| 1. |
- Hultkvist, Henrik, et al.
(författare)
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Evaluation of left ventricular diastolic function in patients operated for aortic stenosis
- 2022
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 17:2
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Tidskriftsartikel (refereegranskat)abstract
- Background Left ventricular diastolic dysfunction is common in patients with aortic valve stenosis (AS) and reportedly affects prognosis after surgical aortic valve replacement (SAVR). Here we investigated whether and how diastolic function (assessed following the most recent guidelines) was affected by SAVR, and whether preoperative diastolic function affected postoperative outcome. We also examined whether long-term mortality was associated with preoperative NT-proBNP and postoperative heart failure (PHF). Methods We performed a prospective observational study of 273 patients with AS who underwent AVR with or without concomitant coronary artery bypass surgery. Of these patients, 247 were eligible for assessment of left ventricular (LV) filling pressure. Preoperatively and at the 6-month postoperative follow-up, we measured N-terminal pro-B type natriuretic peptide (NT-proBNP) in serum and assessed diastolic function with Doppler echocardiography. PHF was diagnosed using prespecified criteria. Multivariable logistic regression was performed to explore variables associated with high LV filling pressure. Cox regression was performed to explore variables associated with mortality, accounting for timeto-event. Results At the time of surgery, 22% (n = 54) of patients had diastolic dysfunction expressed as high LV filling pressure. Of these 54 patients, 27 (50%) showed postoperative diastolic function improvement. Among the 193 patients with preoperative low LV filling pressure, 24 (12%) showed postoperative diastolic function deterioration. Increased long-term mortality was associated with PHF and high preoperative NT-proBNP, but not with preoperative or postoperative diastolic dysfunction. Cox regression revealed the following independent risk factors for long-term mortality: diabetes, renal dysfunction, preoperative NT-proBNP>960 ng/L, age, and male gender. Conclusions Surgery for aortic stenosis improved diastolic function in patients with high LV filling pressure in 50% of the patients. Our results could not confirm the previously suggested role of diastolic dysfunction as a marker for poor long-term survival after SAVR. Our findings showed that both PHF and high preoperative NT-proBNP were associated with long-term mortality.
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| 2. |
- Maret, Eva, 1961-, et al.
(författare)
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Feature tracking of cine-MRI identifies left ventricular segments with myocardial scar
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: The aim of the study was to apply a new feature tracking software (Diogenes MRI, Tomtec GmbH, Unterschliessheim, Germany) on cine-MR images to evaluate its utility and ability to detect infarcted myocardium and to assess the transmural extent of scar without the need for administering intravenous gadolinium-based contrast agents. Methods: Thirty patients (3 women and 27 men) were selected based on the presence or absence of extensive myocardial scar in the perfusion area of the left anterior descending coronary artery (LAD) but not in remote areas. Seventeen had a scar transmurality >75% in at least one segment belonging to the LAD area (scar patients) and thirteen had scar <1% in this area or in other parts of the myocardium (non-scar patients). The software tracked the motion of the wall through the entire cardiac cycle using two different techniques. Velocity, displacement and strain were calculated in 48 points in the longitudinal direction, tangential to the endocardial outline, and in the radial direction, perpendicular to the tangent. Results: In the scar patients, LAD segments showed lower functional measures than remote segments. The remote segments in the scar group showed, in turn, lower functional measures than the remote segments in the non-scar group. Receiver-operatorcharacteristic (ROC) curves were constructed for all measurements. Best area-undercurve was for radial strain, 0.89, where a cut-off value of 38.8% had 80% sensitivity and 86% specificity for the detection of a segment with scar transmurality >50% in the LAD distribution. As a percentage of the mean, intraobserver variability was for radial measures 16-14-26% for displacement-velocity-strain and for the corresponding interobserver measurements 13-12-18%. Conclusions: With the presented method, we show for the first time its ability to detect scar segments with various transmurality already from an analysis of cine-MRI, without the need for the administration of gadolinium-based contrast. The accuracy and repeatability of the radial functional measurements is satisfactory and global measures agree with other aspects of global left ventricular function.
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| 3. |
- Maret, Eva, et al.
(författare)
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Functional measurements based on feature tracking of cine magnetic resonance images identify left ventricular segments with myocardial scar.
- 2009
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Ingår i: Cardiovascular Ultrasound. - : Springer Science and Business Media LLC. - 1476-7120. ; 7:53, s. 1-14
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe aim of the study was to perform a feature tracking analysis on cine magnetic resonance (MR) images to elucidate if functional measurements of the motion of the left ventricular wall may detect scar defined with gadolinium enhanced MR.Myocardial contraction can be measured in terms of the velocity, displacement and local deformation (strain) of a particular myocardial segment. Contraction of the myocardial wall will be reduced in the presence of scar and as a consequence of reduced myocardial blood flow.MethodsThirty patients (3 women and 27 men) were selected based on the presence or absence of extensive scar in the anteroseptal area of the left ventricle. The patients were investigated in stable clinical condition, 4-8 weeks post ST-elevation myocardial infarction treated with percutaneous coronary intervention. Seventeen had a scar area >75% in at least one anteroseptal segment (scar) and thirteen had scar area <1% (non-scar). Velocity, displacement and strain were calculated in the longitudinal direction, tangential to the endocardial outline, and in the radial direction, perpendicular to the tangent.ResultsIn the scar patients, segments with scar showed lower functional measurements than remote segments. Radial measurements of velocity, displacement and strain performed better in terms of receiver-operator-characteristic curves (ROC) than the corresponding longitudinal measurements. The best area-under-curve was for radial strain, 0.89, where a cut-off value of 38.8% had 80% sensitivity and 86% specificity for the detection of a segment with scar area >50%. As a percentage of the mean, intraobserver variability was 16-14-26% for radial measurements of displacement-velocity-strain and corresponding interobserver variability was 13-12-18%.ConclusionFeature tracking analysis of cine-MR displays velocity, displacement and strain in the radial and longitudinal direction and may be used for the detection of transmural scar. The accuracy and repeatability of the radial functional measurements is satisfactory and global measures agree.
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| 4. |
- Blomstrand, Peter, et al.
(författare)
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Left ventricular diastolic function, assessed by echocardiography and tissue Doppler imaging, is a strong predictor of cardiovascular events, superior to global left ventricular longitudinal strain, in patients with type 2 diabetes
- 2015
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Ingår i: European Heart Journal Cardiovascular Imaging. - : Oxford University Press (OUP). - 2047-2404 .- 2047-2412. ; 16:9, s. 1000-1007
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of the study was to determine whether left ventricular systolic function, in terms of global left ventricular longitudinal strain (GLS), and diastolic function, expressed as the ratio between early diastolic transmitral flow and mitral annular motion velocities (E/e'), can predict cardiovascular events in patients with diabetes mellitus type 2.Methods and results: We prospectively investigated 406 consecutive patients, aged 55-65 years, with diabetes mellitus, who participated in the CARDIPP study. Echocardiography, pulse pressure (pp), and glycosylated haemoglobin (HbA1c) were analysed. Twelve cases of myocardial infarction and seven cases of stroke were identified during the follow-up period of 67 +/- 17 months. Univariate Cox regression analysis showed that E/e' was a strong predictor of cardiovascular events (hazards ratio 1.12; 95% confidence interval 1.06-1.18, P < 0.001). E/e' was prospectively associated with cardiovascular events independent of age, sex, GLS, left ventricular ejection fraction (LVEF), pp, and HbA1c in multivariate analysis. Receiver operating characteristic curves showed that E/e' and HbA1c were the strongest predictors for cardiovascular events, both having an area under the curve (AUC) of 0.71 followed by LVEF with an AUC of 0.65 and GLS of 0.61. In a Kaplan-Meyer analysis, the cumulative probability of an event during the follow-up period was 8.6% for patients with an E/e' ratio >15 compared with 2.6% for patients with E/e' <= 15, P = 0.011.Conclusion: In middle-aged patients with type 2 diabetes, E/e' is a strong predictor of myocardial infarction and stroke, comparable with HbA1c and superior to GLS and LVEF.
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| 5. |
- Blomstrand, Peter, et al.
(författare)
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Pulsed tissue Doppler imaging for the detection of myocardial ischaemia, a comparison with myocardial perfusion SPECT
- 2004
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Ingår i: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; 24:5, s. 289-295
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Tidskriftsartikel (refereegranskat)abstract
- In order to compare the diagnostic ability of pulsed tissue Doppler and myocardial perfusion Single Photon Emission Computed Tomography (SPECT) in patients with a history of unstable coronary artery disease, CAD, 26 patients, 22 men and four women, age 47-76 years, were investigated in a prospective study, 5-10 day after an episode of unstable angina. Tissue Doppler and two-dimensional echocardiography were performed during dobutamine stress testing and myocardial scintigraphy after bicycle exercise and at rest. Patients with a normal SPECT had higher peak systolic velocity during dobutamine infusion, 18.9 ± 4.1 cm s-1, than patients with ischaemia, 12.2 ± 3.8 cm s-1 (P<0.001) or scar, 8.8 ± 3.0 cm s-1 (P<0.01). In a territorial analysis the difference in peak systolic velocity between areas with a normal and abnormal SPECT was less apparent. Failure to achieve ≥13 cm s-1 in mean-peak systolic velocity was the most accurate criterion for detection of significant CAD on SPECT. We conclude that pulsed tissue Doppler can be used for objective quantification of left ventricular wall motion during dobutamine stress testing and for identification of patients with CAD on SPECT but not for identification of regional ischaemia.
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| 6. |
- Engvall, Jan, et al.
(författare)
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Moderately trained male football players, compared to sedentary male adults, exhibit anatomical but not functional cardiac remodelling, a cross-sectional study
- 2021
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Ingår i: Cardiovascular Ultrasound. - : BMC. - 1476-7120. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Background Elite athletes have been the subject of great interest, but athletes at an intermediate level of physical activity have received less attention in respect to the presence of cardiac enlargement and/or hypertrophy. We hypothesized that playing football, often defined as demanding less endurance components than running or cycling, would still induce remodelling similar to sports with a dominating endurance component. Methods 23 male football players, age 25+/- 3.9 yrs. underwent exercise testing, 2D- and 3D- echocardiography and cardiac magnetic resonance (CMR). The results were compared with a control group of engineering students of similar age. The athletes exercised 12 h/week and the control subjects 1 h/week, p < 0.001. Results The football players achieved a significantly higher maximal load at the exercise test (380 W vs 300 W, p < 0.001) as well as higher calculated maximal oxygen consumption, (49.7 vs 37.4 mL x kg(- 1) x min(- 1), p < 0.001) compared to the sedentary group. All left ventricular (LV) volumes assessed by 3DEcho and CMR, as well as CMR left atrial (LA) volume were significantly higher in the athletes (3D-LVEDV 200 vs 154 mL, CMR-LVEDV 229 vs 185 mL, CMR-LA volume 100 vs 89 mL, p < 0.001, p = 0.002 and p = 0.009 respectively). LVEF and RVEF, LV strain by CMR or by echo did not differentiate athletes from sedentary participants. Right ventricular (RV) longitudinal strain, LA and right atrial (RA) strain by CMR all showed similar results in the two groups. Conclusion Moderately trained intermediate level football players showed anatomical but not functional cardiac remodelling compared to sedentary males.
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| 7. |
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| 8. |
- Maret, Eva, et al.
(författare)
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Computer-assisted determination of left ventricular endocardial borders reduces variability in the echocardiographic assessment of ejection fraction
- 2008
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Ingår i: Cardiovascular Ultrasound. - : Springer Science and Business Media LLC. - 1476-7120. ; 6:55
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Tidskriftsartikel (refereegranskat)abstract
- Background: Left ventricular size and function are important prognostic factors in heart disease. Their measurement is the most frequent reason for sending patients to the echo lab. These measurements have important implications for therapy but are sensitive to the skill of the operator. Earlier automated echo-based methods have not become widely used. The aim of our study was to evaluate an automatic echocardiographic method (with manual correction if needed) for determining left ventricular ejection fraction (LVEF) based on an active appearance model of the left ventricle (syngo (R) AutoEF, Siemens Medical Solutions). Comparisons were made with manual planimetry (manual Simpson), visual assessment and automatically determined LVEF from quantitative myocardial gated single photon emission computed tomography (SPECT). Methods: 60 consecutive patients referred for myocardial perfusion imaging (MPI) were included in the study. Two-dimensional echocardiography was performed within one hour of MPI at rest. Image quality did not constitute an exclusion criterion. Analysis was performed by five experienced observers and by two novices. Results: LVEF (%), end-diastolic and end-systolic volume/BSA (ml/m(2)) were for uncorrected AutoEF 54 +/- 10, 51 +/- 16, 24 +/- 13, for corrected AutoEF 53 +/- 10, 53 +/- 18, 26 +/- 14, for manual Simpson 51 +/- 11, 56 +/- 20, 28 +/- 15, and for MPI 52 +/- 12, 67 +/- 26, 35 +/- 23. The required time for analysis was significantly different for all four echocardiographic methods and was for uncorrected AutoEF 79 +/- 5 s, for corrected AutoEF 159 +/- 46 s, for manual Simpson 177 +/- 66 s, and for visual assessment 33 +/- 14 s. Compared with the expert manual Simpson, limits of agreement for novice corrected AutoEF was lower than for novice manual Simpson (0.8 +/- 10.5 vs. -3.2 +/- 11.4 LVEF percentage points). Calculated for experts and with LVEF (%) categorized into < 30, 30-44, 45-54 and >= 55, kappa measure of agreement was moderate (0.44-0.53) for all method comparisons (uncorrected AutoEF not evaluated). Conclusion: Corrected AutoEF reduces the variation in measurements compared with manual planimetry, without increasing the time required. The method seems especially suited for unexperienced readers.
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| 9. |
- Maret, Eva, et al.
(författare)
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Feasibility and diagnostic power of transthoracic coronary Doppler for coronary flow velocity reserve in patients referred for myocardial perfusion imaging
- 2008
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Ingår i: Cardiovascular Ultrasound. - : Springer Science and Business Media LLC. - 1476-7120. ; 6:12
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Myocardial perfusion imaging (MPI), using single photon emission computed tomography (SPECT) is a validated method for detecting coronary artery disease. Transthoracic Doppler echocardiography (TTDE) of flow at rest and during adenosine provocation has previously been evaluated in selected patient groups. We therefore wanted to compare the diagnostic ability of TTDE in the left anterior descending coronary artery (LAD) to that of MPI in an unselected population of patients with chest pain referred for MPI. Our hypothesis was that TTDE with high accuracy would identify healthy individuals and exclude them from the need for further studies, enabling invasive investigations to be reserved for patients with a high probability of disease. METHODS: Sixty-nine patients, 44 men and 25 women, age 61 +/- 10 years (range 35-82), with a clinical suspicion of stress induced myocardial ischemia, were investigated. TTDE was performed at rest and during adenosine stress for myocardial scintigraphy. RESULTS: We found that coronary flow velocity reserve (CFVR) determined from diastolic measurements separated normal from abnormal MPI findings with statistical significance. TTDE identified coronary artery disease, defined from MPI, as reversible ischemia and/or permanent defect, with a sensitivity of 60% and a specificity of 79%. The positive predictive value was 43% and the negative predictive value was 88%. There was an overlap between groups which could be due to abnormal endothelial function in patients with normal myocardial perfusion having either hypertension or diabetes. CONCLUSION: TTDE is an attractive non-invasive method to evaluate chest pain without the use of isotopes, but the diagnostic power is strongly dependent on the population investigated. Even in our heterogeneous clinical cardiac population, we found that CFVR>2 in the LAD excluded significant coronary artery disease detected by MPI.
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| 10. |
- Maret, Eva, 1961-
(författare)
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Noninvasive Evaluation of Myocardial Ischemia and Left Ventricular Function
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was, following the path of the ischemic cascade, to evaluate the feasibility of some new non-invasive techniques for the detection of myocardial ischemia, the extent of infarcted myocardium, and for the quantification of systolic left ventricular function.Reduced longitudinal myocardial velocity and displacement may be early signs of ischemia. We evaluated the diagnostic sensitivity and specificity of pulsed tissue Doppler for the detection of ischemia and scar during dobutamine stress testing and compared it with myocardial perfusion scintigraphy (SPECT) in patients with a history of unstable angina. Pulsed tissue Doppler was useful for objective quantification of left ventricular longitudinal shortening and for differentiation between patients with a normal, ischemic or necrotic myocardium.The coronary flow velocity reserve (CFVR) of the left anterior descending artery (LAD) was studied with transthoracic Doppler echocardiography (TTDE) during adenosine stress. Patients with a clinical suspicion of stress induced myocardial ischemia were investigated, and the results were compared with the findings from SPECT. A CFVR >2 in the LAD could exclude significant coronary artery disease in a clinical setting, however, in cases with low CFVR, multiple cardiovascular and metabolic risk factors as well as epicardial coronary artery disease or microvascular dysfunction might be responsible. TTDE is a promising tool, e.g. for follow-up after coronary interventions or for evaluating endothelial function over time.A third study focused on the importance of accurate and reproducible measurements of left ventricular volumes and ejection fraction (LVEF). Patients with known or suspected coronary artery disease with different levels of LVEF were enrolled. We compared the LVEF determined with an automatic echocardiographic method with manual planimetry, visual assessment of LVEF and with quantitative myocardial gated SPECT. The software using learned pattern recognition and artificial intelligence (AutoEF) applied on biplane apical echocardiographic views reduced the variation in measurements without increasing the time required. The method seems to be able to reduce variation in the assessment of LVEF in clinical patients, especially for less experienced readers.We evaluated a new feature tracking software for its ability to detect infarcted myocardium on cine-MR images. Patients were selected based on the presence or absence of myocardial scar in the perfusion area of the LAD. The software tracked myocardial wall motion and allowed the calculation of velocity, displacement and strain in radial and longitudinal directions. Feature tracking of cine-MR images detected scar segments with transmurality >50% within the distribution of the LAD with 80% sensitivity and 86% specificity (radial strain), without the need for the administration of gadolinium-based contrast.In summary, we have evaluated some of the noninvasive techniques in the wide array of diagnostic tools available for the diagnosis of ischemic heart disease. Their availability, low costs, freedom from radiation and repeatability are essential as well as their diagnostic ability.
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