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Sökning: WFRF:(Brodin Lars Åke) > Kungliga Tekniska Högskolan

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1.
  • Bratel, Tomas, et al. (författare)
  • Ventilation-perfusion relationships in pulmonary arterial hypertension : Effect of intravenous and inhaled prostacyclin treatment
  • 2007
  • Ingår i: Respiratory Physiology & Neurobiology. - : Elsevier BV. - 1569-9048 .- 1878-1519. ; 158:1, s. 59-69
  • Tidskriftsartikel (refereegranskat)abstract
    • In seven patients with idiopathic or secondary pulmonary arterial hypertension (PAH), ventilation-perfusion (V-A/Q) relationships were measured during a right heart catheterization using the multiple inert-gas elimination technique before and during intravenous infusion with epoprostenol (EPO), and following 5 months of 20 mu g inhaled iloprost taken three times daily (ILO). Pre-treatment pulmonary vascular resistance (PVR) was 9.3 +/- 5.0 mmHg/l/min and the dispersion of perfusion and ventilation for V-A/Q-ratios was increased. EPO reduced PVR by 20%, and increased cardiac output, shunt, and mixed venous oxygenation (Sv(O2)) The arterial oxygen tension (Pa-O2) remained unchanged. Basal central haemodynamics did not change after 5 months of ILO. Fifteen minutes after ILO, PVR decreased by 20%, and the shunt, Sv(O2), and Pa-O2 remained unaltered. Conclusions: In secondary PAH with normal lung volumes, significant V-A/Q mismatching occurred. The PVR was reduced to a similar degree during EPO and after ILO, but only EPO increased the shunt and Sv(O2). EPO and ILO did not significantly affect the Pa-O2.
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  • Linnersjö, Anette, et al. (författare)
  • Low mortality and myocardial infarction incidence among flying personnel during working career and beyond
  • 2011
  • Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 37:3, s. 219-226
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective The aim of this study was to evaluate mortality and acute myocardial infarction (AM!) incidence among commercial and military flying personnel in Sweden. Methods Flying personnel, employed at the Swedish part of Scandinavian Airlines and/or the Swedish Armed Forces at some point between 1957-1994, were included. The cohort was followed regarding mortality and AMI incidence using national registers of hospital discharges and deaths. The observed mortality and AMI incidence was compared with the expected rate in the general Swedish population through standardized mortality ratios (SMR) and standardized incidence ratios (SIR) taking age, gender, and calendar year into account. Results Swedish flying personnel, except male cabin crew, had a lower-than-expected all-cause mortality (SMR ranging from 0.57 among female cabin crew to 0.79 among navigators and mechanics; male cabin crew 0.89) and cardiovascular mortality (SMR from 0.31 among female cabin crew to 0.79 among navigators and mechanics). We observed an elevated mortality in aircraft accidents (SMR ranging from 23.87 among commercial pilots to 165.68 among military pilots). Male cabin attendants had a higher-than-expected mortality for alcohol-related death causes and acquired immunodeficiency syndrome (AIDS). AMI incidence was reduced in all groups and across the lifespan (SIR between 0.13 among female cabin crew and 0.61 among navigators and mechanics). Conclusions Swedish flying personnel have a low all-cause mortality. This is mostly due to a reduced cardiovascular mortality reflecting a low AMI incidence during the working life as well as after retirement.
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4.
  • Andersson, L., et al. (författare)
  • Effect of CO2 pneumoperitoneum on ventilation-perfusion relationships during laparoscopic cholecystectomy
  • 2002
  • Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 46:5, s. 552-560
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Previous studies have shown that pneumoperitoneum transiently reduces venous admixture as assessed by a calculation based on the shunt formula, and increases arterial oxygen tension (PaO2) in patients without heart or lung disease. The aim of the present study was to further explore the relationship between ventilation-perfusion ((V) over dot (A)/(Q) over dot) before and during pneumoperitoneum by using the multiple inert gas technique. Methods: Nine patients without heart or lung disease (ASA I), with a mean age of 42 years, scheduled for laparoscopic cholecystectomy were included. After premedication and induction of anaesthesia, radial artery and pulmonary artery catheters were introduced percutaneously. The (V) over dot (A)/(Q) over dot relationships were evaluated by the multiple inert gas elimination technique before and during pneurnoperitoneum to obtain a direct measure of the pulmonary shunt. Results: Induction of pneumoperitoneum decreased the pulmonary shunt from 5.8 (4.5) to 4.1 (3.2)% (P<0.05) and increased PaO2 from 21.7 (5.9) to 24.7 (4.8) kPa (P<0.01). During surgery, the shunt increased from 3.2 (2.8) to 5.2 (3.4)% to the same level as before pneumoperitoneum induction. No area with low (V) over dot (A)/(Q) over dot was seen. Dead space ventilation amounted to 20.0 (1.2)% in the supine position and did not change during the investigation. Conclusions: In patients without heart or lung disease, pneumoperitoneum at an intra-abdominal pressure level of 11-13 mmHg- causes a transient reduction of the pulmonary shunt. The mechanisms underlying the present finding remain to be elucidated.
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5.
  • Bjällmark, Anna, et al. (författare)
  • A system to quantify and visualize ventricular rotation pattern of the heart
  • 2009
  • Patent (populärvet., debatt m.m.)abstract
    • Different modalities have been used to describe the rotational motion of the ventricles of the heart and studies have indicated LV twist to be an additional integral component in LV function. So far, only amplitudes and timings of rotation have been reported, whereas no method is available to fully describe the rotation pattern of the ventricles. The object of the present application is to achieve a system that presents a novel way to quantify and visualize the ventricular rotation pattern of the heart. We present a novel method that assesses and describes the rotation pattern by calculating the rotation axis of the ventricle. Non- invasive image acquisition is required to collect rotation values from different positions of the myocardium. Thereafter, a kinematic model of a ventricle is constructed to determine the rotation planes at different levels of the heart. The motion of the rotation planes are visualized by plotting the normal vectors of the planes over time, i.e. the rotation axis of the planes. This new method is different to all other methods used today for assessing cardiac function, as it does not describe the amplitude of a motion but the relationship in motion between different parts within a ventricle. Preliminary results indicate that the rotation axis is more sensitive to changes in the rotation pattern than conventional measurements of ventricular rotation. This new method could be used for early detection of cardiac diseases and for selection of patients for and optimization of cardiac resynchronization therapy.
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6.
  • Bjällmark, Anna, et al. (författare)
  • Effects of hemodialysis on the cardiovascular system: Quantitative analysis using wave intensity wall analysis and tissue velocity imaging
  • 2010
  • Ingår i: Heart and Vessels. - : Springer Science and Business Media LLC. - 0910-8327 .- 1615-2573.
  • Tidskriftsartikel (refereegranskat)abstract
    • Cardiovascular disease is the leading cause of death in patients with end stage renal disease (ESRD). The aim of this study was to investigate the changes in cardiovascular function induced by a single session of hemodialysis (HD) by the analysis of cardiovascular dynamics using wave intensity wall analysis (WIWA) and of systolic and diastolic myocardial function using tissue velocity imaging (TVI). Grey-scale cine loops of the left common carotid artery, conventional echocardiography and TVI images of the left ventricle were acquired before and after HD in 45 patients (17 women, mean age 54) with ESRD. The WIWA indexes, W1 preload-adjusted W1, W2 and preload-adjusted W2, and the TVI variables, isovolumic contraction velocity (IVCV), isovolumic contraction time (IVCT), peak systolic velocity (PSV), displacement, isovolumic relaxation velocity (IVRV), isovolumic relaxation time (IVRT), peak early diastolic velocity (E’) and peak late diastolic velocity (A’), were compared before and after HD. The WIWA measurements showed significant increases in W1 (p < 0.05) and preload-adjusted W1 (p < 0.01) after HD. W2 was significantly decreased (p < 0.05) after HD, whereas the change in preload-adjusted W2 was not significant. Systolic velocities, IVCV (p < 0.001) and PSV (p < 0.01), were increased after HD, whereas the AV-plane displacement were decreased (p < 0.01). For the measured diastolic variables, E’ was significantly decreased (p < 0.01) and IVRT was significantly prolonged (p < 0.05), after HD. A few correlations were found between WIWA and TVI variables. The WIWA and TVI measurements indicate that a single session of HD improves systolic function. The load dependency of the diastolic variables seems to be more pronounced than for the systolic variables. Preload-adjusted wave intensity indexes may contribute in the assessment of true LV contractility and relaxation.
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7.
  • Bjällmark, Anna, 1980- (författare)
  • New ultrasonographic approaches to monitoring cardiac and vascular function
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Atherosclerotic cardiovascular disease is the leading cause of death worldwide. To decrease mortality and morbidity in cardiovascular disease, the development of accurate, non-invasive methods for early diagnosis of atherosclerotic cardiac and vascular engagement is of considerable clinical interest. Cardiovascular ultrasound imaging is today the cornerstone in the routine evaluation of cardiovascular function and recent development has resulted in two new techniques, tissue velocity imaging (TVI) and speckle tracking, which allow objective quantification of cardiovascular function. TVI and speckle tracking are the basis for three new approaches to cardiac and vascular monitoring presented in this thesis: wave intensity wall analysis (WIWA), two-dimensional strain imaging in the common carotid artery, and the state diagram of the heart.   WIWA uses longitudinal and radial strain rate as input for calculations of wave intensity in the arterial wall. In this thesis, WIWA was validated against a commercially available wave intensity system, showing that speckle tracking-derived strain variables can be useful in wave intensity analysis. WIWA was further tested in patients with end stage renal disease and documented high mortality in cardiovascular disease. The latter study evaluated the effects of a single session of hemodialysis using WIWA and TVI variables and showed improved systolic function after hemodialysis. The results also indicated that preload-adjusted early systolic wave intensity obtained by the WIWA system may contribute in the assessment of left ventricular contractility in this patient category. Two-dimensional strain imaging in the common carotid artery is a new approach showing great potential to detect age-dependent differences in mechanical properties of the common carotid artery. Among the measured strain variables, global circumferential strain had the best discriminating performance and appeared to be superior to conventional measures of arterial stiffness such as elastic modulus and β stiffness index. The state diagram is a visualisation tool that provides a quantitative overview of the temporal interrelationship of mechanical events in the left and right ventricles. Case examples and a small clinical study showed that state diagrams clearly visualize cardiac function and can be useful in the detection of non ST-elevation myocardial infarction (NSTEMI).   Even though WIWA, two-dimensional strain imaging in the common carotid artery and the state diagram show potential to be useful in the evaluation of cardiovascular function, there still remains a considerable amount of work to be done before they can be used in the daily clinical practice.
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8.
  • Bjällmark, Anna, et al. (författare)
  • Ultrasonographic strain imaging is superior to conventional non-invasive measures of vascular stiffness in the detection of age-dependent differences in the mechanical properties of the common carotid artery
  • 2010
  • Ingår i: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 11:7, s. 630-636
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: Elastic properties of large arteries have been shown to deteriorate with age and in the presence of atherosclerotic vascular disease. In this study, the performance of ultrasonographic strain measurements was compared to conventional measures of vascular stiffness in the detection of age-dependent differences in the elastic properties of the common carotid artery.Methods and results: In 10 younger (25-28 years, 4 women) and 10 older (50-59 years, 4 women) healthy individuals, global and regional circumferential and radial strain variables were measured in the short-axis view of the right common carotid artery using ultrasonographic two-dimensional (2D) strain imaging with recently introduced speckle tracking technique. Conventional elasticity variables, elastic modulus (Ep) and β stiffness index, were calculated using M-mode sonography and non-invasive blood pressure measurements. Global and regional circumferential systolic strain and strain rate values were significantly higher (p < 0.001, p < 0.01 for regional late systolic strain rate) in the younger individuals, whereas the values of conventional elasticity variables in the same group were lower (p < 0.05). Among all strain and conventional elasticity variables, principal component analysis and its regression extension identified only circumferential systolic strain variables as contributing significantly to the observed discrimination between the younger and older age groups.Conclusion: Ultrasonographic 2D-strain imaging is a sensitive method for the assessment of elastic properties in the common carotid artery, being in this respect superior to conventional measures of vascular elasticity. The method has potential to become a valuable non-invasive tool in the detection of early atherosclerotic vascular changes.
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9.
  • Bjällmark, Anna, et al. (författare)
  • Velocity tracking - a novel method for quantitative analysis of longitudinal myocardial function
  • 2007
  • Ingår i: Journal of the American Society of Echocardiography. - : Elsevier. - 0894-7317 .- 1097-6795. ; 20:7, s. 847-856
  • Tidskriftsartikel (refereegranskat)abstract
    • Doppler tissue imaging is a method for quantitative analysis of longitudinal myocardial velocity. Commercially available ultrasound systems can only present velocity information using a color Dopplerbased overlapping continuous color scale. The analysis is time-consuming and does not allow for simultaneous analysis in different projections. We have developed a new method, velocity tracking, using a stepwise color coding of the regional longitudinal myocardial velocity. The velocity data from 3 apical projections are presented as static and dynamic bull's-eye plots to give a 3-dimensional understanding of the function of the left ventricle. The static bull's-eye plot can display peak systolic velocity, late diastofic tissue velocity, or the sum of peak systolic velocity and early diastolic tissue velocity. Conversely, the dynamic bull's-eye plot displays how the myocardial velocities change over one heart cycle. Velocity tracking allows for a fast, simple, and hituitive visual analysis of the regional longitudinal contraction pattern of the left ventricle with a great potential to identify characteristic pathologic patterns.
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