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  • 1.
    Bjällmark, Anna
    et al.
    KTH, School of Technology and Health (STH), Medical Engineering.
    Larsson, Matilda
    KTH, School of Technology and Health (STH), Medical Engineering.
    Lind, Britta
    KTH, School of Technology and Health (STH), Medical Engineering.
    Brodin, Lars-Åke
    KTH, School of Technology and Health (STH), Medical Engineering.
    Winter, Reidar
    Westholm, Carl
    Jacobsen, Per
    Velocity tracking - a novel method for quantitative analysis of longitudinal myocardial function2007In: Journal of the American Society of Echocardiography, ISSN 0894-7317, E-ISSN 1097-6795, Vol. 20, no 7, p. 847-856Article in journal (Refereed)
    Abstract [en]

    Doppler tissue imaging is a method for quantitative analysis of longitudinal myocardial velocity. Commercially available ultrasound systems can only present velocity information using a color Dopplerbased overlapping continuous color scale. The analysis is time-consuming and does not allow for simultaneous analysis in different projections. We have developed a new method, velocity tracking, using a stepwise color coding of the regional longitudinal myocardial velocity. The velocity data from 3 apical projections are presented as static and dynamic bull's-eye plots to give a 3-dimensional understanding of the function of the left ventricle. The static bull's-eye plot can display peak systolic velocity, late diastofic tissue velocity, or the sum of peak systolic velocity and early diastolic tissue velocity. Conversely, the dynamic bull's-eye plot displays how the myocardial velocities change over one heart cycle. Velocity tracking allows for a fast, simple, and hituitive visual analysis of the regional longitudinal contraction pattern of the left ventricle with a great potential to identify characteristic pathologic patterns.

  • 2.
    da Silva, Cristina
    et al.
    KTH, School of Technology and Health (STH). Karolinska Inst, Sweden.
    Sahlen, Anders
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering. Karolinska Univ Hosp, Sweden.
    Back, Magnus
    Ruck, Andreas
    Settergren, Magnus
    Manouras, Aristomenis
    KTH, School of Technology and Health (STH), Medical Engineering. Karolinska Univ Hosp, Sweden.
    Shahgaldi, Kambiz
    KTH, School of Technology and Health (STH), Medical Engineering. Sunderby Hosp, Sweden.
    Prosthesis-patient mismatch after transcatheter aortic valve implantation: impact of 2D-transthoracic echocardiography versus 3D-transesophageal echocardiography2014In: International Journal of Cardiac Imaging, ISSN 1569-5794, E-ISSN 1875-8312, Vol. 30, no 8, p. 1549-1557Article in journal (Refereed)
    Abstract [en]

    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.

  • 3.
    da Silva, Cristina
    et al.
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging. Karolinska Institute, Stockholm, Sweden .
    Sahlén, Anders
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging. Karolinska University Hospital, Sweden.
    Bäck, Magnus
    Ruck, Andreas
    Settergren, Magnus
    Manouras, Aristomenis
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging. Department of Cardiology, Karolinska University Hospital, Huddinge, Sweden .
    Shahgaldi, Kambiz
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging. Department of Cardiology, Karolinska University Hospital, Huddinge, Sweden .
    Hemodynamic outcomes of transcatheter aortic valve implantation with the CoreValve system: an early assessment2015In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 35, no 3, p. 216-222Article in journal (Refereed)
    Abstract [en]

    Background and Aims: Transcatheter aortic valve implantation (TAVI) is an established method for the treatment of high-risk patients with aortic stenosis (AS). The beneficial effects of TAVI in cardiac hemodynamics have been described in recent studies, but those investigations were mostly performed after an interval of more than 6 months following aortic valve implantation. The aim of this study is to investigate the acute and short-term alterations in hemodynamic conditions using the echocardiography outcomes in patients undergoing TAVI. Methods and Results: A total of 60 patients (26 males, 34 females; age 84·7 ± 5·8) who underwent TAVI with CoreValve system were included in the study. Echocardiography was performed before hospital discharge and at 3 months follow-up. As expected, TAVI was associated with an immediate significant improvement in aortic valve area (AVA) (from 0·64 ± 0·16 cm2 to 1·67 ± 0·41 cm2, P-value<0·001) and mean gradient (from 51·9 ± 15·4 mmHg to 8·8 ± 3·8 mmHg, P-value<0·001). At 3-month follow-up, systolic LV function was augmented (EF: 50 ± 14% to 54 ± 11%, P-value = 0·024). Left ventricle (LV) mass and left atrium (LA) volume were significantly reduced (LV mass index from 126·5 ± 30·5 g m-2 to 102·4 ± 32·4 g m-2; LA index from 42·9 ± 17·3 ml m-2 to 33·6 ± 10·6 ml m-2; P-value<0·001 for both). Furthermore, a decrement in systolic pulmonary artery pressure (SPAP) from 47·5 ± 13·5 mmHg to 42·5 ± 11·2 mmHg, P-value = 0·02 was also observed. Despite the high incidence of paravalvular regurgitation (PVR) (80%), most of the patients presented mild or trace PVR and no significant progress of the regurgitation grade was seen after 3 months. Conclusion: This study demonstrates that the beneficial effects of TAVI in cardiac function and hemodynamics occur already after a short period following aortic valve implantation.

  • 4.
    Janerot-Sjöberg, Birgitta
    et al.
    Linköping University Hospital, Sweden.
    Winter, Reidar
    Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Engvall, Jan
    Brodin, Lars-Åke
    Mobile bedside diagnostic techniques2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 43, p. 3025-30Article in journal (Refereed)
  • 5.
    Larsson, Malin
    et al.
    KTH, School of Technology and Health (STH), Medical Engineering.
    Bjällmark, Anna
    KTH, School of Technology and Health (STH), Medical Engineering.
    Larsson, Matilda
    KTH, School of Technology and Health (STH), Medical Engineering.
    Caidahl, Kenneth
    Karolinska Institutet.
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering.
    Brodin, Lars-Åke
    KTH, School of Technology and Health (STH), Medical sensors, signals and systems (MSSS).
    A new ultrasound-based approach to visualize target specific polymeric contrast agent2011In: 2011 IEEE International Ultrasonics Symposium (IUS), IEEE , 2011, p. 1626-1629Conference paper (Refereed)
    Abstract [en]

    There are advantages of using a polymeric shelled contrast agent (CA) during ultrasound imaging instead of lipid shelled CA, e.g. particles can be attached to the surface, which enables an introduction of antibodies to the surface making the CA target specific. For this application it is essential to have a sensitive imaging technique suitable for polymeric CA. However, previously presented results have indicated difficulties in visualizing polymeric CA with commercially available contrast algorithms. Therefore a new subtraction algorithm (SA), was developed that define the difference between contrast and reference images. The aim of this study was to evaluate the response from a polymeric CA, when using the SA and compare it with existing contrast algorithms. Moreover, the possibility to detect a thin layer of CA was tested using the SA.

    Ultrasound short-axis images of a tissue-mimicking vessel phantom with a pulsating flow were obtained using a GE Vivid7 system (M12L) and a Philips iE33 system (S5-1). Repeated (n=91) contrast to tissue ratios (CTR) calculated at various mechanical index (MI) using the contrast algorithms pulse inversion (PI), power modulation (PM) and SA at a concentration of 105microbubbles/ml.

    The developed SA showed improvements in CTR compared to existing contrast algorithms. The CTRs were -0.99 dB ± 0.67 (MI 0.2), 9.46 dB ± 0.77 (MI 0.4) and 2.98 dB ± 0.60 (MI 0.8) with PI, 8.17 dB ± 1.15 (MI 0.2), 15.60 dB ± 1.29 (MI0.4) and 11.60 dB ± 0.73 (MI 0.8) with PM and 14.97 dB ± 3.97 (MI 0.2), 20.89 dB ± 3.54 (MI 0.4) and 21.93 dB ± 4.37 (MI 0.8) with the SA. In addition to this, the layer detection, when using the SA was successful.

  • 6.
    Larsson, Malin
    et al.
    KTH, School of Technology and Health (STH), Medical Engineering.
    Bjällmark, Anna
    KTH, School of Technology and Health (STH), Medical Engineering.
    Larsson, Matilda
    KTH, School of Technology and Health (STH), Medical Engineering.
    Caidahl, Kenneth
    Winter, Reidar
    Brodin, Lars-Åke
    KTH, School of Technology and Health (STH), Medical Engineering.
    A novel technique to visualize target specific polymeric contrast agents2011Conference paper (Other academic)
  • 7.
    Larsson, Malin K.
    et al.
    KTH, School of Technology and Health (STH), Medical Engineering.
    Da Silva, Cristina
    Gunyeli, Elif
    Bin Ilami, Ali Akebat
    Szummer, Karolina
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering. Karolinska University Hospital, Sweden.
    Bjällmark, Anna
    KTH, School of Technology and Health (STH), Medical Engineering. Karolinska Institutet, Sweden.
    The potential clinical value of contrast-enhanced echocardiography beyond current recommendations2016In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 14, article id 2Article in journal (Refereed)
    Abstract [en]

    Background: Contrast agents are used in resting echocardiography to opacify the left ventricular (LV) cavity and to improve LV endocardial border delineation in patients with suboptimal image quality. If a wider use of contrast-enhanced echocardiography would be adopted instead of the current selective approach, diagnoses such as myocardial ischemia and LV structural abnormalities could potentially be detected earlier. The aim was therefore to retrospectively investigate if contrast- enhanced echocardiography beyond the current recommendations for contrast agent usage affects assessment of wall motion abnormalities, ejection fraction (EF) and detection of LV structural abnormalities. A secondary aim was to evaluate the user dependency during image analysis. Methods: Experienced readers (n = 4) evaluated wall motion score index (WMSI) and measured EF on greyscale and contrast-enhanced images from 192 patients without indications for contrast-enhanced echocardiography. Additionally, screening for LV structural abnormalities was performed. Repeated measurements were performed in 20 patients by the experienced as well as by inexperienced (n = 2) readers. Results: Contrast analysis resulted in significantly higher WMSI compared to greyscale analysis (p < 0.003). Of the 83 patients, classified as healthy by greyscale analysis, 55 % were re-classified with motion abnormalities by contrast analysis. No significant difference in EF classification (>= 55 %, 45-54 %, 30-44 %, < 30 %) was observed. LV structural abnormalities, such as increased trabeculation (n = 21), apical aneurysm (n = 4), hypertrophy (n = 1) and thrombus (n = 1) were detected during contrast analysis. Intra- and interobserver variability for experienced readers as well as the variability between inexperienced and experienced readers decreased for WMSI and EF after contrast analysis. Conclusions: Contrast-enhanced echocardiography beyond current recommendations for contrast agent usage increased the number of detected wall motion and LV structural abnormalities. Moreover, contrast- enhanced echocardiography increased reproducibility for assessment of WMSI and EF.

  • 8.
    Larsson, Matilda
    et al.
    KTH, School of Technology and Health (STH), Medical Engineering.
    Bjällmark, Anna
    KTH, School of Technology and Health (STH), Medical Engineering.
    Lind, Britta
    KTH, School of Technology and Health (STH), Medical Engineering.
    Balzano, Rita
    KTH, School of Technology and Health (STH), Medical Engineering.
    Peolsson, Michael
    KTH, School of Technology and Health (STH).
    Winter, Reidar
    Brodin, Lars-Åke
    KTH, School of Technology and Health (STH), Medical Engineering.
    Wave intensity wall analysis: a novel noninvasive method to measure wave inntensity2009In: Heart and Vessels, ISSN 0910-8327, E-ISSN 1615-2573, Vol. 24, p. 357-365Article in journal (Refereed)
    Abstract [en]

    Wave intensity analysis is a concept providing information about the interaction of the heart and the vascular system. Originally, the technique was invasive. Since then new noninvasive methods have been developed. A recently developed ultrasound technique to estimate tissue motion and deformation is speckle-tracking echocardiography. Speckle tracking-based techniques allow for accurate measurement of movement and deformation variables in the arterial wall in both the radial and the longitudinal direction. The aim of this study was to test if speckle tracking-derived deformation data could be used as input for wave intensity calculations. The new concept was to approximate changes of flow and pressure by deformation changes of the arterial wall in longitudinal and radial directions. Flow changes (dU/dt) were approximated by strain rate (sr, 1/s) of the arterial wall in the longitudinal direction, whereas pressure changes (dP/dt) were approximated by sign reversed strain rate (1/s) in the arterial wall in the radial direction. To validate the new concept, a comparison between the newly developed Wave Intensity Wall Analysis (WIWA) algorithm and a commonly used and validated wave intensity system (SSD-5500, Aloka, Tokyo, Japan) was performed. The studied population consisted of ten healthy individuals (three women, seven men) and ten patients (all men) with coronary artery disease. The present validation study indicates that the mechanical properties of the arterial wall, as measured by a speckle tracking-based technique are a possible input for wave intensity calculations. The study demonstrates good visual agreement between the two systems and the time interval between the two positive peaks (W1-W2) measured by the Aloka system and the WIWA system correlated for the total group (r = 0.595, P < 0.001). The correlation for the diseased subgroup was r = 0.797, P < 0.001 and for the healthy subgroup no significant correlation was found (P > 0.05). The results of the study indicate that the mechanical properties of the arterial wall could be used as input for wave intensity calculations. The WIWA concept is a promising new method that potentially provides several advantages over earlier wave intensity methods, but it still has limitations and needs further refinement and larger studies to find the optimal clinical use.

  • 9. Lund, Mikael
    et al.
    Tsai, Jon A.
    Nilsson, Magnus
    Winter, Reidar
    KTH, School of Technology and Health (STH). Karolinska Inst, Sweden.
    Lundell, Lars
    Kalman, Sigridur
    Effects of neoadjuvant chemo or chemoradiotherapy for oesophageal cancer on perioperative haemodynamics A prospective cohort study within a randomised clinical trial2016In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 9, p. 653-661Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Neoadjuvant chemoradiotherapy might improve oncological outcome compared with chemotherapy after surgery for oesophagus or gastrooesophageal junction cancer. However, radiotherapy may induce cardiovascular side-effects that could increase the risk of perioperative adverse effects and postoperative morbidity. OBJECTIVES The aim of this study was to compare the perioperative haemodynamics in patients undergoing oesophagectomy following neoadjuvant chemotherapy or chemoradiotherapy for cancer. DESIGN A prospective single-centre cohort study within a randomised multi-centre trial. SETTING A Swedish University Hospital from January 2009 to March 2013. PATIENTS A total of 31 patients (chemotherapy 17, chemoradiotherapy 14) included in a multi-centre trial randomising chemotherapy vs. chemoradiotherapy and operated at Karolinska University Hospital, Huddinge. INTERVENTIONS Cisplatin and 5-fluorouracil, either with or without concurrent radiotherapy (40 Gy), were given prior to surgery. Cardiac function was assessed with LiDCOplus (LiDCO Ltd, London, United Kingdom), echocardiography, troponin T and N-terminal pro-B-type natriuretic peptide, before, during and after surgery. MAIN OUTCOME MEASURES The primary outcome was the interaction effect of the neoadjuvant treatment on stroke volume index during the perioperative period. Secondary outcomes were the interaction effects of oxygen delivery index, cardiac index, echocardiography and biochemical markers. RESULTS The groups were matched regarding comorbidities, but patients in the chemoradiotherapy group were older (66 vs. 60 years P = 0.03). Haemodynamic values changed in a similar way in both groups during the study period. The chemoradiotherapy group had a lower cardiac index before surgery (2.9 vs. 3.4 l min(-1) m(-2), P = 0.03). On the third postoperative day, both groups displayed a hyperdynamic state compared with baseline, with no increase in troponin T, and a similar increase in N-terminal pro-B-type natriuretic peptide. CONCLUSION Neoadjuvant chemoradiotherapy for oesophageal or gastrooesophageal junction cancer seems to induce only a marginal negative effect on cardiac function compared with neoadjuvant chemotherapy. This difference did not remain when patients' haemodynamics were challenged by surgery.

  • 10. Lund, Mikael
    et al.
    von Dobeln, Gabriella Alexandersson
    Nilsson, Magnus
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging. Karolinska Institutet, Sweden.
    Lundell, Lars
    Tsai, Jon A.
    Kalman, Sigridur
    Effects on heart function of neoadjuvant chemotherapy and chemoradiotherapy in patients with cancer in the esophagus or gastroesophageal junction: a prospective cohort pilot study within a randomized clinical trial2015In: Radiation Oncology, ISSN 1748-717X, E-ISSN 1748-717X, Vol. 10, article id 16Article in journal (Refereed)
    Abstract [en]

    Background: Neoadjuvant therapy for cancer of the esophagus or gastroesophageal (GE)-junction is well established. The pros and cons of chemoradiotherapy and chemotherapy are debated. Chemoradiotherapy might impair cardiac function eliciting postoperative morbidity. The aim of this pilot study was to describe acute changes in left ventricular function following chemoradiotherapy or chemotherapy. Methods: Patients with esophageal and (GE)-junction cancer enrolled at our center into a multicenter trial comparing neoadjuvant chemoradiotherapy and chemotherapy were eligible. Patients were randomized to receive cisplatin and 5-fluorouracil with or without the addition of 40 Gy radiotherapy prior to surgery. Left ventricular function was evaluated using echocardiography and plasma N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) before and after neoadjuvant treatment. The primary outcome measure was left ventricular global strain (GS). Clinical effects were assessed using repeated exercise tests. Linear mixed models were used to analyze the effects of treatment group, and the interaction between groups. Results: 40 patients participated (chemoradiotherapy, n = 17; chemotherapy, n = 23). In the chemoradiotherapy group there was no change in left ventricular global strain but mitral annular plane systolic excursion (MAPSE) of the ventricular septum, early diastolic filling velocity (E-velocity), and the ratio of early to late ventricular filling velocities (E/A ratio) decreased significantly (p = 0.02, p = 0.01, and p = 0.03, respectively). No changes were observed in the chemotherapy group. There was a trend towards an interaction effect for MAPSE sept and E (p = 0.09 and p = 0.09). NT-proBNP increased following chemoradiotherapy (p = 0.05) but not after chemotherapy (p > 0.99), and there was a trend towards an interaction effect (p = 0.07). Working capacity decreased following neoadjuvant treatment (chemoradiotherapy p = 0.001, chemotherapy p = 0.03) and was more pronounced after chemoradiotherapy with a trend towards an interaction effect (p = 0.10). Conclusions: Neoadjuvant chemoradiotherapy but not chemotherapy before surgery for cancer of the esophagus or GE-junction seems to induce an acute negative effect on both systolic and diastolic left ventricular function. Future studies on neoadjuvant treatment for esophageal cancer are suggested to add measurements of cardiac function.

  • 11.
    Mårtensson, Mattias
    et al.
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging.
    Olsson, Mats
    Segall, Björn
    Fraser, Alan G.
    Winter, Reidar
    Brodin, Lars-Åke
    KTH, School of Technology and Health (STH), Medical Engineering.
    High incidence of defective ultrasound transducers in use in routine clinical practice2009In: European Journal of Echocardiography, ISSN 1525-2167, E-ISSN 1532-2114, Vol. 10, no 3, p. 389-394Article in journal (Refereed)
    Abstract [en]

    The objective was to evaluate the function of ultrasound transducers in use in routine clinical practice and thereby estimating the incidence of defective transducers. The study comprised a one-time test of 676 transducers from 7 manufacturers which were in daily use in clinical departments at 32 hospitals. They were tested with the Sonora FirstCall Test System; 39.8% exhibited a transducer error. Delamination was detected in 26.5% and break in the cable was detected in 8.4% of the tested transducers. Errors originating from the piezoelectrical elements were unusual. Delamination and short circuit occurred without significant differences between transducers from all tested manufacturers, but the errors break in the cable, weak and dead element showed a statistically significant higher frequency in transducers from certain manufacturers. The high error frequency and the risk for incorrect medical decisions when using a defective transducer indicate an urgent need for increased testing of the transducers in clinical departments.

  • 12. Naar, J.
    et al.
    Mortensen, L.
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering.
    Johnson, Jonas
    KTH, School of Technology and Health (STH), Medical Engineering.
    Shahgaldi, K.
    Manouras, A.
    Braunschweig, F.
    Ståhlberg, M.
    Heart rate and dyssynchrony in patients with cardiac resynchronization therapy: a pilot study2017In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 51, no 3, p. 143-152Article in journal (Refereed)
    Abstract [en]

    Objectives: The objective of this pilot study was to describe the impact of paced heart rate on left ventricular (LV) mechanical dyssynchrony in synchronous compared to dyssynchronous pacing modes in patients with heart failure. Methods: Echocardiography was performed in 14 cardiac resynchronization therapy (CRT) patients at paced heart rates of 70 and 90 bpm in synchronous- (CRT), and dyssynchronous (atrial pacing + wide QRS activation) pacing modes. LV dyssynchrony was quantified using the 12-segment standard deviation model (Ts-SD) derived from Tissue Doppler Imaging. In addition, cardiac cycle intervals were assessed using cardiac state diagrams and stroke volume (SV) and filling pressure were estimated. Results: Ts-SD decreased significantly with CRT at 90 bpm (25 ± 12 ms) compared to 70 bpm (35 ± 15 ms, p =.01), but remained unchanged with atrial pacing at different paced heart rates (p =.96). The paced heart rate dependent reduction in Ts-SD was consistent when Ts-SD was indexed to average Ts and systolic time interval. Cardiac state diagram derived analysis of cardiac cycle intervals demonstrated a significant reduction of the pre-ejection interval and an increase in diastole with CRT compared to atrial pacing. SV was maintained at the higher paced heart rate with CRT pacing but decreased with atrial pacing. Discussion: Due to the small sample size in this pilot study general and firm conclusions are difficult to render. However, the data suggest that pacing at higher heart rates acutely reduces remaining LV dyssynchrony during CRT, but not during atrial pacing with dyssynchronous ventricular activation. These results need confirmation in a larger patient cohort.

  • 13. Nagy, A. I.
    et al.
    Venkatesharan, Ashwin I.
    KTH, School of Technology and Health (STH). Sri Sathya Sai Institute of Higher Medical Sciences, India.
    Merkely, B.
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering. Karolinska University Hospital, Sweden.
    Barooah, B.
    Dash, P. K.
    Manouras, Aristomenis I.
    KTH, School of Technology and Health (STH), Medical Engineering. Karolinska University Hospital, Sweden.
    The pulmonary capillary wedge pressure accurately reflects both normal and elevated left atrial pressure2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, p. 1184-1184Article in journal (Other academic)
  • 14. Nagy, Aniko I.
    et al.
    Sahlen, Anders
    Manouras, Aristomenis
    KTH, School of Technology and Health (STH). Karolinska Institute, Sweden.
    Henareh, Loghman
    da Silva, Cristina
    KTH, School of Technology and Health (STH). Karolinska Institute, Sweden.
    Gunyeli, Elif
    Apor, Astrid A.
    Merkely, Bela
    Winter, Reidar
    KTH, School of Technology and Health (STH). Karolinska Institute, Sweden.
    Combination of contrast-enhanced wall motion analysis and myocardial deformation imaging during dobutamine stress echocardiography2015In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 16, no 1, p. 88-95Article in journal (Refereed)
    Abstract [en]

    Background The combination of deformation analysis with conventional wall motion scoring (WMS) has been shown to increase the diagnostic sensitivity of dobutamine stress echocardiography (DSE). The feasibility and diagnostic power of WMS is largely improved by contrast agents; however, they are not used in combination with deformation analysis, as contrast agents are generally considered to render strain measurement unfeasible. Aims To assess the feasibility of tissue velocity (TVI)- and 2D speckle tracking (ST)-based strain analysis during contrast-enhanced DSE; and to show whether there is an incremental value in combining deformation analysis with contrast-enhanced WMS. Methods DS echocardiograms containing native, tissue Doppler, and contrast-enhanced loops of 60 patients were analysed retrospectively. The feasibility of WMS, TVI-, and ST-strain measurement was determined in 40 patients according to pre-defined criteria. The diagnostic ability of a combined protocol integrating data from contrast-WMS and TVI-strain measurement was then compared with contrast-WMS alone in all 60 patients, using coronary angiograms as a gold standard. Results Both TVI- and ST-based strain analysis were feasible during contrast-DSE (feasibility at peak stress: 87 and 75%). At the patient level, the diagnostic accuracy of the combined method did not prove superior to contrast-WMS (82 vs. 78%); a trend towards improved sensitivity and specificity for detecting coronary artery disease in the right coronary artery circulation (sensitivity: 85 vs. 77%, P = NS; specificity: 96 vs. 94%) was, however, observed. Conclusion Both TVI- and ST-based myocardial deformation analysis are feasible during contrast-enhanced DSE, however, our results fail to demonstrate a clear diagnostic benefit of additional strain analysis over expert WMS alone.

  • 15. Nagy, Aniko I.
    et al.
    Venkateshvaran, Ashwin
    KTH, School of Technology and Health (STH).
    Dash, Pravat Kumar
    Barooah, Banajit
    Merkely, Bela
    Winter, Reidar
    KTH, School of Technology and Health (STH).
    Manouras, Aristomenis
    KTH, School of Technology and Health (STH).
    The pulmonary capillary wedge pressure accurately reflects both normal and elevated left atrial pressure2014In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 167, no 6, p. 876-883Article in journal (Refereed)
    Abstract [en]

    Background Pulmonary capillary wedge pressure (PCWP) is routinely used as an indirect measure of the left atrial pressure (LAP), although the accuracy of this estimate, especially under pathological hemodynamic conditions, remains controversial. Objectives The aim of this prospective study was to investigate the reliability of PCWP for the evaluation of LAP under different hemodynamic conditions. Methods Simultaneous left and right heart catheterization data of 117 patients with pure mitral stenosis, obtained before and immediately after percutaneous mitral comissurotomy, were analyzed. Results A strong correlation and agreement between PCWP and LAP measurements was demonstrated (correlation coefficient = 0.97, mean bias +/- CI, 0.3 +/- -3.7 to 4.2 mm Hg). Comparison of measurements performed within a 5-minute interval and those performed simultaneously revealed that simultaneous pressure acquisition yielded better agreement between the 2 methods (bias +/- CI, 1.82 +/- 1.98 mm Hg). In contrast to previous observations, the discrepancy between the 2 measures did not increase with elevated PCWP. Multiple regression analysis failed to identify hemodynamic confounders of the discrepancy between the 2 pressures. The ability of PCWP to distinguish between normal and elevated LAP (cutoff set at 12 and 15 mm Hg, respectively), as tested by receiver operating characteristics analysis, demonstrated a remarkably high diagnostic accuracy (area under the curve: 0.989 and 0.996, respectively). Conclusions Although the described limits of agreement may not allow the interchangeability of PCWP and LAP, especially at lower pressure ranges, our data support the clinical use of PCWP as a robust and accurate estimate of LAP.

  • 16.
    Nordenfur, Tim
    et al.
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging.
    Babic, Aleksandar
    GE Vingmed Ultrasound.
    Bulatovic, Ivana
    Karolinska Institutet.
    Giesecke, Anders
    Karolinska Institutet.
    Ripsweden, Jonaz
    Department of Clinical Science, Division of Medical Imaging and Technology, Intervention and Technology at Karolinska Institutet.
    Samset, Eigil
    GE Vingmed Ultrasound.
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering. Karolinska Institutet, Sweden.
    Larsson, Matilda
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging. Karolinska Institutet, Sweden.
    Verification of Fusion Algorithm for 3D-Echocardiographyand Coronary Computed Tomography Angiography2015Conference paper (Refereed)
  • 17. Sahlen, A.
    et al.
    Abdula, G.
    Norman, M.
    Manouras, Aristomenis
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging.
    Lund, L. H.
    Shahgaldi, Kambiz
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging.
    Brodin, Lars-Åke
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging.
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging.
    Altered arterial haemodynamics during exercise in elderly female hypertensives with poor stroke volume reserve2011In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 32, p. 10-11Article in journal (Other academic)
  • 18. Sahlen, A.
    et al.
    Shahgaldi, Kambiz
    KTH, School of Technology and Health (STH), Medical Engineering.
    Manouras, Aristomenis
    KTH, School of Technology and Health (STH), Medical Engineering.
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering.
    Johnson, Jonas
    KTH, School of Technology and Health (STH), Medical Engineering.
    Altered visco-elasticity of common carotid artery of elderly female hypertensives2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, p. 618-618Article in journal (Other academic)
  • 19. Sahlen, Anders
    et al.
    Abdula, Göran
    Norman, Mikael
    Manouras, Aristomenis
    KTH, School of Technology and Health (STH), Medical Engineering.
    Brodin, Lars-Ake
    KTH, School of Technology and Health (STH), Medical Engineering.
    Lund, Lars H.
    Shahgaldi, Kambiz
    KTH, School of Technology and Health (STH), Medical Engineering.
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering.
    Arterial vasodilatory and ventricular diastolic reserves determine the stroke volume response to exercise in elderly female hypertensive patients2011In: American Journal of Physiology. Heart and Circulatory Physiology, ISSN 0363-6135, E-ISSN 1522-1539, Vol. 301, no 6, p. H2433-H2441Article in journal (Refereed)
    Abstract [en]

    Sahlen A, Abdula G, Norman M, Manouras A, Brodin LA, Lund LH, Shahgaldi K, Winter R. Arterial vasodilatory and ventricular diastolic reserves determine the stroke volume response to exercise in elderly female hypertensive patients. Am J Physiol Heart Circ Physiol 301: H2433-H2441, 2011. First published September 16, 2011; doi:10.1152/ajpheart.00555.2011.-Elderly female hypertensives with arterial stiffening constitute a majority of patients with heart failure with preserved ejection fraction (HFpEF), a condition characterized by inability to increase cardiac stroke volume (SV) with physical exercise. As SV is determined by the interaction between the left ventricle (LV) and its load, we wished to study the role of arterial hemodynamics for exertional SV reserve in patients at high risk of HFpEF. Twenty-one elderly (67 +/- 9 yr) female hypertensive patients were studied at rest and during supine bicycle stress using echocardiography including pulsed-wave Doppler to record flow in the LV outflow tract and arterial tonometry for central arterial pressure waveforms. Arterial compliance was estimated based on an exponential relationship between pressure and volume. The ratio of aortic pressure-to-flow in early systole was used to derive characteristic impedance, which was subsequently subtracted from total resistance (mean arterial pressure/cardiac output) to yield systemic vascular resistance (SVR). It was found that patients with depressed SV reserve (NoRes; reserve <15%; n = 10) showed decreased arterial compliance during exercise, while patients with SV reserve >= 15% (Res; n = 11) showed increased compliance. Exercise produced parallel increases in LV end-diastolic volume and arterial volume in Res patients while NoRes patients exhibited a lesser decrease in SVR and a drop in effective arterial volume. Poor SV reserve in elderly female hypertensives is due to simultaneous failure of LV preload and arterial vasodilatory reserves. Abnormal arterial function contributes to a high risk of HFpEF in these patients.

  • 20. Sahlén, Anders
    et al.
    Shahgaldi, Kambiz
    KTH, School of Technology and Health (STH), Medical Engineering.
    Aagaard, Philip
    Manouras, Aristomenis
    KTH, School of Technology and Health (STH), Medical Engineering.
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering.
    Braunschweig, Frieder
    Altered ventriculo-arterial coupling during exercise in athletes releasing biomarkers after endurance running2012In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 112, no 12, p. 4069-4079Article in journal (Refereed)
    Abstract [en]

    Exercise can lead to release of biomarkers such as cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP), a poorly understood phenomenon proposed to especially occur with highintensity exercise in less trained subjects. We hypothesised that haemodynamic perturbations during exercise are larger in athletes with cTnT release, and studied athletes with detectable cTnT levels after an endurance event (HIGH; n = 16; 46 ± 9 years) against matched controls whose levels were undetectable (LOW; n = 11; 44 ± 7 years). Echocardiography was performed at rest and at peak supine bicycle exercise stress. Left ventricular (LV) end-systolic elastance (ELV a load-independent measure of LV contractility), effective arterial elastance (EA a lumped index of arterial load) and end-systolic meridional wall stress were calculated from cardiac dimensions and brachial blood pressure. Efficiency of cardiac work was judged from the ventriculo-arterial coupling ratio (EA/ELV: optimal range 0.5-1.0). While subgroups had similar values at rest, we found ventriculo-arterial mismatch during exercise in HIGH subjects (0.47 (0.39-0.58) vs. LOW: 0.73 (0.62-0.83); p<0.01] due to unopposed increase in ELV (p<0.05). In LOW subjects, a greater increase occurred in EA during exercise (+81 ± 67 % vs. HIGH: +39 ± 32 %; p = 0.02) which contributed to a maintained coupling ratio. Subjects with higher baseline NT-proBNP had greater systolic wall stress during exercise (R2 = 0.39; p<0.01) despite no correlation at rest (p = ns). In conclusion, athletes with exercise-induced biomarker release exhibit ventriculo-arterial mismatch during exercise, suggesting non-optimal cardiac work may contribute to this phenomenon.

  • 21. Sahlén, Anders
    et al.
    Winter, Reidar
    Karolinska Institutet, Department of Clinical Physiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Lind, Britta
    Karolinska Institutet, Department of Clinical Physiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Jacobsen, Per-Herman
    Ståhlberg, Marcus
    Marklund, Tony
    Fux, Thomas
    Svensson, Jan
    Braunschweig, Frieder
    Magnitude, reproducibility, and association with baseline cardiac function of cardiac biomarker release in long-distance runners aged > or =55 years2008In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 102, no 2, p. 218-222Article in journal (Refereed)
    Abstract [en]

    Cardiac biomarker release after endurance exercise has been described in young athletes. Although older athletes are increasingly active in such sports, they have not previously been studied. Therefore, the aim of this study was to assess the magnitude and reproducibility of biomarker release in athletes aged > or =55 years. Forty-three healthy athletes (mean age 61 +/- 3.6 years) were assessed before and immediately after a 30-km cross-country race and studied with echocardiography at rest. The median N-terminal pro-brain natriuretic peptide (NT-proBNP; normal <194 ng/L) level was 42 ng/L (interquartile range 30 to 95) at baseline and 191 ng/L (interquartile range 114 to 308) after the race. Troponin T (normal <0.03 microg/L) was elevated in 19 subjects (44%) after the race. Twenty-two subjects had also been studied 3 years before at the same race, using an identical test protocol. Between the 2 races, strong correlations were seen for individual runners' postrace biomarker levels (NT-proBNP: r = 0.82, log transformed data; troponin T: Spearman's rho = 0.84; p <0.001 for both). The coefficient of variation for NT-proBNP release was 8.1%. Levels of NT-proBNP after the race were correlated with levels at baseline (r = 0.93, p <0.001) and with left ventricular mass index (r = 0.32, p = 0.03). Moreover, participants with elevated postrace NT-proBNP were significantly older (62.0 vs 59.8 years, p = 0.04). In conclusion, long-distance runners aged > or =55 years released NT-proBNP and troponin T in a reproducible fashion. The magnitude of NT-proBNP release during the race was correlated strongly with NT-proBNP baseline levels and was associated with left ventricular mass and age. These findings may suggest a potential adverse effect of long-distance running on cardiac function in certain participants in this age group.

  • 22. Settergren, Magnus
    et al.
    Back, Magnus
    Shahgaldi, Kambiz
    KTH, School of Technology and Health (STH), Medical Engineering.
    Jacobsen, Per
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering.
    3D TEE With Stereovision for Guidance of the Transcatheter Mitral Valve Repair2012In: JACC Cardiovascular Imaging, ISSN 1936-878X, E-ISSN 1876-7591, Vol. 5, no 10, p. 1066-1069Article in journal (Other academic)
  • 23.
    Venkateshvaran, Ashwin
    et al.
    KTH, School of Technology and Health (STH).
    Sola, S.
    Govind, Satish Chandra
    KTH, School of Technology and Health (STH).
    Dash, P. K.
    Barooah, B.
    Shahgaldi, Kambiz
    KTH, School of Technology and Health (STH).
    Sahlén, Anders
    KTH, School of Technology and Health (STH).
    Lund, L.
    Winter, Reidar
    KTH, School of Technology and Health (STH).
    Nagy, A. I.
    Manouras, Aristomenis
    KTH, School of Technology and Health (STH).
    The impact of arterial load on left ventricular performance: An invasive haemodynamic study in severe mitral stenosis2015In: Journal of Physiology, ISSN 0022-3751, E-ISSN 1469-7793, Vol. 593, no 8, p. 1901-1912Article in journal (Refereed)
    Abstract [en]

    Key points: A hallmark of mitral stenosis (MS) is the markedly altered left ventricular (LV) loading. As most of the methods used to determine LV performance in MS patients are influenced by loading conditions, previous studies have shown conflicting results. The present study calculated LV elastance, which is a robust method to quantify LV function. We demonstrate that LV loading in MS patients is elevated but normalizes after valve repair and might be a result of reflex pathways. Additionally, we show that the LV in MS is less compliant than normal due to a combination of right ventricular loading and the valvular disease itself. Immediately after valve dilatation the increase in blood inflow into the LV results in even greater LV stiffness. Our findings enrich our understanding of heart function in MS patients and provide a simple reproducible way of assessing LV performance in MS. Left ventricular (LV) function in rheumatic mitral stenosis (MS) remains an issue of controversy, due to load dependency of previously employed assessment methods. We investigated LV performance in MS employing relatively load-independent indices robust to the altered loading state. We studied 106 subjects (32 ± 8 years, 72% female) with severe MS (0.8 ± 0.2 cm2) and 40 age-matched controls. MS subjects underwent simultaneous bi-ventricular catheterization and transthoracic echocardiography (TTE) before and immediately after percutaneous transvenous mitral commisurotomy (PTMC). Sphygmomanometric brachial artery pressures and TTE recordings were simultaneously acquired in controls. Single-beat LV elastance (E<inf>es</inf>) was employed for LV contractility measurements. Effective arterial elastance (E<inf>a</inf>) and LV diastolic stiffness were measured. MS patients demonstrated significantly elevated afterload (E<inf>a</inf>: 3.0 ± 1.3 vs. 1.5 ± 0.3 mmHg ml-1; P < 0.001) and LV contractility (E<inf>es</inf>: 4.1 ± 1.6 vs. 2.4 ± 0.5 mmHg ml-1; P < 0.001) as compared to controls, with higher E<inf>a</inf> in subjects with smaller mitral valve area (≤ 0.8 cm2) and pronounced subvalvular fusion. Stroke volume (49 ± 16 to 57 ± 17 ml; P < 0.001) and indexed LV end-diastolic volume (LVEDV<inf>index</inf>: 57 ± 16 to 64 ± 16 ml m-2; P < 0.001) increased following PTMC while E<inf>es</inf> and E<inf>a</inf> returned to more normal levels. Elevated LV stiffness was demonstrated at baseline and increased further following PTMC. Our findings provide evidence of elevated LV contractility, increased arterial load and increased diastolic stiffness in severe MS. Following PTMC, both LV contractility and afterload tend to normalize.

  • 24. Westholm, C.
    et al.
    Johnson, Jonas
    KTH, School of Technology and Health (STH), Medical Engineering.
    Jernberg, T.
    Winter, Reider
    KTH, School of Technology and Health (STH), Medical Engineering.
    Peak Systolic Velocity (PSV) using colour-coded Tissue Doppler Imaging (TDI) is a strong and independent predictor of outcome in acute coronary syndrome patients2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, p. 924-924Article in journal (Other academic)
  • 25.
    Westholm, Carl
    et al.
    Karolinska Institute, Sweden.
    Johnson, Jonas
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging.
    Gunyeli, Elif
    Karolinska Institute, Sweden.
    Manouras, Aristomenis
    KTH, School of Technology and Health (STH), Medical Engineering. Karolinska Institute, Sweden.
    Jernberg, Tomas
    Lundbäck, Stig
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging.
    The Cardiac State Index (CSI), a new timing-based diagnostic tool foridentifying patients with acute coronary syndromeManuscript (preprint) (Other academic)
  • 26. Westholm, Carl
    et al.
    Johnson, Jonas
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging.
    Jernberg, Tomas
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering.
    The prognostic value of mechanical left ventricular dyssynchrony in patients with acute coronary syndrome2013In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 11, no 1, p. 35-Article in journal (Refereed)
    Abstract [en]

    Background: Echocardiography is a well-established tool for risk stratification in patients with acute coronary syndrome (ACS). ACS has significant impact on LV dyssynchrony, and detrimental effects on systolic function and long term outcome. The aims of this study were to determine whether LV dyssynchrony carries any predictive information in an unselected ACS population and to evaluate if it has any incremental value to the information given from conventional echocardiographic measurements. Methods: The study included 227 consecutive ACS patients. Primary endpoint was the composite of death, new MI, or rehospitalisation due to heart failure. Dyssynchrony was measured as intersegmental variation of time to peak strain, the post systolic index (PSI) and myocardial performance index (MPI) with the standard deviation and difference between lowest and highest value (delta) expressing the amount of dyssynchrony. Septal-lateral delay was also tested. All dyssynchrony parameters were compared with Ejection fraction (EF). Results: The median follow up time was 53 months. 85 patients reached the combined endpoint. Patients with and without a subsequent combined endpoint differed significantly regarding calculated SD: s and delta-value for PSI, time to peak 2D-strain and MPI but not regarding septal-lateral delay. In ROC-analysis none of the dyssynchrony parameters had larger AUC than EF. When adjusting for traditional risk factors none of the dyssynchrony parameters remained associated with outcome, whereas EF still did. Conclusion: LV dyssynchrony seem to have significant prognostic information in patient with acute coronary syndrome but in comparison to conventional parameters such as EF there is no incremental value of this information.

  • 27. Westholm, Carl
    et al.
    Johnson, Jonas
    KTH, School of Technology and Health (STH), Medical Engineering.
    Sahlen, Anders
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering.
    Jernberg, Tomas
    Peak systolic velocity using color-coded tissue Doppler imaging, a strong and independent predictor of outcome in acute coronary syndrome patients2013In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 11, p. 9-Article in journal (Refereed)
    Abstract [en]

    Background: Traditional echocardiographic methods like left ventricular ejection fraction(EF) and wall motion scoring (WMS) and new methods like speckle tracking (ST) based 2D strain carry important prognostic information in acute coronary syndrome (ACS) patients. Parameters from tissue Doppler imaging (TDI), with its high time resolution, may further increase the prognostic value. Peak systolic velocity (PSV) of the basal segments of the left ventricle from TDI is a robust and user independent parameter. The aim was to investigate the prognostic value of PSV compared to EF, WMS, 2D strain and E/e'. Methods: Echocardiographic images were collected and post processed in 227 ACS patients. Additional clinical data was prospectively gathered and patients were followed for 3-5 years regarding the combined endpoint of death or re-admission due to ACS or heart failure. Results: The combined endpoint occurred in 85 (37%) patients. Those with an event had lower median PSV than those without (4,4 cm/s) vs. (5,3 cm/s), (p<0.001). In a ROC analysis, the AUC was larger for PSV (0.75) than for EF (0.68), WMS (0.63), 2D strain (0.67) and E/e'(0.70). The combined endpoint increased with decreasing PSV. When adjusting for differences in baseline characteristics in a COX-regression model, PSV remained independently associated with outcome where the others did not. PSV was also less sensitive to image quality with fewer values missing or unacceptable for analysis. Conclusion: Peak systolic velocity (PSV) is a robust measurement that seems to have a strong and independent association with outcome compared to traditional echocardiographic measurements in ACS patients.

  • 28. Zahid, W.
    et al.
    Johnson, Jonas
    KTH, School of Technology and Health (STH), Medical Engineering.
    Westholm, C.
    Eek, C.
    Skulstad, R.
    Fosse, E.
    Winter, Reider
    Edvardsen, T.
    Mitral annular excursion in patients with suspected non-ST-elevation acute coronary syndrome can identify coronary occlusion and predict mortality2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, p. 912-912Article in journal (Other academic)
  • 29. Zahid, Wasim
    et al.
    Johnson, Jonas
    KTH, School of Technology and Health (STH), Medical Engineering.
    Westholm, Carl
    Eek, Christian H.
    Haugaa, Kristina H.
    Smedsrud, Marit Kristine
    Skulstad, Helge
    Fosse, Erik
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering.
    Edvardsen, Thor
    Mitral Annular Displacement by Doppler Tissue Imaging May Identify Coronary Occlusion and Predict Mortality in Patients with Non-ST-Elevation Myocardial Infarction2013In: Journal of the American Society of Echocardiography, ISSN 0894-7317, E-ISSN 1097-6795, Vol. 26, no 8, p. 875-884Article in journal (Refereed)
    Abstract [en]

    Background: Mitral annular displacement (MAD) is a simple marker of left ventricular (LV) systolic function. The aim of this study was to test the hypothesis that MAD can distinguish patients with non-ST-segment elevation myocardial infarctions (NSTEMIs) from those with significant coronary artery disease without infarctions, identify coronary occlusion, and predict mortality in patients with NSTEMIs. MAD was compared with established indices of LV function. Methods: In this retrospective study, 167 patients with confirmed NSTEMIs were included at two Scandinavian centers. Forty patients with significant coronary artery disease but without myocardial infarctions were included as controls. Doppler tissue imaging was performed at the mitral level of the left ventricle in the three apical planes, and velocities were integrated over time to acquire MAD. LV ejection fraction, global longitudinal strain (GLS), and wall motion score index were assessed according to guidelines. Results: MAD and GLS could accurately distinguish patients with NSTEMIs from controls. During 48.6 +/- 12.1 months of follow-up, 22 of 167 died(13%). MAD, LV ejection fraction, and GLS were reduced and wall motion score index was increased among those who died compared with those who survived (P<.001, P<.001, P<.001, and P=.02, respectively). Multivariate Cox proportional-hazards analyses revealed that MAD was an independent predictor of death (hazard ratio, 1.36; 95% confidence interval, 1.07-1.73; P=.01). MAD and GLS were reduced and wall motion score index was increased in patients with coronary artery occlusion compared with those without occlusion (P=.006, P=.001, and P=.02), while LV ejection fraction did not differ (P=.20). Conclusions: MAD accurately identified patients with NSTEMIs, predicted mortality, and identified coronary occlusion in patients with NSTEMIs.

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