| 1. |
- Albano, Amanda, et al.
(författare)
-
Echocardio-variability - Low and high frequency beat-to-beat variability in echocardiographic signals
- 2013
-
Ingår i: Computing in Cardiology 2013. - 9781479908844 ; , s. 767-770
-
Konferensbidrag (refereegranskat)abstract
- Measurement signals originating from the cardiovascular system are known to comprise oscillating components and beat-to-beat variability, e.g., heart-rate variability and blood pressure variability. In clinical echocardiographic procedures, typically only a few cardiac cycles are acquired. This pilot study analyses the beat-to-beat variability of echocardiographic variables (echocardio-variability) in minute long acquisitions.
|
|
| 2. |
- Grönlund, Christer, 1975-, et al.
(författare)
-
Significant beat-to-beat variability of E/e’ irrespective of respiration
- 2013
-
Ingår i: International cardiovascular forum. - : Barcaray Publishing. - 2409-3424 .- 2410-2636. ; 1:2, s. 88-89
-
Tidskriftsartikel (refereegranskat)abstract
- The E/e’ ratio is commonly used in Doppler echocardiographic examinations to estimate the pulmonary capillary wedge pressure. The rationale of using this ratio is to combine left ventricular (LV) filling (E) and relaxation (e’) velocities to indirectly assess left atrial pressure. However, the accuracy of this index has recently been questioned, particularly in patients with controlled heart failure. Likewise, the potential beat-to-beat variability of such measurements remains undetermined. The cardiovascular system is subject to several oscillations with the potential of influencing LV function and its intra-cavitary pressures, hence measurements of its filling and relaxation velocities. The aim of this pilot study was to assess the beat-to-beat variability of the E/e’ ratio in one minute long examination in healthy subjects, and patients with various severity of amyloid heart disease. The results show that despite critical application of the standard echocardiographic recording recommendations, E/e’ beat-to-beat variability was 36 % (22 to 50%) in healthy subjects and 17 % (11-26%) in patients, and where the most severe amyloid heart disease had the least variability. Thus, clinical use of a single or few cardiac beats might not necessarily reflect an accurate ratio between the two velocities, and hence casts doubt over their diagnostic value.
|
|
| 3. |
|
|
| 4. |
- Gustavsson, Sandra, et al.
(författare)
-
Can echocardiography and ECG discriminate hereditary transthyretin V30M amyloidosis from hypertrophic cardiomyopathy?
- 2015
-
Ingår i: Amyloid. - : Informa UK Limited. - 1350-6129 .- 1744-2818. ; 22:3, s. 163-170
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Hereditary transthyretin (ATTR) amyloidosis with increased left ventricular wall thickness could easily be misdiagnosed by echocardiography as hypertrophic cardiomyopathy (HCM). Our aim was to create a diagnostic tool based on echocardiography and ECG that could optimise identification of ATTR amyloidosis. Methods: Data were analysed from 33 patients with biopsy proven ATTR amyloidosis and 30 patients with diagnosed HCM. Conventional features from ECG were acquired as well as two dimensional and Doppler echocardiography, speckle tracking derived strain and tissue characterisation analysis. Classification trees were used to select the most important variables for differentiation between ATTR amyloidosis and HCM. Results: The best classification was obtained using both ECG and echocardiographic features, where a QRS voltage >30 mm was diagnostic for HCM, whereas in patients with QRS voltage <30 mm, an interventricular septal/posterior wall thickness ratio (IVSt/PWt) >1.6 was consistent with HCM and a ratio <1.6 supported the diagnosis of ATTR amyloidosis. This classification presented both high sensitivity (0.939) and specificity (0.833). Conclusion: Our study proposes an easily interpretable classification method for the differentiation between HCM and increased left ventricular myocardial thickness due to ATTR amyloidosis. Our combined echocardiographic and ECG model could increase the ability to identify ATTR cardiac amyloidosis in clinical practice.
|
|
| 5. |
- Hörnsten, Rolf, et al.
(författare)
-
Heart complications in familial transthyretin amyloidosis: impact of age and gender.
- 2010
-
Ingår i: Amyloid. - : Informa UK Limited. - 1350-6129 .- 1744-2818. ; 17:2, s. 63-68
-
Tidskriftsartikel (refereegranskat)abstract
- Heart arrhythmia is common in Swedish patients with familial amyloidotic polyneuropathy (FAP), as well as cardiomyopathy. We investigated the relationship between Holter ECG and echocardiographic findings in 108 FAP patients, with particular focus on age and gender differences. Female patients were younger than male patients at symptom onset (p < 0.01). Only 4 of 39 patients with septal hypertrophy were females. Regression analysis showed that age of onset, gender and duration of disease were significantly related with intraventricular septum (IVS) thickness. Sixty-five patients (25 females) presented with abnormal 24-h ECG recordings. IVS thickness was not significantly related to conduction disturbances or the presence of ventricular arrhythmia (VA). However, IVS thickness and atrial dimension were both related to increased rate of supraventricular arrhythmia (SVA). Male gender was clearly associated with more pronounced septal thickness of the heart. Conduction disturbances were not related to IVS thickness, indicating that the distribution and extent of infiltration of the heart by amyloid are heterogeneous and related to gender and age of onset. These findings highlight the necessity of 24-h ECGs to detect conduction disturbances, due to their occurrence in the absence of echocardiographic evidence of amyloid deposition in the myocardium.
|
|
| 6. |
- Suhr, Ole B., et al.
(författare)
-
New Insights into the clinical evaluation of hereditary transthyretin amyloidosis patients : A single center’s experience
- 2012
-
Ingår i: Degenerative Neurological and Neuromuscular Disease. - : Dove Press. - 1179-9900. ; 2012:2, s. 93-106
-
Tidskriftsartikel (refereegranskat)abstract
- Over the last decade, new medical treatment modalities have emerged based on increased insights into amyloid formation. With the increased possibilities for treatment of amyloidosis caused by transthyretin (TTR) amyloid deposits comes the need for diagnostic procedures for early diagnosis and better tools to follow disease progression. This is of particular importance in clinical trials evaluating the efficacy of new treatments. Until recently, the treatment of TTR amyloidosis (ATTR) was based solely on liver transplantation, a procedure that has halted disease progression in many patients. Liver transplantation has been especially effective in patients under the age of 50 years carrying the TTR V30M mutation, whereas the outcome of the procedure has been variable for others, particularly elderly male patients and those carrying a non-V30M mutation. This review concentrates on new insights derived from our center's experience with liver transplantation, how to implement this experience in evaluation of new treatment modalities for ATTR, and how to facilitate early diagnosis of neuropathy with easily available diagnostic tools. Attention has focused on manifestations of the disease that involve the heart and the peripheral nervous system; change in peripheral nerve function has been the primary endpoint in two controlled clinical trials, one finished and one ongoing. New insights into the amyloid formation process and the lessons learned from liver transplantation give the opportunity to design potentially effective treatment modalities for ATTR. It appears reasonable to suspect that a combination of different treatment modalities may be required to treat the disease, and that different treatment regimes will be designed according to the phenotype of the disease. For the patients and their relatives there is now a solid foundation for optimism, with prospects of several effective medical treatment possibilities within the coming decade.
|
|
| 7. |
- Tossavainen, Erik, 1977-, et al.
(författare)
-
Passive leg-lifting in heart failure patients predicts exercise-induced rise in left ventricular filling pressures
- 2020
-
Ingår i: Clinical Research in Cardiology. - : Springer. - 1861-0684 .- 1861-0692. ; 109:4, s. 498-507
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to assess PCWP with passive leg-lifting (PLL) and exercise, in two groups of patients presenting with normal left ventricular ejection fraction (LVEF); one group with elevated NT-proBNP (eBNP), and one with normal NT-proBNP (nBNP) plasma concentration.Methods and results: Fifty-one patients with eBNP (NT-proBNP ≥ 125 ng/l) and LVEF > 50%, were investigated and compared with 34 patients with nBNP (NT-proBNP < 125 ng/l) and LVEF > 50%. Both groups underwent right heart catheterization (RHC) at rest, PLL and exercise. From RHC, mean pulmonary arterial pressure (mPAP), cardiac output (CO), and PCWP were measured. All nBNP patients had PCWP < 15 mmHg at rest, and a PCWP of < 25 mmHg with PLL and during exercise. Patients with eBNP had higher (p < 0.01) resting mPAP, PCWP, and mPAP/CO. These values increased with exercise; however, CO increased less in comparison with nBNP patients (p = 0.001). 20% of patients with eBNP had a PCWP > 15 mmHg at rest, this percentage increased to 47% with PLL and 41% had a PCWP > 25 mmHg during exercise. Of those with PCWP > 25 mmHg during exercise, 91% had a PCWP > 15 mmHg with PLL. A PCWP > 15 mmHg on PLL had a 91% sensitivity and 92% specificity in predicting exercise-induced PCWP of > 25 mmHg.Conclusion: In patients presenting with eBNP, PLL can predict which patients will develop elevated PCWP with exercise. These findings highlight the role of stress assessment.
|
|
| 8. |
- Vanoli, Davide, 1972-, et al.
(författare)
-
Fully automated on-screen carotid intima-media thickness measurement : a screening tool for subclinical atherosclerosis
- 2013
-
Ingår i: Journal of Clinical Ultrasound. - Hoboken : Wiley-Blackwell. - 0091-2751 .- 1097-0096. ; 41:6, s. 333-339
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose Carotid intima-media thickness (CIMT) is generally considered an appropriate direct vascular method for cardiovascular risk assessment. The objective of this study was to evaluate the feasibility and reproducibility of a newly developed automated on-screen carotid ultrasound with respect to manual measurement with a conventional system.Methods We assessed CIMT in 50 consecutive patients (age 62 +/- 5 years, range 21-79 years, 36 men) twice, using a newly developed automated ultrasound (CardioHealth Station) and a conventional system with manual measurement (Acuson, Sequoia). For each patient, three frozen frames of the distal 10 mm of the right and left common carotid arteries were acquired on the two systems, by operators blinded to each other. The average of the mean value of three readings of each system was calculated.Results The intraclass correlation coefficient of the interoperator variability was 0.95 and 0.94 for the automated and manual measurements, respectively. The comparative coefficient of variation of the interoperator variability was 8.2 and 8.7% for the automated and manual measurements, respectively. There was no clinically relevant difference between measurements obtained by the two systems (intraclass correlation coefficient=0.98). The acquisition time of the automated system was significantly shorter than the conventional system (p<0.01).Conclusions Fully automated on-screen measurements of CIMT are feasible, faster, and as reproducible as conventional manual measurements and may be suitable and cost-effective for screening application in community medicine.
|
|
| 9. |
- Vanoli, Davide, et al.
(författare)
-
Successful novice's training in obtaining accurate assessment of carotid IMT using an automated ultrasound system
- 2014
-
Ingår i: European Heart Journal Cardiovascular Imaging. - Oxford : Oxford University Press. - 2047-2404 .- 2047-2412. ; 15:6, s. 637-642
-
Tidskriftsartikel (refereegranskat)abstract
- Aims The aim of this study was to assess the feasibility and learning curve of training novice operators in using automated ultrasound to achieve satisfactory carotid intima-media thickness (CIMT) measurements.Methods and results Four novices underwent 4 weeks carotid ultrasound training using a newly developed automated ultrasonograph. A longitudinal B-mode image of the distal right common carotid artery (CCA) was acquired in 96 patients. The interoperator CIMT reproducibility was analysed by the coefficient of variation (CV) and intraclass correlation coefficient (ICC) for every week and compared with that from an expert operator. The weekly mean CV of the measurements on the 24 patients made by all novices was consistently reduced: 0.06, 0.05, 0.03, and 0.02, respectively. For the expert, the mean CV was 0.02, 0.02, 0.03, and 0.02, respectively. The novices' standard deviation (SD) of CVs also reduced weekly from 0.04 in the first week to 0.01 in the last week (P < 0.05). The corresponding weekly variation in the SD for the expert was 0.02 for the first week to 0.01 in the last week (P = 0.27). The agreement between measurements made by the novices was expressed by the ICC being 0.97 (P < 0.001) in the first week and increased to 0.99 (P < 0.001) in the fourth week.Conclusion CIMT assessment by novices using an automated ultrasound could be reliably achievable after a short training period. These results may have encouraging implications when designing screening programmes for primary prevention in community health service.
|
|
| 10. |
- Zhao, Ying, et al.
(författare)
-
Left ventricular dyssynchrony is associated with reduced heart rate variability in familial amyloidotic polyneuropathy
- 2012
-
Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 155:2, s. 272-278
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cardiac complications are common in familial amyloidotic polyneuropathy (FAP), in which heart rate variability (HRV) is reduced. Although autonomic disturbances are well-established, mechanisms for reduced HRV, their relationship with left ventricular (LV) function in FAP are not well understood. METHODS: Twenty-nine FAP patients and 29 healthy controls were studied using Doppler echocardiography. Patients' and controls' HRV were studied using power spectral analysis from 24-hour Holter-ECG recordings. RESULTS: In FAP patients, all HRV parameters were lower (p<0.01 for all) than those in controls. Echocardiography showed a normal LV systolic function in patients. Relative filling time (FT/RR) was shorter (p<0.01) and total isovolumic time (t-IVT) was longer (p<0.01) in patients than in controls. E/Em was higher (p<0.01), as was Tei index (p=0.02) as compared to controls. T-IVT and Tei index correlated with stroke volume (SV) (r=-0.54, p<0.01 and r=-0.44, p<0.05, respectively) in patients. HRV was reduced in 9/29 (31%) patients, who had shorter FT/RR (p<0.01), longer t-IVT (p<0.01), higher Tei index (p=0.05), A wave (p<0.01) and E/Em (p<0.05) than in subjects without reduced HRV. FT/RR and t-IVT correlated with HRV spectral parameters (p<0.05 for all). The correlation between t-IVT and SV was stronger in patients with reduced HRV (r=-0.80, p<0.01) than in those without. QRS duration was not different in the two subgroups of patients. CONCLUSIONS: In a subset of patients with FAP, HRV was significantly reduced and appeared to be associated with shortened LV filling time and prolonged t-IVT, which reflect ventricular dyssynchrony, despite normal QRS. Thus, in addition to autonomic disturbances in FAP, ventricular dyssynchrony is another factor associated with reduced HRV. Correction of such disturbed ventricular function by cardiac resynchronization therapy may control patients' symptom.
|
|
