Completeness and correctness of acute myocardial infarction diagnoses in a medical quality register and an administrative health register.

Aims: Health registers are used for administrative purposes, disease surveillance, quality assessment, and research. The value of the registers is entirely dependent on the quality of their data. The aim of this study was to investigate and compare the completeness and correctness of the acute myocardial infarction (AMI) diagnosis in the Norwegian Myocardial Infarction Register and in the Norwegian Patient Register. Methods: All Norwegian patients admitted directly to St Olavs hospital, Trondheim University Hospital, Trondheim University Hospital from 1 July to 31 December 2012 and who had plasma levels of cardiac troponin T measured during their hospitalization (n=4835 unique individuals, n=5882 hospitalizations) were identified in the hospital biochemical database. A gold standard for AMI was established by evaluation of maximum troponin T levels and by review of the information in the medical records. Cases of AMI in the registers were classified as true positive, false positive, true negative, and false negative according to the gold standard. We calculated sensitivity, positive predictive value (PPV), specificity, and negative predictive value (NPV). Results: The Norwegian Myocardial Infarction Register had a sensitivity of 86.0% (95% confidence interval (CI) 82.8-89.3%), PPV of 97.9% (96.4-99.3%), and specificity of 99.9% and NPV of 98.9% (98.6-99.2%) (99.8-100%). The corresponding figures for the Norwegian Patient Register were 85.8% (95% CI 82.5-89.1%), 95.1% (92.9-97.2%), and 99.7% (99.5-99.8%) and 98.9% (98.6-99.2%), respectively. Both registers had a sensitivity higher than 95% when compared to hospital discharge diagnoses. The results were similar for men and women and for cases below and above 80 years of age. Conclusions: The Norwegian Myocardial Infarction Register and the Norwegian Patient Register are adequately complete and correct for administrative purposes, disease surveillance, quality assessment, and research.

Interrater reliability of a national acute myocardial infarction register.

BACKGROUND: Disease-specific registers may be used for measuring and improving healthcare and patient outcomes, and for disease surveillance and research, provided they contain valid and reliable data. The aim of this study was to assess the interrater reliability of all variables in a national myocardial infarction register. METHODS: We randomly selected 280 patients who had been enrolled from 14 hospitals to the Norwegian Myocardial Infarction Register during the year 2013. Experienced audit nurses, who were blinded to the data about the 280 patients already in the register, completed the Norwegian Myocardial Infarction paper forms for 240 patients by review of medical records. We then extracted all registered data on the same patients from the Norwegian Myocardial Infarction Register. To compare the interrater reliability between the register and the audit nurses, we calculated intraclass correlations coefficient for continuous variables, Cohen's kappa and Gwet's first agreement coefficient (AC1) for nominal variables, and quadratic weighted Cohen's kappa and Gwet's second AC for ordinal variables. RESULTS: We found excellent (AC1 >0.80) or good (AC1 0.61-0.80) agreement for most variables, including date and time variables, medical history, investigations and treatments during hospitalization, medication at discharge, and ST-segment elevation or non-ST-segment elevation acute myocardial infarction. However, only moderate agreement (AC1 0.41-0.60) was found for family history of coronary heart disease, diagnostic electrocardiography, and complications during hospitalization, whereas fair agreement (AC1 0.21-0.40) was found for acute myocardial infarction location. A high percentage of missing data was found for symptom onset, family history, body mass index, infarction location, and new Q-wave. CONCLUSION: Most variables in Norwegian Myocardial Infarction Register had excellent or good reliability. However, some important variables had lower reliability than expected or had missing data. Precise definitions of data elements and proper training of data abstractors are necessary to ensure that clinical registries contain valid and reliable data.

The MacNew Heart Disease Health-Related Quality of Life Questionnaire: A Scandinavian Validation Study.

The aim of this study is to validate the Danish, Norwegian and Swedish versions of the self-administered MacNew Heart Disease Health-related Quality of Life questionnaire in patients with ischemic heart disease. The MacNew questionnaire, the Short Form SF-36, and the Hospital Anxiety and Depression Scale were completed at baseline by 976 patients (Denmark n = 353, Norway n = 328, Sweden n = 295) with a diagnosis of angina (n = 335), myocardial infarction (n = 352), or heart failure (n = 289). Each language version of the MacNew satisfied reliability criteria with Cronbach's α values for the total group data (0.90-0.94) as well as the diagnostic group data (0.91-0.96). The test-retest correlations exceeded the criteria for group comparison (r ≥ 0.70) in Danish and Norwegian patients. The multidimensionality of the MacNew was confirmed although the original three-factor solution did not fully meet the criteria for good fit. Convergent and discriminative validity were confirmed in each language and diagnosis group with the exception of discriminative validity in Swedish angina patients. The psychometric properties of the Danish, Norwegian, and Swedish versions of the MacNew are largely confirmed. The MacNew can be recommended as a specific instrument for assessing and evaluating HRQL in Danish, Norwegian, and Swedish patients with angina, MI, and heart failure. However, the MacNew factor structure needs to be revisited in future studies.

Physical therapy intervention in patients with non-cardiac chest pain following a recent cardiac event: A randomized controlled trial.

OBJECTIVES: To assess the effect of two different physical therapy interventions in patients with stable coronary heart disease and non-cardiac chest pain. METHODS: A randomized controlled trial was carried out at a university hospital in Norway. A total of 30 patients with known and stable coronary heart disease and self-reported persistent chest pain reproduced by palpation of intercostal trigger points were participating in the study. The intervention was deep friction massage and heat pack versus heat pack only. The primary outcome was pain intensity after the intervention period and 3 months after the last treatment session, measured by Visual Analogue Scale, 0 to 100. Secondary outcome was health-related quality of life. RESULTS: Treatment with deep friction massage and heat pack gave significant pain reduction compared to heat pack only (-17.6, 95% confidence interval: -30.5, -4.7; p < 0.01), and the reduction was persistent at 3 months' follow-up (-15.2, 95% confidence interval: -28.5, -1.8; p = 0.03). Health-related quality of life improved in all three domains in patients with no significant difference between groups. CONCLUSION: Deep friction massage combined with heat pack is an efficient treatment of musculoskeletal chest pain in patients with stable coronary heart disease.

Disturbed adiponectin ­ AMPK system in skeletal muscle of patients with metabolic syndrome.

Patients with metabolic syndrome are characterized by low circulating adiponectin levels and reduced adiponectin sensitivity in skeletal muscles. Through binding on its main skeletal muscle receptor AdipoR1, adiponectin activates AMP-activated protein kinase (AMPK), a key player in energy homeostasis. Fourteen metabolic syndrome patients and seven healthy control subjects were included. Blood samples were taken to determine insulin resistance, adiponectin, lipoproteins, and C-reactive protein. Muscle biopsies (m. vastus lateralis) were obtained to assess mRNA expression of AdipoR1 and both AMPKα1 and AMPKα2 subunits, as well as downstream targets in lipid and glucose metabolism. Skeletal muscle mRNA expression of AMPKα1 and AMPKα2 was lower in metabolic syndrome patients (100 ± 6 vs. 122 ± 8 AU, p = 0.030 and 64 ± 4 vs. 85 ± 9 AU, p = 0.044, respectively), whereas the expression of AdipoR1 was upregulated (138 ± 9 vs. 105 ± 7, p = 0.012). AMPKα1 and AdipoR1 correlated positively in both the control (r = 0.964, p < 0.001) and the metabolic syndrome group (r = 0.600, p = 0.023). However, this relation was shifted upwards in metabolic syndrome patients, indicating increased AdipoR1mRNA expression for a similar AMPKα1 expression. Previously, a blunted stimulatory effect of adiponectin on AMPK activation has been shown in metabolic syndrome patients. The present data suggest that the disturbed interaction of adiponectin with AMPK is located downstream of the AdipoR1 receptor.

Myocardial infarction in Norway in 2013.

BACKGROUND: The Norwegian Myocardial Infarction Registry was established in 2012 as a national quality registry. This first report from the registry presents the number of myocardial infarctions, the treatment provided and the 30-day mortality rate for myocardial infarctions admitted to Norwegian hospitals. MATERIAL AND METHOD: All patients with myocardial infarction admitted to Norwegian hospitals in 2013 and recorded in the Norwegian Myocardial Infarction Registry are included. The number of myocardial infarctions, patient characteristics and their treatment are indicated for myocardial infarctions with and without ST-segment elevation on ECG (STEMI and nSTEMI). The 30-day mortality is calculated for each health region. RESULTS: In 2013, a total of 13,043 myocardial infarctions in 12,336 patients were recorded in the Norwegian Myocardial Infarction Registry. Altogether 3,658 (28%) of the infarctions were classified as STEMI and 9,188 (70%) as nSTEMI. The average age at the time of the infarction was 68.1 years for men and 75.9 years for women. Percutaneous coronary intervention was performed for a total of 2,798 (77%) ST-segment elevation myocardial infarctions, whereas the corresponding number for nSTEMI was 3,179 (35%). The 30-day mortality in the entire infarction population was 10% (< 60 years: 2%, 60-69 years: 4%, 70-79 years: 9%, ≥ 80 years: 20%). We found no differences in mortality between health regions or between men and women. INTERPRETATION: This first report from the Norwegian Myocardial Infarction Registry shows that the treatment service is functioning well for most patients. Secondary prophylaxis using drug therapy and increased use of invasive examination of patients with nSTEMI appear to be areas for improvement.

Home-based aerobic interval training improves peak oxygen uptake equal to residential cardiac rehabilitation: a randomized, controlled trial.

UNLABELLED: Aerobic capacity, measured as the peak oxygen uptake, is a strong predictor of survival in cardiac patients. Aerobic interval training (AIT), walking/running four times four minutes at 85-95% of peak heart rate, has proven to be effective in increasing peak oxygen uptake in coronary heart disease patients. As some patients do not attend organized rehabilitation programs, home-based exercise should be an alternative. We investigated whether AIT could be performed effectively at home, and compared the effects on peak oxygen uptake with that observed after a standard care, four-week residential rehabilitation. Thirty patients undergoing coronary artery bypass surgery were randomized to residential rehabilitation or home-based AIT. At six months follow-up, peak oxygen uptake increased 4.6 (±2.7) and 3.9 (±3.6) mL·kg(-1) min(-1) (both p<0.005, non-significant between-group difference) after residential rehabilitation and AIT, respectively. Quality of life increased significantly in both groups, with no statistical significant difference between groups. We found no evidence for a different treatment effect between patients randomized to home-based AIT compared to patients attending organized rehabilitation (95% confidence interval -1.8, 3.5). AIT patients reported good adherence to exercise training. Even though these first data indicate positive effects of home-based AIT in patients undergoing coronary artery bypass surgery, more studies are needed to provide supporting evidence for the application of this rehabilitation strategy. TRIAL REGISTRATION: ClinicalTrials.gov NCT00363922.

Effect of exercise training on inflammation status among people with metabolic syndrome.

BACKGROUND: Metabolic syndrome is associated with chronic low-grade inflammation, a condition thought to play a key role in the pathogenesis of the syndrome. Among a number of proinflammatory cytokines, interleukin-18 (IL-18) seems to be the best marker for inflammation among people with metabolic syndrome. The aim of this study was to examine the effect of aerobic training versus strength training on circulating IL-18 and other proinflammatory markers in people with metabolic syndrome. METHODS: Thirty-one inactive men and women with metabolic syndrome were randomized to either high-intensity aerobic interval training (AIT, n=11), strength training (ST, n=10), or a control group (n=10). Exercise training was carried out three times per week for 12 weeks. Serum insulin, high-sensitivity C-reactive protein (hsCRP), IL-18, IL-6, and tumor necrosis factor-α (TNF-α) were measured before and after the intervention. RESULTS: Serum IL-18 was reduced by 43% after AIT (P<0.001). Although there was no change in TNF-α from baseline after AIT, the levels were lower compared to the ST (P=0.032) and control groups (P=0.039) after the intervention. Total body fat was reduced after AIT (from 33.9 ± 7.3% to 32.2 ± 7.9%, P<0.001) and ST (from 31.2 ± 3.9% to 29.7 ± 3.4%, P=0.025). There were no changes in serum IL-6, insulin, or hsCRP within or between the groups. CONCLUSION: Both ST and AIT reduced fat mass. However, only the latter intervention was associated with a more favorable inflammatory status among people with metabolic syndrome. CLINICAL TRIAL REGISTRATION INFORMATION: http://clinicaltrials.gov/show/NCT00986024/ .

Aerobic interval training increases peak oxygen uptake more than usual care exercise training in myocardial infarction patients: a randomized controlled study.

OBJECTIVE: Exercise capacity strongly predicts survival and aerobic interval training (AIT) increases peak oxygen uptake effectively in cardiac patients. Usual care in Norway provides exercise training at the hospitals following myocardial infarction (MI), but the effect and actual intensity of these rehabilitation programmes are unknown. DESIGN: Randomized controlled trial. SETTING: Hospital cardiac rehabilitation. SUBJECTS: One hundred and seven patients, recruited two to 12 weeks after MI, were randomized to usual care rehabilitation or treadmill AIT. INTERVENTIONS: Usual care aerobic group exercise training or treadmill AIT as 4 × 4 minutes intervals at 85-95% of peak heart rate. Twice weekly exercise training for 12 weeks. MAIN MEASURES: The primary outcome measure was peak oxygen uptake. Secondary outcome measures were endothelial function, blood markers of cardiovascular disease, quality of life, resting heart rate, and heart rate recovery. RESULTS: Eighty-nine patients (74 men, 15 women, 57.4 ± 9.5 years) completed the programme. Peak oxygen uptake increased more (P = 0.002) after AIT (from 31.6 ± 5.8 to 36.2 ± 8.6 mL·kg(-1)·min(-1), P < 0.001) than after usual care rehabilitation (from 32.2 ± 6.7 to 34.7 ± 7.9 mL·kg(-1)·min(-1), P < 0.001). The AIT group exercised with significantly higher intensity in the intervals compared to the highest intensity in the usual care group (87.3 ± 3.9% versus 78.7 ± 7.2% of peak heart rate, respectively, P < 0.001). Both programmes increased endothelial function, serum adiponectin, and quality of life, and reduced serum ferritin and resting heart rate. High-density lipoprotein cholesterol increased only after AIT. CONCLUSIONS: AIT increased peak oxygen uptake more than the usual care rehabilitation provided to MI patients by Norwegian hospitals.

Maternal left ventricular and endothelial functions in preeclampsia.

OBJECTIVE: To compare maternal left ventricular and endothelial functions in preeclampsia and normal pregnancy, during pregnancy and after delivery. DESIGN: Observational study with follow-up. SETTING: University hospital and midwife-led antenatal care center. SAMPLES: Twenty untreated women with preeclampsia and 20 women with normal pregnancy, matched for gestational age and parity. METHODS: The women were examined during pregnancy and three months after delivery. Left ventricular function was assessed by echocardiography, including tissue-Doppler imaging. Endothelial function was assessed by measuring flow-mediated dilation of the brachial artery. MAIN OUTCOME MEASURES: Early diastolic mitral annular tissue velocity, "e", peak systolic tissue velocity, "S", and flow-mediated dilation. RESULTS: The diastolic function was reduced in preeclampsia, with lower "e", and there was a higher ratio of early diastolic mitral inflow velocity and early diastolic mitral annular velocity, "E/e". Early diastolic mitral inflow deceleration time and isovolumetric relaxation time were similar between the groups, suggesting pseudonormalization and increased filling pressures in preeclampsia. "S" was lower in the preeclampsia group during pregnancy. Both diastolic and systolic left ventricular functions normalized postpartum. The flow-mediated dilation was impaired in the preeclampsia group both during pregnancy and three months after delivery. CONCLUSIONS: The maternal left ventricular function was impaired during preeclampsia but had normalized three months after delivery. The endothelial function, measured by flow-mediated dilation, was impaired in the preeclampsia group as compared with the normal pregnancy group both during pregnancy and three months after delivery.

Even low level of physical activity is associated with reduced mortality among people with metabolic syndrome, a population based study (the HUNT 2 study, Norway).

BACKGROUND: Low levels of physical activity may increase the risk of developing metabolic syndrome, a cluster of metabolic factors that are associated with the risk of premature death. It has been suggested that physical activity may reduce the impact of factors associated with metabolic syndrome, but it is not known whether physical activity may reduce mortality in people with metabolic syndrome. METHODS: In a prospective study of 50,339 people, 13,449 had metabolic syndrome at baseline and were followed up for ten years to assess cause-specific mortality. The population was divided into two age groups: those younger than 65 years of age and those older than age 65. Information on their physical activity levels was collected at baseline. RESULTS: Metabolic syndrome was associated with higher mortality from all causes (hazard ratio (HR) 1.35, 95% confidence interval (95% CI) 1.20 to 1.52) and from cardiovascular causes (HR 1.78, 95% CI 1.39 to 2.29) in people younger than 65 years old than among other populations. In older people, there was no overall association of metabolic syndrome with mortality. People with metabolic syndrome who reported high levels of physical activity at baseline were at a reduced risk of death from all causes compared to those who reported no physical activity, both in the younger age group (HR 0.52, 95% CI 0.37 to 0.73) and in the older age group (HR 0.59, 95% CI 0.47 to 0.74). CONCLUSION: Among people with metabolic syndrome, physical activity was associated with reduced mortality from all causes and from cardiovascular causes. Compared to inactivity, even low levels of physical activity were associated with reduced mortality.

Psychometric properties of the Norwegian MacNew Heart Disease health-related quality of life inventory.

BACKGROUND: MacNew is a health-related quality of life (HQOL) inventory for patients with ischaemic heart disease and includes three domains; emotional, physical and social. The MacNew gives new opportunities to compare directly patients with the three major ischaemic heart diagnoses, angina, myocardial infarction and heart failure. However, this inventory has not earlier been evaluated in Norwegian. OBJECTIVE: The purpose of this study was to validate the Norwegian version of the disease-specific HQOL inventory MacNew by assessing the measurement model, internal consistent reliability and test-retest and convergent validity. METHOD: Patients with ischaemic heart disease (n=124; angina pectoris, n=53; myocardial infarction, n=35; and heart failure; n=36) participated in this cross-sectional study. Patients completed the self-administered MacNew and the generic HQOL-instrument SF-36. The MacNew and the SF-36 were repeated 2-3 weeks later (test-retest) by 17 patients. RESULTS: The psychometric properties were satisfactory to good. The construct validity assessed by factor analysis explained 61.5% of the variance. The internal consistent reliability was high (exceeded 0.90 in all domains). The test-retest analysis showed equivalent results demonstrating good reproducible properties. The convergent validity within each domain was evaluated with correlation analysis, demonstrating correlations of 0.74, 0.69 and 0.71 on the emotional, physical and social domains, respectively. CONCLUSION: The Norwegian version of the MacNew inventory demonstrated satisfactory to good psychometric properties and can be recommended for evaluating HQOL for patients with heart diseases in clinical studies.

Strength training versus aerobic interval training to modify risk factors of metabolic syndrome.

Metabolic syndrome is characterized by central obesity, elevated blood pressure, high fasting glucose and triglyceride levels, and low HDL levels. Regular physical activity can improve the metabolic profile and reduce the risks of cardiovascular diseases and premature mortality. However, the optimal training regime to treat metabolic syndrome and its associated cardiovascular abnormalities remains undefined. Forty-three participants with metabolic syndrome were randomized to one of the following groups: aerobic interval training (AIT; n = 11), strength training (ST; n = 11), a combination of AIT and ST (COM; n = 10) 3 times/wk for 12 wk, or control (n = 11). Risk factors comprising metabolic syndrome were evaluated before and after the intervention. Waist circumference (in cm) was significantly reduced after AIT [95% confidence interval (CI): -2.5 to -0.04], COM (95% CI: -2.11 to -0.63), and ST (95% CI: -2.68 to -0.84), whereas the control group had an increase in waist circumference (95% CI: 0.37-2.9). The AIT and COM groups had 11% and 10% increases in peak O2 uptake, respectively. There were 45% and 31% increases in maximal strength after ST and COM, respectively. Endothelial function, measured as flow-mediated dilatation (in %), was improved after AIT (95% CI: 0.3-3), COM (95% CI: 0.3-3), and ST (95% CI: 1.5-4.5). There were no changes in body weight, fasting plasma glucose, or HDL levels within or between the groups. In conclusion, all three training regimes have beneficial effects on physiological abnormalities associated with metabolic syndrome.

Pre-pregnancy physical activity and preeclampsia risk: a prospective population-based cohort study.

OBJECTIVE: To test the hypothesis that women physically active prior to pregnancy are at reduced risk of preeclampsia. Design. Population-based prospective cohort study. Setting. Linkage between the HUNT-1 Study (health study) and the Medical Birth Registry of Norway. POPULATION: Women with singleton live births after participation in the HUNT-1 Study were included, if the newborn's gestational age was more than 22 weeks or birthweight above 500 g. Women pregnant during participation in the health study were excluded. METHODS: The physical activity level was measured by a questionnaire. Information on the women's coming birth was provided by the Medical Birth Registry of Norway. Odds ratios of preeclampsia were calculated and adjusted for maternal age, parity, smoking and body mass index. MAIN OUTCOME MEASURE: Preeclampsia. RESULTS: Of 3,656 women included, 167 (4.6%) developed preeclampsia. Overall, we found no link between pre-pregnancy physical activity and preeclampsia. Only among the women physically active for 120 min/week or more, a tendency for reduced risk was found (adjusted odds ratio 0.6:95% CI 0.3-1.2). CONCLUSION: Women physically active prior to pregnancy were not at reduced risk of developing preeclampsia.

The association of metabolic clustering and physical activity with cardiovascular mortality: the HUNT study in Norway.

BACKGROUND: In asymptomatic populations, physical activity is inversely associated with the risk of cardiovascular death, but it is not known if physical activity compensates for adverse effects of multiple cardiovascular risk factors. The aim of this study was to assess if the positive association of a clustering of cardiovascular risk factors (CRFs) with cardiovascular disease (CVD) mortality could be weakened by exercise training. METHODS: We followed 53 542 individuals who were free from known CVD, among which 3751 had CRF, from baseline between 1984 and 1986 until the date of death from any cause, or until the end of follow-up (31 December 2004). We used the Cox proportional hazards model to estimate HR of cardiovascular death. RESULTS: The HR of death from CVD among people with CRF was 1.38 (95% CI 1.28 to 1.48) compared to those without CRF. The association was stronger among women than in men. In people with CRF, cardiovascular mortality was inversely related to physical activity: risk was 24% lower (HR 0.76, 95% CI 0.61 to 0.95) in the physically active compared to the inactive group. Compared to inactive people without CRF, people with CRF who reported no activity had 41% higher risk of cardiovascular death (HR 1.41, 95% CI 1.16 to 1.70). CONCLUSION: These data show that individuals with CRF are at greater risk of premature cardiovascular death compared to people without CRF, and that the risk of people with CRF who were physically active appears to be comparable to that of inactive individuals without CRF.

Aerobic interval training versus continuous moderate exercise after coronary artery bypass surgery: a randomized study of cardiovascular effects and quality of life.

BACKGROUND: Peak oxygen uptake (Vo(2peak)) strongly predicts mortality in cardiac patients. We compared the effects of aerobic interval training (AIT) versus moderate continuous training (MCT) on Vo(2peak) and quality of life after coronary artery bypass grafting (CABG). METHODS: Fifty-nine CABG patients were randomized to either AIT at 90% of maximum heart rate or MCT at 70% of maximum heart rate, 5 d/wk, for 4 weeks at a rehabilitation center. Primary outcome was Vo(2peak), at baseline, after rehabilitation (4 weeks), and after 6 months of home-based exercise (6 months). RESULTS: Vo(2peak) increased between baseline and 4 weeks in AIT (27.1 +/- 4.5 vs 30.4 +/- 5.5 mL.kg(-1).min(-1), P < .001) and MCT (26.2 +/- 5.2 vs 28.5 +/- 5.6 mL.kg(-1).min(-1), P < .001; group difference, not significant). Aerobic interval training increased Vo(2peak) between 4 weeks and 6 months (30.4 +/- 5.5 vs 32.2 +/- 7.0 mL.kg(-1).min(-1), P < .001), with no significant change in MCT (28.5 +/- 5.6 vs 29.5 +/- 5.7 mL.kg(-1).min(-1)). Quality of life improved in both groups from baseline to 4 weeks, remaining improved at 6 months. There were no changes in echocardiographic systolic and diastolic left ventricular function. Adiponectin increased between 4 weeks and 6 months in both groups (group differences, not significant). CONCLUSIONS: Four weeks of intense training increased Vo(2peak) significantly after both AIT and MCT. Six months later, the AIT group had a significantly higher Vo(2peak) than MCT. The results indicate that AIT and MCT increase Vo(2peak) similarly in the short term, but with better long-term effect of AIT after CABG.

Left ventricular myocardial function during the acute phase of a subarachnoid haemorrhage.

OBJECTIVES: Previous reports suggest that left myocardial ventricular function changes during the course of a subarachnoid haemorrhage. The aim of this study was to evaluate left myocardial ventricular function with tissue Doppler echocardiography at two time points during the acute phase of a subarachnoid haemorrhage. DESIGN: Eighteen consecutive patients (median 52 years, range 33-74) with spontaneous subarachnoid haemorrhage and no history of heart disease were examined at 1-5 days and at 6-11 days following ictus. Eighteen control subjects were included for comparison (52 years, 32-72). RESULTS: Tissue Doppler indices of left ventricular contractility were higher in patients than in controls at both examinations (p<0.001). Indices of left ventricular stroke volume were elevated compared to controls at examination 1 (p<0.05), but not at examination 2. Early diastolic relaxation rate decreased from examination 1 to 2 (p=0.001). Three patients had increased troponin T (range 0.010-0.131 microg/l). CONCLUSION: In patients with subarachnoid haemorrhage, systolic and diastolic function is increased compared to healthy controls, suggesting a hyperdynamic and hypervolemic circulation.

Aerobic interval training reduces cardiovascular risk factors more than a multitreatment approach in overweight adolescents.

The aim of the present study was to compare the effects of a multidisciplinary approach (MTG) and aerobic interval training (AIT) on cardiovascular risk factors in overweight adolescents. A total of 62 overweight and obese adolescents from Trøndelag County in Norway, referred to medical treatment at St Olav's Hospital, Trondheim, Norway, were invited to participate. Of these, 54 adolescents (age, 14.0 +/- 0.3 years) were randomized to either AIT (4 x 4 min intervals at 90% of maximal heart rate, each interval separated by 3 min at 70%, twice a week for 3 months) or to MTG (exercise, dietary and psychological advice, twice a month for 12 months). Follow-up testing occurred at 3 and 12 months. VO(2max) (maximal oxygen uptake) increased more after AIT compared with MTG, both at 3 months (11 compared with 0%; P<0.01) and 12 months (12 compared with -1%; P<0.01). AIT enhanced endothelial function compared with MTG at both 3 months (absolute change, 5.1 compared with 3.9%; P<0.01) and 12 months (absolute change, 6.3 compared with 1.0%; P<0.01). AIT was favourable compared with MTG in reducing BMI (body mass index), percentage of fat, MAP (mean arterial blood pressure) and increasing peak oxygen pulse. In addition, AIT induced a more favourable regulation of blood glucose and insulin compared with MTG. In conclusion, the novel findings of the present proof-of-concept study was that 3 months of twice weekly high-intensity exercise sessions reduced several known cardiovascular risk factors in obese adolescents more than that observed after a multitreatment strategy, which was initiated as hospital treatment. Follow-up at 12 months confirmed that AIT improved or maintained these risk factors to a better degree than MTG.