| 1. |
- Al-Mashat, Mariam, et al.
(författare)
-
Increased pulmonary blood volume variation in patients with heart failure compared to healthy controls; a non-invasive, quantitative measure of heart failure
- 2020
-
Ingår i: Journal of Applied Physiology. - : American Physiological Society. - 1522-1601 .- 8750-7587. ; 128:2, s. 324-337
-
Tidskriftsartikel (refereegranskat)abstract
- Variation of the blood content of the pulmonary vascular bed during a heartbeat can be quantified by pulmonary blood volume variation (PBVV) using magnetic resonance imaging (MRI). The aim was to evaluate if PBVV differs in patients with heart failure compared to healthy controls and investigate the mechanisms behind the PBVV. Forty-six patients and 10 controls underwent MRI. PBVV was calculated from blood flow measurements in the main pulmonary artery and a pulmonary vein, defined as the maximum difference in cumulative PBV over one heartbeat. PBVV was indexed to stroke volume (SV) in the main pulmonary artery (PBVVSV). Patients displayed higher PBVVSV than controls (58±14% vs 43±7%, p<0.001). The change in PBVVSV could be explained by left ventricular (LV) longitudinal contribution to SV (R2=0.15, p=0.02) and the phase shift between in- and outflow (R2=0.31, p<0.001) in patients. Both variables contributed to the multiple regression analysis model and predicted PBVVSV (R2=0.38), however, the phase shift alone explained about ~30% of the variation in PBVVSV. No correlation was found between PBVVSV and large vessel area. In conclusion, PBVVSV was higher in patients compared to controls. Approximately 40% of the variation of PBVVSV in patients can be explained by the LV longitudinal contribution to SV and the phase shift between pulmonary in- and outflow, where the phase shift alone accounts for ~30%. The remaining variation, (60-70%), most likely occurs on small vessel level. Future studies are needed to show the clinical added value of PBVVSV compared to right heart catheterization.
|
|
| 2. |
- Allencherril, Joseph, et al.
(författare)
-
Appropriateness of anteroseptal myocardial infarction nomenclature evaluated by late gadolinium enhancement cardiovascular magnetic resonance imaging
- 2018
-
Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 51:2, s. 218-223
-
Tidskriftsartikel (refereegranskat)abstract
- Background: In traditional literature, it appears that "anteroseptal" MIs with Q waves in V1-V3 involve basal anteroseptal segments although studies have questioned this belief. Methods: We studied patients with first acute anterior Q-wave (>. 30. ms) MI. All underwent late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (MRI). Results: Those with Q waves in V1-V2 (n = 7) evidenced LGE >. 50% in 0%, 43%, 43%, 57%, and 29% of the basal anteroseptal, mid anteroseptal, apical anterior, apical septal segments, and apex, respectively. Patients with Q waves in V1-V3 (n = 14), evidenced involvement was 14%, 43%, 43%, 50%, and 7% of the same respective segments. In those with extensive anterior Q waves (n = 7), involvement was 0%, 71%, 57%, 86%, and 86%. Conclusions: Q-wave MI in V1-V2/V3 primarily involves mid- and apical anterior and anteroseptal segments rather than basal segments. Data do not support existence of isolated basal anteroseptal or septal infarction. "Anteroapical infarction" is a more appropriate term than "anteroseptal infarction.".
|
|
| 3. |
- Allencherril, Joseph, et al.
(författare)
-
Correlation of anteroseptal ST elevation with myocardial infarction territories through cardiovascular magnetic resonance imaging
- 2018
-
Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 51:4, s. 563-568
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Anteroseptal ST elevation myocardial infarction (STEMI) is traditionally defined on the electrocardiogram (ECG) by ST elevation (STE) in leads V1-V3, with or without involvement of lead V4. It is commonly taught that such infarcts affect the basal anteroseptal myocardial segment. While there are suggestions in the literature that Q waves limited to V1-V4 represent predominantly apical infarction, none have evaluated anteroseptal ST elevation territories. We compared the distribution of the myocardium at risk (MaR) in STEMI patients presenting with STE limited to V1-V4 and those with more extensive STE (V1-V6). Methods: We identified patients in the MITOCARE study presenting with a first acute STEMI and new STE in at least two contiguous anterior leads from V1 to V6. Patients underwent cardiac magnetic resonance (CMR) imaging three to five days after acute infarction. Results: Thirty-two patients met inclusion criteria. In patients with STE in V1-V4 (n = 20), myocardium at risk (MaR) > 50% was seen in 0%, 85%, 75%, 100%, and 90% in the basal anteroseptal, mid anteroseptal, apical anterior, apical septal segments, and apex, respectively. The group with STE in V1-V6 (n = 12), MaR > 50% was seen in 8%, 83%, 83%, 92%, and 83% of the same segments. Conclusions: Patients with acute STEMI and STE in leads V1-V4, exhibit MaR in predominantly apical territories and rarely in the basal anteroseptum. We found no evidence to support existence of isolated basal anteroseptal or septal STEMI. “Anteroapical” infarction is a more precise description than “anteroseptal” infarction for acute STEMI patients exhibiting STE in V1-V4.
|
|
| 4. |
- Carlsson, Marcus, et al.
(författare)
-
Effects of caffeine abstinence on adenosine induced coronary flow reserve quantified on phase contrast velocity encoded MRI of the coronary sinus
- 2010
-
Ingår i: Journal of Cardiovascular Magnetic Resonance. - 1097-6647. ; 12, s. 253-254
-
Konferensbidrag (refereegranskat)abstract
- Introduction: Adenosine is a common pharmacological vasodilator agent used in first pass perfusion MRI as well as nuclear cardiology and echocardiography. Coronary flow reserve (CFR) by adenosine is inhibited by caffeine and therefore caffeine abstinence is routinely proscribed in patients. However, the guidelines differ regarding how long abstinence is needed from 12 to 24 hours. Purpose: This study was performed to investigate if 12 h caffeine abstinence is enough to provide maximal coronary flow reserve (CFR). Methods: 12 healthy individuals (5 females, 39 ± 14 years) were imaged using a 1.5 T Philips Intera CV at rest and during adenosine infusion (140 μg/kg/min) at two occasions, after 12 and 24 h caffeine abstinence respectively. Coronary sinus flow was measured during breath hold with a phase contrast velocity encoded (PC) TFE sequence with 20 phases per cardiac cycle. Typical imaging parameters were: SENSE factor 2, TE/TR/flip: 3.1/4.8 ms/15°, turbo factor 5, spatial resolution 1.2 × 1.2 × 7 mm and VENC 80 cm/s. CFR was calculated as the ratio between coronary sinus flow/min at adenosine and rest. Cardiac output was measured using PC-MRI of the ascending aorta. Results: CFR was higher (5.4 ± 1.0) at 24 h caffeine abstinence compared to 12 h (4.6 ± 0.8, p = 0.03). In most patients the difference was minimal but in three patients (25%) the increase in CFR at 12 h was less than 30% of that at 24 h caffeine abstinence. The increase in HR did not differ at 24 h (40 ± 7%) and 12 h abstinence (39 ± 5%, p = 0.62) nor did the increase in cardiac output (55 ± 8% vs. 48 ± 8%, p = 0.68). Reported symptoms and the blood pressure reaction did not differ between 24 h and 12 h abstinence, Figure 1. Conclusion: Twelve hours caffeine abstinence results in a lower coronary flow reserve compared to 24 hours and there is a large inter-individual difference to caffeine abstinence. This needs to be taken into consideration when performing adenosine perfusion imaging studies. (Figure Presented).
|
|
| 5. |
- Erlinge, David, et al.
(författare)
-
Rapid Endovascular Catheter Core Cooling Combined With Cold Saline as an Adjunct to Percutaneous Coronary Intervention for the Treatment of Acute Myocardial Infarction The CHILL-MI Trial : A Randomized Controlled Study of the Use of Central Venous Catheter Core Cooling Combined With Cold Saline as an Adjunct to Percutaneous Coronary Intervention for the Treatment of Acute Myocardial Infarction
- 2014
-
Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 63:18, s. 1857-1865
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of this study was to confirm the cardioprotective effects of hypothermia using a combination of cold saline and endovascular cooling. Background Hypothermia has been reported to reduce infarct size (IS) in patients with ST-segment elevation myocardial infarctions. Methods In a multicenter study, 120 patients with ST-segment elevation myocardial infarctions (<6 h) scheduled to undergo percutaneous coronary intervention were randomized to hypothermia induced by the rapid infusion of 600 to 2,000 ml cold saline and endovascular cooling or standard of care. Hypothermia was initiated before percutaneous coronary intervention and continued for 1 h after reperfusion. The primary end point was IS as a percent of myocardium at risk (MaR), assessed by cardiac magnetic resonance imaging at 4 +/- 2 days. Results Mean times from symptom onset to randomization were 129 +/- 56 min in patients receiving hypothermia and 132 +/- 64 min in controls. Patients randomized to hypothermia achieved a core body temperature of 34.7 degrees C before reperfusion, with a 9-min longer door-to-balloon time. Median IS/MaR was not significantly reduced (hypothermia: 40.5% [interquartile range: 29.3% to 57.8%; control: 46.6% [interquartile range: 37.8% to 63.4%]; relative reduction 13%; p = 0.15). The incidence of heart failure was lower with hypothermia at 45 +/- 15 days (3% vs. 14%, p < 0.05), with no mortality. Exploratory analysis of early anterior infarctions (0 to 4 h) found a reduction in IS/MaR of 33% (p < 0.05) and an absolute reduction of IS/left ventricular volume of 6.2% (p = 0.15). Conclusions Hypothermia induced by cold saline and endovascular cooling was feasible and safe, and it rapidly reduced core temperature with minor reperfusion delay. The primary end point of IS/MaR was not significantly reduced. Lower incidence of heart failure and a possible effect in patients with early anterior ST-segment elevation myocardial infarctions need confirmation. (Efficacy of Endovascular Catheter Cooling Combined With Cold Saline for the Treatment of Acute Myocardial Infarction [CHILL-MI]; NCT01379261)
|
|
| 6. |
- Ibanez, Borja, et al.
(författare)
-
Cardiac MRI Endpoints in Myocardial Infarction Experimental and Clinical Trials : JACC Scientific Expert Panel
- 2019
-
Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097. ; 74:2, s. 238-256
-
Forskningsöversikt (refereegranskat)abstract
- After a reperfused myocardial infarction (MI), dynamic tissue changes occur (edema, inflammation, microvascular obstruction, hemorrhage, cardiomyocyte necrosis, and ultimately replacement by fibrosis). The extension and magnitude of these changes contribute to long-term prognosis after MI. Cardiac magnetic resonance (CMR) is the gold-standard technique for noninvasive myocardial tissue characterization. CMR is also the preferred methodology for the identification of potential benefits associated with new cardioprotective strategies both in experimental and clinical trials. However, there is a wide heterogeneity in CMR methodologies used in experimental and clinical trials, including time of post-MI scan, acquisition protocols, and, more importantly, selection of endpoints. There is a need for standardization of these methodologies to improve the translation into a real clinical benefit. The main objective of this scientific expert panel consensus document is to provide recommendations for CMR endpoint selection in experimental and clinical trials based on pathophysiology and its association with hard outcomes.
|
|
| 7. |
- Sjöberg, Pia, et al.
(författare)
-
Altered biventricular hemodynamic forces in patients with repaired tetralogy of Fallot and right ventricular volume overload because of pulmonary regurgitation
- 2018
-
Ingår i: American Journal of Physiology - Heart and Circulatory Physiology. - : American Physiological Society. - 1522-1539 .- 0363-6135. ; 315:6, s. 1691-1702
-
Tidskriftsartikel (refereegranskat)abstract
- Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in repaired tetralogy of Fallot (rToF) patients to further understand the pathophysiological mechanisms as this could be a potential marker for pulmonary valve replacement (PVR) in these patients. Patients with rToF and PR>20% (n=18) and healthy controls (n=15) underwent magnetic resonance imaging (MRI) including 4D-flow. A subset of patients (n=8) underwent PVR and MRI after surgery. Time-resolved hemodynamic forces were quantified using 4D-flow data and indexed to ventricular volume. Patients had higher systolic and diastolic left ventricular (LV) hemodynamic forces compared to controls in the lateral-septal/LVOT (p=0.011; p=0.0031) and inferior-anterior (p<0.0001; p<0.0001) directions, which are forces not aligned with blood flow. Forces did not change after PVR. Patients had higher RV diastolic forces compared to controls in the diaphragm-RVOT (p<0.001) and apical-basal (p=0.0017) directions. After PVR RV systolic forces in the diaphragm-RVOT direction decreased (p=0.039) to lower levels than in controls (p=0.0064). RV diastolic forces decreased in all directions (p=0.0078; p=0.0078; p=0.039) but were still higher than in controls in diaphragm-RVOT direction (p=0.046). In conclusion, patients with rToF and PR had LV hemodynamic forces less aligned with the intraventricular blood flow compared to controls and higher diastolic RV forces along the regurgitant flow direction in the RVOT and that of tricuspid inflow. Remaining force differences in LV and RV after PVR suggest that biventricular pumping does not normalize after surgery.
|
|
| 8. |
- Sjöberg, Pia, et al.
(författare)
-
Changes in left and right ventricular longitudinal function after pulmonary valve replacement in patients with Tetralogy of Fallot
- 2020
-
Ingår i: American Journal of Physiology - Heart and Circulatory Physiology. - : American Physiological Society. - 1522-1539 .- 0363-6135. ; 318:2, s. 345-353
-
Tidskriftsartikel (refereegranskat)abstract
- Timing and indication for pulmonary valve replacement (PVR) in patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) are uncertain. To improve understanding of pumping mechanics, we investigated atrioventricular coupling before and after surgical PVR. Cardiovascular magnetic resonance (CMR) were performed in patients (n=12) with rToF and PR>35% before and after PVR and in healthy controls (n=15). Atrioventricular plane displacement (AVPD), global longitudinal peak systolic strain (GLS), atrial and ventricular volumes and caval blood flows were analysed. Right ventricular (RV) AVPD and RV free wall GLS were lower in patients before PVR compared to controls (p<0.0001; p<0.01) and decreased after PVR (both p<0.0001 for both). Left ventricular (LV) AVPD was lower in patients before PVR compared to controls (p<0.05) and decreased after PVR (p<0.01). Left ventricular GLS did not differ between patients and controls (p>0.05). Right atrial reservoir volume and RV stroke volume (SV) generated by AVPD correlated in controls (r=0.93; p<0.0001) and patients before PVR (r=0.88; p<0.001) but not after PVR. In conclusion, there is a clear atrioventricular coupling in patients before PVR that is lost after PVR, possibly due to loss of pericardial integrity. Impaired atrioventricular coupling complicates assessment of ventricular function after surgery using measurements of longitudinal function. Changes in atrioventricular coupling seen in patients with rToF may be energetically unfavourable and long-term effects of surgery on atrioventricular coupling is therefore of interest. Also, AVPD and GLS cannot be used interchangeably to assess longitudinal function in rToF.
|
|
| 9. |
- Stephensen, Sigurdur S., et al.
(författare)
-
Agreement of left ventricular mass in steady state free precession and delayed enhancement MR images : Implications for quantification of fibrosis in congenital and ischemic heart disease
- 2010
-
Ingår i: BMC Medical Imaging. - : Springer Science and Business Media LLC. - 1471-2342. ; 10:4
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Left ventricular mass (LVM) is used when expressing infarct or fibrosis as a percentage of the left ventricle (LV). Quantification of LVM is interchangeably carried out in cine steady state free precession (SSFP) and delayed enhancement (DE) magnetic resonance imaging (MRI). However, these techniques may yield different LVM. Therefore, the aim of the study was to compare LVM determined by SSFP and DE MRI in patients and determine the agreement with these sequences with ex vivo data in an experimental animal model.Methods: Ethics committees approved human and animal studies. Informed written consent was obtained from all patients. SSFP and DE images were acquired in 60 patients (20 with infarction, 20 without infarction and 20 pediatric patients). Ex vivo MRI was used as reference method for LVM in 19 pigs and compared to in vivo SSFP and DE.Results: LVM was greater in SSFP than in DE (p < 0.001) with a bias of 5.0 ± 6.7% in humans (r2 = 0.98), and a bias of 7.3 ± 6.7% (p < 0.001) in pigs (r2 = 0.83). Bias for SSFP and DE images compared to ex vivo LVM was -0.2 ± 9.0% and -7.7 ± 8.5% respectively.Conclusions: LVM was higher when measured with SSFP compared to DE. Thus, the percentage infarction of the LV will differ if SSFP or DE is used to determine LVM. There was no significant difference between SSFP and ex vivo LVM suggesting that SSFP is more accurate for LVM quantification. To avoid intrinsic error due to the differences between the sequences, we suggest using DE when expressing infarct as a percentage of LVM.
|
|
| 10. |
- Stephensen, Sigurdur S., et al.
(författare)
-
Alterations in ventricular pumping in patients with atrial septal defect at rest, during dobutamine stress and after defect closure
- 2018
-
Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961. ; 38:5, s. 830-839
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Regional ventricular pumping mechanisms in patients with volume-loaded right ventricles (RV) are altered, but the cause is unknown. The aim was to determine whether these changes in ventricular pumping mechanisms are influenced by the RV dilatation itself or the aetiology behind it. Methods: Seventeen patients with atrial septal defects (ASD) and 10 healthy controls underwent cardiovascular magnetic resonance (CMR) at rest and during dobutamine/atropine stress. Sixteen patients underwent transcutaneous ASD closure. Follow-up CMR at rest was performed the following day. Thirty patients with RV overload due to pulmonary regurgitation (PR) underwent CMR at rest. Cine images were used to measure left ventricular (LV) and RV volumes as well as septal, longitudinal and lateral contributions to LV and RV stroke volume (SV). Results: At rest, septal contribution to LVSV was lower in ASD patients than controls (-1% versus 7%, P<0·05), but there was no difference in longitudinal or lateral contribution to SV. Patients with PR had lower longitudinal contribution to RV with increased lateral and septal contribution. During dobutamine stress, longitudinal contribution to LV and RVSV decreased and lateral contribution increased for ASD patients and controls. The day after ASD closure, septal contribution to LVSV was 6%, longitudinal contribution had increased for RVSV (P<0·05) and decreased for LVSV (P<0·01). Conclusion: Pumping mechanisms in patients with RV volume overload depend on the aetiology for the RV dilation and not the size of the RV.
|
|
