and confusion at admission were more common in patients developing severe disease. A NEWS2 score ≥ 6 at admission predicted severe disease with 80.0% sensitivity and 84.3% specificity (Area Under the Curve (AUC) 0.822, 95% CI 0.690–0.953). NEWS2 was superior to qSOFA score ≥ 2 (AUC 0.624, 95% CI 0.446–0.810, p < 0.05) and other clinical risk scores for this purpose. Conclusion NEWS2 score at hospital admission predicted severe disease and in-hospital mortality, and was superior to other widely used clinical risk scores in patients with covid-19.

• Ihle-Hansen, Håkon; Berge, Trygve; Tveita, Anders Aune; Rønning, Else Johanne; Ernø, Per Erik & Andersen, Elizabeth Lyster [Vis alle 9 forfattere av denne artikkelen] (2020). Covid-19: Symptomer, forløp og bruk av kliniske skåringsverktøy hos de 42 første pasientene innlagt på et norsk lokalsykehus. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140(7), s. 1–10. doi: 10.4045/TIDSSKR.20.0301. Fulltekst i vitenarkiv Vis sammendrag

  BAKGRUNN Covid-19-utbruddet medfører nye utfordringer for helsevesenet, og det er et stort behov for kunnskap om symptomer, kliniske funn og sykdomsforløp hos pasienter som legges inn med covid-19 på norske sykehus. MATERIALE OG METODE I denne observasjonelle kvalitetsstudien ble alle pasienter innlagt på et norsk lokalsykehus (Bærum sykehus) med påvist covid-19-infeksjon inkludert fortløpende fra utbruddets start. Vi presenterer her pasientkarakteristika, symptomer, kliniske funn, erfaringer med bruk av kliniske skåringsverktøy og sykdomsforløp basert på journalopplysninger. RESULTATER I perioden 9.–31. mars 2020 ble 42 pasienter, hvorav 28 menn (67 %), innlagt på sykehuset med covid-19-infeksjon. Median alder var 72,5 år (spredning 30–95 år). Feber (79 %), redusert allmenntilstand (79 %), dyspné (69 %) og hoste (67 %) var de vanligste symptomene. I alt ni pasienter (21 %) hadde et svært alvorlig sykdomsforløp med behandling på intensivavdeling og/eller død under sykehusoppholdet. Pasienter med svært alvorlig forløp hadde høyere gjennomsnittlig skår på National Early Warning Score 2 (NEWS2) ved innkomst (7,6 vs. 3,3). Kun én av de mest alvorlig syke pasientene skåret ≥ 2 på quick Sepsis-related Organ Failure Assessment (qSOFA) ved innkomst. FORTOLKNING De fleste pasienter innlagt på vårt sykehus med covid-19 hadde feber og luftveissymptomer. En høy andel pasienter hadde svært alvorlig sykdomsforløp. NEWS2-skår ≥ 5 ved innkomst kan være et nyttig hjelpemiddel for å identifisere pasienter med risiko for svært alvorlig sykdomsforløp, mens CRB-65- og qSOFA- skår ≥ 2 var lite egnet til dette formålet i vårt materiale.

• Kjerpeseth, Lars Jøran; Igland, Jannicke; Selmer, Randi Marie; Ellekjær, Hanne; Tveit, Arnljot & Berge, Trygve [Vis alle 13 forfattere av denne artikkelen] (2020). Prevalence and incidence rates of atrial fibrillation in Norway 2004-2014. Heart. ISSN 1355-6037. 107, s. 201–207. doi: 10.1136/heartjnl-2020-316624. Fulltekst i vitenarkiv Vis sammendrag

  ABSTRACT Objective To study time trends in incidence of atrial fibrillation (AF) in the entire Norwegian population from 2004 to 2014, by age and sex, and to estimate the prevalence of AF at the end of the study period. Methods A national cohort of patients with AF (≥18 years) was identified from inpatient admissions with AF and deaths with AF as underlying cause (1994– 2014), and AF outpatient visits (2008–2014) in the Cardiovascular Disease in Norway (CVDNOR) project. AF admissions or out-of-hospital death from AF, with no AF admission the previous 10 years defined incident AF. Age-standardised incidence rates (IR) and incidence rate ratios (IRR) were calculated. All AF cases identified through inpatient admissions and outpatient visits and alive as of 31 December 2014 defined AF prevalence. Results We identified 175 979 incident AF cases (30% primary diagnosis, 69% secondary diagnosis, 0.6% outof-hospital deaths). AF IRs (95% confidence intervals) per 100 000 person years were stable from 2004 (433 (426–440)) to 2014 (440 (433–447)). IRs were stable or declining across strata of sex and age with the exception of an average yearly increase of 2.4% in 18–44 yearolds: IRR 1.024 (1.014–1.034). In 2014, the prevalence of AF in the adult population was 3.4%. Conclusions We found overall stable IRs of AF for the adult Norwegian population from 2004 to 2014. The prevalence of AF was 3.4% at the end of 2014, which is higher than reported in previous studies. Signs of an increasing incidence of early-onset AF (<45 years) are worrying and need further investigation.

• Lyngbakken, Magnus; Aagaard, Erika Nerdrum; Kvisvik, Brede Alexander; Berge, Trygve; Pervez, Mohammad Osman & Brynildsen, Jon [Vis alle 10 forfattere av denne artikkelen] (2020). Cardiac troponin I and T are associated with left ventricular function and structure: Data from the Akershus Cardiac Examination 1950 Study. Clinical Chemistry. ISSN 0009-9147. 66(4), s. 567–578. doi: 10.1093/clinchem/hvaa023. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Concentrations of cardiac troponin I (cTnI) and T (cTnT) are associated with clinical cardiac outcomes, but do not correlate closely in subjects recruited from the general population. Accordingly, we hypothesized that cTnI and cTnT concentrations would be influenced by different cardiovascular (CV) and non-CV risk factors and reflect different CV phenotypes. Methods We measured cTnI and cTnT with last generation assays in 1236 women and 1157 men with no known CV disease participating in the prospective observational Akershus Cardiac Examination 1950 Study. All study participants underwent extensive CV phenotyping at baseline, including detailed echocardiography. Results Concentrations of cTnI were measurable in 60.3% and cTnT in 72.5% of study participants (P &amp;lt; 0.001), and correlated moderately (r = 0.53; P &amp;lt; 0.001). cTnI was more strongly associated with male sex (P = 0.018), higher education (P &amp;lt; 0.001), history of hypertension (P &amp;lt; 0.001), and age (P &amp;lt; 0.001), whereas cTnT was more strongly associated with eGFR (P = 0.015). Both cTnI and cTnT were inversely associated with global longitudinal strain and positively associated with LV mass index (LVMI) in analyses adjusted for CV risk factors. The association between cTnI and LVMI was stronger than the association between cTnT and LVMI (P = 0.035). Concentrations of cTnI improved diagnostic accuracy for LV hypertrophy when added to established CV risk factors, but concentrations of cTnT did not improve these models further. Conclusions In a large community-based cohort examined with extensive echocardiography, concentrations of cTnI and cTnT are associated with subclinical LV hypertrophy and dysfunction. Concentrations of cTnI appear superior to cTnT in predicting subclinical LV hypertrophy.

• Kalstad, Are; Tveit, Sjur Hansen; Myhre, Peder Langeland; Laake, Kristian; Opstad, Trine Baur & Tveit, Arnljot [Vis alle 10 forfattere av denne artikkelen] (2019). Leukocyte telomere length and serum polyunsaturated fatty acids, dietary habits, cardiovascular risk factors and features of myocardial infarction in elderly patients. BMC Geriatrics. 19:376, s. 1–9. doi: 10.1186/s12877-019-1383-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Telomeres are non-coding sequences at the end of eukaryote chromosomes, which in complex with associated proteins serve to protect subtelomeric DNA. Telomeres shorten with each cell division, are regarded as a biomarker for aging and have also been suggested to play a role in atherosclerosis and cardiovascular disease (CVD). The aim of the present study was to explore the associations between leukocyte telomere length and serum polyunsaturated fatty acids, diet, cardiovascular risk factors and features of myocardial infarction (MI) in elderly patients. Methods The material is based upon the first 299 included patients in the OMEMI trial, where patients aged 70–82 years of age are randomized to receive omega-3 supplements or corn oil (placebo) after MI. Patients were included 2–8 weeks after the index MI. DNA was extracted from whole blood, and leukocyte telomere length (LTL) was analyzed by qPCR and reported as a number relative to a reference gene. Serum long chain polyunsaturated fatty acid (LCPUFA) content was analyzed by gas chromatography. Diet was evaluated with the validated SmartDiet food frequency questionnaire. Medical records, patient interviews and clinical examination provided previous medical history and anthropometric data. Non-parametric statistical tests were used. Results Median (25, 75 percentile) LTL was 0.55 (0.42, 0.72). Patients had a median age of 75 years, 70.2% were male and 45.2% used omega-3 supplements. There was a weak, but significant correlation between LTL and linoleic acid (r = 0.139, p = 0.017), but not with other LCPUFAs. There was a trend towards longer telomeres with a healthier diet, but this did not reach statistical significance (p = 0.073). No associations were found between LTL and CVD risk factors or features of MI. Conclusions In our population of elderly with a recent myocardial infarction LTL was associated with linoleic acid concentrations, but not with other LCPUFAs. Patients with a healthy diet tended to have longer telomeres. The limited associations may be due to age and the narrow age-span in our population. Further studies, designed to detect longitudinal changes should be performed to explore the role of telomeres in cardiovascular aging. Trial registration Clinical trials no. NCT01841944, registration date April 29, 2013.

• Chandra, Anupam; Røsjø, Helge; Eide, Ivar Anders; Vigen, Thea; Ihle-Hansen, Håkon & Orstad, Eivind Bjørkan [Vis alle 13 forfattere av denne artikkelen] (2019). Plasma marine n-3 polyunsaturated fatty acids and cardiovascular risk factors: data from the ACE 1950 study. European Journal of Nutrition. ISSN 1436-6207. s. 1–11. doi: 10.1007/s00394-019-02007-3. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Purpose A high intake of marine n-3 polyunsaturated fatty acids (PUFAs) might improve cardiovascular (CV) health. We conducted a cross-sectional study to investigate associations between plasma phospholipid levels of marine n-3 PUFAs and CV risk factors, educational level, physical activity and smoking habits. Methods A total of 3706 individuals from a general population, all born in 1950 and residing in Akershus County, Norway, were included in this study. The main statistical approach was multivariable adjusted linear regression. Results Plasma marine n-3 PUFA levels ranged from 2.7 to 20.3 wt%, with a median level of 7.7 wt% (interquartile range 4.3–11.1 wt%). High levels of plasma marine n-3 PUFAs were associated with lower serum triglycerides [Standardized regression coefficient (Std.β-coeff.) − 0.14, p < 0.001], body mass index (Std. β-coeff. −0.08, p < 0.001), serum creatinine (Std. β-coeff. -0.03, p = 0.05), C-reactive protein levels (Std. β-coeff. – 0.03, p = 0.04), higher levels of serum high-density lipoprotein cholesterol (Std. β-coeff. 0.08, p < 0.001) and low-density lipoprotein cholesterol (Std. β-coeff. 0.04, p = 0.003). High levels of plasma marine n-3 PUFAs were also associated with lower glycated hemoglobin (Std. β-coeff. – 0.04, p = 0.01), however, only in individuals without diabetes. We found no associations between plasma marine n-3 PUFA levels and fasting plasma glucose or carotid intima-media thickness. High levels of plasma marine n-3 PUFAs were associated with higher educational level, more physical activity and lower prevalence of smoking. Conclusion In this cross-sectional study of Norwegian individuals born in 1950, high levels of plasma marine n-3 PUFAs were favourably associated with several CV risk factors, suggesting that fish consumption might improve CV health.

• Vigen, Thea; Ihle-Hansen, Håkon; Lyngbakken, Magnus; Berge, Trygve; Thommessen, Bente & Ihle-Hansen, Hege [Vis alle 11 forfattere av denne artikkelen] (2019). Carotid Atherosclerosis is Associated with Middle Cerebral Artery Pulsatility Index. Journal of Neuroimaging (JON). ISSN 1051-2284. doi: 10.1111/jon.12684. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND AND PURPOSE Pulsatility index (PI) in the middle cerebral artery (MCA) is considered a measure of peripheral vascular resistance. Several established cardiovascular risk factors are common for both MCA PI and carotid atherosclerosis. Accordingly, in the present study we hypothesized an association between ultrasound‐derived indices of carotid atherosclerosis and MCA PI. METHODS All residents in Akershus County, born in 1950, were invited to a cardiovascular examination, The Akershus Cardiac Examination (ACE) 1950 Study (2012‐2015). A thorough ultrasound examination was performed to assess indices of atherosclerosis in the carotid arteries, and PI in the MCAs. In all, 3154 (85.1%) had adequate transcranial and carotid data. Associations between indices of carotid atherosclerosis and MCA PI were assessed by regression analyses adjusted for established cardiovascular risk factors. RESULTS Mean age was 64 (standard deviation [SD]: .6) years, and 1,357 (43%) were women. Mean MCA PI was .97 (SD: .17). Participants in the upper quartile of MCA PI had higher pulse pressure, more frequently hypertension, diabetes mellitus, and a history of coronary artery disease. Both carotid plaque score (B .007 [95% CI: .003‐.010]) and carotid intimamedia thickness (B .173 [95% CI: .120‐.226]) were significantly associated with MCA PI in adjusted analysis. The model R 2 was .055. CONCLUSION In a population‐based sample of middle‐aged adults, ultrasound‐derived indices of carotid atherosclerosis were independently associated with MCA PI. However, the overall explained variance of MCA PI was low, suggesting other factors than atherosclerosis and cardiovascular risk factors to play an important role for MCA PI.

• Vigen, Thea; Ihle-Hansen, Håkon; Lyngbakken, Magnus; Berge, Trygve; Thommessen, Bente & Ihle-Hansen, Hege [Vis alle 12 forfattere av denne artikkelen] (2019). Blood pressure at age 40 predicts carotid atherosclerosis two decades later: Data from the Akershus Cardiac Examination 1950 Study. Journal of Hypertension. ISSN 0263-6352. 37(10), s. 1982–1990. doi: 10.1097/HJH.0000000000002131. Fulltekst i vitenarkiv Vis sammendrag

  Objective: We assessed the impact of a single time-point measurement of SBP, DBP and pulse pressure at the age of 40, on carotid plaque burden, echolucent plaques and carotid intima–media thickness late midlife. Methods: Individuals participating in two separate studies, 23 years apart, defined our cohort (n = 2714). ‘The Age 40 Program’, a nationwide Norwegian cardiovascular screening survey, performed 1985–1999, assessed cardiovascular risk factors and lifestyle variables at age 40. ‘The ACE 1950 Study’, a population-based cohort study on individuals born in 1950, performed 2012–2015, included ultrasound examinations of the carotid arteries. Blood pressure (BP) determinants of carotid atherosclerosis were assessed by regression models adjusted for cardiovascular risk factors at age 40, and late midlife BP. Results: The participants, 50.3% women, had a mean age of 40 (SD 0.3) years in the first study, and 64 (SD 0.6) years in the second. At age 40, mean SBP was 128 (SD 14) mmHg, mean DBP was 78 (SD 10) mmHg and mean pulse pressure was 50 (SD 9) mmHg. SBP and DBP at age 40 predicted carotid plaque burden in late midlife. Only DBP predicted echolucent plaques, and none of the BP components predicted carotid intima–media thickness. Conclusion: A single time-point measurement of SBP and DBP at age 40 is associated with carotid plaque burden late midlife, also after adjustment for other cardiovascular risk factors at age 40, and of late midlife BP. Our findings emphasize the strong association between BP and atherosclerosis.

• Ihle-Hansen, Håkon; Vigen, Thea; Berge, Trygve; Hagberg, Guri; Engedal, Knut & Rønning, Ole M. [Vis alle 12 forfattere av denne artikkelen] (2019). Carotid Atherosclerosis and Cognitive Function in a General Population Aged 63-65 Years: Data from the Akershus Cardiac Examination (ACE) 1950 Study. Journal of Alzheimer's Disease. ISSN 1387-2877. 70(4), s. 1041–1049. doi: 10.3233/JAD-190327. Fulltekst i vitenarkiv Vis sammendrag

  Background:Studies on the relationship between carotid atherosclerosis and cognitive function in subjects from the general population are few and results have been inconsistent. Objective:We aimed to investigate the association between carotid atherosclerotic burden and cognitive function in a cross-sectional analysis of a population-based cohort aged 63–65 years. Methods:All habitants born in 1950 from Akershus County, Norway were invited to participate. A linear regression model was used to assess the association between carotid atherosclerosis and cognitive function. We used carotid plaque score as a measure of carotid atherosclerotic burden and the Montreal Cognitive Assessment (MoCA) for global cognitive function. Results:We analyzed 3,413 individuals aged 63–65 with mean MoCA score 25.3±2.9 and 87% visible carotid plaques. We found a negative correlation between carotid plaque score and MoCA score (r = –0.14, p < 0.001), but this association was lost in multivariable analysis. In contrast, diameter or area of the thickest plaque was independently associated with MoCA score. Lower educational level, male sex, current smoking, and diabetes were also associated with lower MoCA score in multivariable analysis. Conclusion:Carotid atherosclerotic burden was, unlike other measures of advanced carotid atherosclerosis, not independently associated with global cognitive function.

• Aagaard, Erika Nerdrum; Kvisvik, Brede Alexander; Pervez, Mohammad Omar; Lyngbakken, Magnus; Berge, Trygve & Enger, Steve [Vis alle 12 forfattere av denne artikkelen] (2019). Left ventricular mechanical dispersion in a general population: Data from the Akershus Cardiac Examination 1950 study. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 21. doi: 10.1093/ehjci/jez210. Fulltekst i vitenarkiv
• Seifert, Mariam B.; Olesen, Morten S.; Christophersen, Ingrid E.; Nielsen, Jonas B.; Carlson, Jonas & Holmqvist, Fredrik [Vis alle 10 forfattere av denne artikkelen] (2019). Genetic variants on chromosomes 7p31 and 12p12 are associated with abnormal atrial electrical activation in patients with early-onset lone atrial fibrillation. Annals of Noninvasive Electrocardiology. ISSN 1082-720X. 24. doi: 10.1111/anec.12661. Fulltekst i vitenarkiv
• Chandra, Anupam; Røsjø, Helge; Eide, Ivar Anders; Vigen, Thea; Ihle-Hansen, Håkon & Orstad, Eivind Bjørkan [Vis alle 13 forfattere av denne artikkelen] (2019). Plasma marine n-3 polyunsaturated fatty acids and cardiovascular risk factors: data from the ACE 1950 study. European Journal of Nutrition. ISSN 1436-6207. doi: 10.1007/s00394-019-02007-3. Fulltekst i vitenarkiv
• Myrstad, Marius; Malmo, Vegard; Ulimoen, Sara Reinvik; Tveit, Arnljot & Loennechen, Jan Pål (2019). Exercise in individuals with atrial fibrillation. Clinical Research in Cardiology. ISSN 1861-0684. 108(4), s. 347–354. doi: 10.1007/s00392-018-1361-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Despite the high prevalence of atrial fibrillation (AF), there is a lack of recommendations for physical activity and exercise in individuals with AF, including athletes with AF. Methods With the aim to review studies that have investigated effects and safety of exercise in individuals with AF, we conducted a literature search in Pubmed using the key words atrial fibrillation AND exercise OR physical activity OR exercise/adverse effects OR adverse outcome. Results Observational data from one registry suggest that regular exercise is associated with reduced mortality in AF patients. Three randomized controlled trials (RCTs) have demonstrated that 12-week exercise interventions might reduce the burden of AF and improve exercise capacity by 10–16% in patients with paroxysmal or persistent AF. Three small RCTs suggest that exercise might improve exercise capacity with 15–41% in patients with permanent AF. Exercise might improve quality of life in patients with AF. Data on safety of exercise are sparse. No studies have evaluated the effect of exercise in athletes with AF. Conclusions Despite weak evidence, we suggest that individuals with AF should exercise regularly after evaluation of underlying conditions. Recommendations should be individualized. There is a lack of data to support exercise recommendations in athletes with AF.

• Berge, Trygve; Lyngbakken, Magnus; Ihle-Hansen, Håkon; Brynildsen, Jon; Pervez, Mohammad Osman & Aagaard, Erika Nerdrum [Vis alle 14 forfattere av denne artikkelen] (2018). Prevalence of atrial fibrillation and cardiovascular risk factors in a 63-65 years old general population cohort: The Akershus Cardiac Examination (ACE) 1950 Study. BMJ Open. 8:e021704(7), s. 1–9. doi: 10.1136/bmjopen-2018-021704. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To investigate the sex-specific prevalence of atrial fibrillation (AF), including subclinical AF found by screening in a general population aged 63–65 years. The prevalence of cardiovascular risk factors and their association with AF will also be investigated. Methods: All participants underwent extensive cardiovascular examinations, including 12-lead ECG. History of AF and other cardiovascular diseases were self-reported. Subsequent validation of all reported or detected AF diagnoses was performed. Results: Mean age was 63.9±0.7 years. Prevalence of ECG-verified AF was 4.5% (women 2.4%, men 6.4%; p<0.001), including screen-detected AF in 0.3% (women 0.1%, men 0.6%; p<0.01). Hypertension was found in 62.0% (women 57.8%, men 66.0%; p<0.001). Overweight or obesity was found in 67.6% (women 59.8%, men 74.9%; p<0.001). By multivariate logistic regression, risk factors associated with AF were height (OR 1.67 per 10 cm; 95% CI 1.26 to 2.22; p<0.001), weight (OR 1.15 per 10 kg; 95% CI 1.01 to 1.30; p=0.03), hypertension (OR 2.49; 95% CI 1.61 to 3.86; p<0.001), heart failure (OR 3.51; 95% CI 1.71 to 7.24; p=0.001), reduced estimated glomerular filtration rate (OR 2.56; 95% CI 1.42 to 4.60; p<0.01) and at least one first-degree relative with AF (OR 2.32; 95% CI 1.63 to 3.31; p<0.001), whereas male sex was not significantly associated (OR 1.00; 95% CI 0.59 to 1.68; p=0.99). Conclusion: In this cohort from the general population aged 63–65 years, we found a higher prevalence of known AF than previously reported below the age of 65 years. The additional yield of single time point screening for AF was low. Body size and comorbidity may explain most of the sex difference in AF prevalence at this age.

• Roselli, Carolina; Chaffin, Mark D.; Weng, Lu-Chen; Aeschbacher, Stefanie; Ahlberg, Gustav & Albert, Christine M. [Vis alle 218 forfattere av denne artikkelen] (2018). Multi-ethnic genome-wide association study for atrial fibrillation. Nature Genetics. ISSN 1061-4036. s. 1–15. doi: 10.1038/s41588-018-0133-9. Fulltekst i vitenarkiv
• Ihle-Hansen, Håkon; Vigen, Thea; Ihle-Hansen, Hege; Rønning, Ole M.; Berge, Trygve & Thommessen, Bente [Vis alle 12 forfattere av denne artikkelen] (2018). Prevalence of carotid plaque in a 63- to 65-Year-Old Norwegian cohort from the general population: The ACE (Akershus Cardiac Examination) 1950 study. Journal of the American Heart Association (JAHA). 7(10). doi: 10.1161/JAHA.118.008562. Fulltekst i vitenarkiv Vis sammendrag

  Background New data on extracranial carotid atherosclerosis are needed, as improved ultrasound techniques may detect more atherosclerosis, the definition of plaque has changed over the years, and better cardiovascular risk control in the population may have changed patterns of carotid arterial wall disease and actual prevalence of established cardiovascular disease. We investigated the prevalence of atherosclerotic carotid plaques and carotid intima–media thickness (cIMT) and their relation to cardiovascular risk factors in a middle‐aged cohort from the general population. Methods and Results We performed carotid ultrasound in 3683 participants who were born in 1950 and included in a population‐based Norwegian study. Carotid plaque and cIMT were assessed according to the Mannheim Carotid Intima–Media Thickness and Plaque Consensus, and a carotid plaque score was used to calculate atherosclerotic burden. The participants were aged 63 to 65 years, and 49% were women. The prevalence of established cardiovascular disease was low (10%), but 62% had hypertension, 53% had hypercholesterolemia, 11% had diabetes mellitus, and 23% were obese. Mean cIMT was 0.73±0.11 mm, and atherosclerotic carotid plaques were present in 87% of the participants (median plaque score: 2; interquartile range: 3). Most of the cardiovascular risk factors, with the exception of diabetes mellitus, obesity and waist–hip ratio, were independently associated with the plaque score. In contrast, only sex, hypertension, obesity, current smoking, and cerebrovascular disease were associated with cIMT. Conclusions We found very high prevalence of carotid plaque in this middle‐aged population, and our data support a greater association between cardiovascular risk factors and plaque burden, compared with cIMT.

• Horjen, Anja Wiedswang; Ulimoen, Sara Reinvik; Norseth, Jon; Svendsen, Jesper Hastrup; Smith, Pål & Arnesen, Harald [Vis alle 8 forfattere av denne artikkelen] (2018). High-sensitivity troponine I in persistent atrial fibrillation - relation to NT-proBNP and markers of inflammation and haemostasis. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 78(5), s. 386–392. doi: 10.1080/00365513.2018.1481224. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: As cardiac troponins emerge as prognostic markers in atrial fibrillation (AF), it is important to identify mechanisms initiating and perpetuating cardiac troponin release, including its relations to other circulating biomarkers, in AF populations. We studied associations between high-sensitivity troponin I (hs-TnI) and markers representing myocardial wall tension, inflammation and haemostasis in persistent AF. Methods: In a double blind, placebo-controlled study, 171 patients referred for electrical cardioversion for persistent AF were randomised to receive candesartan or placebo for 3–6 weeks before and 6 months after cardioversion. Associations between baseline levels of hs-TnI and other biomarkers were investigated by bivariate non-parametric correlations (Spearman’s correlation coefficient denoted rs). Results: Baseline levels of hs-TnI correlated significantly, although weakly, with interleukin-6 (rs¼0.260, p¼.003), N-terminal pro-B-type natriuretic peptide (rs¼0.251, p¼.004), tissue-plasminogen activator antigen (rs¼0.233, p¼.008), D-dimer (rs¼0.220, p¼.013), E-selectin (rs¼0.207, p¼.019), high-sensitivity C-reactive protein (rs¼0.202, p¼.022) and vascular cell adhesion molecule-1 (rs¼0.189, p¼.032). Conclusions: Hs-TnI correlated weakly with biomarkers representing myocardial wall tension, inflammation and haemostasis in persistent AF. The lack of any strong correlation between hs-TnI and the investigated biomarkers is in concert with the idea that hs-TnI release is an independent process parallel to other pathophysiological mechanisms associated with AF. Abbreviations: AF: atrial fibrillation; CAPRAF study: CAndesartan in the Prevention of Relapsing Atrial Fibrillation study; CD40L: CD40 ligand; CHA2DS2-VASc score: a measure of stroke risk in patients with atrial fibrillation, with scores ranging from 0 to 9 and higher scores indicating greater risk; CV: coefficient of variation; hs-CRP: high-sensitivity C-reactive protein; ELISA: enzyme-linked immunosorbent assay; ETP: endogenous thrombin potential; hs-TnI: high-sensitivity troponin I; IL-6: interleukin-6; NTproBNP: N-terminal pro-B-type natriuretic peptide; F1þ2: prothrombin fragment 1þ2; TNF-a: tumour necrosis factor alpha; sTF: soluble tissue factor; t-PA antigen: tissue-plasminogen activator antigen; PAI- 1: plasminogen activator inhibitor type 1; VCAM-1: vascular cell adhesion molecule-1; vWF: von Willebrand factor; YKL-40: chitinase-3-like protein 1

• Laake, Kristian; Seljeflot, Ingebjørg; Schmidt, EB; Myhre, Peder Langeland; Tveit, Arnljot & Nordseth, Jon [Vis alle 8 forfattere av denne artikkelen] (2017). Galectin-3, a marker of cardiac remodeling, is inversely related to serum Levels of marine omega-3 fatty acids. A cross-sectional study. Journal of the Royal Society of Medicine Cardiovascular Disease. ISSN 0959-5287. 6, s. 1–7. doi: 10.1177/2048004017729984. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Marine polyunsaturated n-3 fatty acids (n-3 PUFA) may have cardioprotective effects and beneficial influence on the fibrotic process. We evaluated the associations between serum marine n-3 PUFA and selected biomarkers of fibrosis and cardiac remodeling in elderly patients with acute myocardial infarction. Setting: From the ongoing OMega-3 fatty acids in Elderly patients with Myocardial Infarction (OMEMI) trial, 299 patients were investigated. Soluble ST2 (sST2), Galectin-3 (Gal-3) and the serum content of major marine n-3 and n-6 PUFA were analyzed 2–8 weeks after the index acute myocardial infarction. Results: Gal-3 was inversely correlated to eicosapentaenoic acid (r = −.120, p = .039) and docosahexaenoic acid (r = −.125, p = .031) and positively correlated to the n-6/n-3 ratio (r = .131, p = .023). Gal-3 levels were significantly higher in diabetics vs non-diabetics (12.00 vs 9.61 ng/mL, p = .007) and in patients with NYHA class ≥III for dyspnea at inclusion (11.33 vs 9.75 ng/mL, p = .006). Conclusions: The associations between the marine n-3 PUFA and levels of Gal-3 indicate beneficial effects of n-3 PUFA on cardiac remodeling in an elderly population with acute myocardial infarction.

• Johansen, Odd Erik & Tveit, Arnljot (2017). Understanding modifiable risk factors for new onset atrial fibrillation: the knowledge gap is closing. AME Medical Journal. ISSN 2520-0518. doi: 10.21037/amj.2017.12.01. Fulltekst i vitenarkiv
• Berge, Trygve; Brynildsen, Jon; Larssen, Hege Kristin Netmangen; Onarheim, Sophia; Jenssen, Gaute Reier & Ihle-Hansen, Håkon [Vis alle 11 forfattere av denne artikkelen] (2017). Systematic screening for atrial fibrillation in a 65-year-old population with risk factors for stroke: data from the Akershus Cardiac Examination 1950 study. Europace. ISSN 1099-5129. 20(3), s. f299–f305. doi: 10.1093/europace/eux293. Fulltekst i vitenarkiv Vis sammendrag

  Aims To investigate the yield of screening for atrial fibrillation (AF) in a cohort of 65-year-old individuals from the general population with additional risk factors for stroke. Methods and results We invited participants with additional risk factors for stroke (CHA2DS2-VASc score ≥2 for men or ≥ 3 for women) without previously known AF from a population-based study in Norway to participate in a 2-week screening for AF. Screening was performed by one-lead ‘thumb electrocardiography (ECG)’ recordings of 30 s twice daily or when the participants experienced symptoms. In total, 1742 (47.0%) participants of the Akershus Cardiac Examination (ACE) 1950 study had at least one additional risk factor for stroke. Of these, 123 cases reported a history of AF and 101 (5.8%) cases were ECG validated. Eight [0.5%, 95% confidence interval (CI) 0.2–0.9] new AF cases were diagnosed by 12-lead ECG at baseline, and 10 additional participants were diagnosed with AF before screening commenced. We invited all 1601 participants who met the inclusion criteria for screening, of which 1510 (94.3%) participants were included (44% women and 56% men). The screening revealed AF in 13 (0.9%, 95% CI 0.5–1.5) participants. The total prevalence of ECG-validated AF after screening among the 65-year-olds with risk factors for stroke was 7.6% (95% CI 6.4–8.9), in men 10.0% (95% CI 8.2–12.0), and in women 4.3% (95% CI 3.0–6.1) (P < 0.001). Conclusion In a group of 1510 well-characterized 65-year-olds with risk factors for stroke, 2-week intermittent ECG screening identified undiagnosed AF in 0.9%. The total prevalence of AF was 7.6%

• Freedman, Ben; Camm, John; Calkins, Hugh; Healey, Jeffrey S.; Rosenqvist, Mårten & Wang, Jiguang [Vis alle 59 forfattere av denne artikkelen] (2017). Screening for Atrial Fibrillation. A Report of the AF-SCREEN International Collaboration. Circulation. ISSN 0009-7322. 135(19), s. 1851–1867. doi: 10.1161/CIRCULATIONAHA.116.026693. Fulltekst i vitenarkiv
• Ihle-Hansen, Håkon; Vigen, Thea; Berge, Trygve; Einvik, Gunnar; Aarsland, Dag & Rønning, Ole M. [Vis alle 10 forfattere av denne artikkelen] (2017). Montreal Cognitive Assessment in a 63- to 65-year-old Norwegian Cohort from the General Population: Data from the Akershus Cardiac Examination 1950 Study. Dementia and Geriatric Cognitive Disorders Extra. 7(3), s. 318–327. doi: 10.1159/000480496. Fulltekst i vitenarkiv Vis sammendrag

  Aims: To investigate Montreal Cognitive Assessment (MoCA) test scores in a cohort aged 63–65 years from a general population in relation to the proposed cut-off score of 26 for mild cognitive impairment (MCI) and to explore the impact of education. Methods: MoCA scores were assessed in the Akershus Cardiac Examination 1950 Study, a cross-sectional cohort study of all men and women born in 1950 living in Akershus County, Norway. The participants were aged 63–65 at the time of data collection. Results: MoCA scores were available in 3,413 participants, of which 47% had higher education (>12 years). The mean MoCA score was 25.3 (95% confidence interval [CI] 25.2–25.4), and 49% had a score below the suggested cut-off of 26 points. Those with higher education had significantly higher scores (mean 26.2, 95% CI 26.1–26.3 vs. 24.4, 95% CI 24.3–24.6, p < 0.001). Conclusions: Approximately 50% scored below the cut-off score of 26 points, suggesting that the cut-off score may have been set too high to distinguish normal cognitive function from MCI. Educational level had a significant impact on MoCA scores.

• Horjen, Anja Wiedswang; Seljeflot, Ingebjørg; Berge, Trygve; Smith, Pål; Arnesen, Harald & Tveit, Arnljot (2017). Effect of sinus rhythm restoration on markers of thrombin generation in atrial fibrillation. Thrombosis Journal. 15(1). doi: 10.1186/s12959-017-0153-1. Fulltekst i vitenarkiv Vis sammendrag

  Background Atrial fibrillation (AF) confers a hypercoagulable state; however, it is not clear whether restoration of sinus rhythm is associated with normalisation of markers of thrombogenesis. We studied the impact of sustained sinus rhythm on prothrombotic markers, and their predictive abilities in foreseeing rhythm outcome after cardioversion. Methods In a double blind, placebo-controlled study, 171 patients referred for electrical cardioversion of persistent AF were randomised to receive candesartan or placebo for 3-6 weeks before and 6 months after cardioversion. Endogenous thrombin potential (ETP), prothrombin fragment 1 + 2 (F1 + 2) and D-dimer were measured before cardioversion and at end of study. These markers were also measured in a reference group comprising 49 subjects without AF. Results The markers remained unchanged in those 28 patients who maintained sinus rhythm. Discontinuation of warfarin treatment in a subset of 13 low-risk patients in sinus rhythm was associated with significantly higher levels of D-dimer and F1 + 2 compared to the reference group; D-dimer (456 ng/mL (276, 763) vs. 279 ng/mL (192, 348), p = 0.002) and F1 + 2 (700 pmol/L (345, 845) vs. 232 pmol/L (190, 281), p < 0.001). None of the markers were associated with rhythm outcome after electrical cardioversion. Conclusions Sustained sinus rhythm for 6 months after cardioversion for AF had no impact on ETP, F1 + 2 or D-dimer levels. Discontinuation of warfarin in low-risk patients with sustained sinus rhythm was associated with significantly higher levels of D-dimer and F1 + 2 compared to the reference group. Our results suggest persistent hypercoagulability in AF patients despite long-term maintenance of sinus rhythm. Trial registration The CAPRAF study was registered at clinicaltrials.gov (NCT00130975) in August 2005.

• Laake, Kristian; Seljeflot, Ingebjørg; Schmidt, Erik Berg; Myhre, Peder Langeland; Tveit, Arnljot & Arnesen, Harald [Vis alle 7 forfattere av denne artikkelen] (2016). Serum fatty acids, traditional risk factors and comorbidity as related to nyocardial injury in an elderly population with acute myocardial infarction. Journal of Lipids. ISSN 2090-3030. 2016. doi: 10.1155/2016/4945720. Fulltekst i vitenarkiv
• Horjen, Anja Wiedswang; Ulimoen, Sara Reinvik; Enger, Steve; Norseth, Jon; Seljeflot, Ingebjørg & Arnesen, Harald [Vis alle 7 forfattere av denne artikkelen] (2016). Troponin I levels in permanent atrial fibrillation-impact of rate control and exercise testing. BMC Cardiovascular Disorders. 16(1). doi: 10.1186/s12872-016-0255-x. Fulltekst i vitenarkiv
• Horjen, Anja Wiedswang; Ulimoen, Sara Reinvik; Enger, Steve; Berge, Trygve; Ihle-Hansen, Håkon & Norseth, Jon [Vis alle 7 forfattere av denne artikkelen] (2015). Impact of atrial fibrillation on levels of high-sensitivity troponin I in a 75-year-old population. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 75(4), s. 308–313. doi: 10.3109/00365513.2015.1011224. Fulltekst i vitenarkiv
• Sandberg, Frida A.; Corino, Valentina D; Mainardi, Luca T.; Ulimoen, Sara Reinvik; Enger, Steve & Tveit, Arnljot [Vis alle 8 forfattere av denne artikkelen] (2015). Non-invasive assessment of the effect of beta blockers and calcium channel blockers on the AV node during permanent atrial fibrillation. Journal of Electrocardiology. ISSN 0022-0736. 48(5), s. 861–866. doi: 10.1016/j.jelectrocard.2015.07.019. Fulltekst i vitenarkiv
• Corin, Valentina D. A.; Platonov, Pyotr G.; Enger, Steve; Tveit, Arnljot & Ulimoen, Sara Reinvik (2015). Circadian variation of variability and irregularity of heart rate in patients with permanent atrial fibrillation: Relation to symptoms and rate control drugs. American Journal of Physiology. Heart and Circulatory Physiology. ISSN 0363-6135. 309(12), s. H2152–H2157. doi: 10.1152/ajpheart.00300.2015. Fulltekst i vitenarkiv
• Berge, Trygve; Vigen, Thea; Pervez, Mohammad Omar; Ihle-Hansen, Håkon; Lyngbakken, Magnus Nakrem & Omland, Torbjørn [Vis alle 10 forfattere av denne artikkelen] (2015). Heart and brain interactions - the Akershus Cardiac Examination (ACE) 1950 study design. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 49(6), s. 308–315. doi: 10.3109/14017431.2015.1086813. Fulltekst i vitenarkiv
• Ursin, Marie Helene; Bergland, Astrid; Fure, Brynjar; Tørstad, Audhild; Tveit, Arnljot & Ihle-Hansen, Hege (2015). Balance and Mobility as Predictors of Post-Stroke Cognitive Impairment. Dementia and Geriatric Cognitive Disorders Extra. 5(2). doi: 10.1159/000381669. Fulltekst i vitenarkiv Vis sammendrag

  Background: The number of patients with cognitive impairment following stroke is increasing due to the rise in the number of stroke survivors. Health authorities highlight the need for prediction and early diagnostics. The aims of this study were to investigate if balance and mobility may predict cognitive impairment 1 year after stroke. Methods: The participants were patients with first-ever stroke or transient ischaemic attack (TIA). The exclusion criteria were pre-stroke cognitive impairment and dementia. Measurements of balance comprised the Berg Balance Scale (BBS) and the Figure of Eight test (Fig8). Mobility was measured by maximum walking speed and the Timed Up and Go test. Dementia and mild cognitive impairment were merged into a main outcome: cognitive impairment. Unadjusted and adjusted multivariate logistic regression models were performed. Results: One hundred and eighty subjects performed balance and mobility measures at baseline, and 158 participated in the follow-up; 13 died and 9 did not complete the follow-up. Two variables made a significant contribution in the adjusted analyses (Fig8, BBS). The strongest predictor of cognitive impairment was Fig8 with an odds ratio of 1.06. Conclusion: The results of Fig8 and BBS measured in the acute phase of stroke were predictors of cognitive impairment 1 year later in this cohort of firstever stroke or TIA.

• Ursin, Marie Helene; Ihle-Hansen, Hege; Fure, Brynjar; Tveit, Arnljot & Bergland, Astrid (2015). Effects of premorbid physical activity on stroke severity and post-stroke functioning. Journal of Rehabilitation Medicine. ISSN 1650-1977. 47(7), s. 612–617. doi: 10.2340/16501977-1972. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To explore the impact of premorbid physical ac - tivity on stroke severity and functioning, measured by activi - ties of daily living, gait and balance during the acute period of first-ever stroke and at one-year follow-up. Methods: Acute phase and one-year follow-up registrations of 183 patients with first-ever stroke or transient ischaemic attack were included in the study. Gender, age, education, living arrangements, body mass index, smoking, hyperten - sion, stroke classification and use of walking aids were re - corded. Premorbid physical activity was recorded with the Walking Habits questionnaire. The outcomes post-stroke were the National Institutes of Health Stroke Scale, the Mod - ified Ranking Scale, Barthel ADL Index, Maximal Walking Speed and Berg Balance Scale. Results: Significant associations ( p < 0.05) were found be - tween the participants` pre-stroke “duration of regular walks” and functioning on all outcomes in the acute phase of stroke. Participants who walked for more than 30 min each time achieved significantly better results. The measures of gait and balance showed similar associations ( p < 0.05) at one-year follow-up. Conclusion: There are significant associations between pre - morbid walking habits and functional status after first-ever stroke. Weekly light-intensity activity, such as walking for more than 30 min, may have a sustained impact on function - ing after stroke.

• Horjen, Anja Wiedswang; Ulimoen, Sara Reinvik; Seljeflot, Ingebjørg; Smith, Pål; Arnesen, Harald & Norseth, Jon [Vis alle 7 forfattere av denne artikkelen] (2015). High-sensitivity troponin I and rhythm outcome after electrical cardioversion for persistent Atrial fibrillation. Cardiology. ISSN 0008-6312. 133(4), s. 233–238. doi: 10.1159/000442249. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: We hypothesised that high-sensitivity troponin I (hs-TnI) might predict long-term rhythm outcome after cardioversion for persistent atrial fibrillation (AF), and that maintenance of sinus rhythm and/or treatment with the angiotensin II type 1 receptor blocker candesartan would reduce hs-TnI levels. Methods: In a double-blind, placebo-controlled study, 171 patients referred for electrical cardioversion for AF were randomised to receive candesartan or placebo for 3-6 weeks before cardioversion and for 6 months after electrical cardioversion. Blood samples for analysis of hs-TnI (Abbott Diagnostics) were available in 129 patients at baseline and in 60 successfully cardioverted patients at study end. Results: Hs-TnI was detectable in all subjects, with a median value of 5.3 ng/l (25th percentile 3.7, 75th percentile 7.2). hs-TnI at baseline was not predictive of rhythm outcome 6 months after electrical cardioversion for persistent AF. Treatment with candesartan did not influence the levels of hs-TnI. hs-TnI was unchanged from baseline to study end in patients who maintained sinus rhythm [4.9 (3.7, 7.0) and 5.0 (4.0, 6.4) ng/l, respectively; p = 0.699). Conclusions: hs-TnI did not predict AF recurrence after cardioversion. hs-TnI levels were unchanged in patients maintaining sinus rhythm for 6 months after electrical cardioversion. hs-TnI levels were not influenced by treatment with candesartan.

• Corino, Valentina D; Ulimoen, Sara Reinvik; Enger, Steve; Mainardi, Luca T.; Tveit, Arnljot & Platonov, Pyotr G. (2014). Modification of atrioventricular node conduction increases RR variability but not RR irregularity in atrial fibrillation patients. Computing in cardiology. ISSN 2325-8861. 41(January), s. 821–824. doi: 10.1111/jce.12580. Fulltekst i vitenarkiv
• Kristiansen, Annette; Brandt, Linn; Agoritsas, Thomas; Akl, Elie A.; Berge, Eivind & Bondi, Johan Fridtjof [Vis alle 19 forfattere av denne artikkelen] (2014). Adaptation of trustworthy guidelines developed using the GRADE methodology: a novel five-step process. Chest. ISSN 0012-3692. 146(3), s. 727–734. doi: 10.1378/chest.13-2828. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: Adaptation of guidelines for use at the national or local level can facilitate their implementation. We developed and evaluated an adaptation process in adherence with standards for trustworthy guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, aiming for efficiency and transparency. This article is the first in a series describing our adaptation of Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines for a Norwegian setting. METHODS: Informed by the ADAPTE framework, we developed a five-step adaptation process customized to guidelines developed using GRADE: (1) planning, (2) initial assessment of the recommendations, (3) modification, (4) publication, and (5) evaluation. We developed a taxonomy for describing how and why recommendations from the parent guideline were modified and applied a mixed-methods case study design for evaluation of the process. RESULTS: We published the adapted guideline in November 2013 in a novel multilayered format. The taxonomy for adaptation facilitated transparency of the modification process for both the guideline developers and the end users. We excluded 30 and modified 131 of the 333 original recommendations according to the taxonomy and developed eight new recommendations. Unforeseen obstacles related to acquiring a licensing agreement and procuring a publisher resulted in a 9-month delay. We propose modifications of the adaptation process to overcome these obstacles in the future. CONCLUSIONS: This case study demonstrates the feasibility of a novel guideline adaptation process. Replication is needed to further validate the usefulness of the process in increasing the organizational and methodologic efficiency of guideline adaptation.

• Corino, Valentina D; Sandberg, Frida A.; Platonov, Pyotr G.; Mainardi, Luca T.; Ulimoen, Sara Reinvik & Enger, Steve [Vis alle 8 forfattere av denne artikkelen] (2014). Non-invasive evaluation of the effect of metoprolol on the atrioventricular node during permanent atrial fibrillation. Europace. ISSN 1099-5129. Suppl(16), s. iv129–iv134. doi: 10.1093/europace/euu246. Fulltekst i vitenarkiv
• Corino, Valentina D; Ulimoen, Sara Reinvik; Enger, Steve; Mainardi, Luca T.; Tveit, Arnljot & Platonov, Pyotr G (2014). Rate-Control drugs affect variability and irregularity measures of RR intervals in patients with permanent atrial fibrillation. Cardiovascular Electrophysiology. ISSN 1045-3873. 26(2), s. 137–141. doi: 10.1111/jce.12580. Fulltekst i vitenarkiv
• Laake, Kristian; Myhre, Peder Langeland; Nordby, Linn Marie; Seljeflot, Ingebjørg; Abdelnoor, Michael & Smith, Pål [Vis alle 9 forfattere av denne artikkelen] (2014). Effects of omega 3 supplementation in elderly patients with acute myocardial infarction: Design of a prospective randomized placebo controlled study. BMC Geriatrics. 14(1). doi: 10.1186/1471-2318-14-74. Fulltekst i vitenarkiv

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• Kvalvaag, Elisabeth Myrset; Maltzahn, Niklas Nyboe; Hjellvik, Vidar; Anjum, Mariam; Skovlund, Eva & Wisløff, Torbjørn [Vis alle 17 forfattere av denne artikkelen] (2026). Factors associated with initiation of oral anticoagulants in atrial fibrillation. Fulltekst i vitenarkiv
• Nes, Bjarne Martens; Letnes, Jon Magne; Johnson, Kristin Espolin; Sellevold, Andreas Berg; Byrkjeland, Rune & Brown, Fedelix Phetogo [Vis alle 14 forfattere av denne artikkelen] (2025). Effects of 1-year exercise in patients with atrial fibrillation: Study protocol for the Norwegian Exercise in Atrial Fibrillation (NEXAF) randomised controlled trial. doi: 10.1136/openhrt-2024-003077. Fulltekst i vitenarkiv
• Myrstad, Marius; Apelland, Turid; Letnes, Jon Magne; Enger, Steve; Onarheim, Sophia & Sellevold, Andreas Berg [Vis alle 13 forfattere av denne artikkelen] (2023). Temporal relationship between training and episodes of atrial fibrillation in endurance athletes. European Heart Journal, Supplement. ISSN 1520-765X. doi: 10.1093/eurheartj/ehad655.2608. Fulltekst i vitenarkiv
• Apelland, Turid; Janssens, Kristel; Loennechen, Jan Pål; Claessen, Guido; Sørensen, Eivind & Mitchell, Amy [Vis alle 14 forfattere av denne artikkelen] (2023). Effects of training adaption in endurance athletes with atrial fibrillation: Protocol for a multicentre randomised controlled trial. BMJ Open sport & exercise medicine. 9(2). doi: 10.1136/bmjsem-2023-001541. Fulltekst i vitenarkiv Vis sammendrag

  Endurance athletes have a high prevalence of atrial fibrillation (AF), probably caused by exercise-induced cardiac remodelling. Athletes diagnosed with AF are often advised to reduce the intensity and amount of training but the efficacy of this intervention has not been investigated in endurance athletes with AF. Effects of detraining in endurance athletes with atrial fibrillation is a two-arm international multicentre randomised (1:1) controlled trial on the effects of a period of training adaption on AF burden in endurance athletes with paroxysmal AF. One-hundred-and-twenty endurance athletes diagnosed with paroxysmal AF are randomised to a 16-week period of intervention (training adaption) or a control group. We define training adaption as training with a heart rate (HR) not exceeding 75% of the individual maximum HR (HRmax), and total duration of weekly training not exceeding 80% of the self-reported average before the study. The control group is instructed to uphold training intensity including sessions with HR ≥85% of HRmax. AF burden is monitored with insertable cardiac monitors, and training intensity with HR chest-straps and connected sports watches. The primary endpoint, AF burden, will be calculated as the cumulative duration of all AF episodes lasting ≥30sec divided by total duration of monitoring. Secondary endpoints include number of AF episodes, adherence to training adaption, exercise capacity, AF symptoms and health-related quality of life, echocardiographic signs of cardiac remodelling and risk of cardiac arrhythmias related to upholding training intensity.

• Rønningen, Peter Selmer; Walle-Hansen, Marte; Ihle-Hansen, Håkon; Heide, Jens Bendiks Bremnes; Rønning, Else Johanne & Andersen, Elizabeth Lyster [Vis alle 9 forfattere av denne artikkelen] (2023). Sykdomsforløp blant pasienter innlagt på Bærum sykehus med deltaog omikronvariantene av SARS-CoV-2-viruset. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(10). doi: 10.4045/tidsskr.22.0808. Fulltekst i vitenarkiv Vis sammendrag

  BAKGRUNN Covid-19-pandemien har hatt form av smittebølger. En smittebølge dominert av deltavarianten av SARS-CoV-2-viruset høsten 2021 ble i løpet av få uker rundt jul avløst av en ny smittebølge med omikronvarianten. Vi beskriver hvordan overgangen påvirket pasientpopulasjonen innlagt med covid-19 på et norsk lokalsykehus. MATERIALE OG METODE Alle pasienter innlagt ved Bærum sykehus med påvist SARS-CoV-2-virus ble inkludert i en kvalitetsstudie med mål om å beskrive pasientkarakteristika og sykdomsforløp. Vi presenterer pasienter innlagt i periodene 28.6.2021–31.12.2021 og 1.1.2022–12.6.2022, her omtalt som henholdsvis deltabølgen og omikronbølgen. RESULTATER I alt 144 innlagte pasienter fikk påvist SARS-CoV-2-viruset under deltabølgen og 261 under omikronbølgen. Henholdsvis 14/144 (10 %) og 89/261 (34 %) var innlagt av annen årsak enn covid-19. Pasienter med covid-19 under deltabølgen var i gjennomsnitt yngre (59 år vs. 69 år) samt hadde lavere skår på Charlsons komorbiditetsindeks (2,6 vs. 4,9) og på klinisk skrøpelighetsskala (2,8 vs. 3,7) enn dem i omikronbølgen. Blant 302/405 pasienter innlagt med covid-19 som hoveddiagnose var det 88/130 (68 %) med respirasjonssvikt under deltabølgen og 59/172 (34 %) under omikronbølgen, med median antall sykehusdøgn på henholdsvis 8 (interkvartilbredde 5–15) og 5 (interkvartilbredde 3–8). FORTOLKNING Overgangen fra smittebølgen dominert av deltavarianten til smittebølgen dominert av omikronvarianten påvirket i stor grad karakteristika og sykdomsforløp hos pasienter innlagt på sykehuset med SARS-CoV-2-infeksjon.

• Myrstad, Marius; Vandvik, Inger Helene; Engebretsen, Erik Hauge & Tveit, Arnljot (2017). Hjerneslag etter seponering av nye antikoagulasjonsmidler før kirurgi. 137(23/24), s. 1878–1880. doi: 10.4045/tidsskr.17.0532. Fulltekst i vitenarkiv

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