| 1. |
- Emilsson, Kent, 1963-
(författare)
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Can the amplitude of mitral annulus motion be used in the assessment of left ventricular systolic function in patients with left ventricular wall thickness in the upper limit of normal to mild hypertrophy?
- 2003
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Ingår i: Experimental and clinical cardiology. - 1205-6626. ; 8:1, s. 29-30
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mitral annulus motion (MAM) obtained by echocardiography can be used in the assessment of left ventricular systolic function (LVSF). However, it has been shown that the amplitude of MAM is decreased in patients with left ventricular wall thickness (LVWT) greater than 14 mm.OBJECTIVE: To study if the amplitude of MAM can be used in the assessment of LVSF in patients with LVWT in the upper limit of normal to mild hypertrophy (12 mm to 14 mm).METHODS: Eighteen consecutive patients with LVWT of 12 mm to 14 mm were compared to 18 age- and sex-matched patients with LVWT less than 12 mm.RESULTS: There was no significant difference between the amplitude of MAM in the two groups.CONCLUSIONS: MAM can be used in the assessment of LVSF in patients with LVWT in the upper limit of normal to mild hypertrophy and be related to reference values.
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| 2. |
- Emilsson, Kent, 1963-, et al.
(författare)
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Comparison between angiographic right coronary artery motion and echocardiographic tricuspid annulus motion
- 2004
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 38:2, s. 85-92
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare echocardiographic M-mode measurements of tricuspid annulus motion (TAM) with angiographic M-mode measurements of right coronary artery motion (RAM).DESIGN: Twenty-four patients were included and examined by echocardiography before the angiographic examination. The amplitudes and the velocities of TAM and the atrial contribution to the total amplitude of TAM were measured. The obtained values were compared with angiographic M-mode measurements of RAM at a proximal and a distal site of the second segment of the right coronary artery.RESULTS: There was no significant difference between several of the echocardiographic M-mode measurements of TAM and the angiographic M-mode measurements of RAM. However, the agreement was rather poor for some variables.CONCLUSION: Different parameters obtained from echocardiographic TAM are not interchangeable with values from angiographic RAM. If measurements of RAM are to be used in the assessment of right ventricular (RV) function further studies are needed to examine the correlation and agreement between RAM and different methods of measuring RV function, i.e. radionuclide angiography or magnetic resonance imaging.
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| 3. |
- Emilsson, Kent, 1963-, et al.
(författare)
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Comparison between circumflex artery motion and mitral annulus motion.
- 2001
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 35:5, s. 318-325
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare mitral annulus motion (MAM) with circumflex artery motion (CXM) and the motion amplitude at an endocardial site (representing MAM) with an epicardial site (representing CXM) at the most basal lateral part of the atrioventricular plane (AVP).DESIGN: MAM and CXM were obtained in 28 patients examined by echocardiography and coronary angiography. The motion amplitude epicardially and endocardially was recorded by echocardiography in 13 patients with normal ejection fraction (EF) (> or = 0.50) and in 13 patients with decreased EF (<0.50).RESULTS: CXM was higher than MAM in most patients with normal EF but lower than MAM in most patients with decreased EF. The motion amplitude epicardially was significantly higher (p < 0.001) than endocardially in patients with normal EF. while there was no significant difference in patients with decreased EF.CONCLUSION: CXM represents the motion of the epicardial part of the AVP and differs from MAM, which represents the endocardial part of the wall. This must be considered when CXM is used for assessment of left ventricular systolic function.
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| 4. |
- Emilsson, Kent, 1963-, et al.
(författare)
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Isovolumetric relaxation time of the right ventricle assessed by tissue Doppler imaging
- 2004
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Ingår i: Scandinavian Cardiovascular Journal. - Oslo : Taylor& Francis. - 1401-7431 .- 1651-2006. ; 38:5, s. 278-282
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Tidskriftsartikel (refereegranskat)abstract
- Objectives-The isovolumetric relaxation time of the right ventricle (RV-IVRT) can be assessed using a method based on ECG and pulsed wave Doppler (PW). Recently pulsed wave Doppler tissue imaging (PW-DTI) has been introduced in the assessment.Design-RV-IVRT obtained by the two methods was compared in 20 consecutive patients as was the time from the R wave on the ECG to the onset of tricuspid flow (R-T), to the closure of the pulmonic valve (R-P), to the onset of early diastolic motion of the tricuspid annulus tissue (R-E) and to the end of the systolic motion (R-S).Results-RV-IVRT obtained by the PW method was significantly (p<0.001) shorter than RV-IVRT obtained by PW-DTI. R-S had significantly (p<0.001) shorter duration than R-P, while there was no significant difference between R-E and R-T.Conclusions-The methods are not measuring the same interval. Only the PW method measures RV-IVRT according to the usual definition. Different reference values have to be used if the methods are used in the assessment of RV diastolic function.
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| 5. |
- Emilsson, Kent, 1963-
(författare)
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Mitral annulus motion in left ventricular pumping
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focus on the role of the mitral annulus motion (MAM) versus outer contour changes in the short axis, in left ventricular (LV) pumping. The influence of atrial contraction on LV dimensions and volumes and the relation between MAM and ejection fraction (EF) in sinus rhythm and in atrial fibrillation was also studied.Echocardiography was used in all studies and in the study about circumflex artery motion angiography was also used.In a study including 20 healthy adults the role of MAM, i.e. the systolic shortening of the left ventricle in the long axis, as the main mechanism of LV pumping was confirmed. There was also, however, a significant contribution to the stroke volume from an outer contour decrease in the short axis during systole. At the chordae tendineae level a cross sectional area decrease of 24% was measured. From calculations based on measures of the long axis shortening of the LV, the outer short axis diameter of the LV and calculated stroke volume, a mean systolic cross sectional area decrease of about 6% was found along the whole length of the ventricle. The higher cross-sectional area decrease at the chordae level is thougth to be caused by regional differences.In previous studies the relation between EF and MAM has been assumed to be linear, but in a meta-analysis of 434 patients it was shown that the relation is non-linear and that a linear regression model overestimates EF in the low range of MAM. It was shown that the relation between EF and MAM in adults is influenced by age but only in the normal range of EF or MAM and not in patients with decreased EF (EF <0.5 or MAM < 10mm). The relation was also shown to be influenced by the LV wall thickness.In 20 patients with atrial fibrillation the ratio EF/MAM was shown to be higher than in 20 age- and gender matched patients with sinus rhythm, due to a decrease in MAM, caused by the loss of atrial contraction.The relation between EF and MAM is thus complex and it therefore seems logical not to "translate" MAM to EF. MAM should be used as such related to reference values in the assessment of LV systolic function.In 13 patients who had atrial fibrillation the stroke volume was shown to increase after successful direct-current cardioversion due to an increase in long axis diastolic elongation of the LV and thereby increased diastolic volume, when atrial contraction was regained.In 28 patients the angiographic measure of circumflex artery motion amplitude tended to be higher than MAM in the higher range of amplitudes while the opposite was found in the lower range of amplitudes.In 13 patients with normal EF it was shown that the motion amplitude of a site epicardially at the most basal lateral part of the LV wall was significantly (P < 0.001) higher than endocardially, but in 13 patients with decreased EF (< 0.5) there was no significant difference between the two sites. The motion amplitude epicardially corresponds to the motion amplitude of the circumflex artery.In the 13 patients with normal EF the motion amplitude of the closed mitral valves was significantly lower than the motion amplitude epi- and endocardially during systole, with a rather conic shape of the atrioventricular plane at the onset of systole. In end-systole the different parts of the left atrioventricular plane, the epicardial part, the endocardial part (mitral annulus) and the valves were almost on the same level.
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| 6. |
- Emilsson, Kent, 1963-
(författare)
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Right ventricular long-axis function in relation to left ventricular systolic function
- 2004
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Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961 .- 1475-097X. ; 24:4, s. 212-215
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Tidskriftsartikel (refereegranskat)abstract
- A decrease in left ventricular (LV) systolic function is accompanied by a decrease in maximal relaxation velocity in LV long-axis direction, but is it also accompanied by a decrease in right ventricular (RV) long-axis function? To study this 35 consecutive patients were examined by echocardiography. Ejection fraction (LVEF) and mitral annulus motion (MAM) were used as indices of LV systolic function and tricuspid annulus motion (TAM), that is the systolic shortening in RV long-axis direction, was used as an index of RV systolic long-axis function. In the same way the maximal relaxation velocity in LV long-axis direction, that is the maximal diastolic velocity of MAM (MDV MAM), has been suggested as an index of LV diastolic function the maximal diastolic velocity of TAM (MDV TAM) can be supposed to be an index of RV diastolic function measuring the maximal relaxation velocity in the RV long-axis direction. A significant positive correlation was found between MDV TAM and MAM (r = 0.64, P<0001) and LVEF (r = 0.54, P = 0.001) and between TAM and the two studied indices of LV systolic function, with the highest correlation to MAM (r = 0.68, P<0.001) and the lowest to LVEF (r = 0.57, P<0.001). Thus, a decrease in LV systolic function is accompanied by a decrease in both systolic and diastolic RV long-axis function, findings that probably are due to the close anatomical connection between the ventricles and to changes that occur in afterload of the RV secondary to LV systolic dysfunction.
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| 7. |
- Emilsson, Kent, 1963-, et al.
(författare)
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The mode of left ventricular pumping : is there an outer contour change in addition to the atrioventricular plane displacement?
- 2001
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Ingår i: Clinical Physiology. - : Wiley. - 0144-5979 .- 1365-2281. ; 21:4, s. 437-446
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Tidskriftsartikel (refereegranskat)abstract
- The outer contour of the heart has in some studies been shown to be constant during the heart cycle and the epicardial apex almost stationary whilst the base of the ventricles moves towards apex during systole. The base of the left ventricle has been regarded as a cylinder with constant cross-sectional area with changes in height during the heart cycle, the latter corresponding to the amplitude of mitral annulus motion (MAM). In this echocardiographic study, including 20 healthy adults, the stroke volume calculated by the cylinder model was significantly lower than by a reference method (modified Simpson's rule). MAM explained 82% of the stroke volume and 18% must, therefore, be explained by an inward motion of the outer left ventricular wall. A mean outer diameter shortening of about 3% (about 2 mm) was calculated.
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| 8. |
- Emilsson, Kent, 1963-, et al.
(författare)
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The relation between ejection fraction and mitral annulus motion before and after direct-current electrical cardioversion.
- 2000
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Ingår i: Clinical Physiology. - : Wiley. - 0144-5979 .- 1365-2281. ; 20:3, s. 218-24
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Tidskriftsartikel (refereegranskat)abstract
- Mitral annulus motion (MAM) and the relation between left ventricular ejection fraction (EF) and MAM has been shown to differ between patients with sinus rhythm and patients with atrial fibrillation. However, it has not been investigated how the relation between EF and MAM changes on direct-current (DC) electrical cardioversion to sinus rhythm. Therefore, 31 consecutive patients on the waiting list for DC electrical cardioversion were examined by echocardiography before DC electrical cardioversion, and those who maintained sinus rhythm (13 patients) were examined again 4-8 weeks after cardioversion. The conversion factor (CF) (ratio EF/MAM) decreased from 8.4 +/- 1.7 before to 5.8 +/- 0.8 SD after cardioversion (P<0.001). The EF increased slightly (P<0.05) but the MAM had a much greater increase (P<0.001), resulting in the decrease in CF. There was no significant difference in CF between patients after cardioversion and age- and gender-matched control patients with sinus rhythm, indicating that CF is normalized or almost normalized 4-8 weeks after cardioversion. This indicates that when MAM is used for investigation of the left ventricular function, and the function is expressed as EF, the same CF as in other patients with sinus rhythm can be used 4-8 weeks after DC electrical cardioversion.
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| 9. |
- Emilsson, Kent, 1963-, et al.
(författare)
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The relation between mitral annulus motion and ejection fraction : a nonlinear function.
- 2000
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317 .- 1097-6795. ; 13:10, s. 896-901
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Tidskriftsartikel (refereegranskat)abstract
- In previous studies of the relation between mitral annulus motion (MAM) and left ventricular ejection fraction (EF), a linear relationship has been suggested. In this meta-analysis of 434 patients, we show that the relation is nonlinear and that a linear regression model overestimates EF in the lower range of MAM. The relation is better described by an S function and is influenced by age and heart size.
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| 10. |
- Emilsson, Kent, 1963-, et al.
(författare)
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The relation between mitral annulus motion and ejection fraction changes with age and heart size.
- 2000
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Ingår i: Clinical Physiology. - : John Wiley & Sons. - 0144-5979 .- 1365-2281. ; 20:1, s. 38-43
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Tidskriftsartikel (refereegranskat)abstract
- Mitral annulus motion (MAM) has recently been introduced as an index of left ventricular function. Several echocardiographic studies have shown good agreement between ejection fraction (EF) and MAM x 5, where MAM is the total mitral annulus motion, measured in mm, and EF is expressed as a percentage. This means that if MAM is used for estimation of left ventricular function, the conversion factor 5 is used, if the function is expressed as EF. In these studies, the mean age of the patients was over 60 years. The present study, including 102 patients, shows that in patients aged 20-40 years, the conversion factor is about 4.3, in patients aged 41-60 years it is about 4.6 and in patients aged 61-80 years it is about 5.0. It was also found that the ratio EF/MAM decreases with increasing height and left ventricular diameter, both variables closely connected to heart size. The results suggest that when MAM is used in assessment of left ventricular function, it is unwise to express the function in terms of EF. It is preferable to use MAM as a direct index of ventricular function, using reference values referred to aged and height. If the estimated function is expressed in terms of EF, different converting factors must be used depending on the age of the patients.
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