Gunnar Einvik

• Stavem, Knut; Einvik, Gunnar; Lerum, Tøri Vigeland; Meltzer, Carin; Rivero, Jezabel Rodriguez & Ashraf, Haseem [Vis alle 10 forfattere av denne artikkelen] (2026). Long-term chest CT abnormalities up to 4.5 years after COVID-19 hospitalization and their association with dyspnea and fatigue: a prospective cohort study. Respiratory Research. ISSN 1465-9921. 27(1). doi: 10.1186/s12931-026-03771-7. Fulltekst i vitenarkiv
• Søyseth, Vidar; Henneberger, Paul K.; Lindstrøm, Jonas Christoffer; Virji, Mohammed Abbas; Einvik, Gunnar & Bakke, Berit [Vis alle 7 forfattere av denne artikkelen] (2026). Exposure to Polycyclic Aromatic Hydrocarbons, but Not to Dust or Fluorides, in the Norwegian Aluminum Industry Is Associated With Accelerated Annual Decline in Lung Function. American Journal of Industrial Medicine. ISSN 0271-3586. 69(8), s. 674–682. doi: 10.1002/ajim.70102.
• Feng, Xin; Sigurdardottir, Fjola Dögg Hugberg; Arnardottir, Erna Sif; Dammen, Toril; Einvik, Gunnar & Korkalainen, Henri [Vis alle 15 forfattere av denne artikkelen] (2026). Association of major adverse cardiovascular events with the apnea-hypopnea index, desaturation severity parameters, and cardiac troponins in participants of the Akershus Sleep APnea cohort. Sleep. ISSN 0161-8105. 49(8). doi: 10.1093/sleep/zsag013. Fulltekst i vitenarkiv Vis sammendrag

  Study Objectives: To examine the prognostic value of the apnea-hypopnea index (AHI), desaturation severity parameters, and cardiac troponins alone and combined for major cardiovascular events (MACEs). Methods: MACE data were retrieved in 2021 from the Norwegian Patient Registry for 518 participants in the Akershus Sleep APnea (ASAP) cohort. Baseline polysomnography and fasting blood samples were collected between June 2006 and January 2008. Desaturation duration (DesDur) and severity (DesSev) were calculated using Automatic Blood Oxygen Saturation Analysis software. Cox regression models estimated hazard ratios (HRs) for MACE. Predictive properties of combining troponins and obstructive sleep apnea severity were calculated by comparing established clinical thresholds for cardiac troponin I (cTnI) and T (cTnT) with AHI clinical thresholds of ≥15 and ≥30, respectively. Results: High AHI, DesDur, DesSev, cTnI, and cTnT were associated with increased MACE risk. However, only cTnI independently predicted MACE after adjustment (HR: 1.74, 95% CI: 1.32–2.29). The HR for MACE was 2.68 (95% CI: 1.03–6.97) in patients with both high cTnI and AHI ≥30 events/h. Conclusion: In this 15-year follow-up, cTnI was independently associated with risk of MACE, whereas the AHI, desaturation parameters, and cTnT were not independent predictors. cTnI, especially when combined with AHI, was a stronger MACE predictor than cTnT. Provided our findings are validated in clinical obstructive sleep apnea populations, the measurement of cTnI may be considered for cardiovascular risk stratification.

• Neumann, Kirill; Hovind, Magrit Jarlsdatter; Berdal, Jan-Erik; Dalgard, Olav; Leegaard, Truls Michael & Siljan, William Ward [Vis alle 8 forfattere av denne artikkelen] (2026). Acute Respiratory Failure and Ventilatory Support in Hospitalized Adults With Viral Respiratory Infection: A Retrospective Cohort Study. Open Forum Infectious Diseases. 13(4). doi: 10.1093/ofid/ofag189. Fulltekst i vitenarkiv
• Hardang, Ingrid Marie; Neumann, Kirill; Gjønnes, Geir Tormod; Strand, Trond-Eirik; Ashraf, Haseem & Einvik, Gunnar (2026). Biomarker-Defined Iron Deficiency in Heavy Smokers with and without COPD and/or Emphysema. The International Journal of Chronic Obstructive Pulmonary Disease. ISSN 1176-9106. Volume 21, s. 1–11. doi: 10.2147/copd.s573503. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Assess whether iron deficiency prevalence in heavy smokers is higher in presence of COPD and/or emphysema, how the prevalence of iron deficiency is impacted by the biomarker used to define it, and examine the prevalence of anemia and polycythemia in heavy smokers with or without COPD. Patients and Methods: A cross-sectional analysis was conducted on 1002 participants from the Norwegian Early Lung Cancer Screening study. All participants underwent chest CT scans, spirometry, and venous blood sampling to analyze iron-related parameters, C-reactive protein (CRP), and hemoglobin. Iron deficiency was defined using transferrin saturation (TSat) < 20%, ferritin < cutoff (CRP-dependent), or a combination of both. Results: The prevalence of iron deficiency varied from 3% to 30%, being highest when defined by TSat < 20%, and was more prevalent in participants with COPD. Emphysema was not associated with iron deficiency. Decreasing hemoglobin, increasing soluble transferrin receptor (sTfR) and CRP were associated with TSat < 20%. COPD was not independently associated with iron deficiency. Increasing age and sTfR, along with female sex, were associated with ferritin < cutoff. Anemia was more common than polycythemia, with approximately one-third of anemia cases attributable to iron deficiency. Conclusion: Iron deficiency was more prevalent in heavy smokers with COPD than in those without, but not in individuals with emphysema. TSat < 20% identified significantly more cases of iron deficiency than ferritin < cutoff. Eight percent of participants had anemia, while four percent had polycythemia, with neither condition related to COPD or emphysema.

• 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

• Hardang, Ingrid Marie; Benth, Jurate Saltyte; Moe, Morten Kaare; Kononova, Natalia; Søyseth, Vidar & Einvik, Gunnar (2025). Hepcidin Isoforms in Chronic Obstructive Pulmonary Disease Compared with the General Population. The Journal of Applied Laboratory Medicine (JALM). ISSN 2576-9456. 10(5), s. 1265–1278. doi: 10.1093/jalm/jfaf095. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Hepcidin (Hep), a major regulator of iron metabolism, has several isoforms whose biological functions remain unknown. In chronic obstructive pulmonary disease (COPD) several factors, such as inflammation and hypoxemia, stimulate or inhibit Hep production. Our aims were to assess the isoform concentrations in COPD, explore the associations between the isoforms and pathophysiological variables, and assess the effect of initiation of long-term oxygen treatment (LTOT) on Hep concentrations. Methods The study population constituted 84 patients with COPD and 59 non-COPD participants. Hep isoforms, parameters of inflammation and iron status, and partial pressures of arterial oxygen (pO2) were measured at baseline and at 6-months follow-up in COPD patients. Associations between isoforms and clinical and biochemical characteristics were examined by multivariable tobit regression, while tobit regression with random effects was used to assess whether initiation of LTOT influenced the isoforms. Results At least one isoform was detected in 96% of the participants, of which Hep25 was the most and Hep22 the least common. All isoforms were associated with C-reactive protein and ferritin. Hep25 and Hep24 were also associated with transferrin saturation, and Hep24 was associated with urine albumin-creatinine ratio. None of the isoforms were associated with hemoglobin, pO2, smoking, or COPD. There was a significant reduction of Hep25 and Hep24 from baseline to follow-up. Conclusions All isoforms were associated with inflammation, while Hep25 and Hep24 were associated with circulating iron and Hep24 with kidney disease. The concentrations of Hep isoforms were not associated with COPD, nor did initiation of LTOT result in significant changes of isoform concentrations.

• Hardang, Ingrid Marie; Søyseth, Vidar; Kononova, Natalia; Hagve, Tor Arne & Einvik, Gunnar (2024). COPD: Iron Deficiency and Clinical Characteristics in Patients With and Without Chronic Respiratory Failure. Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation. 11(3), s. 261–269. doi: 10.15326/jcopdf.2023.0477. Fulltekst i vitenarkiv
• Folkvord, Frans; Würth, Ana Roca-Umbert; Houten, Karlijn van; Liefveld, Aad R.; Carlson, Jim Ingebretsen & Bol, Nadine [Vis alle 26 forfattere av denne artikkelen] (2024). A systematic review on experimental studies about patient adherence to treatment. Pharmacology Research & Perspectives. 12(1). doi: 10.1002/prp2.1166. Fulltekst i vitenarkiv Vis sammendrag

  A better understanding of patients' adherence to treatment is a prerequisite to maximize the benefit of healthcare provision for patients, reduce treatment costs, and is a key factor in a variety of subsequent health outcomes. We aim to understand the state of the art of scientific evidence about which factors influence patients' adherence to treatment. A systematic literature review was conducted using PRISMA guidelines in five separate electronic databases of scientific publications: PubMed, PsycINFO (ProQuest), Cochrane library (Ovid), Google Scholar, and Web of Science. The search focused on literature reporting the significance of factors in adherence to treatment between 2011 and 2021, including only experimental studies (e.g., randomized controlled trials [RCT], clinical trials, etc.). We included 47 experimental studies. The results of the systematic review (SR) are grouped according to predetermined categories of the World Health Organization (WHO): socioeconomic, treatment, condition, personal, and healthcare-related factors. This review gives an actual overview of evidence-based studies on adherence and analyzed the significance of factors defined by the WHO classification. By showing the strength of certain factors in several independent studies and concomitantly uncovering gaps in research, these insights could serve as a basis for the design of future adherence studies and models.

• 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
• Øvrebotten, Tarjei; Mecinaj, Albulena; Stavem, Knut; Ghanima, Waleed; Brønstad, Eivind & Durheim, Michael Thomas [Vis alle 14 forfattere av denne artikkelen] (2024). Trajectory of cardiac troponin T following moderate-to-severe COVID-19 and the association with cardiac abnormalities. BMC Cardiovascular Disorders. 24(1). doi: 10.1186/s12872-024-03854-7. Fulltekst i vitenarkiv Vis sammendrag

  Background COVID-19 has been associated with cardiac troponin T (cTnT) elevations and changes in cardiac structure and function, but the link between cardiac dysfunction and high-sensitive cardiac troponin T (hs-cTnT) in the acute and convalescent phase is unclear. Objective To assess whether hs-cTnT concentrations are associated with cardiac dysfunction and structural abnormalities after hospitalization for COVID-19, and to evaluate the performance of hs-cTnT to rule out cardiac pathology. Methods Patients hospitalized with COVID-19 had hs-cTnT measured during the index hospitalization and after 3-and 12 months, when they also underwent an echocardiographic study. A subset also underwent cardiovascular magnetic resonance imaging (CMR) after 6 months. Cardiac abnormalities were defined as left ventricular hypertrophy or dysfunction, right ventricular dysfunction, or CMR late gadolinium. Results We included 189 patients with hs-cTnT concentrations measured during hospitalization for COVID-19, and after 3-and 12 months: Geometric mean (95%CI) 13 (11–15) ng/L, 7 (6–8) ng/L and 7 (6–8) ng/L, respectively. Cardiac abnormalities after 3 months were present in 45 (30%) and 3 (8%) of patients with hs-cTnT ≥ and < 5 ng/L at 3 months, respectively (negative predictive value 92.3% [95%CI 88.5–96.1%]). The performance was similar in patients with and without dyspnea. Hs-cTnT decreased from hospitalization to 3 months (more pronounced in intensive care unit-treated patients) and remained unchanged from 3 to 12 months, regardless of the presence of cardiac abnormalities. Conclusion Higher hs-cTnT concentrations in the convalescent phase of COVID-19 are associated with the presence of cardiac pathology and low concentrations (< 5 ng/L) may support in ruling out cardiac pathology following the infection.

• Aaløkken, Trond Mogens; Ashraf, Haseem; Einvik, Gunnar; Lerum, Tøri Vigeland; Meltzer, Carin & Rivero, Jezabel Rodriguez [Vis alle 8 forfattere av denne artikkelen] (2024). CT abnormalities 3 and 12 months after hospitalization for COVID-19 and association with disease severity: A prospective cohort study. PLOS ONE. 19(5). doi: 10.1371/journal.pone.0302896. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To investigate changes in chest CT between 3 and 12 months and associations with disease severity in patients hospitalized for COVID-19 during the first wave in 2020. Materials and methods Longitudinal cohort study of patients hospitalized for COVID-19 in 2020. Chest CT was performed 3 and 12 months after admission. CT images were evaluated using a CT severity score (CSS) (0–12 scale) and recoded to an abbreviated version (0–3 scale). We analyzed determinants of the abbreviated CSS with multivariable mixed effects ordinal regression. Results 242 patients completed CT at 3 months, and 124 (mean age 62.3±13.3, 78 men) also at 12 months. Between 3 and 12 months (n = 124) CSS (0–12 scale) for ground-glass opacities (GGO) decreased from median 3 (25th–75th percentile: 0–12) at 3 months to 0.5 (0–12) at 12 months (p<0.001), but increased for parenchymal bands (p<0.001). In multivariable analysis of GGO, the odds ratio for more severe abbreviated CSS (0–3 scale) at 12 months was 0.11 (95%CI 0.11 0.05 to 0.21, p<0.001) compared to 3 months, for WHO severity category 5–7 (high-flow oxygen/non-invasive ventilation/ventilator) versus 3 (non-oxygen use) 37.16 (1.18 to 43.47, p = 0.032), and for age ≥60 compared to <60 years 4.8 (1.33 to 17.6, p = 0.016). Mosaicism was reduced at 12 compared to 3 months, OR 0.33 (95%CI 0.16 to 0.66, p = 0.002). Conclusions GGO and mosaicism decreased, while parenchymal bands increased from 3 to 12 months. Persistent GGO were associated with initial COVID-19 severity and age ≥60 years.

• Thorshov, Thea Christine; Dammen, Toril; Moen, Anne; Einvik, Gunnar & Hrubos-Strøm, Harald (2024). Prevalence of insomnia and feasibility of a nurse-administered digital cognitive behavioural therapy two years after corona virus disease hospitalisation. Sleep Medicine. ISSN 1389-9457. 125, s. 108–113. doi: 10.1016/j.sleep.2024.11.028. Fulltekst i vitenarkiv Vis sammendrag

  Background Disturbed sleep is prevalent after corona virus disease (COVID-19). However, little is known of post infectious prevalence, course, predictors and treatment of chronic insomnia. Aim To estimate the prevalence of chronic insomnia three and twelve months after hospitalisation for COVID-19, to identify predictors of chronic insomnia, and to evaluate the feasibility of a nurse-administered digital cognitive behavioural therapy for insomnia (dCBTi) protocol. Method Patients hospitalised at Akershus University Hospital (Norway) for COVID-19 between February–June 2020 were eligible. The 94 patients that consented to participate were contacted by phone and interviewed with a modified DUKE structured interview three- and twelve months after discharge. Participants with chronic insomnia after twelve months were offered a nurse-administered dCBTi treatment protocol. Outcome measurements were sleep efficiency (SE) calculated by standard formulas (0-100 %) and the Bergen Insomnia Scale (BIS) (0-42). Results At three-month follow-up, 22 persons (23 %) fulfilled the diagnostic criteria for chronic insomnia. At twelve-month follow-up, 23 fulfilled the diagnostic criteria. The odds ratios for chronic insomnia after twelve months were 0.857 (0.742–0.989) for body mass index (BMI), and 0.239 (0.069–0.821) for male sex. Ten participated in the dCBTi feasibility study. Five completed the treatment protocol. SE improved, but not significantly. The BIS score improved significantly from 24 to 12 (p-value = 0.036). Conclusion Chronic insomnia remained stable three- and twelve months post COVID-19 hospitalisation. Female sex and low BMI were independent predictors of chronic insomnia twelve months post infection, but only 50 % of participants completed the protocol. Completers significantly reduced insomnia symptoms.

• Lerum, Tøri Vigeland; Meltzer, Carin; Rivero, Jezabel Rodriguez; Aaløkken, Trond Mogens; Brønstad, Eivind & Aarli, Bernt Bøgvald [Vis alle 12 forfattere av denne artikkelen] (2023). A prospective study of pulmonary outcomes and chest computed tomography in the first year after COVID-19. European Respiratory Journal Open Research (ERJ Open Research). 9(2). doi: 10.1183/23120541.00575-2022. Fulltekst i vitenarkiv Vis sammendrag

  COVID-19 primarily affects the respiratory system. We aimed to evaluate how pulmonary outcomes develop after COVID-19 by assessing participants from the first pandemic wave prospectively 3 and 12 months following hospital discharge. Pulmonary outcomes included self-reported dyspnoea assessed with the modified Medical Research Council dyspnoea scale, 6-min walk distance (6MWD), spirometry, diffusing capacity of the lung for carbon monoxide (DLCO), body plethysmography and chest computed tomography (CT). Chest CT was repeated at 12 months in participants with pathological findings at 3 months. The World Health Organization (WHO) ordinal scale for clinical improvement defined disease severity in the acute phase. Of 262 included COVID-19 patients, 245 (94%) and 222 (90%) participants attended the 3- and 12-month follow-up, respectively. Self-reported dyspnoea and 6MWD remained unchanged between the two time points, while DLCO and total lung capacity improved (0.28 mmol·min−1·kPa−1, 95% CI 0.12–0.44, and 0.13 L, 95% CI 0.02–0.24, respectively). The prevalence of fibrotic-like findings on chest CT at 3 and 12 months in those with follow-up chest CT was unaltered. Those with more severe disease had worse dyspnoea, DLCO and total lung capacity values than those with mild disease. There was an overall positive development of pulmonary outcomes from 3 to 12 months after hospital discharge. The discrepancy between the unaltered prevalence of self-reported dyspnoea and the improvement in pulmonary function underscores the complexity of dyspnoea as a prominent factor of long-COVID. The lack of increase in fibrotic-like findings from 3 to 12 months suggests that SARS-CoV-2 does not induce a progressive fibrotic process in the lungs.

• Selvakumar, Joel Pradeepkumar; Havdal, Lise Beier; Drevvatne, Martin Solstrand; Brodwall, Elias Myrstad; Lund-Berven, Lise & Stiansen-Sonerud, Tonje [Vis alle 19 forfattere av denne artikkelen] (2023). Prevalence and Characteristics Associated With Post-COVID-19 Condition Among Nonhospitalized Adolescents and Young Adults. JAMA Network Open. 6(3). doi: 10.1001/jamanetworkopen.2023.5763. Fulltekst i vitenarkiv Vis sammendrag

  Importance The prevalence and baseline risk factors of post–COVID-19 condition (PCC) remain unresolved among the large number of young people who experienced mild COVID-19. Objectives To determine the point prevalence of PCC 6 months after the acute infection, to determine the risk of development of PCC adjusted for possible confounders, and to explore a broad range of potential risk factors. Design, Setting, and Participants This cohort study included nonhospitalized individuals from 2 counties in Norway between ages 12 and 25 years who underwent reverse transcription–polymerase chain reaction (RT-PCR) testing. At the early convalescent stage and at 6-month follow-up, participants underwent a clinical examination; pulmonary, cardiac, and cognitive functional testing; immunological and organ injury biomarker analyses; and completion of a questionnaire. Participants were classified according to the World Health Organization case definition of PCC at follow-up. Association analyses of 78 potential risk factors were performed. Exposures SARS-CoV-2 infection. Main Outcomes and Measures The point prevalence of PCC 6 months after RT-PCR testing in the SARS-CoV-2–positive and SARS-CoV-2–negative groups, and the risk difference with corresponding 95% CIs. Results A total of 404 individuals testing positive for SARS-CoV-2 and 105 individuals testing negative were enrolled (194 male [38.1%]; 102 non-European [20.0%] ethnicity). A total of 22 of the SARS-CoV-2–positive and 4 of the SARS-CoV-2–negative individuals were lost to follow-up, and 16 SARS-CoV-2–negative individuals were excluded due to SARS-CoV-2 infection in the observational period. Hence, 382 SARS-CoV-2–positive participants (mean [SD] age, 18.0 [3.7] years; 152 male [39.8%]) and 85 SARS-CoV-2–negative participants (mean [SD] age, 17.7 [3.2] years; 31 male [36.5%]) could be evaluated. The point prevalence of PCC at 6 months was 48.5% in the SARS-CoV-2–positive group and 47.1% in the control group (risk difference, 1.5%; 95% CI, −10.2% to 13.1%). SARS-CoV-2 positivity was not associated with the development of PCC (relative risk [RR], 1.06; 95% CI, 0.83 to 1.37; final multivariable model utilizing modified Poisson regression). The main risk factor for PCC was symptom severity at baseline (RR, 1.41; 95% CI, 1.27-1.56). Low physical activity (RR, 0.96; 95% CI, 0.92-1.00) and loneliness (RR, 1.01; 95% CI, 1.00-1.02) were also associated, while biological markers were not. Symptom severity correlated with personality traits. Conclusions and Relevance The persistent symptoms and disability that characterize PCC are associated with factors other than SARS-CoV-2 infection, including psychosocial factors. This finding raises questions about the utility of the World Health Organization case definition and has implications for the planning of health care services as well as for further research on PCC.

• Dammen, Toril; Papageorgiou, Constantinos; Lindstrøm, Jonas Christoffer & Einvik, Gunnar (2023). Metacognitions in patients with chronic obstructive pulmonary disease: a psychometric study of the metacognitions questionnaire-30. Frontiers in Psychology. 14. doi: 10.3389/fpsyg.2023.1265102. Fulltekst i vitenarkiv Vis sammendrag

  The metacognitions questionnaire-30 (MCQ-30) was developed for the assessment of metacognitive beliefs and processes that are central components of the metacognitive model of emotional disorders. Anxiety and depression commonly occur in patients with chronic obstructive pulmonary disease (COPD). Testing such a model for anxiety and depression in patients with COPD is warranted. However, the psychometric properties of the MCQ-30 in COPD patients are unknown. Therefore, in this study we aimed to examine these properties in COPD patients. The MCQ-30 was administered to 203 COPD patients referred to a rehabilitation unit in respiratory medicine. Confirmatory factor analysis (CFA) was used to test the five-factor as well as the bi-factor models of MCQ-30. Exploratory factor analyses were also performed. Both models did not meet the criteria for an acceptable fit on Comparative Fit Index (CFI) of 0.810 and 0.858 vs. criterion of ≥0.9, but the Root Mean Square Error of Approximation (RMSEA) criterion ≤0.08 was acceptable for both models with RMSEA = 0.074 and 0.066, respectively. The factors were mostly moderately correlated (0.41–0.58) with acceptable reliability coefficients (0.73–0.87). The exploratory factor analysis identified three of the five factors originally described in the five-factor model of the MCQ-30. These data show that the factor structure of the MCQ-30 appears to differ from that of the original instrument in COPD patients and further studies are needed to confirm its validity and reliability in this patient group.

• Johannessen, Øyvind; Reite, Fride Uthaug; Bhatnagar, Rahul; Øvrebotten, Tarjei; Einvik, Gunnar & Myhre, Peder Langeland (2023). Lung Ultrasound to Assess Pulmonary Congestion in Patients with Acute Exacerbation of COPD. The International Journal of Chronic Obstructive Pulmonary Disease. ISSN 1176-9106. 18, s. 693–703. doi: 10.2147/COPD.S396855. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Heart failure (HF) often coexists with chronic obstructive pulmonary disease (COPD) and is associated with worse outcomes. We aimed to assess the feasibility of detecting vertical artifacts (B-lines) on lung ultrasound (LUS) to identify concurrent HF in patients hospitalized with acute exacerbation of COPD (AECOPD). Second, we wanted to assess the association between B-lines and the risk of rehospitalization for AECOPD or death. Patients and Methods: In a prospective cohort study, 123 patients with AECOPD underwent 8-zone bedside LUS within 24h after admission. A positive LUS was defined by ≥ 3 B-lines in ≥ 2 zones bilaterally. The ability to detect concurrent HF (adjudicated by a cardiologist committee) and association with events were evaluated by logistic- and Cox regression models. Results: Forty-eight of 123 patients with AECOPD (age 75± 9 years, 57[46%] men) had concurrent HF. Sixteen (13%) patients had positive LUS, and the prevalence of positive LUS was similar between patients with and without concurrent HF (8[17%] vs 8[11%], respectively, p=0.34). The number of B-lines was higher in concurrent HF: median 10(IQR 6– 16) vs 7(IQR 5– 12), p=0.03. The sensitivity and specificity for a positive LUS to detect concurrent HF were 17% and 89%, respectively. Positive LUS was not associated with rehospitalization and mortality: Adjusted HR: 0.93(0.49– 1.75), p=0.81. Conclusion: LUS did not detect concurrent HF or predict risk in patients with AECOPD.

• Øvrebotten, Tarjei; Heck, Siri Lagethon; Skjørten, Ingunn; Einvik, Gunnar; Stavem, Knut & Ingul, Charlotte Ingeborg Björk [Vis alle 8 forfattere av denne artikkelen] (2023). Minor Myocardial Scars in Association with Cardiopulmonary Function after COVID-19. Cardiology. ISSN 0008-6312. 148(4), s. 300–306. doi: 10.1159/000530942. Fulltekst i vitenarkiv Vis sammendrag

  Background: Myocardial scars detected by cardiovascular magnetic resonance (CMR) imaging after COVID-19 have caused concerns regarding potential long-term cardiovascular consequences. Objective: The objective of this study was to investigate cardiopulmonary functioning in patients with versus without COVID-19-related myocardial scars. Methods: In this prospective cohort study, CMR was performed approximately 6 months after moderate-to-severe COVID-19. Before (∼3 months post-COVID-19) and after (∼12 months post-COVID-19) the CMR, patients underwent extensive cardiopulmonary testing with cardiopulmonary exercise tests, 24-h ECG, and echocardiography. We excluded participants with overt heart failure. Results: Post-COVID-19 CMR was available in 49 patients with cardiopulmonary tests at 3 and 12 months after the index hospitalization. Nine (18%) patients had small late gadolinium enhancement-detected myocardial scars. Patients with myocardial scars were older (63.2 ± 13.2 vs. 56.2 ± 13.2 years) and more frequently men (89% vs. 55%) compared to those without scars. Cardiorespiratory fitness was similar in patients with and without scars, i.e., peak oxygen uptake: 82.1 ± 11.5% versus 76.3 ± 22.5% of predicted, respectively (p = 0.46). The prevalence of ventricular premature contractions and arrhythmias was low and not different by the presence of myocardial scar. Cardiac structure and function assessed by echocardiography were similar between the groups, except for a tendency of greater left ventricular mass in those with scars (75 ± 20 vs. 62 ± 14, p = 0.02 and p = 0.08 after adjusting for age and sex). There were no significant associations between myocardial scar and longitudinal changes in cardiopulmonary function from 3 to 12 months. Conclusion: Our findings imply that the presence of minor myocardial scars has limited clinical significance with respect to cardiopulmonary function after COVID-19.

• Øvrebotten, Tarjei; Myhre, Peder Langeland; Grimsmo, Jostein; Mecinaj, Albulena; Trebinjac, Divna & Nossen, Magnus Berger [Vis alle 12 forfattere av denne artikkelen] (2022). Changes in cardiac structure and function from 3 to 12 months after hospitalization for COVID-19. Clinical Cardiology. ISSN 0160-9289. 45(10), s. 1044–1052. doi: 10.1002/clc.23891. Fulltekst i vitenarkiv Vis sammendrag

  Background Cardiac function may be impaired during and early after hospitalization for COVID-19, but little is known about the progression of cardiac dysfunction and the association with postacute COVID syndrome (PACS). Methods In a multicenter prospective cohort study, patients who had been hospitalized with COVID-19 were enrolled and comprehensive echocardiography was performed 3 and 12 months after discharge. Twenty-four-hour electrocardiogram (ECG) was performed at 3 and 12 months in patients with arrhythmias at 3 months. Results In total, 182 participants attended the 3 and 12 months visits (age 58 ± 14 years, 59% male, body mass index 28.2 ± 4.2 kg/m2). Of these, 35 (20%) had severe COVID-19 (treatment in the intensive care unit) and 74 (52%) had self-reported dyspnea at 3 months. From 3 to 12 months there were no significant overall changes in any measures of left or right ventricle (LV; RV) structure and function (p > .05 for all), including RV strain (from 26.2 ± 3.9% to 26.5 ± 3.1%, p = .29) and LV global longitudinal strain (from 19.2 ± 2.3% to 19.3 ± 2.3%, p = .64). Changes in echocardiographic parameters from 3 to 12 months did not differ by COVID-19 severity or by the presence of persistent dyspnea (p > .05 for all). Among patients with arrhythmia at 3 months, there was no significant change in arrhythmia burden to 12 months. Conclusion Following COVID-19, cardiac structure and function remained unchanged from 3 to 12 months after the index hospitalization, irrespective of COVID-19 severity and presence of persistent dyspnea. These results suggest that progression of cardiac dysfunction after COVID-19 is rare and unlikely to play an important role in PACS.

• Garratt, Andrew; Nerheim, Ellen Margrethe; Einvik, Gunnar; Stavem, Knut & Edvardsen, Anne (2022). Evaluation of the Norwegian version of the Dyspnoea-12 questionnaire in patients with COPD. BMJ Open Respiratory Research. 9(1). doi: 10.1136/bmjresp-2022-001262. Fulltekst i vitenarkiv Vis sammendrag

  Background The Dyspnoea-12 (D-12) questionnaire is widely used and tested in patients with breathing difficulties. The objective of this study was to translate and undertake the first evaluation of the measurement properties of the Norwegian version of the D-12 in patients with chronic obstructive pulmonary disease (COPD) attending a 4-week inpatient pulmonary rehabilitation programme. Methods Confirmatory factor analysis was used to assess structural validity. Fit to the Rasch partial credit model and differential item functioning (DIF) were assessed in relation to age, sex and comorbidity. Based on a priori hypotheses, validity was assessed through comparisons with scores for the COPD Assessment Test (CAT), Hospital Anxiety and Depression Scales (HADS) and clinical variables. Results There were 203 (86%) respondents with a mean age (SD) of 65.2 (9.0) years, and 49% were female. The D-12 showed satisfactory structural validity including presence of physical and affective domains. There was acceptable fit to Rasch model including unidimensionality for the two domains, and no evidence of DIF. Correlations with scores for the CAT, HADS and clinical variables were as hypothesised and highest for domains assessing similar aspects of health. Conclusions The Norwegian version of the D-12 showed good evidence for validity and internal consistency in this group of patients with COPD, including support for two separate domains. Further testing for these measurement properties is recommended in other Norwegian patients with dyspnoea.

• 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
• Sommen, Silke Lauren; Havdal, Lise Beier; Selvakumar, Joel Pradeepkumar; Einvik, Gunnar; Leegaard, Truls Michael & Lund-Johansen, Fridtjof [Vis alle 12 forfattere av denne artikkelen] (2022). Inflammatory markers and pulmonary function in adolescents and young adults 6 months after mild COVID-19. Frontiers in Immunology. 13, s. 1–12. doi: 10.3389/fimmu.2022.1081718. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Both public and scientific attention have shifted from the acute COVID-19 illness to the chronic disability experienced by a proportion of COVID-19 convalescents. Post COVID-19 condition, a term used for long-lasting symptoms after COVID-19, can affect individuals across all disease severity and age groups. Data on post-COVID-19 symptomatology, epidemiology and pathophysiology in adolescents and young adults are scarce. To date, little is known on the immunological and pulmonary trends in these patients after COVID-19. This study investigated immunological markers and pulmonary function in non-hospitalized patients in this group at 6 months after initial mild COVID-19 infection. Methods: Non-hospitalized SARS-CoV-2 positive (n = 405) and SARS-CoV-2 negative (n = 111) adolescents and young adults (aged 12-25 years) were followed prospectively for six months after SARS-CoV-2 PCR testing. At baseline and at six months follow-up, all participants underwent an assessment including clinical examination, questionnaires, spirometry, and blood sampling. Cross-sectional comparisons of blood biomarkers; including white blood cell counts, CRP, GDF-15, a 27-multiplex cytokine assay, complement activation products and SARS-CoV-2 antibodies; and spirometry measures were performed after classification of all participants according to their COVID-19 status and adherence to post-COVID-19 case criteria. Associations between biomarkers and COVID-19 symptoms were explored. Results: No difference in pulmonary function was detected between the groups. COVID-19 convalescents had higher levels of chemokines eotaxin, MCP-1 and IP-10 than non-infected controls. The increase was modest and not associated with long-lasting COVID-19 symptoms. Discussion: Elevated inflammatory mediators were found in adolescents and young adults six months after mild COVID-19, but there was no association with post-COVID-19 condition.

• Stavem, Knut; Einvik, Gunnar & Lundqvist, Christofer (2022). Cognitive Impairment 13 Months After Hospitalization for COVID-19. Open Forum Infectious Diseases. 9(7). doi: 10.1093/ofid/ofac355. Fulltekst i vitenarkiv Vis sammendrag

  Abstract This study assessed cognitive function 13 months after hospital discharge for coronavirus disease 2019 (COVID-19), using computer-based cognitive tests. Compared to population norms, 14%–25% of patients were impaired in each dimension, and 53% had cognitive impairment in 1 or more of 4 tests. There was some association with acute COVID-19 disease severity.

• Stavem, Knut; Einvik, Gunnar; Tholin, Birgitte; Ghanima, Waleed; Hessen, Erik & Lundqvist, Christofer (2022). Cognitive function in non-hospitalized patients 8–13 months after acute COVID-19 infection: A cohort study in Norway. PLOS ONE. 17(8). doi: 10.1371/journal.pone.0273352. Fulltekst i vitenarkiv Vis sammendrag

  Studies have reported reduced cognitive function following COVID-19 illness, mostly from hospital settings with short follow-up times. This study recruited non-hospitalized COVID-19 patients from a general population to study prevalence of late cognitive impairment and associations with initial symptoms. We invited patients with PCR-confirmed COVID-19. A postal questionnaire addressed basic demographics, initial COVID-19 symptoms and co-morbidity about 4 months after diagnosis. About 7 months later, we conducted cognitive tests using the Cambridge Neuropsychological Test Automated Battery, comprising four tests for short-term memory, attention and executive function. We present descriptive statistics using z-scores relative to UK population norms and defined impairment as z-score &lt;-1.5. We used multivariable logistic regression with impairment as outcome. Continuous domain scores were analysed by multiple linear regression. Of the initial 458 participants; 305 were invited, and 234 (77%) completed cognitive testing. At median 11 (range 8–13) months after PCR positivity, cognitive scores for short term memory, visuospatial processing, learning and attention were lower than norms (p≤0.001). In each domain, 4–14% were cognitively impaired; 68/232 (29%) were impaired in ≥ 1 of 4 tests. There was no association between initial symptom severity and impairment. Multivariable linear regression showed association between spatial working memory and initial symptom load (6–9 symptoms vs. 0–5, coef. 4.26, 95% CI: 0.65; 7.86). No other dimension scores were associated with symptom load. At median 11 months after out-of-hospital SARS-Cov-2 infection, minor cognitive impairment was seen with little association between COVID-19 symptom severity and outcome.

• Berven, Lise; Selvakumar, Joel Pradeepkumar; Havdal, Lise Beier; Stiansen-Sonerud, Tonje; Einvik, Gunnar & Leegaard, Truls Michael [Vis alle 10 forfattere av denne artikkelen] (2022). Inflammatory Markers, Pulmonary Function, and Clinical Symptoms in Acute COVID-19 Among Non-Hospitalized Adolescents and Young Adults. Frontiers in Immunology. 13:837288, s. 1–11. doi: 10.3389/fimmu.2022.837288. Fulltekst i vitenarkiv Vis sammendrag

  Summary: Mild, subacute COVID-19 in young people show inflammatory enhancement, but normal pulmonary function. Inflammatory markers are associated with age and male sex, whereas clinical symptoms are associated with age and female sex, but not with objective disease markers. Background: Coronavirus Disease 2019 (COVID-19) is widespread among adolescents and young adults across the globe. The present study aimed to compare inflammatory markers, pulmonary function and clinical symptoms across non-hospitalized, 12 – 25 years old COVID-19 cases and non-COVID-19 controls, and to investigate associations between inflammatory markers, clinical symptoms, pulmonary function and background variables in the COVID-19 group. Methods: The present paper presents baseline data from an ongoing longitudinal observational cohort study (Long-Term Effects of COVID-19 in Adolescents, LoTECA, ClinicalTrials ID: NCT04686734). A total of 31 plasma cytokines and complement activation products were assayed by multiplex and ELISA methodologies. Pulmonary function and clinical symptoms were investigated by spirometry and questionnaires, respectively. Results: A total of 405 COVID-19 cases and 111 non-COVID-19 controls were included. The COVID-19 group had significantly higher plasma levels of IL-1β, IL-4, IL-7, IL-8, IL-12, TNF, IP-10, eotaxin, GM-CSF, bFGF, complement TCC and C3bc, and significantly lower levels of IL-13 and MIP-1α, as compared to controls. Spirometry did not detect any significant differences across the groups. IL-4, IL-7, TNF and eotaxin were negatively associated with female sex; eotaxin and IL-4 were positively associated with age. Clinical symptoms were positively associated with female sex and age, but not with objective disease markers. Conclusions: Among non-hospitalized adolescents and young adults with COVID-19 there was significant alterations of plasma inflammatory markers in the subacute stage of the infection. Still, pulmonary function was normal. Clinical symptoms were independent of inflammatory and pulmonary function markers, but positively associated with age and female sex.

• Kononova, Natalia; Einvik, Gunnar; Holmedahl, Nils Henrik; Hagve, Tor-Arne; Omland, Torbjørn & Søyseth, Vidar (2022). It is unlikely that oxygen supplementation in COPD patients with chronic respiratory failure reduce cardiac troponin level. BMC Pulmonary Medicine. 22, s. 1–8. doi: 10.1186/s12890-022-02169-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Cardiac troponin T (cTnT) is a biomarker of myocardial injury frequently elevated in COPD patients, potentially because of hypoxemia. This non-randomised observational study investigates whether long-term oxygen treatment (LTOT) reduces the cTnT level. Methods We compared cTnT between COPD patients who were candidates for LTOT (n = 20) with two reference groups. Patients from both reference groups were matched with the index group using propensity score.Reference groups consists of institutional pulmonary rehabilitation patients (short-term group) (n = 105 after matching n = 11) and outpatients at a pulmonary rehabilitation clinic (long-term group)(n = 62 after matching n = 10). Comparison was done within 24 h after LTOT initiation in first reference group and within 6 months after inclusion in the second group. Results The geometric mean of (standard deviation in parentheses) cTnT decreased from 17.8 (2.3) ng/L (between 8 and 9 a.m.) to 15.4 (2.5) ng/L between 1 and 2 p.m. in the LTOT group, and from 18.4 (4.8) ng/L to15.4 (2.5) ng/L in group (1) The corresponding long-term results were 17.0 (2.9) ng/L at inclusion (between 10 and 12 a.m.) to 18.4 (2.4) ng/L after 3 months in the LTOT-group, and from 14.0 (2.4) ng/L to 15.4 (2.5) ng/L after 6 months in group (2) None of the differences in cTnT during the follow-up between the LTOT-group and their matched references were significant. Conclusion Initiation of LTOT was not associated with an early or sustained reduction in cTnT after treatment with oxygen supplementation.

• Mickelson, Nina; Mellingsæter, Marte; Hegna, Bendik Westlund; Benth, Jurate Saltyte; Einvik, Gunnar & Juliebø, Vibeke [Vis alle 8 forfattere av denne artikkelen] (2022). Impact of a dementia-friendly program on detection and management of patients with cognitive impairment and delirium in acute-care hospital units: a controlled clinical trial design. BMC Geriatrics. 22(1), s. 1–14. doi: 10.1186/s12877-022-02949-0. Fulltekst i vitenarkiv Vis sammendrag

  Background Frail older persons with cognitive impairment (CI) are at special risk of experiencing delirium during acute hospitalisation. The purpose of this study was to investigate whether a dementia-friendly hospital program contributes to improved detection and management of patients with CI and risk of delirium at an acute-care hospital in Norway. Furthermore, we aimed to explore whether the program affected the detection of delirium, pharmacological treatment, 30-day re-hospitalisation, 30-day mortality and institutionalisation afterwards. Methods This study was part of a larger quality improvement project aiming at developing and implementing a new program for early screening and management of patients with CI. This study, evaluating the program are designed as a controlled clinical trial with a historical control group. It was conducted at two different medical wards at a large acute-care hospital in Norway from September 2018 to December 2019. A total of 423 acute hospitalised patients 75 years of age or older were included in the study. Delirium screening and cognitive tests were recorded by research staff with the 4 ‘A’s Test (4AT) and the Confusion Assessment Measure (CAM), while demographic and medical information was recorded from the electronic medical records (EMR). Results Implementation of the dementia-friendly hospital program did not show any significant changes in the identification of patients with CI. However, the share of patients screened with 4AT within 24 h increased from 0% to 35.5% (P < .001). The proportion of the patients with CI identified by the clinical staff, who received measures to promote “dementia-friendly” care and reduce the risk for delirium increased by 32.2% (P < .001), compared to the control group. Furthermore, the number of patients with CI who were prescribed antipsychotic, hypnotic or sedative medications was reduced by 24.5% (P < .001). There were no differences in delirium detection, 30-day readmission or 30-day mortality. Conclusions A model for early screening and multifactorial non-pharmacological interventions for patients with CI and delirium may improve management of this patient group, and reduce prescriptions of antipsychotic, hypnotic and sedative medications. The implementation in clinical practice of early screening using quality improvement methodology deserves attention. Trial registration The protocol of this study was retrospectively registered in the ClinicalTrials.gov Protocol Registration and Results System with the registration number: NCT04737733 and date of registration: 03/02/2021.

• Ingul, Charlotte Bjørk; Edvardsen, Anne; Follestad, Turid; Trebinjac, Divna; Ankerstjerne, Odd Andre Wathne & Brønstad, Eivind [Vis alle 14 forfattere av denne artikkelen] (2022). Changes in cardiopulmonary exercise capacity and limitations 3-12 months after COVID-19. European Respiratory Journal. ISSN 0903-1936. 61(2). doi: 10.1183/13993003.00745-2022. Fulltekst i vitenarkiv Vis sammendrag

  Rationale: To describe cardiopulmonary function during exercise 12 months after hospital discharge for coronavirus disease 2019 (COVID-19), assess the change from 3 to 12 months, and compare the results with matched controls without COVID-19. Methods: In this prospective, longitudinal, multicentre cohort study, hospitalised COVID-19 patients were examined using a cardiopulmonary exercise test (CPET) 3 and 12 months after discharge. At 3 months, 180 performed a successful CPET, and 177 did so at 12 months (mean age 59.3 years, 85 females). The COVID-19 patients were compared with controls without COVID-19 matched for age, sex, body mass index and comorbidity. Main outcome was peak oxygen uptake (V′O2 peak). Results: Exercise intolerance (V′O2 peak <80% predicted) was observed in 23% of patients at 12 months, related to circulatory (28%), ventilatory (17%) and other limitations including deconditioning and dysfunctional breathing (55%). Estimated mean difference between 3 and 12 months showed significant increases in V′O2 peak % pred (5.0 percentage points (pp), 95% CI 3.1–6.9 pp; p<0.001), V′O2 peak·kg−1 % pred (3.4 pp, 95% CI 1.6–5.1 pp; p<0.001) and oxygen pulse % pred (4.6 pp, 95% CI 2.5–6.8 pp; p<0.001). V′O2 peak was 2440 mL·min−1 in COVID-19 patients compared to 2972 mL·min−1 in matched controls. Conclusions: 1 year after hospital discharge for COVID-19, the majority (77%), had normal exercise capacity. Only every fourth had exercise intolerance and in these circulatory limiting factors were more common than ventilator factors. Deconditioning was common. V′O2 peak and oxygen pulse improved significantly from 3 months.

• Sigurdardóttir, Fjóla Dögg; Øverby, Tonje Caroline; Nikkonen, Sami; Karhu, Tuomas; Dammen, Toril & Nordhus, Inger Hilde [Vis alle 14 forfattere av denne artikkelen] (2022). Novel oxygen desaturation parameters are associated with cardiac troponin I: Data from the Akershus Sleep Apnea Project. Journal of Sleep Research. ISSN 0962-1105. 31(5). doi: 10.1111/jsr.13581. Fulltekst i vitenarkiv Vis sammendrag

  Novel diagnostic markers for obstructive sleep apnea beyond the apnea–hypopnea index (AHI) have been introduced. There are no studies on their association with markers of subclinical myocardial injury. We assessed the association between novel desaturation parameters and elevated cardiac troponin I and T. Participants with polysomnography (498) from the Akershus Sleep Apnea study were divided into normal and elevated biomarker groups based on sex-specific concentration thresholds (cardiac troponin I: ≥4 ng/L for women, ≥6 ng/L for men; and cardiac troponin T: ≥7 ng/L for women, ≥8 ng/L for men). Severity of obstructive sleep apnea was evaluated with the AHI, oxygen desaturation index, total sleep time with oxygen saturation below 90% (T90), lowest oxygen saturation (Min SpO2%), and novel oxygen desaturation parameters: desaturation duration and desaturation severity. How the AHI and novel desaturation parameters predicted elevated cardiac troponin I and cardiac troponin T levels was assessed by the area under the curve (AUC). Based on multivariable-adjusted linear regression, the AHI (β = 0.004, p = 0.012), desaturation duration (β = 0.007, p = 0.004), and desaturation severity (β = 0.147, p = 0.002) were associated with cardiac troponin I levels but not cardiac troponin T. T90 was associated with cardiac troponin I (β = 0.006, p = 0.009) and cardiac troponin T (β = 0.005, p = 0.007). The AUC for the AHI 0.592 (standard error 0.043) was not significantly different from the AUC of T90 (SD 0.640, p = 0.08), desaturation duration 0.609 (SD 0.044, p = 0.42) or desaturation severity 0.616 (SD 0.043, p = 0.26) in predicting myocardial injury as assessed by cardiac troponin I. Oxygen desaturation parameters and the AHI were associated with cardiac troponin I levels but not cardiac troponin T levels. Novel oxygen desaturation parameters did not improve the prediction of subclinical myocardial injury compared to the AHI.

• Ingul, Charlotte Ingeborg Björk; Grimsmo, Jostein; Mecinaj, Albulena; Trebinjac, Divna; Nossen, Magnus Berger & Andrup, Simon [Vis alle 14 forfattere av denne artikkelen] (2022). Cardiac Dysfunction and Arrhythmias 3 Months After Hospitalization for COVID-19. Journal of the American Heart Association (JAHA). 11(3). doi: 10.1161/JAHA.121.023473. Fulltekst i vitenarkiv Vis sammendrag

  Background - The extent of cardiac dysfunction post‐COVID‐19 varies, and there is a lack of data on arrhythmic burden. Methods and Results - This was a combined multicenter prospective cohort study and cross‐sectional case‐control study. Cardiac function assessed by echocardiography in patients with COVID‐19 3 to 4 months after hospital discharge was compared with matched controls. The 24‐hour ECGs were recorded in patients with COVID‐19. A total of 204 patients with COVID‐19 consented to participate (mean age, 58.5 years; 44% women), and 204 controls were included (mean age, 58.4 years; 44% women). Patients with COVID‐19 had worse right ventricle free wall longitudinal strain (adjusted estimated mean difference, 1.5 percentage points; 95% CI, −2.6 to −0.5; P=0.005) and lower tricuspid annular plane systolic excursion (−0.10 cm; 95% CI, −0.14 to −0.05; P<0.001) and cardiac index (−0.26 L/min per m2; 95% CI, −0.40 to −0.12; P<0.001), but slightly better left ventricle global strain (−0.8 percentage points; 95% CI, 0.2–1.3; P=0.008) compared with controls. Reduced diastolic function was twice as common compared with controls (60 [30%] versus 29 [15%], respectively; odds ratio, 2.4; P=0.001). Having dyspnea or fatigue were not associated with cardiac function. Right ventricle free wall longitudinal strain was worse after intensive care treatment. Arrhythmias were found in 27% of the patients, mainly premature ventricular contractions and nonsustained ventricular tachycardia (18% and 5%, respectively). Conclusions - At 3 months after hospital discharge with COVID‐19, right ventricular function was mildly impaired, and diastolic dysfunction was twice as common compared with controls. There was little evidence for an association between cardiac function and intensive care treatment, dyspnea, or fatigue. Ventricular arrhythmias were common, but the clinical importance is unknown.

• Stavem, Knut; Heir, Trond; Dammen, Toril; Brønstad, Eivind; Lerum, Tøri Vigeland & Durheim, Michael Thomas [Vis alle 9 forfattere av denne artikkelen] (2022). The course and determinants of post-traumatic stress over 12 months after hospitalization for COVID-19. Frontiers in Psychiatry. 13. doi: 10.3389/fpsyt.2022.931349. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To assess the trajectory of symptoms and symptom-defined post-traumatic stress disorder (PTSD) from 1.5 to 12 months after hospitalization for COVID-19 and determine risk factors for persistent symptoms and PTSD. Methods: This was a prospective cohort study of consecutive patients discharged after hospitalization for COVID-19 before 1 June 2020 in six hospitals in Southern Norway. Symptom-defined PTSD was assessed by the post-traumatic stress disorder (PTSD) checklist for DSM-5 (PCL-5) at 1.5, 3 and/or 12 months after hospitalization, using DSM-5 criteria. Changes in PCL-5 symptom score and the prevalence of PTSD were analyzed with multivariable mixed models. Results: In total, 388 patients were discharged alive, and 251 (65%) participated. Respondents had a mean (SD) age of 58.4 (14.2) years, and 142 (57%) were males. The prevalence of symptom-defined PTSD was 14, 8, and 9% at 1.5, 3, and 12 months, respectively. WHO disease severity for COVID-19 was not associated with PCL-5 scores. Female sex, lower age and non-Norwegian origin were associated with higher PCL-5 scores. The odds ratio (OR) (95%CI) for PTSD was 0.32 (0.12 to 0.83, p = 0.019) at 3 months and 0.38 (0.15 to 0.95, p = 0.039) at 12 months compared to 1.5 months. There was no association between PTSD and WHO severity rating. Conclusions: The level of PTSD symptoms decreased from 1.5 to 3 months after hospitalization, but did not decrease further to 12 months, and there was no association between PTSD symptoms and COVID-19 disease severity.

• Lerum, Tøri Vigeland; Maltzahn, Niklas; Aukrust, Pål; Trøseid, Marius; Nezvalova-Henriksen, Katerina & Kåsine, Trine [Vis alle 27 forfattere av denne artikkelen] (2021). Persistent pulmonary pathology after COVID-19 is associated with high viral load, weak antibody response, and high levels of matrix metalloproteinase-9. Scientific Reports. 11, s. 1–12. doi: 10.1038/s41598-021-02547-x. Fulltekst i vitenarkiv Vis sammendrag

  The association between pulmonary sequelae and markers of disease severity, as well as pro-fibrotic mediators, were studied in 108 patients 3 months after hospital admission for COVID-19. The COPD assessment test (CAT-score), spirometry, diffusion capacity of the lungs (DLCO), and chest-CT were performed at 23 Norwegian hospitals included in the NOR-SOLIDARITY trial, an open-labelled, randomised clinical trial, investigating the efficacy of remdesivir and hydroxychloroquine (HCQ). Thirty-eight percent had a CAT-score ≥ 10. DLCO was below the lower limit of normal in 29.6%. Ground-glass opacities were present in 39.8% on chest-CT, parenchymal bands were found in 41.7%. At admission, low pO2/FiO2 ratio, ICU treatment, high viral load, and low antibody levels, were predictors of a poorer pulmonary outcome after 3 months. High levels of matrix metalloproteinase (MMP)-9 during hospitalisation and at 3 months were associated with persistent CT-findings. Except for a negative effect of remdesivir on CAT-score, we found no effect of remdesivir or HCQ on long-term pulmonary outcomes. Three months after hospital admission for COVID-19, a high prevalence of respiratory symptoms, reduced DLCO, and persistent CT-findings was observed. Low pO2/FiO2 ratio, ICU-admission, high viral load, low antibody levels, and high levels of MMP-9 were associated with a worse pulmonary outcome.

• 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

• Skjørten, Ingunn; Ankerstjerne, Odd Andre Wathne; Trebinjac, Divna; Brønstad, Eivind; Rasch-Halvorsen, Øystein & Einvik, Gunnar [Vis alle 10 forfattere av denne artikkelen] (2021). Cardiopulmonary exercise capacity and limitations 3 months after COVID-19 hospitalisation. European Respiratory Journal. ISSN 0903-1936. 58(2). doi: 10.1183/13993003.00996-2021. Fulltekst i vitenarkiv Vis sammendrag

  Background This study aimed to describe cardiopulmonary function during exercise 3 months after hospital discharge for COVID-19 and compare groups according to dyspnoea and intensive care unit (ICU) stay. Methods Participants with COVID-19 discharged from five large Norwegian hospitals were consecutively invited to a multicentre, prospective cohort study. In total, 156 participants (mean age 56.2 years, 60 females) were examined with a cardiopulmonary exercise test (CPET) 3 months after discharge and compared with a reference population. Dyspnoea was assessed using the modified Medical Research Council (mMRC) dyspnoea scale. Results Peak oxygen uptake (V′O2 peak) <80% predicted was observed in 31% (n=49). Ventilatory efficiency was reduced in 15% (n=24), while breathing reserve <15% was observed in 16% (n=25). Oxygen pulse <80% predicted was found in 18% (n=28). Dyspnoea (mMRC ≥1) was reported by 47% (n=59). These participants had similar V′O2 peak (p=0.10) but lower mean±sd V′O2 peak·kg−1 % predicted compared with participants without dyspnoea (mMRC 0) (76±16% versus 89±18%; p=0.009) due to higher body mass index (p=0.03). For ICU- versus non-ICU-treated participants, mean±sd V′O2 peak % predicted was 82±15% and 90±17% (p=0.004), respectively. Ventilation, breathing reserve and ventilatory efficiency were similar between the ICU and non-ICU groups. Conclusions One-third of participants experienced V′O2 peak <80% predicted 3 months after hospital discharge for COVID-19. Dyspnoeic participants were characterised by lower exercise capacity due to obesity and lower ventilatory efficiency. Ventilation and ventilatory efficiency were similar between ICU- and non-ICU-treated participants.

• Søyseth, Vidar; Kononova, Natalia; Neukamm, Anke; Holmedahl, Nils Henrik; Hagve, Tor-Arne & Omland, Torbjørn [Vis alle 7 forfattere av denne artikkelen] (2021). Systemic inflammation induced by exacerbation of COPD or pneumonia in patients with COPD induces cardiac troponin elevation. BMJ Open Respiratory Research. 8(1), s. 1–8. doi: 10.1136/bmjresp-2021-000997. Fulltekst i vitenarkiv Vis sammendrag

  Background Troponin is a biomarker of myocardial injury. In chronic obstructive pulmonary disease (COPD), troponin is an important determinant of mortality after acute exacerbation. Whether acute exacerbation of COPD (AECOPD) causes troponin elevation is not known. Here, we investigated whether troponin is increased in AECOPD compared to stable COPD. Methods We included 320 patients with COPD in the stable state and 63 random individuals from Akershus University hospital’s catchment area. All participants were ≥40 years old (mean 65·1 years, SD 7·6) and 176 (46%) were females. The geometric mean of high-sensitivity cardiac troponin T (hs-cTnT) was 6·9 ng/L (geometric-SD 2·6). They were followed regarding hospital admission for the subsequent 5 years. Results During the 5-year follow-up, we noted 474 hospitalisations: Totally, 150 and 80 admissions were due to AECOPD or pneumonia, respectively. The geometric mean ratio with geometric SE ( GSE) between cTnT at admission and stable state in AECOPD and pneumonia was 1·27 (GSE=1.11, p=0·023) and 1·28 (GSE=1.14, p=0·054), respectively. After inclusion of blood leucocyte count and C reactive protein at hospitalisation, these ratios attenuated to zero. However, we estimated an indirect of AECOPD and pneumonia on the ratio between hs-cTnT at admission and the stable state to 1·16 (p=0·022) and 1·22 (p=0·008), representing 91% (95% CI 82% to 100%) and 95% (95% CI 83% to 100%) of the total effects, respectively. Conclusion AECOPD and pneumonia in patients with COPD is associated with higher cTnT levels. This association appears to be mediated by systemic inflammation.

• Tholin, Birgitte; Ghanima, Waleed Khalid; Einvik, Gunnar; Aarli, Bernt Bøgvald; Brønstad, Eivind & Skjønsberg, Ole Henning [Vis alle 7 forfattere av denne artikkelen] (2021). Incidence of thrombotic complications in hospitalised and non-hospitalised patients after COVID-19 diagnosis. British Journal of Haematology. ISSN 0007-1048. 194(3), s. 542–546. doi: 10.1111/bjh.17522. Fulltekst i vitenarkiv Vis sammendrag

  Infection with coronavirus disease-2019 (COVID-19) may predispose for venous thromboembolism (VTE). There is wide variation in reported incidence rates of VTE in COVID-19, ranging from 3% to 85%. Therefore, the true incidence of thrombotic complications in COVID-19 is uncertain. Here we present data on the incidence of VTE in both hospitalised and non-hospitalised patients from two ongoing prospective cohort studies. The incidence of VTE after diagnosis of COVID-19 was 3·9% [95% confidence interval (CI): 2·1–7·2] during hospitalisation, 0·9% (95% CI: 0·2–3·1) in the three months after discharge and 0·2% (95% CI: 0·00–1·25) in non-hospitalised patients, suggesting an incidence rate at the lower end of that in previous reports.

• Stavem, Knut; Ghanima, Waleed Khalid; Olsen, Magnus Kringstad; Gilboe, Hanne M. & Einvik, Gunnar (2021). Prevalence and determinants of fatigue after covid-19 in non-hospitalized subjects: A population-based study. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(4), s. 1–11. doi: 10.3390/ijerph18042030. Fulltekst i vitenarkiv Vis sammendrag

  This study assessed the prevalence and determinants of fatigue in a population-based cohort of non-hospitalized subjects 1.5–6 months after COVID-19. It was a mixed postal/web survey of all non-hospitalized patients ≥18 years with a positive PCR for SARS-CoV-2 until 1 June 2020 in a geographically defined area. In total, 938 subjects received a questionnaire including the Chalder fatigue scale (CFQ-11) and the energy/fatigue scale of the RAND-36 questionnaire. We estimated z scores for comparison with general population norms. Determinants were analyzed using multivariable logistic and linear regression analysis. In total, 458 subjects (49%) responded to the survey at median 117.5 days after COVID-19 onset, and 46% reported fatigue. The mean z scores of the CFQ-11 total was 0.70 (95% CI 0.58 to 0.82), CFQ-11 physical 0.66 (0.55 to 0.78), CFQ-11 mental 0.47 (0.35 to 0.59) and RAND-36 energy/fatigue −0.20 (−0.31 to −0.1); all CFQ-11 scores differed from those of the norm population (p &lt; 0.001). Female sex, single/divorced/widowed, short time since symptom debut, high symptom load, and confusion during acute COVID-19 were associated with higher multivariable odds of fatigue. In conclusion, the burden of post-viral fatigue following COVID-19 was high, and higher than in a general norm population. Symptoms of fatigue were most prevalent among women, those having a high symptom load, or confusion during the acute phase.

• Einvik, Gunnar; Dammen, Toril; Ghanima, Waleed Khalid; Heir, Trond & Stavem, Knut (2021). Prevalence and risk factors for post-traumatic stress in hospitalized and non-hospitalized COVID-19 patients. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(4), s. 1–12. doi: 10.3390/ijerph18042079. Fulltekst i vitenarkiv Vis sammendrag

  This population-based study assessed the prevalence and determinants of symptom-defined post-traumatic stress disorder (PTSD) in a cohort of hospitalized and non-hospitalized patients about 1.5–6 months after their COVID-19 onset. The data were acquired from two mixed postal/web surveys in June–September 2020 from patients all aged ≥18 years with a positive polymerase chain reaction for severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) until 1 June 2020, comprising both hospitalized and non-hospitalized subjects. The catchment areas of the two included hospitals covers about 17% of the population of Norway. In total, 211 hospitalized and 938 non-hospitalized subjects received invitation. The prevalence of symptom-defined PTSD was assessed using the PTSD checklist for DSM-5 (PCL-5). Determinants of symptom-defined PTSD and PTSD symptoms were analyzed using multivariable logistic and linear regression analysis. In total, 583 (51%) subjects responded at median 116 (range 41–200) days after COVID-19 onset. The prevalence of symptom-defined PTSD was 9.5% in hospitalized and 7.0% in non-hospitalized subjects (p = 0.80). Female sex, born outside of Norway, and dyspnea during COVID-19 were risk factors for persistent PTSD symptoms. In non-hospitalized subjects, previous depression and COVID-19 symptom load were also associated with persistent PTSD symptoms. In conclusion, COVID-19 symptom load, but not hospitalization, was associated with symptom-defined PTSD and PTSD symptom severity.

• Stavem, Knut; Ghanima, Waleed Khalid; Olsen, Magnus Kringstad; Gilboe, Hanne Margrethe & Einvik, Gunnar (2020). Persistent symptoms 1.5-6 months after COVID-19 in non-hospitalised subjects: A population-based cohort study. Thorax. ISSN 0040-6376. doi: 10.1136/thoraxjnl-2020-216377. Fulltekst i vitenarkiv Vis sammendrag

  This study assessed symptoms and their determinants 1.5–6 months after symptom onset in non-hospitalised subjects with confirmed COVID-19 until 1 June 2020, in a geographically defined area. We invited 938 subjects; 451 (48%) responded. They reported less symptoms after 1.5–6 months than during COVID-19; median (IQR) 0 (0–2) versus 8 (6–11), respectively (p&lt;0.001); 53% of women and 67% of men were symptom free, while 16% reported dyspnoea, 12% loss/disturbance of smell, and 10% loss/disturbance of taste. In multivariable analysis, having persistent symptoms was associated with the number of comorbidities and number of symptoms during the acute COVID-19 phase.

• Lerum, Tøri Vigeland; Aaløkken, Trond M; Brønstad, Eivind; Aarli, Bernt Bøgvald; Ikdahl, Eirik & Lund, Kristine Marie Aarberg [Vis alle 14 forfattere av denne artikkelen] (2020). Dyspnoea, lung function and CT findings three months after hospital admission for COVID-19. European Respiratory Journal. ISSN 0903-1936. 57. doi: 10.1183/13993003.03448-2020. Fulltekst i vitenarkiv Vis sammendrag

  The long-term pulmonary outcomes of coronavirus disease 2019 (COVID-19) are unknown. We aimed to describe self-reported dyspnoea, quality of life, pulmonary function, and chest CT findings three months following hospital admission for COVID-19. We hypothesised outcomes to be inferior for patients admitted to intensive care units (ICU), compared with non-ICU patients. Discharged COVID-19-patients from six Norwegian hospitals were consecutively enrolled in a prospective cohort study. The current report describes the first 103 participants, including 15 ICU patients. Modified Medical Research Council dyspnoea scale (mMRC), EuroQol Group's Questionnaire, spirometry, diffusion capacity (DLCO), six-minute walk test, pulse oximetry, and low-dose CT scan were performed three months after discharge. mMRC was >0 in 54% and >1 in 19% of the participants. The median (25th–75th percentile) forced vital capacity and forced expiratory volume in one second were 94% (76, 121) and 92% (84, 106) of predicted, respectively. DLCO was below the lower limit of normal in 24%. Ground-glass opacities (GGO) with >10% distribution in ≥1 of 4 pulmonary zones were present in 25%, while 19% had parenchymal bands on chest CT. ICU survivors had similar dyspnoea scores and pulmonary function as non-ICU patients, but higher prevalence of GGO (adjusted odds ratio [95% confidence interval] 4.2 [1.1, 15.6]) and performance in lower usual activities. Three months after admission for COVID-19, one fourth of the participants had chest CT opacities and reduced diffusion capacity. Admission to ICU was associated with pathological CT findings. This was not reflected in increased dyspnoea or impaired lung function.

• Kononova, Natalia; Sikkeland, Liv Ingunn Bjoner; Mahmood, Faiza; Vistnes, Maria; Kongerud, Johny & Einvik, Gunnar [Vis alle 7 forfattere av denne artikkelen] (2019). Annual decline in forced expiratory volume and airway inflammatory cells and mediators in a general population-based sample. BMC Pulmonary Medicine. 19. doi: 10.1186/s12890-018-0765-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Few studies have examined the relationships between sputum inflammatory markers and subsequent annual decline in forced expiratory volume in 1 s (dFEV1). This study investigated whether indices of airway inflammation are predictors of dFEV1 in a general population-based sample. Methods The study, conducted from 2003 to 2005, included 120 healthy Norwegian subjects aged 40 to 70 years old. At baseline, the participants completed a self-administered respiratory questionnaire and underwent a clinical examination that included spirometry, venous blood sampling, and induced sputum examination. From 2015 to 2016, 62 (52%) participants agreed to a follow-up examination that did not include induced sputum examination. Those with a FEV1/forced vital capacity (FVC) ratio <  0.70 underwent a bronchial reversibility test. The levels of cytokines, pro-inflammatory M1 macrophage phenotypes were measured in induced sputum using bead-based multiplex analysis. The associations between cytokine levels and dFEV1 were then analysed. Results The mean dFEV1 was 32.9 ml/year (standard deviation 26.3). We found no associations between dFEV1 and the baseline indices of sputum inflammation. Seven participants had irreversible airflow limitation at follow-up. They had lower FEV1 and gas diffusion at baseline compared with the remaining subjects. Moreover, two of these individuals had a positive reversibility test and sputum eosinophilia at baseline. Conclusions In this cohort of presumably healthy subjects, we found no associations between sputum inflammatory cells or mediators and dFEV1 during 10 years of follow-up.

• Caspersen, Nina Faksvåg; Røsjø, Helge; Flyvbjerg, Allan; Bjerre, Mette; Randby, Anna & Hrubos-Strøm, Harald [Vis alle 8 forfattere av denne artikkelen] (2018). The association between circulating adiponectin levels, lung function and adiposity in subjects from the general population; data from the Akershus Sleep Apnea Project. BMC Pulmonary Medicine. 18(54). doi: 10.1186/s12890-018-0618-4. Fulltekst i vitenarkiv Vis sammendrag

  Background Circulating adiponectin (ADPN) levels are inversely associated with disease severity in patients with chronic obstructive pulmonary disease (COPD), while studies assessing the relationship between ADPN and lung function in subjects from the general population have shown diverging results. Accordingly, we hypothesized that ADPN would be associated with lung function in a population-based sample and tested how abdominal adiposity, metabolic syndrome, and systemic inflammation influenced this association. Methods We measured total ADPN in serum, forced vital capacity (FVC) and forced expiratory volume during the 1st second (FEV1) in 529 participants (median 50 years, 54.6% males) recruited from the general population. We assessed the association between ADPN and lung function by multivariate linear regression analyses and adjusted for age, gender, height, smoking habits, weight, body mass index, waist-hip ratio, metabolic syndrome, obstructive sleep apnoea (OSA) and C-reactive protein. Results The median (interquartile range) level of serum ADPN was 7.6 (5.4–10.4) mg/L. ADPN levels were positively associated with FVC % of predicted (beta 3.4 per SD adiponectin, p < 0.001)) in univariate linear regression analysis, but the association was attenuated in multivariate analysis (standardized beta 0.03, p = 0.573)). Among co-variates only WHR significantly attenuated the relationship. ADPN levels were also associated with FEV1% of predicted in bivariate analysis that adjusted for smoking (beta 1.4, p = 0.042)), but this association was attenuated and no longer significant in multivariate analysis (standardized beta -0.06, p = 0.254)). Conclusion In this population-based sample no association between ADPN and lung function was evident after adjustment for covariates related to adiposity.

• Berge, Kristian; Lyngbakken, Magnus; Einvik, Gunnar; Winther, Jacob Andreas; Brynildsen, Jon & Røysland, Ragnhild [Vis alle 11 forfattere av denne artikkelen] (2018). Diagnostic and prognostic properties of procalcitonin in patients with acute dyspnea: Data from the ACE 2 Study. Clinical Biochemistry. ISSN 0009-9120. 59, s. 62–68. doi: 10.1016/j.clinbiochem.2018.07.006. Fulltekst i vitenarkiv
• Einvik, Gunnar; Bhatnagar, Rahul; Holmedahl, Nils Henrik; Neukamm, Anke; Omland, Torbjørn & Søyseth, Vidar (2017). Premature Ventricular Complex is More Prevalent During Acute Exacerbated than Stable States of Chronic Obstructive Pulmonary Disease, and Is Related to Cardiac Troponin T. COPD: Journal of Chronic Obstructive Pulmonary Disease. ISSN 1541-2555. 14(3), s. 318–323. doi: 10.1080/15412555.2017.1298085. Fulltekst i vitenarkiv Vis sammendrag

  During acute exacerbation of chronic obstructive pulmonary disease (AECOPD), myocardial stress may be aggravated. Sparse data exist concerning the prevalence and correlates of cardiac arrhythmias in the stable and exacerbated states of COPD. We hypothesized that AECOPD is associated with increased prevalence of cardiac arrhythmias independent of COPD-severity and co-morbidity, and explored possible mechanisms. A 24-hour Holter recording was obtained in 74 patients with stable COPD and 45 patients with AECOPD (mean age 54 years, 56% women). Any incidence of supraventricular tachycardia (SVT), frequent premature ventricular complex (PVC, >30/hour) and complex ventricular ectopy (bigeminy, trigeminy or non-sustained ventricular tachycardia) was recorded and compared between the two groups. Adjustments were made for by stable disease-related co-variates (demography, co-morbidity, COPD-severity) and by acute disease-related co-variates (heart rate, cardiac troponin T (cTnT), PO2, PCO2 and C-reactive protein (CRP)) in explorative analyses. The prevalence of SVT, frequent PVCs or complex ventricular ectopy was 40%, 27% and 33% in AECOPD, and 31%, 31% and 12% in stable COPD, respectively. Frequent PVC, but not SVT or complex ventricular ectopy, was significantly increased in AECOPD compared to stable COPD, odds ratio 3.03 (1.03–10.5, p = 0.039) when adjusted for stable disease-related co-variates. Higher heart rate, cTnT and CRP attenuated the association between AECOPD and frequent PVC to non-significant, while heart rate remained associated with frequent PVC. In conclusion, frequent PVC is more prevalent in exacerbated than in the stable states of COPD. Attenuation effects of cTnT, tachycardia and CRP suggest that cardiac stress or inflammation may be involved in mechanisms causing frequent PVC i AECOPD. © 2017 Taylor & Francis

• 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.

• Omland, Torbjørn; Randby, Anna; Hrubos-Strøm, Harald; Røsjø, Helge & Einvik, Gunnar (2016). Relation of Erectile Dysfunction to Subclinical Myocardial Injury. American Journal of Cardiology. ISSN 0002-9149. 118(12), s. 1821–1825. doi: 10.1016/j.amjcard.2016.08.070. Fulltekst i vitenarkiv
• Skranes, Julia Brox; Einvik, Gunnar; Namtvedt, Silje Kjeka; Randby, Anna; Hrubos-Strøm, Harald & Brynildsen, Jon [Vis alle 10 forfattere av denne artikkelen] (2016). Biomarkers of cardiovascular injury and stress are associated with increased frequency of ventricular ectopy: A population-based study. BMC Cardiovascular Disorders. 16(1). doi: 10.1186/s12872-016-0407-z. Fulltekst i vitenarkiv Vis sammendrag

  Background Asymptomatic ventricular arrhythmias are common and associated with increased risk of cardiovascular mortality. Cardiac troponins, natriuretic peptides and C–reactive protein (CRP) are also predictive of adverse cardiovascular events in the general population, but limited information is available on the relationship between these biomarkers and ventricular ectopy in a community-based population. The objectives were to evaluate the associations between ventricular ectopic activity and N-terminal pro-B-type natriuretic peptide (NT-proBNP), high sensitivity-troponin I (hs-TnI) and hs-CRP in a community-based setting. Methods We performed a 24 h Holter-recording and blood sampling in 498 subjects. Premature ventricular complexes (PVC) were classified as frequent at >5/h and the presence of any bigeminy, trigeminy or non-sustained ventricular tachycardia were classified as complex ventricular ectopy. The associations between biomarkers and ventricular arrhythmias were investigated by univariate and multivariate logistic regression analyses. Results Frequent PVC’s and complex ventricular ectopy were detected in 46 (9%) and 47 (9%) participants respectively, and were associated with significantly (p < 0.001) higher concentrations of NT-proBNP and hs-TnI. The association between NT-proBNP and both frequent PVC’s (p = 0.020) and complex ventricular ectopy (p = 0.001) remained significant after adjusting for conventional risk markers in multivariate analyses. Conclusion Increased level of NT-proBNP was independently associated with ventricular ectopy, whereas no independent association was observed between hs-TnI and hs-CRP levels and ventricular ectopy in this community-based sample.

• Søyseth, Vidar; Henneberger, Paul K; Einvik, Gunnar; Virji, Mohammed Abbas; Bakke, Berit & Kongerud, Johny (2016). Annual decline in forced expiratory volume is steeper in aluminum potroom workers than in workers without exposure to potroom fumes. American Journal of Industrial Medicine. ISSN 0271-3586. 59(4), s. 322–329. doi: 10.1002/ajim.22570. Fulltekst i vitenarkiv Vis sammendrag

  Background: Aluminum potroom exposure is associated with increased mortality of COPD but the association between potroom exposure and annual decline in lung function is unknown. We have measured lung volumes annually using spirometry from 1986 to 1996. The objective was to compare annual decline in forced expiratory volume in 1 s (dFEV1) and forced vital capacity (dFVC). Methods: The number of aluminum potroom workers was 4,546 (81% males) and the number of workers in the reference group was 651 (76% males). The number of spirometries in the index group and the references were 24,060 and 2,243, respectively. Results: After adjustment for confounders, the difference in dFEV1 and dFVC between the index and reference groups were 13.5 (P < 0.001) and −8.0 (P = 0.060) ml/year. Conclusion: Aluminum potroom operators have increased annual decline in FEV1 relative to a comparable group with non‐exposure to potroom fumes and gases.

• Neukamm, Anke; Einvik, Gunnar; Høiseth, Arne Didrik; Søyseth, Vidar; Holmedahl, Nils Henrik & Kononova, Natalia [Vis alle 7 forfattere av denne artikkelen] (2016). The prognostic value of measurement of high-sensitive cardiac troponin T for mortality in a cohort of stable chronic obstructive pulmonary disease patients. BMC Pulmonary Medicine. 16(1). doi: 10.1186/s12890-016-0319-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Cardiovascular disease (CVD) is a common comorbidity in chronic obstructive pulmonary disease (COPD). Cardiac troponin (cTn) elevation, indicating myocardial injury, is frequent during acute COPD exacerbations and associated with increased mortality. The prognostic value of circulating cTnT among COPD patients in the stable state of the disease is still unknown. The purpose of the present study was to assess the association between circulating cTnT measured by a high sensitive assay (hs-cTnT) and all-cause mortality among patients with stable COPD without overt CVD. Methods In a prospective cohort study we included 275 patients from the Akershus University Hospital’s outpatient clinic and from Glittre, a pulmonary rehabilitation clinic. COPD-severity and cardiovascular risk factors were assessed, and time to all-cause death was recorded during a mean follow-up time of 2.8 years. Results One hundred-eighty patients (65%) had hs-cTnT concentrations ≥ the level of detection (5.0 ng/L) and 66 patients (24%) had hs-cTnT above the normal range (≥14.0 ng/L). In total, 47 patients (17%) died. hs-cTnT concentrations in the ranges <5.0, 5.0–13.9 and ≥14 ng/L were associated with crude mortality rates of 2.8, 4.4 and 11.0 per 100 patient-years, respectively. In adjusted analyses the hazard ratios (95% confidence intervals) for death were 1.7 (0.8–3.9) and 2.9 (1.2–7.2) among patients with hs-cTnT concentrations 5.0–13.9 and ≥14 ng/L, respectively, compared to patients with hs-cTnT <5.0 ng/L. Conclusions hs-cTnT elevation is frequently present in patients with stable COPD without overt CVD, and associated with increased mortality, independently of COPD-severity and other cardiovascular risk factors.

• Neukamm, Anke; Høiseth, Arne Didrik; Einvik, Gunnar; Lehmann, Sverre; Hagve, Tor-Arne & Søyseth, Vidar [Vis alle 7 forfattere av denne artikkelen] (2015). Rosuvastatin treatment in stable chronic obstructive pulmonary disease (RODEO): a randomized controlled trial. Journal of Internal Medicine. ISSN 0954-6820. 278(1), s. 59–67. doi: 10.1111/joim.12337. Fulltekst i vitenarkiv
• Einvik, Gunnar; Dammen, Toril; Høiseth, Arne Didrik; Brynildsen, Jon; Hagve, Tor-Arne & Christensen, Geir Arve [Vis alle 8 forfattere av denne artikkelen] (2015). Psychological distress and mortality in patients with acute dyspnea: Data from the Akershus Cardiac Examination (ACE) 2 Study. General Hospital Psychiatry. ISSN 0163-8343. 37(6), s. 548–553. doi: 10.1016/j.genhosppsych.2015.07.007. Fulltekst i vitenarkiv
• Einvik, Gunnar; Dammen, Toril; Namtvedt, Silje Kjeka; Hrubos-Strøm, Harald; Randby, Anna & Kristiansen, Håvard Anton [Vis alle 9 forfattere av denne artikkelen] (2014). Type D personality is associated with increased prevalence of ventricular arrhythmias in community-residing persons without coronary heart disease. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 21(5), s. 592–600. doi: 10.1177/2047487312462800. Fulltekst i vitenarkiv
• Einvik, Gunnar; Røsjø, Helge; Randby, Anna; Namtvedt, Silje Kjeka; Hrubos-Strøm, Harald & Brynildsen, Jon [Vis alle 8 forfattere av denne artikkelen] (2014). Severity of obstructive sleep apnea is associated with cardiac troponin I concentrations in a community-based sample: Data from the Akershus Sleep Apnea Project. Sleep. ISSN 0161-8105. 37(6), s. 1111–1116. doi: 10.5665/sleep.3772. Fulltekst i vitenarkiv
• Faiz, Kashif Waqar; Thommessen, Bente; Einvik, Gunnar; Brekke, Pål Haugar; Omland, Torbjørn & Rønning, Ole M. (2014). Determinants of high sensitivity cardiac troponin T elevation in acute ischemic stroke. BMC Neurology. 14(1). doi: 10.1186/1471-2377-14-96. Fulltekst i vitenarkiv Vis sammendrag

  Background A proportion of patients with acute ischemic stroke have elevated cardiac troponin levels and ECG changes suggestive of cardiac injury, but the etiology is unclear. The aims of this study were to assess the frequency of high sensitivity cardiac troponin T (hs-cTnT) elevation, to identify determinants and ECG changes associated with hs-cTnT elevation, to identify patients with myocardial ischemia and to assess the impact of hs-cTnT elevation on in-hospital mortality. Methods Patients discharged with a diagnosis of acute ischemic stroke during a 1-year period, were included. Patients diagnosed with acute myocardial infarction (MI) within the last 7 days before admission or during hospitalization were excluded. Results In all, 156 (54.4%) of 287 patients had elevated hs-cTnT. The factors independently associated with hs-cTnT elevation were age ≥ 76 years (OR 3.71 [95% CI 2.04-6.75]), previous coronary heart disease (CHD) (OR 2.61 [1.23-5.53]), congestive heart failure (OR 4.26 [1.15-15.82]), diabetes mellitus (OR 4.02 [1.50-10.76]) and lower eGFR (OR 0.97 [0.95-0.98]). Of the 182 patients who had two hs-cTnT measurements, 12 (6.6%) had both a rise or fall of hs-cTnT with at least one elevated value, and ECG manifestations of myocardial ischemia, e.g. meeting the criteria of acute MI. Both dynamic relative change (p = 0.026) and absolute change (p = 0.032) in hs-cTnT were significantly associated with higher in-hospital mortality. Conclusions Established CHD and cardiovascular risk factors are associated with hs-cTnT elevation. Acute MI is likely underdiagnosed in acute ischemic stroke patients. Dynamic changes in troponin levels seem to be related to poor short-term prognosis.

• Faiz, Kashif Waqar; Thommessen, Bente; Einvik, Gunnar; Omland, Torbjørn & Rønning, Ole M. (2014). Prognostic Value of High-sensitivity Cardiac Troponin T in Acute Ischemic Stroke. Journal of Stroke & Cerebrovascular Diseases. ISSN 1052-3057. 23(2), s. 241–248. doi: 10.1016/j.jstrokecerebrovasdis.2013.01.005. Fulltekst i vitenarkiv
• Søyseth, Vidar; Bhatnagar, Rahul; Holmedahl, Nils Henrik; Neukamm, Anke; Høiseth, Arne Didrik & Hagve, Tor-Arne [Vis alle 8 forfattere av denne artikkelen] (2013). Acute exacerbation of COPD is associated with fourfold elevation of cardiac troponin T. Heart. ISSN 1355-6037. 99(2), s. 122–126. doi: 10.1136/heartjnl-2012-302685. Fulltekst i vitenarkiv
• Randby, Anna; Namtvedt, Silje Kjeka; Hrubos-Strøm, Harald; Einvik, Gunnar; Somers, Virend K. & Omland, Torbjørn (2013). Sex-Dependent Impact of OSA on Digital Vascular Function. Chest. ISSN 0012-3692. 144(3), s. 915–922. doi: 10.1378/chest.12-2283. Fulltekst i vitenarkiv
• Einvik, Gunnar; Flyvbjerg, Allan; Hrubos-Strøm, Harald; Randby, Anna; Frystyk, Jan & Mette, Bjerre [Vis alle 12 forfattere av denne artikkelen] (2013). Novel cardiovascular risk markers in depression: No association between depressive symptoms and osteoprotegerin or adiponectin in persons at high risk for sleep apnea. Journal of Affective Disorders. ISSN 0165-0327. 145(3), s. 400–404. doi: 10.1016/j.jad.2012.05.065. Fulltekst i vitenarkiv
• Hrubos-Strøm, Harald; Nordhus, Inger Hilde; Einvik, Gunnar; Randby, Anna; Omland, Torbjørn & Sundet, Kjetil Søren [Vis alle 8 forfattere av denne artikkelen] (2012). Obstructive sleep apnea, verbal memory, and executive function in a community-based high-risk population identified by the Berlin Questionnaire Akershus Sleep Apnea Project. Sleep and Breathing. ISSN 1520-9512. 16(1), s. 223–231. doi: 10.1007/s11325-011-0493-1. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Cognitive functions in community-dwelling adults at high risk of obstructive sleep apnea have not been described and nor are associations between cognitive functions and obstructive sleep apnea severity fully understood. The study aimed to describe verbal memory and executive function in community-dwelling adults identified by the Berlin Questionnaire and to investigate associations between these cognitive domains and different obstructive sleep apnea severity indicators. Methods: Among 29,258 age- and gender-stratified persons 30–65 years who received the Berlin Questionnaire by mail, 16,302 (55.7%) responded. From 654 randomly drawn respondents with BQ high risk who were approached for study participation, 290 participants (55.9% males, mean age 48.2 years) were included. Verbal memory was assessed by Rey Auditory Verbal Learning Test and executive function by Stroop test. Obstructive sleep apnea severity indicators were assessed by polysomnography. Results: Mean (standard deviation) verbal learning score was 42.0 (8.9), mean interference time was 31.1 (12.7), median (25th percentile, 75th percentile) apnea–hypopnea index was 7.7 (2.4–22.2), and mean average oxygen saturation was 94.3 (2.0). Verbal learning score was independently associated with average oxygen saturation (β = 0.721, p = 0.025) in multivariate linear regression models adjusted for putative confounders. Interference time was only related to OSA severity indicators in bivariate analyses. Conclusions: Verbal memory and executive function impairments were mild in community-dwelling adults at high risk of obstructive sleep apnea. Average oxygen saturation was the indicator of obstructive sleep apnea severity most strongly associated with cognitive function.

• Einvik, Gunnar; Vistnes, Maria; Hrubos-Strøm, Harald; Randby, Anna; Namtvedt, Silje Kjeka & Nordhus, Inger Hilde [Vis alle 9 forfattere av denne artikkelen] (2012). Circulating cytokine concentrations are not associated with major depressive disorder in a community-based cohort. General Hospital Psychiatry. ISSN 0163-8343. 34(3), s. 262–267. doi: 10.1016/j.genhosppsych.2012.01.017. Fulltekst i vitenarkiv
• Randby, Anna; Namtvedt, Silje Kjeka; Einvik, Gunnar; Hrubos-Strøm, Harald; Hagve, Tor-Arne & Somers, Virend K. [Vis alle 7 forfattere av denne artikkelen] (2012). Obstructive Sleep Apnea Is Associated With Increased High-Sensitivity Cardiac Troponin T Levels. Chest. ISSN 0012-3692. 142(3), s. 639–646. doi: 10.1378/chest.11-1779. Fulltekst i vitenarkiv
• Hrubos-Strøm, Harald; Einvik, Gunnar; Nordhus, Inger Hilde; Randby, Anna; Pallesen, Ståle & Moum, Torbjørn Åge [Vis alle 8 forfattere av denne artikkelen] (2012). Sleep apnoea, anxiety, depression and somatoform pain: a community-based high-risk sample. European Respiratory Journal. ISSN 0903-1936. 40(2), s. 400–407. doi: 10.1183/09031936.00111411. Fulltekst i vitenarkiv
• Einvik, Gunnar; Hrubos-Strøm, Harald; Randby, Anna; Nordhus, Inger Hilde; Somers, Virend K. & Omland, Torbjørn [Vis alle 7 forfattere av denne artikkelen] (2011). Major depressive disorder, anxiety disorders, and cardiac biomarkers in subjects at high risk of obstructive sleep apnea. Psychosomatic Medicine. ISSN 0033-3174. 73(5), s. 378–384. doi: 10.1097/PSY.0b013e318219e64e. Fulltekst i vitenarkiv
• Einvik, Gunnar; Dammen, Toril; Hrubos-Strøm, Harald; Namtvedt, Silje Kjeka; Randby, Anna & Kristiansen, Håvard Anton [Vis alle 9 forfattere av denne artikkelen] (2011). Prevalence of cardiovascular risk factors and concentration of C-reactive protein in Type D personality persons without cardiovascular disease. European Journal of Cardiovascular Prevention & Rehabilitation. ISSN 1741-8267. 18(3), s. 504–509. doi: 10.1177/1741826710389383. Fulltekst i vitenarkiv
• Hrubos-Strøm, Harald; Randby, Anna; Namtvedt, Silje Kjeka; Kristiansen, Håvard Anton; Einvik, Gunnar & Saltyte-Benth, Jurate [Vis alle 12 forfattere av denne artikkelen] (2011). A Norwegian population-based study on the risk and prevalence of obstructive sleep apnea. Journal of Sleep Research. ISSN 0962-1105. 20(1), s. 162–170. doi: 10.1111/j.1365-2869.2010.00861.x. Fulltekst i vitenarkiv
• Namtvedt, Silje Kjeka; Randby, Anna; Einvik, Gunnar; Hrubos-Strøm, Harald; Somers, VK & Røsjø, Helge [Vis alle 7 forfattere av denne artikkelen] (2011). Cardiac Arrhythmias in Obstructive Sleep Apnea (from the Akershus Sleep Apnea Project). American Journal of Cardiology. ISSN 0002-9149. 108(8), s. 1141–1146. doi: 10.1016/j.amjcard.2011.06.016. Fulltekst i vitenarkiv
• Einvik, Gunnar; Klemsdal, Tor Ole; Sandvik, Leiv & Hjerkinn, Elsa M. (2010). A randomized clinical trial on n-3 polyunsaturated fatty acids supplementation and all-cause mortality in elderly men at high cardiovascular risk. European Journal of Cardiovascular Prevention & Rehabilitation. ISSN 1741-8267. 17(5), s. 588–592. doi: 10.1097/HJR.0b013e328339cc70. Fulltekst i vitenarkiv
• Einvik, Gunnar; Ekeberg, Øivind; Lavik, JG; Ellingsen, Ingrid; Klemsdal, Tor Ole & Hjerkinn, Elsa M. (2010). The influence of long-term awareness of hyperlipidemia and of 3 years of dietary counseling on depression, anxiety, and quality of life. Journal of Psychosomatic Research. ISSN 0022-3999. 68(6), s. 567–572. doi: 10.1016/j.jpsychores.2009.11.004. Fulltekst i vitenarkiv
• Hrubos-Strøm, Harald; Randby, Anna; Namtvedt, Silje Kjeka; Kristiansen, Håvard Anton; Einvik, Gunnar & Saltyte-Benth, Jurate [Vis alle 12 forfattere av denne artikkelen] (2010). A Norwegian population-based study on the risk and prevalence of obstructive sleep apnea. Journal of Sleep Research. ISSN 0962-1105. doi: 10.1111/j.1365-2869.2010.00861.x. Fulltekst i vitenarkiv
• Einvik, Gunnar; Dammen, Toril & Omland, Torbjørn (2010). Depresjon og kardiovaskulær sykdom - er det en sammenheng? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 130(7), s. 729–732. Fulltekst i vitenarkiv
• Einvik, Gunnar; Ekeberg, Øivind; Klemsdal, Tor Ole; Sandvik, Leiv; Lavik, Jørgen & Hjerkinn, Elsa M. (2009). Physical distress is associated with cardiovascular events in a high risk population of elderly men. BMC Cardiovascular Disorders. 9. doi: 10.1186/1471-2261-9-14. Fulltekst i vitenarkiv Vis sammendrag

  Background Self-reported health perceptions such as physical distress and quality of life are suggested independent predictors of mortality and morbidity in patients with established cardiovascular disease. This study examined the associations between these factors and three years incidence of cardiovascular events in a population of elderly men with long term hyperlipidemia. Methods We studied observational data in a cohort of 433 men aged 64–76 years from a prospective, 2 × 2 factorial designed, three-year interventional trial. Information of classical risk factors was obtained and the following questionnaires were administered at baseline: Hospital Anxiety and Depression Scale, Physical Symptom Distress Index and Life Satisfaction Index. The occurrence of cardiovascular death, myocardial infarction, cerebrovascular incidences and peripheral arterial disease were registered throughout the study period. Continuous data with skewed distribution was split into tertiles. Hazard ratios (HR) were calculated from Cox regression analyses to assess the associations between physical distress, quality of life and cardiovascular events. Results After three years, 49 cardiovascular events were registered, with similar incidence among subjects with and without established cardiovascular disease. In multivariate analyses adjusted for age, smoking, systolic blood pressure, serum glucose, HADS-anxiety and treatment-intervention, physical distress was positively associated (HR 3.1, 95% CI 1.2 – 7.9 for 3rd versus 1st tertile) and quality of life negatively associated (HR 2.6, 95% CI 1.1–5.8 for 3rd versus 1st tertile) with cardiovascular events. The association remained statistically significant only for physical distress (hazard ratio 2.8 95% CI 1.2 – 6.8, p < 0.05) when both variables were evaluated in the same model. Conclusion Physical distress, but not quality of life, was independently associated with increased risk of cardiovascular events in an observational study of elderly men predominantly without established cardiovascular disease. Trial Registration Trial registration: NCT00764010

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• Munkhaugen, John; Papageorgiou, Constantinos; Hagen, Roger; Johnson, Sverre Urnes; Einvik, Gunnar & Dammen, Toril (2023). Editorial: Progress in understanding and treating distress, sleep, and personality in heart and lung disease. Frontiers in Psychology. 14. doi: 10.3389/fpsyg.2023.1323677. Fulltekst i vitenarkiv
• Garratt, Andrew Malcolm; Ghanima, Waleed Khalid; Einvik, Gunnar & Stavem, Knut (2021). Quality of life after COVID-19 without hospitalisation: Good overall, but reduced in some dimensions. Journal of Infection. ISSN 0163-4453. 82(5), s. 186–188. doi: 10.1016/j.jinf.2021.01.002. Fulltekst i vitenarkiv
• Faiz, Kashif Waqar; Einvik, Gunnar; Brekke, Pål Haugar & Omland, Torbjørn (2017). Cardiac Troponin T Increase in Patients with Acute Ischemic Stroke with and without Cancer. Clinical Chemistry. ISSN 0009-9147. 64(2), s. 404–406. doi: 10.1373/clinchem.2017.280016. Fulltekst i vitenarkiv
• Hrubos-Strøm, Harald & Einvik, Gunnar (2015). Nye helsekrav til førerkort – medisin med tvilsom effekt. Fulltekst i vitenarkiv
• Neukamm, Anke; Høiseth, Arne Didrik; Einvik, Gunnar; Hagve, Tor-Arne; Lehmann, Sverre & Søyseth, Vidar [Vis alle 7 forfattere av denne artikkelen] (2014). Effect Of Rosuvastatin Treatment In Stable COPD (RODEO). Fulltekst i vitenarkiv
• Einvik, Gunnar; Dammen, Toril; Høiseth, Arne Didrik; Brynildsen, Jon; Hagve, Tor-Arne & Christensen, Geir Arve [Vis alle 8 forfattere av denne artikkelen] (2013). Anxiety is prevalent among patients hospitalized with acute dyspnea and independently associated with long-term mortality: data from the Akershus Cardiac Examination (ACE) 2 study. European Heart Journal. ISSN 0195-668X. 34, s. 949–949. Fulltekst i vitenarkiv
• Neukamm, Anke; Holmedahl, Nils Henrik; Einvik, Gunnar; Hagve, Tor-Arne; Somers, Virend K. & Søyseth, Vidar [Vis alle 7 forfattere av denne artikkelen] (2013). Cardiac troponin T levels increase overnight in patients with stable chronic obstructive pulmonary disease. Fulltekst i vitenarkiv
• Hrubos-Strøm, H; Nordhus, IH; Einvik, Gunnar; Dammen, Toril & Hrubos-Strom, H (2012). Weak associations between insomnia, daytime sleepiness and measures of obstructive sleep apnoea severity were strengthened after adjustment for age, gender and depression in a Norwegian, community-based sample. Journal of Sleep Research. ISSN 0962-1105. 21, s. 292–292. Fulltekst i vitenarkiv
• Einvik, Gunnar; Omland, Torbjørn & Dammen, Toril (2012). Biological markers and cardiovascular risk factors in relation to Type D personality, major depressive disorder and anxiety disorder. Akademika forlag. ISSN 9788282644839. Fulltekst i vitenarkiv

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