1. |
- Bech-Hanssen, Odd, 1956, et al.
(author)
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Characterization of complex flow patterns in the ascending aorta in patients with aortic regurgitation using conventional phase-contrast velocity MRI.
- 2018
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In: The international journal of cardiovascular imaging. - : Springer Science and Business Media LLC. - 1875-8312 .- 1569-5794 .- 1573-0743. ; 34:3, s. 419-429
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Journal article (peer-reviewed)abstract
- Ascending aorta (AA) flow displacement (FD) is a surrogate for increased wall shear stress. We prospectively studied the flow profile in the AA in patients with aortic regurgitation (AR), to identify predictors of FD and investigate whether magnetic resonance imaging (MRI) phase-contrast flow rate curves (PC-FRC) contain quantitative information related to FD. Forty patients with chronic moderate (n=14) or severe (n=26) AR (21 (53%) with bicuspid aortic valve) and 22 controls were investigated. FD was determined from phase-contrast velocity profiles and defined as the distance between the center of the lumen and the "center of velocity" of the peak systolic forward flow or the peak diastolic negative flow, normalized to the lumen radius. Forward and backward volume flow was determined separately for systole and diastole. Seventy percent had systolic backward flow and 45% had diastolic forward flow in large areas of the vessel. AA dimension was an independent predictor of systolic FD while AA dimension and regurgitant volume were independent predictors of diastolic FD. Valve phenotype was not an independent predictor of systolic or diastolic FD. The linear relationships between systolic backward flow and systolic FD and diastolic forward flow and diastolic FD were strong (R=0.77 and R=0.76 respectively). Systolic backward flow and diastolic forward flow identified marked systolic and diastolic FD (≥0.35) with a positive likelihood ratio of 6.0 and 10.8, respectively. In conclusion, conventional PC-FRC data can detect and quantify FD in patients with AR suggesting the curves as a research and screening tool in larger patient populations.
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2. |
- Bengtsson, Anna, 1973-, et al.
(author)
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Multi-view carotid ultrasound is stronger associated with cardiovascular risk factors than presence of plaque or single carotid intima media thickness measurements in subclinical atherosclerosis
- 2023
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In: The International Journal of Cardiovascular Imaging. - : Springer Nature. - 1569-5794 .- 1875-8312. ; 39:8, s. 1461-1471
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Journal article (peer-reviewed)abstract
- We aimed to explore the prevalence of atherosclerosis by using multi-view ultrasound examination of the carotid arteries and its association with clinical risk factors in a middle-aged population at low to intermediate risk of cardiovascular disease (CVD). Carotid vascular ultrasound was performed in 3532 participants in the VIPVIZA trial. Mean and maximal carotid intima media thickness (cIMT) at prespecified angles and plaque presence were examined on the left and right side. Associations between CVD risk factors and ultrasound variables were quantified by partial least squares (PLS) regression. A combined ultrasound variable was computed using weights of the first PLS component. Associations between CVD risk factors and the combined multi-view ultrasound variable, single cIMT and plaque measurements, respectively, were determined using linear regression modelling. The participants’ mean age was 55.7 years and 52.9% were women. Plaque prevalence was 51.1% in men and 39.0% in women. cIMT was higher in men than in women and in the left compared with the right carotid artery. The strongest association of CVD risk factors was observed with the combined multi-view ultrasound variable (R2 = 24%), compared with single cIMT variables (R2 = 14–18%) and plaque presence (R2 = 15%). The pattern was similar in both sexes. The association with CVD risk factors and the combined ultrasound variable was stronger in 40-year olds (R2 = 22%) compared with 50- or 60-year olds (R = 12%). CVD risk factors are stronger associated with a combined ultrasound variable than plaque presence or single cIMT measures suggesting that carotid multi-view ultrasonography better captures the focality of early atherosclerosis. Clinical Trial Registration: ClinicalTrials.gov, number NCT01849575. May 8, 2013.
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3. |
- Brugaletta, Salvatore, et al.
(author)
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Morphology of coronary artery lesions assessed by virtual histology intravascular ultrasound tissue characterization and fractional flow reserve
- 2012
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In: The International Journal of Cardiovascular Imaging. - : Springer Science and Business Media LLC. - 1569-5794 .- 1875-8312 .- 1573-0743. ; 28:2, s. 221-228
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Journal article (peer-reviewed)abstract
- Fractional flow reserve (FFR) is an index of the physiological significance of a coronary stenosis. Patients who have lesions with a FFR of >0.80, even optimally treated with medication, have however a MACE rate ranging from 8 to 21%. Coronary plaques at high risk of rupture and clinical events can be also identified by virtual histology intravascular ultrasound (IVUS-VH) as plaques with high amount of necrotic core (NC) abutting the lumen. Aim of this exploratory study was to investigate whether the geometry and composition of lesions with FFR ≤ 0.80 were different from their counterparts. Fifty-five consecutive patients in whom FFR was clinically indicated on a moderate angiographic lesion, received also an imaging investigation on the same lesion with IVUS-VH. Data on plaque geometry and composition was analyzed. Patients were subdivided in two groups according to the value of FFR (> or ≤0.80). Lesions with a FFR ≤ 0.80 (n = 17) showed a slightly larger plaque burden than those with FFR > 0.80 (n = 38) (54.6 ± 0.7% vs. 51.7 ± 0.7% P = 0.1). In addition, they tend to have less content of necrotic core than their counterparts (14.2 ± 8% vs. 19.2 ± 10.2%, P = 0.08). No difference was found in the distribution of NC-rich plaques (fibroatheroma and thin-capped fibroatheroma) between groups (82% in FFR ≤ 0.80 vs. 79% in FFR > 0.80, P = 0.5). Although FFR ≤ 0.80 lesions have larger plaque size, they do not differ in composition from the ones with FFR > 0.80. Further exploration in a large prospective study is needed to study whether the lesions with FFR > 0.80 that are NC rich are the ones associated with the presence of clinical events at follow-up.
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4. |
- Byström, Björn, et al.
(author)
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The right ventricle : knowing what is right
- 2008
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In: The International Journal of Cardiovascular Imaging. - Dordrecht : Springer. - 1569-5794 .- 1875-8312 .- 1573-0743. ; 24:7, s. 701-702
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Journal article (peer-reviewed)
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5. |
- Cameli, Matteo, et al.
(author)
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Pre-operative left atrial strain predicts post-operative atrial fibrillation in patients undergoing aortic valve replacement for aortic stenosis
- 2014
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In: The International Journal of Cardiovascular Imaging. - Dordrecht : Springer Netherlands. - 1569-5794 .- 1875-8312 .- 1573-0743. ; 30:2, s. 279-286
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Journal article (peer-reviewed)abstract
- Post-operative atrial fibrillation (AF) is a common and serious complication in patients undergoing aortic valve replacement (AVR). Speckle tracking echocardiography (STE) has recently enabled the quantification of longitudinal myocardial left atrial (LA) deformation dynamics. Our aim was to investigate LA preoperative mechanical function in patients undergoing AVR for aortic stenosis using STE and determine predictors of post-operative AF. 76 patients with aortic stenosis in sinus rhythm, undergoing AVR, were prospectively enrolled. Conventional echocardiographic parameters, and peak atrial longitudinal strain (PALS) were measured in all subjects the day before surgery. PALS values were obtained by averaging all segments in the 4- and 2-chamber views (global PALS). All patients received biological valve prostheses and a standard postoperative care. Postoperative AF occurred in 15 patients (19.7 %). On univariate analysis among all clinical and echocardiographic variables, global PALS showed the highest diagnostic accuracy (HR 6.55 p < 0.0001; AUC of 0.89) with a cut-off value < 16.9 %, having sensitivity and specificity of 86 and 91 %, respectively, in predicting postoperative AF. LA volume indexed and E/e' ratio had lower diagnostic accuracy (AUC 0.76 and 0.51, respectively). On multivariate analysis global PALS remains a significant predictor of postoperative AF (p < 0.0001). STE analysis of LA myocardial deformation is considered a promising tool for the evaluation of LA subclinical dysfunction in patients undergoing AVR, giving a potentially better risk stratification for the occurrence of postoperative AF.
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6. |
- Cirovic, Stefan, et al.
(author)
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Vortex formation time in female athletes
- 2024
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In: The International Journal of Cardiovascular Imaging. - : Springer Nature. - 1569-5794 .- 1875-8312. ; 40:2, s. 373-384
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Journal article (peer-reviewed)abstract
- Regular, vigorous physical activity can have a significant impact on cardiac function, leading to cardiac morphological alterations that may be challenging to distinguish from pathological changes. Therefore, new screening methods are needed to accurately differentiate between adaptive changes and pathological alterations in athletes. Vortex formation time (VFT) is an emerging method that shows potential in this regard, as it involves the formation of a rotating vortex ring in the left ventricle during the early filling phase of diastole. In this study, we investigated the difference in VFT between two groups of women: professional handball players and healthy middle-aged female athletes, along with their corresponding control groups. By using echocardiography-Doppler analysis of the heart, VFT was calculated based on the left ventricular ejection fraction, the ratio between the end-diastolic volume and the diameter of the mitral annulus, and the ratio of the atrial contraction volume to the total inflow via the mitral valve. The study reveals a significant increase in VFT in both professional handball players and middle-aged female athletes compared to their respective control groups. Moreover, statistically significant differences between handball players and middle-aged female athletes were observed, indicating that the level of physical activity may affect the VFT. These results suggest that VFT could be a promising screening tool for identifying cardiac adaptations due to long-term vigorous training, potentially enabling more accurate diagnoses of cardiac morphological alterations in athletes. Representation of the graphical abstract of the conducted research.
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7. |
- da Silva, Cristina, et al.
(author)
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Prosthesis-patient mismatch after transcatheter aortic valve implantation : impact of 2D-transthoracic echocardiography versus 3D-transesophageal echocardiography
- 2014
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In: The International Journal of Cardiovascular Imaging. - : Springer Science and Business Media LLC. - 1569-5794 .- 1875-8312 .- 1573-0743. ; 30:8, s. 1549-1557
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Journal article (peer-reviewed)abstract
- To investigate the role of 2D-transthoracic echocardiography (2D-TTE) and 3D-transesophageal echocardiography (3D-TEE) in the determination of aortic annulus size prior transcatheter aortic valve implantation (TAVI) and its' impact on the prevalence of patient prosthesis mismatch (PPM). Echocardiography plays an important role in measuring aortic annulus dimension in patients undergoing TAVI. This has great importance since it determines both eligibility for TAVI and selection of prosthesis type and size, and can be potentially important in preventing an inadequate ratio between the prosthetic valvular orifice and the patient's body surface area, concept known as prosthesis-patient mismatch (PPM). A total of 45 patients were studied pre-TAVI: 20 underwent 3D-TEE (men/women 12/8, age 84.8 +/- A 5.6) and 25 2D-TTE (men/women 9/16, age 84.4 +/- A 5.4) in order to measure aortic annulus diameter. The presence of PPM was assessed before hospital discharge and after a mean period of 3 months. Moderate PPM was defined as indexed aortic valve area (AVAi) a parts per thousand currency sign 0.85 cm(2)/m(2) and severe PPM as AVAi < 0.65 cm(2)/m(2). Immediately post-TAVI, moderate PPM was present in 25 and 28 % of patients worked up using 3D-TEE and 2D-TTE respectively p value = n.s) and severe PPM occurred in 10 % of the patients who underwent 3D-TEE and in 20 % in those with 2D-TTE (p value = n.s). The echocardiographic evaluation 3 months post-TAVI showed 25 % moderate PPM in the 3D-TEE group compared with 24 % in the 2D-TTE group (p value = n.s) and no cases of severe PPM in the 3DTEE group comparing to 20 % in the 2D-TTE group (p = 0.032). Our results indicate a higher incidence of severe PPM in patients who performed 2DTTE compared to those performing 3DTEE prior TAVI. This suggests that the 3D technique should replace the 2DTTE analysis when investigating the aortic annulus diameter in patients undergoing TAVI.
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8. |
- D'Ascenzi, Flavio, et al.
(author)
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Left atrial remodelling in patients undergoing transcatheter aortic valve implantation : a speckle-tracking prospective, longitudinal study.
- 2013
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In: The International Journal of Cardiovascular Imaging. - : Springer Netherlands. - 1569-5794 .- 1875-8312 .- 1573-0743. ; 29:8, s. 1717-1724
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Journal article (peer-reviewed)abstract
- Aortic stenosis (AS) results in several left ventricular (LV) disturbances as well as progressive left atrial (LA) enlargement and dysfunction. Transcatheter aortic valve implantation (TAVI) reverses LV remodelling and improves overall systolic function but its effect on LA function remains undetermined. The aim of this prospective, longitudinal study was to investigate the effects of TAVI on LA structure and function. We studied thirty-two patients with severe symptomatic AS who underwent TAVI, using standard and 2-dimensional speckle-tracking echocardiography before, at 40-day and at 3-month follow-up. Following TAVI, mean transvalvular gradient decreased (p < 0.001). Both LA area index and LA volume index decreased at 40-day follow-up (16.2 ± 6.4 vs. 12.5 ± 2.9 cm(2)/m(2), and 47.3 ± 12.0 vs. 42.8 ± 12.5 mL/m(2), respectively, p < 0.05) and values remained unchanged at 3 months. The reduction of LA size was accompanied by a significant increase in global peak atrial longitudinal strain (14.4 ± 3.9 vs. 19.1 ± 4.7 %, p < 0.001) and in global peak atrial contraction strain (8.4 ± 2.5 vs. 11.0 ± 4.1 %, p < 0.05) at 3-month follow-up. LA stiffness measurements significantly decreased 3 months after TAVI (0.93 ± 0.59 vs. 0.65 ± 0.37, respectively, p < 0.001). Trans-aortic mean gradient change and pre-procedural LA volume were identified as predictors of global peak atrial longitudinal strain increase (β = -0.41, β = -0.35, respectively, p < 0.0001) while pre-procedural LA volume and trans-aortic mean gradient change as predictor of LA volume index reduction 3 months after TAVI (β = -0.37, β = -0.28, respectively, p < 0.0001). TAVI is associated with significant recovery of LA structure and function suggesting a reverse cavity remodelling. Such functional recovery is primarily determined by the severity of pre-procedural valve stenosis.
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9. |
- D'Ascenzi, Flavio, et al.
(author)
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P-wave morphology is unaffected by training-induced biatrial dilatation : a prospective, longitudinal study in healthy athletes
- 2016
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In: International Journal of Cardiac Imaging. - : Springer Science and Business Media LLC. - 1569-5794 .- 1875-8312. ; 32:3, s. 407-415
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Journal article (peer-reviewed)abstract
- Biatrial enlargement is common in athletes with a further increase occurring after training. P-wave morphology seems to be unaffected by atrial size, however longitudinal data are not available. This study aimed to prospectively investigate whether exercise-induced increase in biatrial size corresponds to electrical changes on 12-lead ECG. Thirty-five athletes were evaluated at the beginning of the training and after 6 months by ECG and standard and speckle-tracking echocardiography. Twenty-three sedentary subjects served as controls. Athletes had greater left atrial (LA) and right atrial (RA) size compared with controls (20.7 ± 4.7 vs. 27.1 ± 6.6 and 17.3 ± 3.8 vs. 23.4 ± 6.3 mL/m2, respectively, p < 0.0001). After 6 months, a further increase in LA and RA size was observed (p < 0.0001 and p = 0.002, respectively). Neither athletes nor controls fulfilled the ECG criteria for RA enlargement and no differences were found for LA enlargement criteria between athletes and controls (2/35, 6 % vs. 0/23, 0 %, p = 0.23). This percentage remained unchanged after training. Biatrial stiffness remained normal in athletes also after training. Training causes an increase in biatrial volumes, with normal filling pressures and normal stiffness. These changes in atrial morphology are not associated with respective electrical changes, suggesting that P-wave morphology is unaffected by training-induced biatrial dilatation in young healthy athletes.
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10. |
- D'Ascenzi, Flavio, et al.
(author)
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Reference values of left atrial size and function according to age : should we redefine the normal upper limits?
- 2019
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In: The International Journal of Cardiovascular Imaging. - : Springer. - 1569-5794 .- 1875-8312 .- 1573-0743. ; 35:1, s. 41-48
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Journal article (peer-reviewed)abstract
- Different cut-offs have been proposed for left atrial (LA) size. Furthermore, conflicting results have been reported about the influence of age on LA size and data on the impact of age on LA myocardial function are scanty. The aim of this study was to derive references values for LA size and function in healthy subjects and to evaluate the impact of age. We conducted a systematic literature search of MEDLINE database. We included only studies evaluating healthy subjects, with age ranged between 18 and 80years. Parameters were compared among four age groups, <30, 30-45, >45-60, >60years. Three hundred twenty-six studies met the inclusion criteria and the final population consisted of 62,821 subjects. LA volume index (LAVi) did not differ among different age groups (p=0.21). The normal upper limit of LAVi was 24mL/m(2). LA reservoir function, measured by strain, did not differ among age groups (38 +/- 3%, 32-43%; p=0.74). Left ventricular (LV) size and function were not different among groups, except LV mass index. A decrease in E/A ratio and an increase in E/e ratio were found with advancing age (p<0.0001 and p=0.001, respectively). In healthy subjects the normal upper limit of LAVi was lower than that recommended and is not influenced by advancing age. Furthermore, also LA function measured by strain was not affected by age. The current reference values of LAVi should be used with caution when applied to healthy subjects.
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