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Hammersboen LER, Aalen J, Puvrez A, Larsen CK, Remme EW, Donal E, Duchenne J, Voigt JU, Galli E, Khan FH, Sletten OJ, Penicka M, Stugaard M, Smiseth OA. Resynchronization of the left atrium may play an important role in cardiac resynchronization therapy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Left atrial (LA) dyssynchrony is a predictor of response to cardiac resynchronization therapy (CRT). It is unknown, however, if LA resynchronization contributes to response to CRT. We hypothesize that there is a relationship between correction of LA dyssynchrony and response to CRT.
Purpose
To investigate the association between LA resynchronization and response to CRT.
Methods
In a prospective study of 171 heart failure patients with LBBB, myocardial strain was measured by speckle-tracking echocardiography, before and 6 months after CRT. As indicated by the white arrows in Figure 1, LA dyssynchrony was measured as the time delay between onset systolic stretch of the interatrial septum and the LA lateral wall. Response to CRT was defined as at least 15% reduction in left ventricular (LV) end systolic volume at 6 months follow up.
Results
119 (70%) patients responded to CRT. The panels in Figure 1 shows LA strain traces in a representative LBBB patient that did respond (upper panels), and a patient that did not respond (lower panels). The white arrows in the left panels indicate that both the responder and the non-responder had marked LA dyssynchrony before CRT (198 and 171 ms, respectively). However, after 6 months with CRT, there was recovery of LA synchrony only in the responder (time delay −40 ms), and still marked LA dyssynchrony of 191 ms in the non-responder (right panels).
Figure 2 confirms similar results for the whole study population: CRT response was associated with marked reduction of LA dyssynchrony (p=0.0001). In the CRT non-responders there was, however, only a modest, non-significant reduction of LA dyssynchrony.
Conclusions
Positive CRT response was associated with resynchronization of the left atrium. These findings suggest LA resynchronization as a potential additional target for CRT.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Institute for Surgical Research, Oslo University HospitalThe Intervention Centre, Oslo University Hospital
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Affiliation(s)
- L E R Hammersboen
- Oslo University Hospital Rikshospitalet, Institute for Chirurgical Research , Oslo , Norway
| | - J Aalen
- Oslo University Hospital Rikshospitalet, Institute for Chirurgical Research , Oslo , Norway
| | - A Puvrez
- University Hospitals (UZ) Leuven, Department of Cardiovascular Sciences , Leuven , Belgium
| | - C K Larsen
- Oslo University Hospital Rikshospitalet, Institute for Chirurgical Research , Oslo , Norway
| | - E W Remme
- Oslo University Hospital Rikshospitalet, Institute for Chirurgical Research , Oslo , Norway
| | - E Donal
- Laboratory Signal Processing and Image, Department of Cardiology , Rennes , France
| | - J Duchenne
- University Hospitals (UZ) Leuven, Department of Cardiovascular Sciences , Leuven , Belgium
| | - J U Voigt
- University Hospitals (UZ) Leuven, Department of Cardiovascular Sciences , Leuven , Belgium
| | - E Galli
- Laboratory Signal Processing and Image, Department of Cardiology , Rennes , France
| | - F H Khan
- Oslo University Hospital Rikshospitalet, Institute for Chirurgical Research , Oslo , Norway
| | - O J Sletten
- Oslo University Hospital Rikshospitalet, Institute for Chirurgical Research , Oslo , Norway
| | - M Penicka
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - M Stugaard
- Oslo University Hospital Rikshospitalet, Institute for Chirurgical Research , Oslo , Norway
| | - O A Smiseth
- Oslo University Hospital Rikshospitalet, Institute for Chirurgical Research , Oslo , Norway
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2
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Ribic D, Remme E, Broch K, Massey R, Gullestad L, Eek C, Russell K. Validation of non-invasive assessment of myocardial work in aortic stenosis: improvements by modifying the method for estimating the left ventricular pressure waveform. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Non-invasive myocardial work (MW) index incorporates strain by speckle-tracking echocardiography (STE) and individually estimated left ventricular pressure (LVP) curves to calculate the area of the pressure strain loop without the need for invasive LVP measurements. The method was validated in patients without aortic stenosis (AS) where a reference pressure curve is adjusted for individually measured aortic and mitral valve events and the peak LVP is defined by the brachial artery cuff pressure. Before applying this method in patients with AS, potential limitations which can influence the area of the pressure strain loop, such as the LVP curve profile, correct scaling of peak LVP and correct assessment of aortic events must be addressed.
Purpose
The present study aimed to assess the impact of the potential limitations specific to patients with AS and thereby the validity of non-invasive MW index in patients with AS.
Methods
In 20 patients with severe AS we obtained simultaneous LVP, by a micromanometer-tipped catheter, and strain by STE. For each patient, LVP curve estimations were done using three different models: 1. The established LVP reference model based on patients without AS. 2. Enhancement of the established LVP reference model by defining aortic valve opening with diastolic cuff pressure. 3. A new AS specific LVP reference model based on our current invasive measurements. Valvular events were determined by 2D and Doppler echocardiography, and peak LVP estimated as a sum of mean trans-aortic gradient and systolic cuff pressure. Estimated LVP curve tracings were thereafter directly compared with simultaneous invasive measurements (Figure 1). Furthermore, area of the pressure-strain loops using the different estimations of LVP curve were calculated to assess MW and compared to simultaneous invasive measurements for direct comparison.
Results
All three methods had excellent average correlation coefficient between estimated and invasively measured LVP traces. However, estimations with the AS specific reference curve and those enhanced with incorporation of diastolic pressure for aortic valve opening had a higher correlation coefficient (r=0.99, p<0.001) and a more physiological profile during early systole compared to that of the previously validated reference curve (r=0.96, p<0.001) (Figure 1). Furthermore, there was an excellent correlation (r=0.98, p<0.001) and good agreement between MW calculated with all three non-invasive estimation methods and invasive LVP (Figure 2).
Conclusions
The present study is the first to confirm the validity of non-invasive MW in patients with AS. Furthermore, a AS specific reference curve and the enhanced reference curve incorporating diastolic cuff pressure to define aortic valve opening both increased the accuracy of the estimated LVP curve and hence estimation of MW. This could be pivotal when assessing AS patients with marked regional differences such as LBBB or regional ischaemia.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Oslo University Hospital Rikshospitalet
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Affiliation(s)
- D Ribic
- Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - E Remme
- Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - K Broch
- Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - R Massey
- Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - L Gullestad
- Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - C Eek
- Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - K Russell
- Oslo University Hospital Rikshospitalet , Oslo , Norway
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3
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Witso M, Sletten OJ, Hisdal J, Melau J, Smiseth OA, Remme EW, Skulstad H. Is left ventricular function reduced after ultra-endurance exercise? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Norwegian Health Association
Introduction
Ultra-endurance exercise can be harmful according to previous studies, indicated by reduction in functional parameters and increase in cardiac biomarkers. Changes in load and heart rate with exercise influence left ventricle systolic function, making assessment of standard echocardiographic examination difficult.
Purpose
We investigated the effect of ultra-endurance exercise on myocardial function acutely and at restitution.
Methods
We investigated 10 participants aged 46 ±7 years, before (baseline), within 142 ± 78 minutes after finish (post run) and 5-10 days after (restitution) an ultra-endurance race (3.8 km swimming, 180 km bicycling and 42 km running with a total elevation of 5200 m). Echocardiography was performed at the three time points, including cardiac morphology and -function. Ejection fraction (EF) and stroke volume (SV) were measured by Simpson biplane. Cardiac output was calculated from SV and heart rate (HR). Cardiac power was calculated as the product of CO, mean arterial blood pressure and the conversion factor to Watt (W) 0.00222. Global longitudinal strain (GLS) was calculated using speckle-tracking echocardiography, and myocardial work was calculated by non-invasive pressure-strain analysis.
Results
Acutely after exercise, myocardial function by GLS (p = 0.002), myocardial work (p < 0.001), mitral annular plane systolic excursion (MAPSE, p = 0.003) and EF (p = 0.004) were substantially reduced compared to baseline, whereas cardiac power and cardiac output (CO) were maintained (see table and figure). Heart rate was moderately increased (p < 0.001). End-diastolic volume (EDV) as an index of preload was numerically, but not significantly reduced. End systolic volume (ESV) was numerically increased (p = NS) even though systolic blood pressure (sBP) was reduced (p = 0.01) post race. After restitution all parameters returned to baseline levels.
Conclusions
The temporary reduced strain and EF may be a physiologic response due to the higher heart rate. However, despite reduced systolic pressure the heart did not contract to a lower end systolic volume. This suggests loss of contractile function compensated by increase in heart rate. The findings should be explored in further studies. Abstract Figure Abstract Table
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Affiliation(s)
- M Witso
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - OJ Sletten
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - J Hisdal
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - J Melau
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - OA Smiseth
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - EW Remme
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital Rikshospitalet, Oslo, Norway
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4
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Hammersboen LER, Aalen JM, Puvrez A, Remme EW, Donal E, Duchenne J, Voigt JU, Galli E, Khan FH, Sletten OJ, Smiseth OA, Stugaard M. Left atrial mechanical dyssynchrony: an independent predictor of left ventricular reverse remodelling after cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Institute for Chirurgical Research - Oslo University Hospital
Introduction
Left bundle branch block (LBBB) leads to left ventricular (LV) mechanical dyssynchrony. Since the left atrium (LA) and the left ventricle (LV) are anatomically connected, dyssynchronous LV contractions may be transmitted to the LA causing LA dyssynchrony and disturbed LA function.
Purpose
To investigate if LA dyssynchrony induced by LBBB predicts LV reverse remodelling after cardiac resynchronization therapy (CRT).
Methods
In a prospective study, myocardial strain was measured by speckle-tracking echocardiography in 171 heart failure patients with LBBB, before and 6 months after CRT. LA dyssynchrony was measured as the time delay between onset systolic stretch of the interatrial septum and the LA lateral wall (white arrows in Figure), and LV dyssynchrony as the time from onset septal shortening to onset lateral wall shortening. Septal flash was assessed visually. Response to CRT was defined as at least 15 % reduction in LV end systolic volume at 6 months follow up.
Results
The figure shows a representative LBBB patient with LA and LV dyssynchrony which was abolished by CRT. For the whole study population, LA dyssynchrony was 104 ± 77 ms (mean ± SD) before CRT, and decreased to 43 ± 70 ms (p < 0.0001) after CRT. There was a significant correlation between LA and LV dyssynchrony (r = 0.68, p < 0.0001).
LA dyssynchrony correlated with LV reverse remodelling after CRT (p = 0.009), and multivariable analysis revealed that LA dyssynchrony was an independent predictor of CRT response (β=-0.046, p = 0.04) when combined with septal flash, QRS duration and QRS morphology (Table).
Conclusions
Patients with LBBB had marked LA dyssynchrony which was attributed to direct LV-LA mechanical interaction. Furthermore, LA dyssynchrony was an independent predictor of LV reverse remodelling after CRT. These findings suggest that assessment of LA dyssynchrony should be part of the echocardiographic evaluation in patients with dyssynchronous heart failure. Abstract Figure.
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Affiliation(s)
- LER Hammersboen
- Oslo University Hospital Rikshospitalet, Institute for Chirurgical Research, Oslo, Norway
| | - JM Aalen
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - A Puvrez
- University Hospitals (UZ) Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - EW Remme
- Oslo University Hospital Rikshospitalet, Institute for Chirurgical Research, Oslo, Norway
| | - E Donal
- Laboratory Signal Processing and Image, Department of Cardiology, Rennes, France
| | - J Duchenne
- Laboratory Signal Processing and Image, Department of Cardiology, Rennes, France
| | - JU Voigt
- University Hospitals (UZ) Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - E Galli
- Laboratory Signal Processing and Image, Department of Cardiology, Rennes, France
| | - FH Khan
- Oslo University Hospital Rikshospitalet, Institute for Chirurgical Research, Oslo, Norway
| | - OJ Sletten
- Oslo University Hospital Rikshospitalet, Institute for Chirurgical Research, Oslo, Norway
| | - OA Smiseth
- Oslo University Hospital Rikshospitalet, Institute for Chirurgical Research, Oslo, Norway
| | - M Stugaard
- Oslo University Hospital Rikshospitalet, Institute for Chirurgical Research, Oslo, Norway
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5
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Sletten OJ, Aalen JM, Remme EW, Khan FH, Wajdan A, Villegas M, Hisdal J, Smiseth OA, Skulstad H. Myocardial work still reflect function while strain simply measure deformation when afterload increases. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Global longitudinal strain is recommended by the European Society of Cardiology to detect subclinical left ventricular (LV) dysfunction, but is markedly load-dependent. Myocardial work was recently introduced as a clinical tool to study LV function by pressure-strain analysis. Since myocardial work incorporates afterload, it is assumed to be less afterload-dependent than strain, but the relationship with afterload is incompletely understood.
Hypothesis
Myocardial work is a better tool than strain, to measure myocardial function during elevated afterload.
Methods
In eleven anesthetized dogs, LV volume and longitudinal strain were measured by sonomicrometry, and pressure by micromanometry. Myocardial work was calculated by pressure-strain analysis. Additionally, stroke work was calculated as the area of the pressure-volume loop. Afterload was instantly increased by aortic constriction using a pneumatic cuff around the ascending aorta. Measurements were performed at baseline, during moderate- and marked afterload elevations.
Results
Table 1 summarizes the results. LV pressure (LVP) successively increased with moderate and marked afterload elevation, while longitudinal strain was successively reduced. Myocardial work and stroke work, on the other hand, increased with moderate afterload elevation, but was then reduced at marked afterload increase (Figure 1 and Table 1). Stroke volume and ejection fraction corresponded to strain and were reduced with afterload elevation.
Conclusions
Longitudinal strain and myocardial work have qualitatively different responses to increased afterload. While moderate changes in afterload cause reductions in strain that can be falsely interpreted as reductions in contractility, myocardial work increases as it incorporates the increased workload at moderately elevated afterload.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The Norwegian Health Association
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Affiliation(s)
- O J Sletten
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - J M Aalen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - E W Remme
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - F H Khan
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - A Wajdan
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - M Villegas
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - J Hisdal
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - O A Smiseth
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital Rikshospitalet, Oslo, Norway
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6
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Hammersboen LER, Stugaard M, Remme EW, Donal E, Duchenne J, Voigt JU, Galli E, Sletten OJ, Aalen J, Smiseth OA. Left bundle branch block causes left atrial dyssynchrony: a result of atrio-ventricular mechanical interaction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Left bundle brach block (LBBB) leads to left ventricular (LV) mechanical dyssynchrony with septal flash and delayed lateral wall contractions. Since atrium and ventricle are anatomically connected, dyssynchronous LV contractions may be transmitted to the left atrium, thereby disturbing left (LA) function.
Purpose
To test the hypothesis that patients with LBBB have LA dyssynchrony induced by tethering to the dyssynchronous left ventricle.
Methods
Myocardial strain was measured by speckle-tracking echocardiography in 20 non-ischaemic heart failure patients with LBBB, before and 6 months after cardiac resynchronization therapy (CRT), and in 20 healthy controls. For the LA, dyssynchrony was measured as time delay between onset of the interatrial septum and the lateral wall, and for the LV, between onset septal flash and onset lateral wall contraction. White arrows in Figure indicate onset LA stretch.
Results
As shown in the Figure, patients with LBBB and HF had marked LA reservoir phase dyssynchrony. Before CRT time delay from onset LA septal stretch to onset lateral wall stretch was 125±71 ms (mean±SD), and decreased to 23±70 (p<0.0001) with CRT. In controls there was a small delay of 34±56 ms. The LA dyssynchrony correlated with LV dyssynchrony (r=0.50, p=0.033), supporting the hypothesis that LA dyssynchrony in LBBB represents mechanical interaction due to tethering between the respective walls.
Conclusions
Patients with LBBB had marked LA reservoir phase dyssynchrony, which was abolished with CRT. The LA dyssynchrony was attributed to direct LV-LA mechanical interaction. The observed LA resynchronization by CRT represent an additional benefit of CRT in patients with heart failure.
Funding Acknowledgement
Type of funding sources: None. Left atrial and ventricular dyssynchrony
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Affiliation(s)
- L E R Hammersboen
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - M Stugaard
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - E W Remme
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - E Donal
- Laboratory Signal Processing and Image, Department of Cardiology, Rennes, France
| | - J Duchenne
- University Hospitals (UZ) Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - J U Voigt
- University Hospitals (UZ) Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - E Galli
- Laboratory Signal Processing and Image, Department of Cardiology, Rennes, France
| | - O J Sletten
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - J Aalen
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - O A Smiseth
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
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7
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Villegas-Martinez M, Odland HH, Sletten OJ, Khan F, Wajdan A, Elle OJ, Fosse E, Krogh MR, Remme EW. Duration of the preejection phase is less preload dependent and therefore a better marker of acute response to cardiac resynchronization therapy than maximum pressure rise. Europace 2021. [DOI: 10.1093/europace/euab116.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EU’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie
Background
There is no consensus on which haemodynamic marker should be used to quantify acute response to cardiac resynchronization therapy (CRT) during implantation of the device. CRT has been shown to acutely reduce left ventricular (LV) end systolic as well as end-diastolic volume (EDV), precluding the use of preload dependent markers such as LV maximum pressure rise (dP/dtmax).
Purpose
As resynchronization will abolish the uncoordinated regional early systolic contractions of the LV, it will shorten the time to maximal pressure rise and aortic valve opening. For this reason, the purpose of this study was to investigate if duration from the time-point of ventricular pacing to dP/dtmax is less preload dependent and a better marker of acute response to CRT than dP/dtmax by comparing how the 2 markers reflected LV function during different CRT configurations.
Methods
LV pressure by micromanometer and volume by sonomicrometry were measured in 6 anaesthetized canines with left bundle branch block. Transient caval constrictions were performed to vary preload. Preload dependency of the 2 markers was compared by normalizing their values and calculating their relations to EDV. In 4 of the animals, biventricular pacing was performed at 3 different pacing sites with variations in atrioventricular delays that provided a range of response to CRT. To correct for acute
changes in preload by CRT, stroke volume (SV) at identical EDV found from transient caval constrictions, were assessed and used as reference to grade improved LV function. Linear regression analysis was used to assess the correlation of both the duration of the preejection phase and dP/dtmax with SV.
Results
The duration of the preejection phase varied less with changes in preload compared to dP/dtmax: the slopes of their relation to EDV were -0.6 ± 0.7 %/ml and 4.8 ± 2.1 %/ml (p = 0.004), respectively. Turning CRT on, acutely reduced EDV from 74 ± 16 to 69 ± 17 ml (p < 0.001) at the best pacing configuration. For the different pacing sites and settings, there was a consistent relation in all animals where the preejection phase shortened as SV increased (average r2 = 0.75) (Figure A). dP/dtmax showed no clear relation to SV (average r2 = 0.22) and included cases with both negative and positive slopes (Figure B).
Conclusions
The duration of the preejection phase correlated with changes in LV function induced by CRT while dP/dtmax performed poorly as preload was changed. Hence, the novel timing parameter was less preload dependent and may be a better marker for assessing acute response to CRT. Abstract Figure.
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Affiliation(s)
- M Villegas-Martinez
- Oslo University Hospital Rikshospitalet, The Intervention Centre, Oslo, Norway
| | - HH Odland
- Oslo University Hospital Rikshospitalet, Cardiology, Oslo, Norway
| | - OJ Sletten
- Oslo University Hospital Rikshospitalet, Institute for Surgical Research, Oslo, Norway
| | - F Khan
- Oslo University Hospital Rikshospitalet, Institute for Surgical Research, Oslo, Norway
| | - A Wajdan
- Oslo University Hospital Rikshospitalet, The Intervention Centre, Oslo, Norway
| | - OJ Elle
- Oslo University Hospital Rikshospitalet, The Intervention Centre, Oslo, Norway
| | - E Fosse
- Oslo University Hospital Rikshospitalet, The Intervention Centre, Oslo, Norway
| | - MR Krogh
- Oslo University Hospital Rikshospitalet, The Intervention Centre, Oslo, Norway
| | - EW Remme
- Oslo University Hospital Rikshospitalet, Institute for Surgical Research, Oslo, Norway
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8
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Khan F, Inoue K, Remme EW, Ohte N, Garcia-Izquierdo E, Chetrit M, Andersen OS, Gude E, Andreassen AK, Kikuchi S, Stugaard M, Ha JW, Klein A, Nagueh SF, Smiseth OA. Evaluation of left ventricular filling pressure by echocardiography: incremental diagnostic information from left atrial strain. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority
Background
Elevated left ventricular (LV) filling pressure is an important diagnostic feature of heart failure.
Objectives
To investigate determinants of left atrial (LA) reservoir and pump strain and if these parameters may serve as markers of LV filling pressure.
Methods
In a multicenter study of 322 patients with cardiovascular disease of different etiologies, LA strain by speckle tracking echocardiography was compared to conventional echocardiographic markers using invasive pressure as reference.
Results
Left ventricular filling pressure correlated well with LA reservoir and pump strain (r-values
‑0.52 and ‑0.57, respectively) (Figure). However, LV global longitudinal strain (GLS) was the strongest determinant of LA reservoir strain (r = 0.64), and correlated well with LA pump strain (r = 0.51). For both LA strains, association with filling pressure was strongest in patients with reduced LV ejection fraction. In patients with normal GLS (≥18%), atrial strains provided no information regarding filling pressure (Figure). Reservoir strain <18% and pump strain <8% predicted elevated LV filling pressure better (p < 0.05) than the conventional indices LA volume, ratio of mitral early filling velocity/annular velocity and tricuspid regurgitation velocity. Accuracy to classify filling pressure as normal or elevated was 75% for both LA strains . When any one of the conventional indices were missing, and were replaced by LA strains, the combination of indices had accuracy 82% to correctly classify filling pressure.
Conclusions
Left atrial reservoir and pump strain may serve as clinical markers of LV filling pressure, but will be useful predominantly in patients with reduced systolic function. Due to limited diagnostic accuracy, LA strain should be used in combination with other indices.
Abstract Figure
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Affiliation(s)
- F Khan
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - K Inoue
- Ehime University Graduate School of Medicine, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime, Japan
| | - EW Remme
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - N Ohte
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - M Chetrit
- Cleveland Clinic, Cleveland, United States of America
| | - OS Andersen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - E Gude
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - AK Andreassen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - S Kikuchi
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M Stugaard
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - JW Ha
- Yonsei University College of Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - A Klein
- Cleveland Clinic, Cleveland, United States of America
| | - SF Nagueh
- The Methodist Hospital, Houston, United States of America
| | - OA Smiseth
- Oslo University Hospital Rikshospitalet, Oslo, Norway
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9
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Sletten OJ, Aalen JM, Remme EW, Khan FH, Hisdal J, Smiseth OA, Skulstad H. Myocardial work comes to rescue when afterload-dependency of strain cause false positives. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): The Norwegian Health Association
Introduction
Global longitudinal strain (GLS) can detect subclinical left ventricular (LV) dysfunction. GLS measurement is therefore recommended when chemotherapy-induced cardiotoxicity can be suspected. A relative, percentage reduction in GLS ≥8% may indicate subclinical LV dysfunction induced by chemotherapy. Due to afterload-dependency, moderate increase in blood pressure has the potential to cause reductions in GLS beyond this threshold. However, myocardial work incorporates afterload, and may be used to omit false positive outcomes.
Purpose
To investigate if moderate increases in afterload cause clinically relevant changes in strain, and if myocardial work is more robust to such changes.
Methods
Twenty cancer patients (41 ± 14 years) undergoing chemotherapy and twenty healthy controls (49 ± 11 years, NS) were included. All participants were free from concomitant heart disease. GLS was measured by speckle-tracking echocardiography. Global myocardial work was calculated by pressure-strain analysis using a previously validated method to estimate LV pressure (LVP) non-invasively. Recordings were performed before and after 2 minute stress by handgrip.
Results
At baseline, patients had lower GLS (20.1 ± 1.1 vs 22.1 ± 2.5%, p < 0.01) and global myocardial work (1810 ± 203 vs 2051 ± 287 mmHg·%, p < 0.01) than controls. Stress test moderately increased systolic blood pressure, similar in both groups (116 ± 10 to 146 ± 17 mmHg in patients, and 118 ± 12 to 147 ± 21 mmHg in controls). This afterload-enhancement was associated with a decrease in GLS from 20.1 ± 1.1 to 18.4 ± 1.3% in patients, and from 22.1 ± 2.5 to 20.3 ± 2.5% in controls (both p < 0.01). Every second participant, eleven patients and nine controls, experienced a relative reduction in GLS >8%. In contrast, global myocardial work increased during the stress test from 1810 ± 203 to 2002 ± 281 mmHg·% in patients, and from 2051 ± 287 to 2292 ± 398 mmHg·% in controls (both p < 0.01). Figure 1 shows changes in GLS and myocardial work at moderate increase in afterload.
Conclusions
Moderate increase in afterload caused reductions in GLS sufficient to promote over-diagnosis of chemotherapy-induced cardiotoxicity. Global myocardial work has the potential to distinguish true subclinical LV dysfunction from afterload-induced decline in GLS.
Abstract Figure.
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Affiliation(s)
- OJ Sletten
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - JM Aalen
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - EW Remme
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - FH Khan
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - J Hisdal
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - OA Smiseth
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
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10
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Sletten OJ, Aalen JM, Izci H, Duchenne J, Remme EW, Larsen CK, Hopp E, Galli E, Sirnes PA, Kongsgard E, Voigt JU, Donal E, Smiseth OA, Skulstad H. Regional myocardial work as determinant of heart failure in left bundle branch block. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): The Norwegian Health Association
Background
Left bundle branch block (LBBB) worsen prognosis in heart failure patients. LBBB may also cause heart failure in otherwise healthy individuals. The mechanical changes induced by LBBB are potential determinants of heart failure in these patients, but their relation to left ventricular (LV) systolic function is incompletely understood.
Purpose
This study investigates the contribution of regional contractile function to heart failure in patients with LBBB.
Methods
In 76 patients with LBBB and 11 healthy controls, myocardial strain was measured by speckle-tracking echocardiography and myocardial work by pressure-strain analysis. Patients with ischemic heart disease or myocardial scarring were excluded. LBBB patients were stratified by LV ejection fraction (EF) >50% (EFpreserved), 36-50% (EFmid), and ≤35% (EFlow). 62 LBBB patients subsequently underwent cardiac resynchronization therapy (CRT) implantation and was re-examined at 6 months.
Results
Septal work was significantly and successively reduced from controls, EFpreserved, EFmid, to EFlow (1977 ± 506, 1025 ± 342, 601 ± 494 and -41 ± 303 mmHg·%, respectively, all p < 0.01) (Figure 1). There was a strong correlation (R = 0.84, p < 0.01) between septal work and LVEF. In contrast, work in the LV lateral wall was preserved in both EFpreserved (2367 ± 459 mmHg·%) and EFmid (2252 ± 449 mmHg·%) vs controls (2062 ± 459 mmHg·%, all NS). In the EFlow group, however, LV lateral wall work was reduced (1473 ± 568 mmHg·%, p < 0.01 vs controls). Thus, lateral wall function was not correlated with LVEF in patients with LVEF >35% (NS). At six month CRT septal work was markedly increased (165 ± 485 vs 1288 ± 523 mmHg·%, p < 0.01) and LV lateral wall work reduced (1730 ± 620 vs 1264 ± 490 mmHg·%, p < 0.01). LVEF increased from 32 ± 8 to 47 ± 10 % (p < 0.01).
Conclusions
Heart failure in LBBB patients is determined by degree of septal dysfunction. LV lateral wall function, on the other hand, is preserved in the early phase of heart failure and was only reduced in patients with severe heart failure. Further clinical studies should investigate if measuring LV lateral wall function can increase precision in patient selection for CRT.
Abstract Figure.
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Affiliation(s)
- OJ Sletten
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - JM Aalen
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - H Izci
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - J Duchenne
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - EW Remme
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - CK Larsen
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - E Hopp
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - E Galli
- Hospital Pontchaillou of Rennes, Department of Cardiology, Rennes, France
| | - PA Sirnes
- Ostlandske hjertesenter, Moss, Norway
| | - E Kongsgard
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - JU Voigt
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - E Donal
- Hospital Pontchaillou of Rennes, Department of Cardiology, Rennes, France
| | - OA Smiseth
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
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11
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Sletten OJ, Aalen JM, Remme EW, Izci H, Duchenne J, Larsen CK, Hopp E, Galli E, Sirnes PA, Kongsgard E, Donal E, Voigt JU, Smiseth OA, Skulstad H. Elevated septal wall stress - a driver of left ventricular dysfunction in left bundle branch block? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): The Norwegian Health Association
Background
Septal dysfunction is a main feature of left bundle branch block (LBBB), and increasing wall stress is a proposed mechanism of heart failure development in LBBB patients. To try to reveal the pathophysiologic pathway from dyssynchrony to heart failure, we investigated the relationship between septal and left ventricular (LV) lateral wall stress in patients with LBBB.
Hypothesis
Increased septal wall stress causes septal dysfunction in LBBB.
Methods
We included 24 LBBB-patients (65 ± 11 years, 11 males) with LV ejection fraction (EF) ranging from 18 to 67%, and 8 healthy controls (58 ± 10 years, 4 males). Wall stress was calculated at peak LV pressure (LVP) according to the law of La Place ([LVP x radius]/[wall thickness]). Wall thickness was measured using M-mode, and regional curvature was measured in mid-ventricular shortaxis from 2D echocardiographic images. We used a previously validated non-invasive method to estimate LVP from brachial blood pressure and adjusted for valvular events. Myocardial scar was ruled out by late gadolinium enhancement cardiac magnetic resonance imaging.
Results
Wall stress was significantly higher in septum than LV lateral wall at peak LVP (48 ± 12 vs 37 ± 11 kPa, p < 0.01) in LBBB patients, while no difference was seen in the controls (Figure A). In patients, septal wall thickening showed a strong correlation with LVEF (r = 0.77, p < 0.01) (Figure B). Similar correlation was not significant for the LV lateral wall (r = 0.13, NS). Attenuation of septal wall thickening in LBBB-patients correlated well with increasing septal wall stress (r=-0.60, p < 0.01). Wall thickening and stress did not correlate in the LV lateral wall (r=-0.14, NS).
Conclusion
Increased septal wall stress is associated with reduced systolic thickening in patients with LBBB. Septal wall thickening, in contrast to LV lateral wall thickening, was correlated to global LV function. These findings suggest that septal remodeling which could have normalized septal wall stress, was not achieved and heart failure may develop.
Abstract Figure.
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Affiliation(s)
- OJ Sletten
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - JM Aalen
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - EW Remme
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - H Izci
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - J Duchenne
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - CK Larsen
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - E Hopp
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - E Galli
- Hospital Pontchaillou of Rennes, Department of Cardiology, Rennes, France
| | - PA Sirnes
- Ostlandske hjertesenter, Moss, Norway
| | - E Kongsgard
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - E Donal
- Hospital Pontchaillou of Rennes, Department of Cardiology, Rennes, France
| | - JU Voigt
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - OA Smiseth
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
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12
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Sletten OJ, Aalen J, Khan FH, Larsen CK, Inoue K, Remme EW, Hisdal J, Smiseth OA, Skulstad H. 158 Myocardial work exposes afterload-dependent changes in strain. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Norwegian Health Association
Background
Global longitudinal strain (GLS) is used for detection of subclinical left ventricular (LV) dysfunction, for example when screening for chemotherapy-induced cardiotoxicity. A relative percentage reduction in GLS ≥8% is considered abnormal. However, as GLS is load-dependent, modest increases in afterload can potentially prove sufficient to cause clinical implication. In contrast, global myocardial work (GMW) which incorporates afterload, may be more accurate in detecting LV-dysfunction.
Purpose
We investigated the effect of increased afterload on GLS, and if GMW may be a more accurate parameter of myocardial function during increased afterload.
Methods
In 20 healthy individuals (age 49 ± 11 years (mean ± SD), 10 men), blood pressure was increased by a 3 minute arithmetic mental stress test. GLS was measured by speckle tracking echocardiography and LV ejection fraction (EF) by biplane Simpson. GMW was calculated from LV pressure-strain analysis using a non-invasive estimate for LV pressure (LVP).
Results
During the afterload-elevation, systolic blood pressure increased by 25 ± 16 mmHg (p < 0.01), and heart rate by 16 ± 13 bpm (p < 0.01). This was followed by a decrease in EF from 62 ± 5 to 59 ± 5% (p < 0.01) and GLS from 21.9 ± 2.2 to 20.8 ± 2.0% (p < 0.01). In contrast, GMW increased from 2052 ± 278 to 2382 ± 388 mmHg·% (p < 0.01). In 5 of 20 (25%) individuals, the relative percentage reduction of GLS was >8%, despite an increase in GMW. The figure shows an individual example during rest and afterload-elevation, where an increase in systolic blood pressure of 16 mmHg was associated with a 9% relative percentage reduction in GLS, but a small increase in GMW as illustrated by the loop areas.
Conclusions
This study demonstrated that a modest increase in afterload can result in significant reduction in GLS, that may lead to overdiagnosis of LV-dysfunction. GMW did not decrease, suggesting it has a better specificity in patients at risk for subclinical LV dysfunction. Future studies should investigate if GMW is more accurate than strain in detecting LV-dysfunction.
Abstract 158 Figure.
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Affiliation(s)
- O J Sletten
- Institute for Surgical Research and Center for Cardiological Innovation, Department of Cardiology, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - J Aalen
- Institute for Surgical Research and Center for Cardiological Innovation, Department of Cardiology, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - F H Khan
- Institute for Surgical Research and Center for Cardiological Innovation, Department of Cardiology, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - C K Larsen
- Institute for Surgical Research and Center for Cardiological Innovation, Department of Cardiology, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - K Inoue
- Institute for Surgical Research, Oslo, Norway. Ehime University Graduate School of Medicine, Deptartment of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime, Japan
| | - E W Remme
- Institute for Surgical Research and Center for Cardiological Innovation, Department of Cardiology, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - J Hisdal
- Institute for Surgical Research, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - O A Smiseth
- Institute for Surgical Research and Center for Cardiological Innovation, Department of Cardiology, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - H Skulstad
- Institute for Surgical Research and Center for Cardiological Innovation, Department of Cardiology, University of Oslo, Oslo University Hospital, Oslo, Norway
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13
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Khan FH, Inoue K, Andersen OS, Gude E, Skulstad H, Smiseth OA, Remme EW. 1231 Left atrial septal and lateral wall strains contain different pressure information: Utility in pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
South-Eastern Norway Regional Health Authority
Background
Reduced left atrial (LA) reservoir strain is a marker of elevated LA pressure. Thus it could be a potential non-invasive marker to differentiate pre- and post-capillary pulmonary hypertension (PH) as the latter is defined by elevated pulmonary capillary wedge pressure (PCWP) > 15 mmHg. However, in pre-capillary PH patients with elevated right atrial pressure (RAP), the atrial septal geometry may be abnormal. This could lead to lower regional LA septal strain, making LA lateral wall strain more accurately reflect PCWP.
Purpose
We investigated if LA lateral wall strain can differentiate between pre- and post-capillary PH, and how LA lateral wall strain and LA septal strain are both affected by elevated RAP in pre-capillary PH. Furthermore we investigated if LA septal strain can be used in pre-capillary PH patients to identify those with elevated RAP.
Methods
We analysed 63 patients with PH, 28 pre-capillary and 35 post-capillary, who underwent right heart catheterisation. Echocardiography was performed simultaneously with or within 24 hours of the invasive pressure measurements. Regional LA septal strain and lateral wall strain were measured from the apical four chamber view.
Results
Pulmonary artery pressure was 39.5 ± 11.1 mmHg (mean ± SD) in the pre-capillary PH patients and 37.0 ± 10.1 mmHg in the post-capillary PH patients (p = ns). Mean PCWP was 9.9 ± 2.5 mmHg and 24.5 ± 6.0 mmHg (p < 0.001), respectively.
LA lateral wall strain was significantly lower in patients with post-capillary PH compared to pre-capillary PH (11.9 ± 7.7% vs 26.6 ± 9.9%, p < 0.001) (Fig. a,b). At a cut-off value of 18.0%, LA lateral wall strain could predict elevated PCWP > 15 mmHg with AUC = 0.88, sensitivity = 85.7% and specificity = 76.3%.
In the 28 patients with pre-capillary PH, we classified mean RAP ≥ 10 mmHg as elevated and < 10 mmHg as normal. Seven of these patients had elevated RAP and showed significantly reduced LA septal strain compared to the 21 patients with normal RAP (13.0 ± 6.2% vs 22.1 ± 7.6%, p < 0.01). LA lateral wall strain showed no difference in these groups of pre-capillary PH patients (25.8 ± 10.1% vs 28.9 ± 9.4%) (Fig. c).
Conclusions
LA lateral wall strain can be used for differentiating between pre- and post-capillary PH. In addition, LA septal strain may be used in pre-capillary PH patients to identify those with elevated RAP.
Abstract 1231 Figure
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Affiliation(s)
- F H Khan
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
| | - K Inoue
- Ehime University Graduate School of Medicine, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime, Japan
| | - O S Andersen
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
| | - E Gude
- Oslo University Hospital, Department of cardiology, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital, Department of cardiology, Oslo, Norway
| | - O A Smiseth
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
| | - E W Remme
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
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14
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Inoue K, Remme EW, Khan FH, Andersen OS, Gude E, Skulstad H, Smiseth OA. P4368Estimation of pulmonary artery pressure from right atrial strain and tricuspid regurgitation velocity. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Systolic pulmonary artery pressure (SPAP) can be estimated non-invasively as the sum of indices for right atrial (RA) pressure and tricuspid regurgitation (TR) pressure gradient. Although echocardiographic evaluation of inferior vena cava diameter and collapsibility is currently being used to estimate RA pressure (IVC method), RA strain may be an alternative since atrial strain is related to atrial pressure.
Objective
We tested if RA strain by speckle tracking echocardiography can be used as a surrogate of mean RA pressure (RA strain method), and by adding the TR pressure gradient, be used to estimate SPAP.
Methods
We retrospectively analyzed 91 patients (mean age, 58 years) referred to right heart catheterization due to unexplained dyspnea or suspected pulmonary hypertension. Echocardiography was performed within 24 hours of the invasive procedure. RA reservoir strain was calculated from apical four-chamber view. SPAP was calculated as the sum of peak TR pressure gradient and estimated RA pressure by the IVC or RA strain methods.
Results
Right heart catheterization showed SPAP and mean RA pressures of 51±20 mmHg and 9±6 mmHg, respectively. RA reservoir strain was inversely correlated with mean RA pressure (r=−0.61, p<0.01). Thus, we set mean RA pressure as 5, 10 and 15 mmHg depending on high (≥25%), middle (10–25%) and low (≤10%) values of RA reservoir strain. As shown in the figure, both the RA strain and IVC methods when combined with peak TR velocity, provided good estimates of invasively measured SPAP.
Conclusions
RA strain provides a semiquantitative measure of RA pressure, which can be used in combination with peak TR velocity to estimate SPAP. This approach can be used as an alternative when the IVC method is not available in cases with poor subcostal window.
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Affiliation(s)
- K Inoue
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - E W Remme
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - F H Khan
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - O S Andersen
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - E Gude
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - O A Smiseth
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
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15
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Inoue K, Remme EW, Khan FH, Andersen OS, Gude E, Skulstad H, Smiseth OA. P2452Application of left atrial strain for differentiation between pre- and post-capillary pulmonary hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pulmonary hypertension (PH) is classified as pre- or post-capillary PH, and pulmonary capillary wedge pressure (PCWP) >15 mmHg is used as criterion for post-capillary PH. Elevated left atrial (LA) pressure is associated with reduced LA reservoir strain. Thus, LA strain may potentially serve to differentiate between these diagnoses.
Objectives
This study tested the hypothesis that LA strain can be used as a noninvasive parameter to differentiate between pre- and post-capillary PH.
Methods
We analyzed 103 patients (mean age: 58 years, 51 female) referred to right heart catheterization due to unexplained dyspnea or suspected heart failure. Echocardiography was performed within 24 hours of the invasive procedure. Mean pulmonary artery pressure (PAP) was noninvasively estimated from tricuspid regurgitation (TR) velocity and inferior vena cava (IVC) diameter and collapsibility. LA reservoir strain was calculated from apical four-chamber view by speckle tracking echocardiography, and was feasible in 101 patients.
Results
Twenty-eight patients were invasively confirmed with pre-capillary PH and 43 patients with post-capillary PH. The remaining 32 patients had no PH. LA reservoir strain was significantly lower in patients with post-capillary PH than patients with pre-capillary PH (9.9±5.5% vs. 24.6±8.2%, p<0.01). At a cut-off value of 15.4%, LA reservoir strain could predict elevated PCWP >15 mmHg with AUC=0.88, sensitivity=84.8% and specificity=81.8%. As shown in the figure, echocardiography with LA reservoir strain correctly differentiated 82% of patients into pre- and post-capillary PH.
Conclusions
These results suggest that LA reservoir strain can be used to predict elevated PCWP, thus allowing discrimination between pre- and post-capillary PH.
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Affiliation(s)
- K Inoue
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - E W Remme
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - F H Khan
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - O S Andersen
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - E Gude
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - O A Smiseth
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
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16
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Khan FH, Andersen OS, Gude E, Skulstad H, Smiseth OA, Remme EW. P1480Left atrial strain improves estimation of left ventricular filling pressure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The current algorithm in the 2016 recommendations for echocardiographic estimation of left ventricular filling pressure (LVFP) as normal or elevated, combines traditional indices of mitral inflow velocities, tissue Doppler, left atrial volume and tricuspid regurgitation velocity (Figure A). Some of the patients remain unclassified by this algorithm. Left atrial (LA) strain is a novel index that correlates well with LVFP and may improve estimation of LVFP in these patients.
Purpose
We tested if LA strain can improve estimation of LVFP for the patients that are unclassified by the 2016 algorithm.
Methods
We analyzed data from 100 patients who were referred to right heart catheterization due to unexplained dyspnea or suspected heart failure. Echocardiography was performed simultaneously with or within 24 hours of right heart catheterization. Pulmonary capillary wedge pressure (PCWP) was used as an estimate for LVFP and defined as elevated if above 12 mmHg. Elevated LVFP was first estimated using the 2016 algorithm. In patients who were unclassified by the algorithm due to conflicting indices or unattainable indices, LA strain was subsequently used to detect elevated LVFP using a cut-off found from ROC analysis of the whole cohort.
Results
Six patients were unclassified by the 2016 algorithm. The ROC analysis of all 100 patients showed that at an LA strain cut-off of above or below 16.2%, LVFP was correctly classified as normal or elevated, respectively, with a sensitivity of 83% and specificity of 88%. All 6 unclassified patients by the 2016 algorithm were correctly classified using the LA strain cut-off, effectively increasing the accuracy of the algorithm by 6 percentage points.
Conclusions
LA strain may have a role in non-invasive estimation of LVFP, particularly in patients who remain unclassified when using the conventional echocardiographic indices.
Acknowledgement/Funding
South-Eastern Norway Regional Health Authority
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Affiliation(s)
- F H Khan
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
| | - O S Andersen
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
| | - E Gude
- Oslo University Hospital, Department of cardiology, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital, Department of cardiology, Oslo, Norway
| | - O A Smiseth
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
| | - E W Remme
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
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17
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Higashi H, Inoue K, Saito M, Kinoshita M, Aono J, Ikeda S, Andersen OS, Gude E, Skulstad H, Remme EW, Smiseth OA, Yamaguchi O. P2458Restricted left atrial motion as a result of atrial stiffening in patients with cardiac amyloidosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Left atrial (LA) involvement of abnormal amyloid fibrils could induce LA dysfunction and stiffening in patients with cardiac amyloidosis (CA). Thus, the assessments of LA function and stiffness might be a potential approach to diagnose CA phenotype among patients with hypertrophied hearts.
Purpose
We sought to determine whether LA reservoir strain with speckle tracking echocardiography could be used a marker of LA stiffness in a derivation cohort. Furthermore, we tested to our hypothesis that LA reservoir strain could differentiate CA patients from hypertrophic cardiomyopathy (HCM) in an independent validation cohort.
Methods
In the derivation cohort, echocardiography was performed simultaneously with measurements of pulmonary capillary wedge pressure (PCWP) in 50 patients with suspected or established heart failure and relatively preserved left ventricular (LV) ejection fraction (56±10%). LA maximum and minimum volume index, and reservoir strain were measured from apical four-chamber view. LA stiffness index was computed as a pressure rise from x-trough to v-wave divided by an increase from minimum to maximum indexed LA volume (Figure A). In an independent validation group, we studied a total of 33 biopsy-proved CA patients and 127 HCM patients (LV ejection fraction: 57±11% vs. 66±10%, P<0.01) in sinus rhythm on the date of comprehensive echocardiographic study. Among them, cardiac magnetic resonance imaging (CMR) could be evaluated in 17 CA patients and 98 HCM patients. Furthermore, right heart catheterization was performed with 12 CA patients and 12 HCM patients in the CMR group.
Results
The derivation cohort study found that there was a significant curvilinear correlation of LA reservoir strain to LA stiffness index (Figure B). In the validation cohort, LA reservoir strain was reduced in patients with CA compared with HCM in all participants (11.6±5.6% vs. 18.5±6.9%, P<0.01), although there was no significant difference of LA maximal volume index between 2 groups (37±16 ml/m2 vs. 37±12 ml/m2, p=0.89). In the CMR group, the late gadolinium enhancement was observed in the LA wall in 16 patients with CA (94.1%) as shown in Figure C. In contrast, the LA enhancement revealed only in 1 patient with HCM (1.0%). Among patients with invasive measures, LA stiffness index [median (interquartile range)] was higher in patients with CA than that in patients with HCM [1.1 (0.4–2.8) vs. 0.2 (0.1–0.6), P=0.01].
Conclusions
LA reservoir function was fairly limited in patients with CA compared with HCM. Restricted LA motion might be related to atrial amyloid deposits or fibrosis, which potentially provokes atrial chamber stiffening.
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Affiliation(s)
- H Higashi
- Ehime University Graduate School of Medicine, Toon, Japan
| | - K Inoue
- Ehime University Graduate School of Medicine, Toon, Japan
| | - M Saito
- Kitaishikai Hospital, Ozu, Japan
| | - M Kinoshita
- Ehime University Graduate School of Medicine, Toon, Japan
| | - J Aono
- Ehime University Graduate School of Medicine, Toon, Japan
| | - S Ikeda
- Ehime University Graduate School of Medicine, Toon, Japan
| | | | - E Gude
- Oslo University Hospital, Oslo, Norway
| | | | - E W Remme
- Oslo University Hospital, Oslo, Norway
| | | | - O Yamaguchi
- Ehime University Graduate School of Medicine, Toon, Japan
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Storsten P, Boe E, Aalen J, Remme EW, Gjesdal O, Andersen ØS, Kongsgaard E, Smiseth OA, Skulstad H. P4709Left ventricular free wall pacing causes excessive work load in septum and right ventricular free wall-a mirror image of left bundle branch block. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Storsten
- Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
| | - E Boe
- Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
| | - J Aalen
- Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
| | - E W Remme
- K.G. Jebsen Cardiac Research Centre and Institute for Surgical Research, Oslo University Hospital, oslo, Norway
| | - O Gjesdal
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Ø S Andersen
- Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
| | - E Kongsgaard
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - O A Smiseth
- Department of Cardiology and Institute for Surgical Research, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - H Skulstad
- Department of Cardiology and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
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Boe E, Smiseth OA, Storsten P, Andersen OS, Aalen J, Eriksen M, Krogh M, Kongsgaard E, Remme EW, Skulstad H. P2489Ventricular volume changes are more accurate markers of acute response to CRT than contraction indices. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Boe
- University of Oslo, Institute for Surgical Research, Oslo, Norway
| | - O A Smiseth
- Oslo University Hospital, Department of Cardiology, Oslo, Norway
| | - P Storsten
- University of Oslo, Institute for Surgical Research, Oslo, Norway
| | - O S Andersen
- University of Oslo, Institute for Surgical Research, Oslo, Norway
| | - J Aalen
- University of Oslo, Institute for Surgical Research, Oslo, Norway
| | - M Eriksen
- University of Oslo, Institute for Surgical Research, Oslo, Norway
| | - M Krogh
- University of Oslo, Institute for Surgical Research, Oslo, Norway
| | - E Kongsgaard
- Oslo University Hospital, Department of Cardiology, Oslo, Norway
| | - E W Remme
- University of Oslo, Institute for Surgical Research, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital, Department of Cardiology, Oslo, Norway
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Aalen J, Remme EW, Krogh MR, Andersen OS, Masuda K, Odland HH, Opdahl A, Smiseth OA. P3739Septal rebound stretch is a tug of war between septum and left ventricular lateral wall. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Aalen
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - E W Remme
- Oslo University Hospital, Inst. for Surgical Research, Oslo, Norway
| | - M R Krogh
- Oslo University Hospital, Inst. for Surgical Research, Oslo, Norway
| | - O S Andersen
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - K Masuda
- Osaka University Hospital, Osaka, Japan
| | - H H Odland
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - A Opdahl
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - O A Smiseth
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
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Storsten P, Aalen J, Boe E, Remme EW, Larsen CK, Gjesdal O, Andersen OS, Kongsgaard E, Duchenne J, Voigt JU, Smiseth OA, Skulstad H. P4707Cardiac resynchronization therapy - Always right for the right ventricle? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Storsten
- Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
| | - J Aalen
- Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
| | - E Boe
- Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
| | - E W Remme
- K.G. Jebsen Cardiac Research Centre and Institute for Surgical Research, Oslo University Hospital, oslo, Norway
| | - C K Larsen
- Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
| | - O Gjesdal
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - O S Andersen
- Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
| | - E Kongsgaard
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - J Duchenne
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - J U Voigt
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - O A Smiseth
- Department of Cardiology and Institute for Surgical Research, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - H Skulstad
- Department of Cardiology and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
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Aalen J, Remme EW, Larsen CK, Hopp E, Andersen OS, Krogh M, Ross S, Odland HH, Kongsgaard E, Skulstad H, Smiseth OA. P5660Reduced left ventricular lateral wall contractility leads to recovery of septal function in left bundle branch block. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Aalen
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - E W Remme
- Oslo University Hospital, Inst. for Surgical Research, Oslo, Norway
| | - C K Larsen
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - E Hopp
- Oslo University Hospital, Dep. of Radiology, Oslo, Norway
| | - O S Andersen
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - M Krogh
- Oslo University Hospital, Inst. for Surgical Research, Oslo, Norway
| | - S Ross
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - H H Odland
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - E Kongsgaard
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - H Skulstad
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - O A Smiseth
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
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Kvaale K, Bersvendsen J, Salles S, Aalen J, Remme E, Brekke P, Edvardsen T, Samset E. P1501Detection of mechanical activation of the left ventricle using high frame rate ultrasound imaging. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Kvaale
- GE Vingmed Ultrasound, Center for Cardiological Innovation, University of Oslo, Oslo, Norway
| | - J Bersvendsen
- GE Vingmed Ultrasound, Center for Cardiological Innovation, Oslo, Norway
| | - S Salles
- Norwegian University of Science and Technology, Trondheim, Norway
| | - J Aalen
- Institute for Surgical Research (Oslo University Hospital), Center for Cardiological Innovation, Oslo, Norway
| | - E Remme
- Institute for Surgical Research (Oslo University Hospital), Center for Cardiological Innovation, Oslo, Norway
| | - P Brekke
- Department of Cardiology (Oslo University Hospital), Center for Cardiological Innovation, Oslo, Norway
| | - T Edvardsen
- Department of Cardiology (OUH), Center for Cardiological Innovation, University of Oslo, Oslo, Norway
| | - E Samset
- GE Vingmed Ultrasound, Center for Cardiological Innovation, University of Oslo, Oslo, Norway
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Aalen J, Izci H, Duchenne J, Larsen CK, Storsten P, Sirnes PA, Skulstad H, Remme EW, Voigt JU, Smiseth OA. P864Septal work is a more sensitive marker of myocardial dysfunction in dyssynchrony than strain. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Aalen
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - H Izci
- KU Leuven, Dep. of Cardiovascular Sciences, Leuven, Belgium
| | - J Duchenne
- KU Leuven, Dep. of Cardiovascular Sciences, Leuven, Belgium
| | - C K Larsen
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - P Storsten
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | | | - H Skulstad
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - E W Remme
- Oslo University Hospital, Inst. for Surgical Research, Oslo, Norway
| | - J U Voigt
- KU Leuven, Dep. of Cardiovascular Sciences, Leuven, Belgium
| | - O A Smiseth
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
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Masuda K, Aalen J, Andersen OS, Krogh M, Odland HH, Stugaard M, Remme EW, Nakatani S, Smiseth OA. P2743Estimation of filling pressure by E/e' in left bundle branch block: why is it so difficult? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Masuda
- Osaka University Graduate School of Medicine Division of Functional Diagnostics, Suita, Osaka, Japan
| | - J Aalen
- Oslo University Hospital, Oslo, Norway
| | | | - M Krogh
- Oslo University Hospital, Oslo, Norway
| | | | - M Stugaard
- Osaka University Graduate School of Medicine Division of Functional Diagnostics, Suita, Osaka, Japan
| | - E W Remme
- Oslo University Hospital, Oslo, Norway
| | - S Nakatani
- Osaka University Graduate School of Medicine Division of Functional Diagnostics, Suita, Osaka, Japan
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Orii M, Tanimoto T, Yokoyama M, Ota S, Kubo T, Hirata K, Tanaka A, Imanishi T, Akasaka T, Michelsen M, Pena A, Mygind N, Hoest N, Prescott E, Abd El Dayem S, Battah A, Abd El Azzez F, Ahmed A, Fattoh A, Ismail R, Andjelkovic K, Kalimanovska Ostric D, Nedeljkovic I, Andjelkovic I, Rashid H, Abuel Enien H, Ibraheem M, Vago H, Toth A, Csecs I, Czimbalmos C, Suhai FI, Kecskes K, Becker D, Simor T, Merkely B, D'ascenzi F, Pelliccia A, Natali B, Cameli M, Lisi M, Focardi M, Corrado D, Bonifazi M, Mondillo S, Zaha V, Kim G, Su K, Zhang J, Mikush N, Ross J, Palmeri M, Young L, Tadic M, Ilic S, Celic V, Jaimes C, Gonzalez Mirelis J, Gallego M, Goirigolzarri J, Pellegrinet M, Poli S, Prati G, Vriz O, Di Bello V, Carerj S, Zito C, Mateescu A, Popescu B, Antonini-Canterin F, Chatzistamatiou E, Moustakas G, Memo G, Konstantinidis D, Mpampatzeva Vagena I, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Hewing B, Theres L, Dreger H, Spethmann S, Stangl K, Baumann G, Knebel F, Uejima T, Itatani K, Nakatani S, Lancellotti P, Seo Y, Zamorano J, Ohte N, Takenaka K, Naar J, Mortensen L, Johnson J, Winter R, Shahgaldi K, Manouras A, Braunschweig F, Stahlberg M, Coisne D, Al Arnaout AM, Tchepkou C, Raud Raynier P, Diakov C, Degand B, Christiaens L, Barbier P, Mirea O, Cefalu C, Savioli G, Guglielmo M, Maltagliati A, O'neill L, Walsh K, Hogan J, Manzoor T, Ahern B, Owens P, Savioli G, Guglielmo M, Mirea O, Cefalu C, Barbier P, Marta L, Abecasis J, Reis C, Ribeiras R, Andrade M, Mendes M, D'andrea A, Stanziola A, Di Palma E, Martino M, Lanza M, Betancourt V, Maglione M, Calabro' R, Russo M, Bossone E, Vogt MO, Meierhofer C, Rutz T, Fratz S, Ewert P, Roehlig C, Kuehn A, Storsten P, Eriksen M, Remme E, Boe E, Smiseth O, Skulstad H, Ereminiene E, Ordiene R, Ivanauskas V, Vaskelyte J, Stoskute N, Kazakauskaite E, Benetis R, Marketou M, Parthenakis F, Kontaraki J, Zacharis E, Maragkoudakis S, Logakis J, Roufas K, Vougia D, Vardas P, Dado E, Dado E, Knuti G, Djamandi J, Shota E, Sharka I, Saka J, Halmai L, Nemes A, Kardos A, Neubauer S, Kurnicka K, Domienik-Karlowicz J, Lichodziejewska B, Goliszek S, Grudzka K, Krupa M, Dzikowska-Diduch O, Ciurzynski M, Pruszczyk P, Chung H, Kim J, Yoon Y, Min P, Lee B, Hong B, Rim S, Kwon H, Choi E, Soya O, Kuryata O, Kakihara R, Naruse C, Inayoshi A, El Sebaie M, Frer A, Abdelsamie M, Eldamanhory A, Ciampi Q, Cortigiani L, Simioniuc A, Manicardi C, Villari B, Picano E, Sicari R, Ferferieva V, Deluyker D, Lambrichts I, Rigo J, Bito V, Kuznetsov V, Yaroslavskaya E, Krinochkin D, Pushkarev G, Gorbatenko E, Trzcinski P, Michalski B, Lipiec P, Szymczyk E, Peczek L, Nawrot B, Chrzanowski L, Kasprzak J, Todaro M, Zito C, Khandheria B, Cusma-Piccione M, La Carrubba S, Antonini-Canterin F, Di Bello V, Oreto G, Di Bella G, Carerj S, Gunyeli E, Oliveira Da Silva C, Sahlen A, Manouras A, Winter R, Shahgaldi K, Spampinato R, Tasca M, Roche E Silva J, Strotdrees E, Schloma V, Dmitrieva Y, Dobrovie M, Borger M, Mohr F, Calin A, Rosca M, Beladan C, Mirescu Craciun A, Gurzun M, Mateescu A, Enache R, Ginghina C, Popescu B, Antova E, Georgievska Ismail L, Srbinovska E, Andova V, Peovska I, Davceva J, Otljanska M, Vavulkis M, Tsuruta H, Kohsaka S, Murata M, Yasuda R, Dan M, Yashima F, Inohara T, Maekawa Y, Hayashida K, Fukuda K, Migliore R, Adaniya M, Barranco M, Miramont G, Gonzalez S, Tamagusuku H, Abid L, Ben Kahla S, Charfeddine S, Abid D, Kammoun S, Amano M, Izumi C, Miyake M, Tamura T, Kondo H, Kaitani K, Nakagawa Y, Ghulam Ali S, Fusini L, Tamborini G, Muratori M, Gripari P, Bottari V, Celeste F, Cefalu' C, Alamanni F, Pepi M, Teixeira R, Monteiro R, Garcia J, Ribeiro M, Cardim N, Goncalves L, Miglioranza M, Muraru D, Cavalli G, Addetia K, Cucchini U, Mihaila S, Tadic M, Veronesi F, Lang R, Badano L, Galian Gay L, Gonzalez Alujas M, Teixido Tura G, Gutierrez Garcia L, Rodriguez-Palomares J, Evangelista Masip A, Conte L, Fabiani I, Giannini C, La Carruba S, De Carlo M, Barletta V, Petronio A, Di Bello V, Mahmoud H, Al-Ghamdi M, Ghabashi A, Salaun E, Zenses A, Evin M, Collart F, Pibarot P, Habib G, Rieu R, Fabregat Andres O, Estornell Erill J, Cubillos-Arango A, Bochard-Villanueva B, Chacon-Hernandez N, Higueras-Ortega L, Perez-Bosca L, Paya-Serrano R, Ridocci-Soriano F, Cortijo-Gimeno J, Mzoughi K, Zairi I, Jabeur M, Ben Moussa F, Mrabet K, Kamoun S, Fennira S, Ben Chaabene A, Kraiem S, Schnell F, Betancur J, Daudin M, Simon A, Lentz P, Tavard F, Hernandes A, Carre F, Garreau M, Donal E, Abduch M, Vieira M, Antunes M, Mathias W, Mady C, Arteaga E, Alencar A, Tesic M, Djordjevic-Dikic A, Beleslin B, Giga V, Trifunovic D, Petrovic O, Jovanovic I, Petrovic M, Stepanovic J, Vujisic-Tesic B, Choi E, Cha J, Chung H, Kim K, Yoon Y, Kim J, Lee B, Hong B, Rim S, Kwon H, Bergler-Klein J, Geier C, Maurer G, Gyongyosi M, Cortes Garcia M, Oliva M, Navas M, Orejas M, Rabago R, Martinez M, Briongos S, Romero A, Rey M, Farre J, Ruisanchez Villar C, Ruiz Guerrero L, Rubio Ruiz S, Lerena Saenz P, Gonzalez Vilchez F, Hernandez Hernandez J, Armesto Alonso S, Blanco Alonso R, Martin Duran R, Gonzalez-Gay M, Novo G, Marturana I, Bonomo V, Arvigo L, Evola V, Karfakis G, Lo Presti M, Verga S, Novo S, Petroni R, Acitelli A, Bencivenga S, Cicconetti M, Di Mauro M, Petroni A, Romano S, Penco M, Park S, Kim S, Kim M, Shim W, Tadic M, Majstorovic A, Ivanovic B, Celic V, Driessen MMP, Meijboom F, Mertens L, Dragulescu A, Friedberg M, De Stefano F, Santoro C, Buonauro A, Muscariello R, Lo Iudice F, Ierano P, Esposito R, Galderisi M, Sunbul M, Kivrak T, Durmus E, Yildizeli B, Mutlu B, Rodrigues A, Daminello E, Echenique L, Cordovil A, Oliveira W, Monaco C, Lira E, Fischer C, Vieira M, Morhy S, Mignot A, Jaussaud J, Chevalier L, Lafitte S, D'ascenzi F, Cameli M, Curci V, Alvino F, Lisi M, Focardi M, Corrado D, Bonifazi M, Mondillo S, Ikonomidis I, Pavlidis G, Lambadiari V, Kousathana F, Triantafyllidi H, Varoudi M, Dimitriadis G, Lekakis J, Cho JS, Cho E, Yoon H, Ihm S, Lee J, Molnar AA, Kovacs A, Apor A, Tarnoki A, Tarnoki D, Horvath T, Maurovich-Horvat P, Jermendy G, Kiss R, Merkely B, Petrovic-Nagorni S, Ciric-Zdravkovic S, Stanojevic D, Jankovic-Tomasevic R, Atanaskovic V, Mitic V, Todorovic L, Dakic S, Coppola C, Piscopo G, Galletta F, Maurea C, Esposito E, Barbieri A, Maurea N, Kaldararova M, Tittel P, Kantorova A, Vrsanska V, Kollarova E, Hraska V, Nosal M, Ondriska M, Masura J, Simkova I, Tadeu I, Azevedo O, Lourenco M, Luis F, Lourenco A, Planinc I, Bagadur G, Bijnens B, Ljubas J, Baricevic Z, Skoric B, Velagic V, Milicic D, Cikes M, Campanale CM, Di Maria S, Mega S, Nusca A, Marullo F, Di Sciascio G, El Tahlawi M, Abdallah M, Gouda M, Gad M, Elawady M, Igual Munoz B, Maceira Gonzalez Alicia A, Estornell Erill J, Donate Betolin L, Vazquez Sanchez Alejandro A, Valera Martinez F, Sepulveda- Sanchez P, Cervera Zamora A, Piquer Gil Marina M, Montero- Argudo A, Naka K, Evangelou D, Lakkas L, Kalaitzidis R, Bechlioulis A, Gkirdis I, Tzeltzes G, Nakas G, Pappas K, Michalis L, Mansencal N, Bagate F, Arslan M, Siam-Tsieu V, Deblaise J, El Mahmoud R, Dubourg O, Wierzbowska-Drabik K, Plewka M, Kasprzak J, Bandera F, Generati G, Pellegrino M, Alfonzetti E, Labate V, Villani S, Gaeta M, Guazzi M, Bandera F, Generati G, Pellegrino M, Labate V, Alfonzetti E, Guazzi M, Generati G, Bandera F, Pellegrino M, Labate V, Alfonzetti E, Guazzi M, Grycewicz T, Szymanska K, Grabowicz W, Lubinski A, Sotaquira M, Pepi M, Tamborini G, Caiani E, Bochard Villanueva B, Chacon-Hernandez N, Fabregat-Andres O, Garcia-Gonzalez P, Cubillos-Arango A, De La Espriella-Juan R, Albiach-Montanana C, Berenguer-Jofresa A, Perez-Bosca J, Paya-Serrano R, Cheng HL, Huang CH, Wang YC, Chou WH, Kuznetsov V, Melnikov N, Krinochkin D, Kolunin G, Enina T, Sierraalta W, Le Bihan D, Barretto R, Assef J, Gospos M, Buffon M, Ramos A, Garcia A, Pinto I, Souza A, Mueller H, Reverdin S, Ehret G, Conti L, Dos Santos S, Abdel Moneim SS, Nhola LF, Huang R, Kohli M, Longenbach S, Green M, Villarraga HR, Bordun KA, Jassal DS, Mulvagh SL, Evangelista A, Madeo A, Piras P, Giordano F, Giura G, Teresi L, Gabriele S, Re F, Puddu P, Torromeo C, Suwannaphong S, Vathesatogkit P, See O, Yamwong S, Katekao W, Sritara P, Iliuta L, Szulik M, Streb W, Wozniak A, Lenarczyk R, Sliwinska A, Kalarus Z, Kukulski T, Weng KP, Lin CC, Hein S, Lehmann L, Kossack M, Juergensen L, Katus H, Hassel D, Turrini F, Scarlini S, Giovanardi P, Messora R, Mannucci C, Bondi M, Olander R, Sundholm J, Ojala T, Andersson S, Sarkola T, Karolyi M, Kocsmar I, Raaijmakers R, Kitslaar P, Horvath T, Szilveszter B, Merkely B, Maurovich-Horvat P. Poster session 4: Friday 5 December 2014, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Badagliacca R, Reali M, Vizza C, Poscia R, Pezzuto B, Gambardella C, Papa S, Mezzapesa M, Nocioni M, Fedele F, Freed B, Bhave N, Tsang W, Gomberg-Maitland M, Mor-Avi V, Patel A, Lang RM, Liel-Cohen N, Yaacobi M, Guterman H, Jurzak P, Ternacle J, Gallet R, Bensaid A, Kloeckner M, Monin JL, Gueret P, Dubois-Rande JL, Lim P, Otsuka T, Suzuki M, Yoshikawa H, Hashimoto G, Ishikawa Y, Osaki T, Masai H, Ono T, Yamamoto M, Sugi K, Satendra M, Sargento L, Sousa C, Arsenio A, Lousada N, Palma Reis R, Wang S, Lam Y, Liu M, Fang F, Shang Q, Luo X, Wang J, Sun J, Sanderson J, Yu C, De Marchi S, Hopp E, Urheim S, Hervold A, Murbrach K, Massey R, Remme E, Hol P, Aakhus S, Bouzas Mosquera A, Peteiro J, Broullon F, Garcia NA, Rodriguez Garrido J, Martinez Ruiz D, Yanez Wonenburger J, Bouzas Zubeldia B, Fabregas Casal R, Castro Beiras A, Le Tourneau T, Sportouch C, Foucher C, Delasalle B, Rosso J, Neuder Y, Trochu J, Roncalli J, Lemarchand P, Manrique A, Sharif D, Sharif-Rasslan A, Shahla C, Khalil A, 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Halvorsen P, Remme E, Espinoza A, Hoff L, Skulstad H, Edvardsen T, Fosse E. Automatic real-time detection of myocardial ischemia by epicardial accelerometer. Crit Care 2009. [PMCID: PMC4084046 DOI: 10.1186/cc7324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Segers P, Carlier S, Pasquet A, Rabben SI, Hellevik LR, Remme E, De Backer T, De Sutter J, Thomas JD, Verdonck P. Individualizing the aorto-radial pressure transfer function: feasibility of a model-based approach. Am J Physiol Heart Circ Physiol 2000; 279:H542-9. [PMID: 10924052 DOI: 10.1152/ajpheart.2000.279.2.h542] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We fitted a three-segment transmission line model for the radial-carotid/aorta pressure transfer function (TFF) in 31 controls and 30 patients with coronary artery disease using noninvasively measured (tonometry) radial and carotid artery pressures (P(car)). Except for the distal reflection coefficient (0.85 +/- 0.21 in patients vs. 0.71 +/- 0.25 in controls; P < 0.05), model parameters were not different between patients or controls. Parameters were not related to blood pressure, age, or heart rate. We further assessed a point-to-point averaged TFF (TFF(avg)) as well as upper (TFF(max)) and lower (TFF(min)) enveloping TFF. Pulse pressure (PP) and augmentation index (AIx) were derived on original and reconstructed P(car) (P(car,r)). TFF(avg) yielded closest morphological agreement between P(car) and P(car,r) (root mean square = 4.3 +/- 2.3 mmHg), and TTF(avg) best predicted PP (41.5 +/- 11.8 vs. 41.1 +/- 10.0 mmHg measured) and AIx (-0.02 +/- 0.19 vs. 0.01 +/- 0.19). PP and AIx, calculated from P(car) or P(car,r), were higher in patients than in controls, irrespectively of the TFF used. We conclude that 1) averaged TFF yield significant discrepancies between reconstructed and measured pressure waveforms and subsequent derived AIx; and 2) different TFFs seem to preserve the information in the pressure wave that discriminates between controls and patients.
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Affiliation(s)
- P Segers
- Hydraulics Laboratory, Institute of Biomedical Technology, University of Gent, 9000 Gent, Belgium.
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