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Holmberg E, Tamás É, Nylander E, Engvall J, Granfeldt H. Right ventricular function in severe aortic stenosis assessed by echocardiography and MRI. Clin Physiol Funct Imaging 2024; 44:211-219. [PMID: 37984438 DOI: 10.1111/cpf.12867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 08/12/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The prevalence of aortic valve stenosis (AS) is increasing due to an ageing population. Despite that right ventricular function has prognostic value for postoperative outcome, the right ventricle (RV) is not extensively studied and often not routinely assessed in AS. Our aim was to explore the relation between severe AS and RV function in a surgical aortic valve replacement (SAVR) cohort, comparing two imaging modalities for RV evaluation. METHODS Patients with severe AS, underwent cardiovascular magnetic resonance imaging (CMR) and transthoracic echocardiography (TTE) before SAVR. RV dysfunction was defined as one or more of the following: tricuspid annular plane systolic excursion (TAPSE) < 17 mm, RV free wall strain (RVFWS) > -20% by TTE and RV ejection fraction (RVEF) <50% by CMR. RESULTS Sixteen (33%) patients were found to have RV dysfunction. Patients with RV dysfunction showed significantly lower indexed aortic valve area, left ventricular (LV) ejection fraction as well as RV and LV stroke volumes compared to patients with maintained RV function. All patients with reduced RVEF also had changes in TAPSE or RVFWS and a larger number of patients had a reduced longitudinal RV function despite a normal RVEF. CONCLUSION In a SAVR cohort one-third of the patients had RV dysfunction, defined by RVEF, TAPSE or RVFW strain. Echocardiography detected subtle changes in RV function before RVEF was reduced. It is likely that the more pronounced the AS, the more frequent the occurrence of RV dysfunction.
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Affiliation(s)
- Erica Holmberg
- Department of Thoracic and Cardiovascular Surgery, Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Éva Tamás
- Department of Thoracic and Cardiovascular Surgery, Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Nylander
- Department of Clinical Physiology, Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology, Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hans Granfeldt
- Department of Thoracic and Cardiovascular Surgery, Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Viola F, Bustamante M, Bolger A, Engvall J, Ebbers T. Diastolic function assessment with four-dimensional flow cardiovascular magnetic resonance using automatic deep learning E/A ratio analysis. J Cardiovasc Magn Reson 2024; 26:101042. [PMID: 38556134 DOI: 10.1016/j.jocmr.2024.101042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Diastolic left ventricular (LV) dysfunction is a powerful contributor to the symptoms and prognosis of patients with heart failure. In patients with depressed LV systolic function, the E/A ratio, the ratio between the peak early (E) and the peak late (A) transmitral flow velocity, is the first step to defining the grade of diastolic dysfunction. Doppler echocardiography (echo) is the preferred imaging technique for diastolic function assessment, while cardiovascular magnetic resonance (CMR) is less established as a method. Previous four-dimensional (4D) Flow-based studies have looked at the E/A ratio proximal to the mitral valve, requiring manual interaction. In this study, we compare an automated, deep learning-based and two semi-automated approaches for 4D Flow CMR-based E/A ratio assessment to conventional, gold-standard echo-based methods. METHODS Ninety-seven subjects with chronic ischemic heart disease underwent a cardiac echo followed by CMR investigation. 4D Flow-based E/A ratio values were computed using three different approaches; two semi-automated, assessing the E/A ratio by measuring the inflow velocity (MVvel) and the inflow volume (MVflow) at the mitral valve plane, and one fully automated, creating a full LV segmentation using a deep learning-based method with which the E/A ratio could be assessed without constraint to the mitral plane (LVvel). RESULTS MVvel, MVflow, and LVvel E/A ratios were strongly associated with echocardiographically derived E/A ratio (R2 = 0.60, 0.58, 0.72). LVvel peak E and A showed moderate association to Echo peak E and A, while MVvel values were weakly associated. MVvel and MVflow EA ratios were very strongly associated with LVvel (R2 = 0.84, 0.86). MVvel peak E was moderately associated with LVvel, while peak A showed a strong association (R2 = 0.26, 0.57). CONCLUSION Peak E, peak A, and E/A ratio are integral to the assessment of diastolic dysfunction and may expand the utility of CMR studies in patients with cardiovascular disease. While underestimation of absolute peak E and A velocities was noted, the E/A ratio measured with all three 4D Flow methods was strongly associated with the gold standard Doppler echocardiography. The automatic, deep learning-based method performed best, with the most favorable runtime of ∼40 seconds. As both semi-automatic methods associated very strongly to LVvel, they could be employed as an alternative for estimation of E/A ratio.
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Affiliation(s)
- Federica Viola
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Mariana Bustamante
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; deCODE Genetics/Amgen Inc., Reykjavik, Iceland
| | - Ann Bolger
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Jan Engvall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
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Ekström M, Sundh J, Andersson A, Angerås O, Blomberg A, Börjesson M, Caidahl K, Emilsson ÖI, Engvall J, Frykholm E, Grote L, Hedman K, Jernberg T, Lindberg E, Malinovschi A, Nyberg A, Rullman E, Sandberg J, Sköld M, Stenfors N, Sundström J, Tanash H, Zaigham S, Carlhäll CJ. Exertional breathlessness related to medical conditions in middle-aged people: the population-based SCAPIS study of more than 25,000 men and women. Respir Res 2024; 25:127. [PMID: 38493081 PMCID: PMC10944596 DOI: 10.1186/s12931-024-02766-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Breathlessness is common in the population and can be related to a range of medical conditions. We aimed to evaluate the burden of breathlessness related to different medical conditions in a middle-aged population. METHODS Cross-sectional analysis of the population-based Swedish CArdioPulmonary bioImage Study of adults aged 50-64 years. Breathlessness (modified Medical Research Council [mMRC] ≥ 2) was evaluated in relation to self-reported symptoms, stress, depression; physician-diagnosed conditions; measured body mass index (BMI), spirometry, venous haemoglobin concentration, coronary artery calcification and stenosis [computer tomography (CT) angiography], and pulmonary emphysema (high-resolution CT). For each condition, the prevalence and breathlessness population attributable fraction (PAF) were calculated, overall and by sex, smoking history, and presence/absence of self-reported cardiorespiratory disease. RESULTS We included 25,948 people aged 57.5 ± [SD] 4.4; 51% women; 37% former and 12% current smokers; 43% overweight (BMI 25.0-29.9), 21% obese (BMI ≥ 30); 25% with respiratory disease, 14% depression, 9% cardiac disease, and 3% anemia. Breathlessness was present in 3.7%. Medical conditions most strongly related to the breathlessness prevalence were (PAF 95%CI): overweight and obesity (59.6-66.0%), stress (31.6-76.8%), respiratory disease (20.1-37.1%), depression (17.1-26.6%), cardiac disease (6.3-12.7%), anemia (0.8-3.3%), and peripheral arterial disease (0.3-0.8%). Stress was the main factor in women and current smokers. CONCLUSION Breathlessness mainly relates to overweight/obesity and stress and to a lesser extent to comorbidities like respiratory, depressive, and cardiac disorders among middle-aged people in a high-income setting-supporting the importance of lifestyle interventions to reduce the burden of breathlessness in the population.
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Affiliation(s)
- Magnus Ekström
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Faculty of Medicine, Lund University, 221 84, Lund, Sweden.
| | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anders Andersson
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
- COPD Center, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg, Sweden
- Center for Lifestyle Intervention, Department MGAÖ, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kenneth Caidahl
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, and Sahlgrenska Academy, Gothenburg, Sweden
| | - Össur Ingi Emilsson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Jan Engvall
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Erik Frykholm
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Ludger Grote
- Center for Sleep and Vigilance Disorders, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Sleep Disorders Centre, Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristofer Hedman
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - André Nyberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Eric Rullman
- Department of Laboratory Medicine, Section of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jacob Sandberg
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Faculty of Medicine, Lund University, 221 84, Lund, Sweden
| | - Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Nikolai Stenfors
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Hanan Tanash
- Department of Respiratory Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Suneela Zaigham
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Carl-Johan Carlhäll
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
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Fridolfsson C, Thegerström J, Åkesson K, Engvall J, Blomstrand P. Lower left atrial function in young individuals with type 1 diabetes mellitus compared to healthy controls: an echocardiographic study. Sci Rep 2024; 14:3982. [PMID: 38368449 PMCID: PMC10874446 DOI: 10.1038/s41598-024-54597-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/14/2024] [Indexed: 02/19/2024] Open
Abstract
In adulthood, individuals with type 1 diabetes mellitus may develop a condition of heart failure with preserved ejection fraction. However, subclinical changes to the heart in diabetes are likely to occur prior to the clinical presentation. This cross-sectional study aimed to compare left atrial function by echocardiography between 43 individuals with type 1 diabetes and 43 healthy controls, aged 10-30 years. All participants underwent echocardiography and 2D speckle tracking measurements for left atrial phase function parameters. Physical capacity was assessed by exercise test on a bicycle. Results showed that participants with type 1 diabetes had significantly lower left atrial function parameters than healthy controls (p < 0.05). There was a significant negative correlation between HbA1c means and reservoir and conduit strain (p < 0.05) and individuals with BMI < 30 showed a lower left atrial stiffness (p < 0.05). Individuals with type 1 diabetes and a higher physical capacity did not differ from their healthy peers. Results indicate that lower HbA1c levels, BMI < 30 and a higher physical capacity are favourable in terms of left atrial function in children and young adults with type 1 diabetes mellitus. Left atrial strain by echocardiography might become a new important tool in assessing heart function in T1DM.
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Affiliation(s)
- Cecilia Fridolfsson
- Department of Clinical Physiology in Kalmar, Region Kalmar County, Kalmar, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Johanna Thegerström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Paediatrics in Kalmar, Region Kalmar County, Kalmar, Sweden
- Faculty of Health and Life Sciences (FHL), Linnaeus University, Kalmar, Sweden
| | - Karin Åkesson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden
| | - Jan Engvall
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, Linköping University Hospital, Linköping, Sweden
| | - Peter Blomstrand
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Natural Sciences and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Blixt PJ, Nguyen M, Cholley B, Hammarskjöld F, Toiron A, Bouhemad B, Lee S, De Geer L, Andersson H, Aneq MÅ, Engvall J, Chew MS. Association between left ventricular systolic function parameters and myocardial injury, organ failure and mortality in patients with septic shock. Ann Intensive Care 2024; 14:12. [PMID: 38236316 PMCID: PMC10796855 DOI: 10.1186/s13613-023-01235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) is inconsistently associated with poor outcomes in patients with sepsis. Newer parameters such as LV longitudinal strain (LVLS), mitral annular plane systolic excursion (MAPSE) and LV longitudinal wall fractional shortening (LV-LWFS) may be more sensitive indicators of LV dysfunction, but are sparsely investigated. Our objective was to evaluate the association between five traditional and novel echocardiographic parameters of LV systolic function (LVEF, peak tissue Doppler velocity at the mitral valve (s´), LVLS, MAPSE and LV-LWFS) and outcomes in patients admitted to the Intensive Care Unit (ICU) with septic shock. METHODS A total of 152 patients admitted to the ICU with septic shock from two data repositories were included. Transthoracic echocardiograms were performed within 24 h of ICU admission. The primary outcome was myocardial injury, defined as high-sensitivity troponin T ≥ 45 ng/L on ICU admission. Secondary outcomes were organ support-free days (OSFD) and 30-day mortality. We also tested for the prognostic value of the systolic function parameters using multivariable analysis. RESULTS LVLS, MAPSE and LV-LWFS, but not LVEF and s´, differed between patients with and without myocardial injury. After adjustment for age, pre-existing cardiac disease, Simplified Acute Physiology (SAPS3) score, Sequential Organ Failure Assessment (SOFA) score, plasma creatinine and presence of right ventricular dysfunction, only MAPSE and LV-LWFS were independently associated with myocardial injury. None of the systolic function parameters were associated with OSFD or 30-day mortality. CONCLUSIONS MAPSE and LV-LWFS are independently associated with myocardial injury and outperform LVEF, s´ and LVLS. Whether these parameters are associated with clinical outcomes such as the need for organ support and short-term mortality is still unclear. Trial registration NCT01747187 and NCT04695119.
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Affiliation(s)
- Patrik Johansson Blixt
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden
| | - Maxime Nguyen
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France
| | - Bernard Cholley
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, Paris, France
- UMR-S1140 "Innovations Thérapeutiques en Hémostase", Université Paris Cité, INSERM, Paris, France
| | - Fredrik Hammarskjöld
- Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden
| | - Alois Toiron
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, Paris, France
| | - Belaid Bouhemad
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France
| | - Shaun Lee
- Intensive Care Unit, St Georges Hospital, London, UK
| | - Lina De Geer
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden
| | - Henrik Andersson
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden
| | - Meriam Åström Aneq
- Department of Clinical Physiology, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden.
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Ekblom-Bak E, Börjesson M, Ekblom Ö, Angerås O, Bergman F, Berntsson C, Carlhäll CJ, Engström G, Engvall J, Fagman E, Flinck A, Johansson P, Jujic A, Kero T, Lind L, Mannila M, Ostenfeld E, Persson A, Persson J, Persson M, Redfors B, Sandberg C, Wennberg P, Öhlin J, Östgren CJ, Jernberg T. Accelerometer derived physical activity and subclinical coronary and carotid atherosclerosis: cross-sectional analyses in 22 703 middle-aged men and women in the SCAPIS study. BMJ Open 2023; 13:e073380. [PMID: 37996228 PMCID: PMC10668326 DOI: 10.1136/bmjopen-2023-073380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES The aim included investigation of the associations between sedentary (SED), low-intensity physical activity (LIPA), moderate-to-vigorous intensity PA (MVPA) and the prevalence of subclinical atherosclerosis in both coronaries and carotids and the estimated difference in prevalence by theoretical reallocation of time in different PA behaviours. DESIGN Cross-sectional. SETTING Multisite study at university hospitals. PARTICIPANTS A total of 22 670 participants without cardiovascular disease (51% women, 57.4 years, SD 4.3) from the population-based Swedish CArdioPulmonary bioImage study were included. SED, LIPA and MVPA were assessed by hip-worn accelerometer. PRIMARY AND SECONDARY OUTCOMES Any and significant subclinical coronary atherosclerosis (CA), Coronary Artery Calcium Score (CACS) and carotid atherosclerosis (CarA) were derived from imaging data from coronary CT angiography and carotid ultrasound. RESULTS High daily SED (>70% ≈10.5 hours/day) associated with a higher OR 1.44 (95% CI 1.09 to 1.91), for significant CA, and with lower OR 0.77 (95% CI 0.63 to 0.95), for significant CarA. High LIPA (>55% ≈8 hours/day) associated with lower OR for significant CA 0.70 (95% CI 0.51 to 0.96), and CACS, 0.71 (95% CI 0.51 to 0.97), but with higher OR for CarA 1.41 (95% CI 1.12 to 1.76). MVPA above reference level, >2% ≈20 min/day, associated with lower OR for significant CA (OR range 0.61-0.67), CACS (OR range 0.71-0.75) and CarA (OR range 0.72-0.79). Theoretical replacement of 30 min of SED into an equal amount of MVPA associated with lower OR for significant CA, especially in participants with high SED 0.84 (95% CI 0.76 to 0.96) or low MVPA 0.51 (0.36 to 0.73). CONCLUSIONS MVPA was associated with a lower risk for significant atherosclerosis in both coronaries and carotids, while the association varied in strength and direction for SED and LIPA, respectively. If causal, clinical implications include avoiding high levels of daily SED and low levels of MVPA to reduce the risk of developing significant subclinical atherosclerosis.
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Affiliation(s)
- Elin Ekblom-Bak
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences GIH, Stockholm, Sweden
| | - Mats Börjesson
- Center for Health and Performance, University of Gothenburg, Goteborg, Sweden
- Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | - Örjan Ekblom
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences GIH, Stockholm, Sweden
| | - Oskar Angerås
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
| | - Frida Bergman
- Department of Public Health and Clinical Medicine, Umeå Universitet, Umeå, Sweden
| | - Caroline Berntsson
- Department of Radiology, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Goteborg, Sweden
| | - Carl-Johan Carlhäll
- Department of Health, Medicine and Caring Sciences and Department of Clinical Physiology, Linköping University, Linkoping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linkoping, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Jan Engvall
- Department of Health, Medicine and Caring Sciences and Department of Clinical Physiology, Linköping University, Linkoping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linkoping, Sweden
| | - Erika Fagman
- Department of Radiology, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Goteborg, Sweden
| | - Agneta Flinck
- Department of Radiology, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Goteborg, Sweden
| | - Peter Johansson
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Amra Jujic
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital Malmö, Malmo, Sweden
| | - Tanja Kero
- Medical Image Centre, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences and Radiology, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Maria Mannila
- Department of Cardiology and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Anders Persson
- Center for Medical Image Science and Visualization, Linköping University, Linkoping, Sweden
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Clinical Sciences, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Jonas Persson
- Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Internal Medicine, University Hospital, Malmö, Sweden
| | - Björn Redfors
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Camilla Sandberg
- Department of Public Health and Clinical Medicine, Umeå Universitet, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umea, Sweden
| | - Patrik Wennberg
- Public Health and Clinical Medicine, Family Medicine, Umeå University, Umea, Sweden
| | - Jerry Öhlin
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Carl Johan Östgren
- Center for Medical Image Science and Visualization, Linköping University, Linkoping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
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El-Saadi W, Engvall J, Karlsson JE, Maret E. Four- to seven-year follow-up of pharmacological postconditioning with mangafodipir as an adjunct to primary PCI in ST-segment elevation myocardial infarction. Clin Physiol Funct Imaging 2023; 43:413-420. [PMID: 37300475 DOI: 10.1111/cpf.12839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Adverse left ventricular remodelling (AR) develops over time in approximately 30% of patients with a history of coronary artery disease. AR manifests as a structural change in the left ventricle (LV) in terms of increased volumes and reduced left ventricular ejection fraction (LVEF). Manganese dipyridoxyl diphosphate (mangafodipir) has demonstrated interesting cardioprotective features in acute myocardial ischaemia. Pharmacological postconditioning (PP) with mangafodipir as an adjunct to primary percutaneous coronary intervention may possibly reduce the development of AR over time in ST-elevation myocardial infarction (STEMI). The aim of this 4-7-year follow-up study is to investigate the potential benefits of PP with mangafodipir in STEMI patients. METHOD Thirteen out of the initial 20 patients that were included in the primary study of Karlsson et al. were followed up between April and June 2017. The study group underwent review of the hospital records, a clinical examination with ECG and blood sample analysis before cardiac magnetic resonance examination of the patient. LVEF, left ventricular diastolic volume, left ventricular end systolic volume, LV mass and myocardial strain in all directions were computed. RESULTS The PP group showed a decrease in LV volume, mass and higher LVEF at follow-up (p < 0.05) while the individual response of the placebo group showed features that are seen in AR. Although there was no difference in myocardial strain, measurement for the PP-group was higher in absolute terms. CONCLUSION Pharmacological postconditioning with mangafodipir in STEMI demonstrated cardioprotective features compared to the placebo group at follow-up. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Walid El-Saadi
- Department of Internal Medicine, Ryhov County Hospital, Region Jönköping County, Jönköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology, Linköping University, Linköping, Sweden
- Center for Medical Imaging Science and Visualization, Linköping University, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, Ryhov County Hospital, Region Jönköping County, Jönköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Maret
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Engvall J. Is it worth screening for congenital structural heart disease in newborn infants? Acta Paediatr 2023; 112:2028-2029. [PMID: 37431185 DOI: 10.1111/apa.16903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Jan Engvall
- Department of Clinical Physiology and Center of Medical Image Science and Visualization, Linköpings Universitet, Linköping, Sweden
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Tunedal K, Viola F, Garcia BC, Bolger A, Nyström FH, Östgren CJ, Engvall J, Lundberg P, Dyverfeldt P, Carlhäll CJ, Cedersund G, Ebbers T. Haemodynamic effects of hypertension and type 2 diabetes: Insights from a 4D flow MRI-based personalized cardiovascular mathematical model. J Physiol 2023; 601:3765-3787. [PMID: 37485733 DOI: 10.1113/jp284652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Type 2 diabetes (T2D) and hypertension increase the risk of cardiovascular diseases mediated by whole-body changes to metabolism, cardiovascular structure and haemodynamics. The haemodynamic changes related to hypertension and T2D are complex and subject-specific, however, and not fully understood. We aimed to investigate the haemodynamic mechanisms in T2D and hypertension by comparing the haemodynamics between healthy controls and subjects with T2D, hypertension, or both. For all subjects, we combined 4D flow magnetic resonance imaging data, brachial blood pressure and a cardiovascular mathematical model to create a comprehensive subject-specific analysis of central haemodynamics. When comparing the subject-specific haemodynamic parameters between the four groups, the predominant haemodynamic difference is impaired left ventricular relaxation in subjects with both T2D and hypertension compared to subjects with only T2D, only hypertension and controls. The impaired relaxation indicates that, in this cohort, the long-term changes in haemodynamic load of co-existing T2D and hypertension cause diastolic dysfunction demonstrable at rest, whereas either disease on its own does not. However, through subject-specific predictions of impaired relaxation, we show that altered relaxation alone is not enough to explain the subject-specific and group-related differences; instead, a combination of parameters is affected in T2D and hypertension. These results confirm previous studies that reported more adverse effects from the combination of T2D and hypertension compared to either disease on its own. Furthermore, this shows the potential of personalized cardiovascular models in providing haemodynamic mechanistic insights and subject-specific predictions that could aid in the understanding and treatment planning of patients with T2D and hypertension. KEY POINTS: The combination of 4D flow magnetic resonance imaging data and a cardiovascular mathematical model allows for a comprehensive analysis of subject-specific haemodynamic parameters that otherwise cannot be derived non-invasively. Using this combination, we show that diastolic dysfunction in subjects with both type 2 diabetes (T2D) and hypertension is the main group-level difference between controls, subjects with T2D, subjects with hypertension, and subjects with both T2D and hypertension. These results suggest that, in this relatively healthy population, the additional load of both hypertension and T2D affects the haemodynamic function of the left ventricle, whereas each disease on its own is not enough to cause significant effects under resting conditions. Finally, using the subject-specific model, we show that the haemodynamic effects of diastolic dysfunction alone are not sufficient to explain all the observed haemodynamic differences. Instead, additional subject-specific variations in cardiac and vascular function combine to explain the complex haemodynamics of subjects affected by hypertension and/or T2D.
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Affiliation(s)
- Kajsa Tunedal
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Federica Viola
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Belén Casas Garcia
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Ann Bolger
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Fredrik H Nyström
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Petter Dyverfeldt
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Gunnar Cedersund
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Swahn E, Lekedal H, Engvall J, Nyström FH, Jonasson L. Prevalence and determinants of dilated ascending aorta in a Swedish population: a case-control study. Eur Heart J Open 2023; 3:oead085. [PMID: 37767013 PMCID: PMC10519809 DOI: 10.1093/ehjopen/oead085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/26/2023] [Accepted: 08/01/2023] [Indexed: 09/29/2023]
Abstract
Aims Dilation of the ascending aorta (AA) is often asymptomatic until a life-threatening dissection or rupture occurs. An overall increase in the use of thoracic imaging has enabled early and sometimes incidental identification of AA dilation. Still, the prevalence and determinants of AA dilation remain to be clarified. The aim was to identify and characterize persons with AA dilation in a middle-aged Swedish population. Methods and results We used the Swedish CardioPulmonary BioImage Study Linköping (n = 5058, age 50-65 years) to identify cases with AA diameter ≥ 40 mm on coronary computed tomography angiography (CCTA) or chest computed tomography. Age- and gender-matched individuals with AA diameter < 40 mm served as controls. Echocardiography, blood pressure (BP) measurements (office and home), pulse wave velocity (PWV), coronary artery calcification (CAC), CCTA-detected coronary atherosclerosis, and carotid ultrasound were used to characterize these subjects. We identified 70 cases (mean AA diameter 44 mm, 77% men) and matched these to 146 controls (mean AA diameter 34 mm). Bicuspid aortic valve and aortic valve dysfunction were more common in cases than in controls (8% vs. 0% and 39% vs. 11%, respectively). Both office and home BP levels were significantly higher among cases. Also, high PWV (>10 m/s) levels were more common in cases (33% vs. 17%). Neither CAC scores nor prevalence or burden of atherosclerosis in coronary and carotid arteries differed between groups. Conclusion The prevalence of dilated AA was 1.4% and showed positive associations with male gender, aortic valve pathology, and diastolic BP, though not with subclinical atherosclerosis.
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Affiliation(s)
- Eva Swahn
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Hanna Lekedal
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
- Department of Clinical Physiology, Linköping University, Linköping, Sweden
- CMIV, Center for Medical Image Science and Viusalization, Linköping University, Linköping, Sweden
| | - Fredrik H Nyström
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Lena Jonasson
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
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af Geijerstam P, Engvall J, Östgren CJ, Rådholm K, Nyström FH. Masked hypertension in a middle-aged population and its relation to manifestations of vascular disease. J Hypertens 2023; 41:1084-1091. [PMID: 37016927 PMCID: PMC10242518 DOI: 10.1097/hjh.0000000000003431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/04/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Masked hypertension is associated with cardiovascular disease (CVD). However, previous large studies have not used the same device to measure office and home blood pressure (BP) and adhered to current home BP measurement recommendations of the European Society of Hypertension. We aimed to characterize masked hypertension and explore its relation to manifestations of CVD. METHODS A randomly selected cohort of 5057 participants aged 50-64 years from the Swedish CardioPulmonary BioImage Study (SCAPIS) was evaluated with office and home BP using the semi-automatic Omron M10-IT oscillometric device. Additional analyses included pulse wave velocity (PWV) and coronary artery calcium score (CACS). RESULTS Of participants, 4122 did not have current antihypertensive treatment, and were thus included in our analyses. Of these, 2634 (63.9%) had sustained normotension, and 172 (4.2%) had masked hypertension. Participants with masked hypertension vs. sustained normotension were more often men (66.9 vs. 46.2%, P < 0.001). Those with masked hypertension had higher mean PWV [9.3 (95% confidence interval, 95% CI 9.1-9.5) vs. 8.3 (95% CI 8.2-8.4) m/s, P < 0.001] and odds ratio for CACS at least 100 [1.65 (95% CI 1.02-2.68), P = 0.040]. These associations were similar in a posthoc analysis of masked hypertension and sustained normotension, matched for age, sex and systolic office BP. CONCLUSION Masked hypertension was associated with markers of CVD. This suggests that home BP is a better predictor of risk, even when the recordings are performed with the same measurement device, in a population-based setting with randomized recruitment.
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Affiliation(s)
- Peder af Geijerstam
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences
| | - Jan Engvall
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences
- Center of Medical Image Science and Visualization
- Department of Clinical Physiology, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences
- Center of Medical Image Science and Visualization
| | - Karin Rådholm
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Fredrik H. Nyström
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences
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Fagman E, Alvén J, Westerbergh J, Kitslaar P, Kercsik M, Cederlund K, Duvernoy O, Engvall J, Gonçalves I, Markstad H, Ostenfeld E, Bergström G, Hjelmgren O. High-quality annotations for deep learning enabled plaque analysis in SCAPIS cardiac computed tomography angiography. Heliyon 2023; 9:e16058. [PMID: 37215775 PMCID: PMC10199173 DOI: 10.1016/j.heliyon.2023.e16058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
Background Plaque analysis with coronary computed tomography angiography (CCTA) is a promising tool to identify high risk of future coronary events. The analysis process is time-consuming, and requires highly trained readers. Deep learning models have proved to excel at similar tasks, however, training these models requires large sets of expert-annotated training data. The aims of this study were to generate a large, high-quality annotated CCTA dataset derived from Swedish CArdioPulmonary BioImage Study (SCAPIS), report the reproducibility of the annotation core lab and describe the plaque characteristics and their association with established risk factors. Methods and results The coronary artery tree was manually segmented using semi-automatic software by four primary and one senior secondary reader. A randomly selected sample of 469 subjects, all with coronary plaques and stratified for cardiovascular risk using the Systematic Coronary Risk Evaluation (SCORE), were analyzed. The reproducibility study (n = 78) showed an agreement for plaque detection of 0.91 (0.84-0.97). The mean percentage difference for plaque volumes was -0.6% the mean absolute percentage difference 19.4% (CV 13.7%, ICC 0.94). There was a positive correlation between SCORE and total plaque volume (rho = 0.30, p < 0.001) and total low attenuation plaque volume (rho = 0.29, p < 0.001). Conclusions We have generated a CCTA dataset with high-quality plaque annotations showing good reproducibility and an expected correlation between plaque features and cardiovascular risk. The stratified data sampling has enriched high-risk plaques making the data well suited as training, validation and test data for a fully automatic analysis tool based on deep learning.
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Affiliation(s)
- Erika Fagman
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jennifer Alvén
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden
- Computer Vision and Medical Image Analysis, Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Johan Westerbergh
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - Michael Kercsik
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden
- Department of Radiology, Alingsås Hospital, Alingsås, Sweden
| | - Kerstin Cederlund
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Olov Duvernoy
- Section of Radiology, Department of Surgical Sciences, Uppsala University, Sweden
| | - Jan Engvall
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
- CMIV – Center for Medical Image Science and Visualization, Linkoping University, Linkoping, Sweden
| | - Isabel Gonçalves
- Department of Cardiology, Skane University Hospital, Lund, Sweden
- Cardiovascular Research Translational Studies, Clinical Sciences Malmö, Lund University, Sweden
| | - Hanna Markstad
- Cardiovascular Research Translational Studies, Clinical Sciences Malmö, Lund University, Sweden
- Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ola Hjelmgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Cederqvist J, Rådholm K, Muhammad IF, Engström G, Engvall J, Östgren CJ. Arterial stiffness and subclinical atherosclerosis in the coronary arteries at different stages of dysglycaemia. Diabet Med 2023:e15102. [PMID: 37004152 DOI: 10.1111/dme.15102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 11/22/2022] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND AND AIM Our aim was to investigate in a large population-based cohort study whether increased arterial stiffness and subclinical atherosclerosis in the coronary arteries differ at different stages of dysglycaemia. METHODS Data were obtained from SCAPIS, a population-based cohort of participants 50-64 years. The study population of 9,379 participants were categorised according to glycaemic status: normoglycaemic, pre-diabetes (fasting glucose: 6.1-6.9 mmol/L and/or HbA1c 6-6.4%), and diabetes. Pulse wave velocity (PWV) was measured by the SphygmoCor XCEL system and arterial stiffness was defined by PWV ≥ 10m/s. Coronary artery calcium score (CACS) was assessed by coronary computed tomography and coronary artery calcification was defined by CACS ≥100. RESULTS We identified 1,964 (21%) participants with dysglycaemia, out of which 742 (7.9%) had diabetes mellitus. PWV ≥ 10m/s was present in 808 (11%), 191 (16%), 200 (27%) and CACS ≥100 in 801 (11%), 190 (16%), 191 (28%) participants with normoglycaemia, pre-diabetes and diabetes, respectively, all, p <0.001. The overlap between PWV ≥10m/s and CACS ≥100 within each glycaemic category was 188 (2.5%), 44 (3.6%) and 77 (10), respectively. There was an association between glycaemic status and increased PWV in the fully adjusted models, but not for glycaemic status and CACS ≥100, where there was no difference for pre-diabetes compared to normoglycaemia, OR 1.2 (95%CI 0.98 - 1.4). In the total study population, there was an association between HbA1c and PWV after adjustment, p<0.001. CONCLUSIONS Our results show that increased arterial stiffness and subclinical coronary artery atherosclerosis are present in the early stages of dysglycaemia, but the overlap between markers of major subclinical vascular damage was small in all glycaemic categories. This could be explained by different pathways in the pathogenesis of arterial stiffness or atherosclerosis in the coronary arteries.
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Affiliation(s)
- John Cederqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Karin Rådholm
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Gunnar Engström
- Department of Clinical Science, Lund University, Malmö, Sweden
| | - Jan Engvall
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping university, Linköping, Sweden
- Centre for Medical Image Science and Visualization (CMIV), Linköping university, Linköping, Sweden
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Centre for Medical Image Science and Visualization (CMIV), Linköping university, Linköping, Sweden
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Karlsson J, Stålhand J, Carlhäll CJ, Länne T, Engvall J. An in vivo study of isotropic and anisotropic wall stress in a hyperelastic holzapfel-gasser-ogden model in the human abdominal aorta: Effects of age and sex. Front Physiol 2023; 14:1128131. [PMID: 36994420 PMCID: PMC10040878 DOI: 10.3389/fphys.2023.1128131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Background: Wall stress of the abdominal aorta (AA) appears to be an important factor in the assessment of risk for rupture based on the relationship between blood pressure and aortic diameter. We therefore investigated peak wall stress as well as isotropic and anisotropic wall stress of AA.Methods: Thirty healthy adults (male = 15) were included. Pulsatile diameter changes were determined non-invasively by an echo-tracking system, and intra-aortic pressure was measured simultaneously. A computer based mechanical model was used to compute the isotropic and anisotropic components of circumferential and longitudinal stresses.Results: Elderly males had higher total wall stress and a higher isotropic stress component in the circumferential direction and higher total longitudinal wall stress than elderly females. The isotropic component increased with age in males but not in females, whereas the anisotropic component decreased with age in both sexes.Conclusion: We found that isotropic and anisotropic properties of the abdominal aortic wall differ between young and elderly participants and between the sexes. A possible explanation could relate to chemical alterations (e.g., due to sex hormones) and changes over time in the physical distribution of fibers. Modeling of wall stress components of the human AA may contribute to a better understanding of elastin-collagen interactions during remodeling of the aortic wall.
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Affiliation(s)
- Jerker Karlsson
- Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- *Correspondence: Jerker Karlsson,
| | - Jonas Stålhand
- Solid Mechanics, Department of Management and Engineering, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Toste Länne
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Thoracic and Vascular Surgery in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
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Bustamante M, Viola F, Engvall J, Carlhäll C, Ebbers T. Automatic Time‐Resolved Cardiovascular Segmentation of 4D Flow MRI Using Deep Learning. J Magn Reson Imaging 2023. [DOI: 10.1002/jmri.28241] [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] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Bustamante M, Viola F, Engvall J, Carlhäll C, Ebbers T. Automatic Time-Resolved Cardiovascular Segmentation of 4D Flow MRI Using Deep Learning. J Magn Reson Imaging 2023; 57:191-203. [PMID: 35506525 PMCID: PMC10946960 DOI: 10.1002/jmri.28221] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Segmenting the whole heart over the cardiac cycle in 4D flow MRI is a challenging and time-consuming process, as there is considerable motion and limited contrast between blood and tissue. PURPOSE To develop and evaluate a deep learning-based segmentation method to automatically segment the cardiac chambers and great thoracic vessels from 4D flow MRI. STUDY TYPE Retrospective. SUBJECTS A total of 205 subjects, including 40 healthy volunteers and 165 patients with a variety of cardiac disorders were included. Data were randomly divided into training (n = 144), validation (n = 20), and testing (n = 41) sets. FIELD STRENGTH/SEQUENCE A 3 T/time-resolved velocity encoded 3D gradient echo sequence (4D flow MRI). ASSESSMENT A 3D neural network based on the U-net architecture was trained to segment the four cardiac chambers, aorta, and pulmonary artery. The segmentations generated were compared to manually corrected atlas-based segmentations. End-diastolic (ED) and end-systolic (ES) volumes of the four cardiac chambers were calculated for both segmentations. STATISTICAL TESTS Dice score, Hausdorff distance, average surface distance, sensitivity, precision, and miss rate were used to measure segmentation accuracy. Bland-Altman analysis was used to evaluate agreement between volumetric parameters. RESULTS The following evaluation metrics were computed: mean Dice score (0.908 ± 0.023) (mean ± SD), Hausdorff distance (1.253 ± 0.293 mm), average surface distance (0.466 ± 0.136 mm), sensitivity (0.907 ± 0.032), precision (0.913 ± 0.028), and miss rate (0.093 ± 0.032). Bland-Altman analyses showed good agreement between volumetric parameters for all chambers. Limits of agreement as percentage of mean chamber volume (LoA%), left ventricular: 9.3%, 13.5%, left atrial: 12.4%, 16.9%, right ventricular: 9.9%, 15.6%, and right atrial: 18.7%, 14.4%; for ED and ES, respectively. DATA CONCLUSION The addition of this technique to the 4D flow MRI assessment pipeline could expedite and improve the utility of this type of acquisition in the clinical setting. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Mariana Bustamante
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
- Center for Medical Image Science and Visualization (CMIV)Linköping UniversityLinköpingSweden
| | - Federica Viola
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Jan Engvall
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
- Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Carl‐Johan Carlhäll
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
- Center for Medical Image Science and Visualization (CMIV)Linköping UniversityLinköpingSweden
- Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Tino Ebbers
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
- Center for Medical Image Science and Visualization (CMIV)Linköping UniversityLinköpingSweden
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17
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Hult L, Kylhammar D, Engvall J, Ostgren CJ, Nystrom F, Blomstrand P, Hedman K. Post systolic shortening by speckle tracking echocardiography as a predictor for cardiovascular events in patients with type 2 diabetes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.923] [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
Background
Post systolic shortening (PSS), measured by speckle tracking echocardiography has emerged as a novel method to evaluate left ventricular function and has been linked to adverse outcomes.
Purpose
Our aim was to assess if the presence of pathological PSS had prognostic value in the prediction of major cardiovascular events in a cohort of patients with type-II diabetes (T2D).
Method
Three-hundred-and-sixty-four patients with T2D in the CARDIPP study (Cardiovascular Risk factors in Patients with Diabetes – a Prospective study in Primary care) underwent echocardiography between 2005 and 2009. All patients were evaluated with strain analysis by speckle tracking. PSS was defined as any myocardial contraction occurring after aortic valve closure (Figure 1). Pathological PSS was defined as a post systolic index (PSI) >5% where PSI was calculated as: (peak global longitudinal strain – peak systolic longitudinal strain) / (peak global longitudinal strain) x 100. The composite endpoint of any major cardiovascular event (MACE) was defined as the diagnosis of or death in heart failure, myocardial infarction, or stroke. Cox proportional hazard ratios (HR) with 95% confidence intervals were calculated and were adjusted for sex, age, body mass index, hypertension, smoking, previous cardiovascular events and HbA1c.
Results
Mean follow-up time was 11.2±2.3 years. Patients with pathological PSS had an increased unadjusted risk of MACE, (HR 3.73, 95% CI 2.06–6.76), which persisted after adjustment (HR 2.20, 95% CI 1.11–4.37) as compared to subjects without pathological PSS. When adding PSS to a risk prediction model including Global Longitudinal Strain (GLS), the adjusted HR (95% CI) for MACE was 2.94 (1.33–6.52) for subjects with reduced GLS (lower limit of normal −16%) and PSI >5%, compared to those with normal GLS and PSI ≤5%. Adverse events were more common in subjects with the combination of pathological PSS and GLS (Figure 2).
Conclusions
Our results suggest that PSS may provide important additional prognostic information in patients with T2D.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): This work was funded by grant support from FORSS, the Research Council of Southeastern Sweden and from FUTURUM, the Research Council of Jönköping.
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Affiliation(s)
- L Hult
- Linkoping University Hospital, Department of Health, Medicine and Caring Sciences, and Department of Clinical Physiology , Linkoping , Sweden
| | - D Kylhammar
- Linkoping University Hospital, Department of Health, Medicine and Caring Sciences, and Department of Clinical Physiology , Linkoping , Sweden
| | - J Engvall
- Linkoping University Hospital, Department of Health, Medicine and Caring Sciences, and Department of Clinical Physiology , Linkoping , Sweden
| | - C J Ostgren
- Linkoping University, Department of Health, Medicine and Caring Sciences , Linkoping , Sweden
| | - F Nystrom
- Linkoping University, Department of Health, Medicine and Caring Sciences , Linkoping , Sweden
| | - P Blomstrand
- Jonkoping University, Department of Natural Science and Biomedicine, School of Health and Welfare , Jonkoping , Sweden
| | - K Hedman
- Linkoping University Hospital, Department of Health, Medicine and Caring Sciences, and Department of Clinical Physiology , Linkoping , Sweden
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18
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Chew MS, Jansson S, Aneq MÅ, Engvall J. Definition and evolution of right ventricular dysfunction in critically ill COVID-19 patients. Author's reply. Ann Intensive Care 2022; 12:83. [PMID: 36040580 PMCID: PMC9424803 DOI: 10.1186/s13613-022-01056-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Michelle S Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Saga Jansson
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Meriam Åström Aneq
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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19
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Edin C, Ekstedt M, Scheffel T, Karlsson M, Swahn E, Östgren CJ, Engvall J, Ebbers T, Leinhard OD, Lundberg P, Carlhäll CJ. Ectopic fat is associated with cardiac remodeling—A comprehensive assessment of regional fat depots in type 2 diabetes using multi-parametric MRI. Front Cardiovasc Med 2022; 9:813427. [PMID: 35966535 PMCID: PMC9366177 DOI: 10.3389/fcvm.2022.813427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDifferent regional depots of fat have distinct metabolic properties and may relate differently to adverse cardiac remodeling. We sought to quantify regional depots of body fat and to investigate their relationship to cardiac structure and function in Type 2 Diabetes (T2D) and controls.MethodsFrom the SCAPIS cohort in Linköping, Sweden, we recruited 92 subjects (35% female, mean age 59.5 ± 4.6 years): 46 with T2D and 46 matched controls. In addition to the core SCAPIS data collection, participants underwent a comprehensive magnetic resonance imaging examination at 1.5 T for assessment of left ventricular (LV) structure and function (end-diastolic volume, mass, concentricity, ejection fraction), as well as regional body composition (liver proton density fat fraction, visceral adipose tissue, abdominal subcutaneous adipose tissue, thigh muscle fat infiltration, fat tissue-free thigh muscle volume and epicardial adipose tissue).ResultsCompared to the control group, the T2D group had increased: visceral adipose tissue volume index (P < 0.001), liver fat percentage (P < 0.001), thigh muscle fat infiltration percentage (P = 0.02), LV concentricity (P < 0.001) and LV E/e'-ratio (P < 0.001). In a multiple linear regression analysis, a negative association between liver fat percentage and LV mass (St Beta −0.23, P < 0.05) as well as LV end-diastolic volume (St Beta −0.27, P < 0.05) was found. Epicardial adipose tissue volume and abdominal subcutaneous adipose tissue volume index were the only parameters of fat associated with LV diastolic dysfunction (E/e'-ratio) (St Beta 0.24, P < 0.05; St Beta 0.34, P < 0.01, respectively). In a multivariate logistic regression analysis, only visceral adipose tissue volume index was significantly associated with T2D, with an odds ratio for T2D of 3.01 (95% CI 1.28–7.05, P < 0.05) per L/m2 increase in visceral adipose tissue volume.ConclusionsEctopic fat is predominantly associated with cardiac remodeling, independently of type 2 diabetes. Intriguingly, liver fat appears to be related to LV structure independently of VAT, while epicardial fat is linked to impaired LV diastolic function. Visceral fat is associated with T2D independently of liver fat and abdominal subcutaneous adipose tissue.
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Affiliation(s)
- Carl Edin
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- *Correspondence: Carl Edin
| | - Mattias Ekstedt
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Gastroenterology in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Tobias Scheffel
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Markus Karlsson
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- AMRA Medical AB, Linköping University, Linköping, Sweden
- Department of Radiation Physics and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Swahn
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Olof Dahlqvist Leinhard
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- AMRA Medical AB, Linköping University, Linköping, Sweden
- Department of Radiation Physics and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Radiation Physics and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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20
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af Geijerstam P, Engvall J, Östgren CJ, Nyström FH, Rådholm K. Home Blood Pressure Compared With Office Blood Pressure in Relation to Dysglycemia. Am J Hypertens 2022; 35:810-819. [PMID: 35849046 PMCID: PMC9434242 DOI: 10.1093/ajh/hpac082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/01/2022] [Accepted: 06/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Masked hypertension is more common in individuals with type 2 diabetes than in individuals with normoglycemia. We aimed to explore if there is a discrepancy between office blood pressure (office BP) and home blood pressure monitoring (HBPM) in relation to HbA1c as well as glycemic status in 5,029 middle-aged individuals. METHODS HBPM was measured in a subsample of 5,029 participants in The Swedish CardioPulmonary BioImage Study (SCAPIS), a population-based cohort of 50-64 years old participants. Both office BP and HBPM were obtained after 5 minutes' rest using the semiautomatic Omron M10-IT oscillometric device. White coat effect was calculated by subtracting systolic HBPM from systolic office BP. Participants were classified according to glycemic status: Normoglycemia, prediabetes, or diabetes based on fasting glucose, HbA1c value, and self-reported diabetes diagnosis. RESULTS Of the included 5,025 participants, 947 (18.8%) had sustained hypertension, 907 (18.0%) reported taking antihypertensive treatment, and 370 (7.4%) had diabetes mellitus. Both systolic office BP and HBPM increased according to worsened glycemic status (P for trend 0.002 and 0.002, respectively). Masked hypertension was more prevalent in participants with dysglycemia compared with normoglycemia (P = 0.036). The systolic white coat effect was reversely associated with HbA1c (P = 0.012). CONCLUSIONS The systolic white coat effect was reversely associated with HbA1c, and the prevalence of masked hypertension increased with dysglycemia.
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Affiliation(s)
- Peder af Geijerstam
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden,Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden,Department of Clinical Physiology, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden,Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Fredrik H Nyström
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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21
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Jansson S, Blixt PJ, Didriksson H, Jonsson C, Andersson H, Hedström C, Engvall J, Aneq MÅ, Chew MS. Incidence of acute myocardial injury and its association with left and right ventricular systolic dysfunction in critically ill COVID-19 patients. Ann Intensive Care 2022; 12:56. [PMID: 35727386 PMCID: PMC9210044 DOI: 10.1186/s13613-022-01030-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/07/2022] [Indexed: 12/26/2022] Open
Abstract
Background Previous studies have found an increase in cardiac troponins (cTns) and echocardiographic abnormalities in patients with COVID-19 and reported their association with poor clinical outcomes. Whether acute injury occurs during the course of critical care and if it is associated with cardiac function is unknown. The purpose of this study was to document the incidence of acute myocardial injury (AMInj) and echocardiographically defined left ventricular (LV) and right ventricular (RV) systolic dysfunction in consecutive patients admitted to an intensive care unit (ICU) for COVID-19. The relationship between AMInj and echocardiographic abnormalities during the first 14 days of ICU admission was studied. Finally, the association between echocardiographic findings, AMInj and clinical outcome was evaluated. Methods Seventy-four consecutive patients (≥18 years) admitted to the ICU at Linköping University Hospital between 19 Mar 2020 and 31 Dec 2020 for COVID-19 were included. High-sensitivity troponin-T (hsTnT) was measured daily for up to 14 days. Transthoracic echocardiography was conducted within 72 h of ICU admission. Acute myocardial injury was defined as an increased hsTnT > 14ng/l and a > 20% absolute change with or without ischaemic symptoms. LV and RV systolic dysfunction was defined as at least 2 abnormal indicators of systolic function specified by consensus guidelines. Results Increased hsTnT was observed in 59% of patients at ICU admission, and 82% developed AMInj with peak levels at 8 (3–13) days after ICU admission. AMInj was not statistically significantly associated with 30-day mortality but was associated with an increased duration of invasive mechanical ventilation (10 (3–13) vs. 5 days (0–9), p=0.001) as well as ICU length of stay (LOS) (19.5 (11–28) vs. 7 days (5–13), p=0.015). After adjustment for SAPS-3 and admission SOFA score, the effect of AMInj was significant only for the duration of mechanical ventilation (p=0.030). The incidence of LV and RV dysfunction was 28% and 22%, respectively. Only indices of LV and RV longitudinal contractility (mitral and tricuspid annular plane systolic excursion) were associated with AMInj. Echocardiographic parameters were not associated with clinical outcome. Conclusions Myocardial injury is common in critically ill patients with COVID-19, with AMInj developing in more than 80% after ICU admission. In contrast, LV and RV dysfunction occurred in approximately one-quarter of patients. AMInj was associated with an increased need for mechanical ventilation and ICU LOS but neither AMInj nor ventricular dysfunction was significantly associated with mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01030-8.
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Affiliation(s)
- Saga Jansson
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Patrik Johansson Blixt
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Helen Didriksson
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Carina Jonsson
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Henrik Andersson
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Cassandra Hedström
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Meriam Åstrom Aneq
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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22
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Pettersson S, Trzebiatowska-Krzynska A, Engvall J. An uncommon case of congenital thoracic venous anomaly and extracardiac sinus venosus defect in an asymptomatic adult first presenting with brain abscesses: a case report. Eur Heart J Case Rep 2022; 6:ytac052. [PMID: 35299706 PMCID: PMC8922713 DOI: 10.1093/ehjcr/ytac052] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/03/2021] [Accepted: 01/19/2022] [Indexed: 12/02/2022]
Abstract
Background Congenital thoracic venous anomalies (CTVAs) with right-to-left shunt constitute an uncommon source of paradoxical embolization in adults. We present a case of a healthy and physically fit individual with a rare asymptomatic anomaly first presenting with brain abscesses after a visit to the dental office; persistent left superior vena cavae (PLSVC) without bridging vein, over-riding right-sided superior vena cavae (RSVC) connected to the left atrium (LA), and an extracardiac sinus venosus defect. Case summary A 29-year-old male presented to the neurosurgical unit due to intracranial abscesses requiring intervention following a visit to his dentist. The abscess cultures isolated bacteria commonly found in the normal oral flora. Transthoracic echocardiography revealed an enlarged coronary sinus consistent with PLSVC. An agitated saline study was performed and raised suspicion of simultaneous extra- and intracardiac shunting. Magnetic resonance angiography confirmed the presence of a PLSVC and revealed an RSVC connected to the LA; however, no intracardiac shunt was evident. Electrocardiogram-gated computed tomography was therefore conducted and discovered the rudimentary remains of the physiologic RSVC forming a connection to the right atrium, explaining the bilateral contrast loading seen on the agitated saline study and diagnosing an extracardiac sinus venosus defect (SVD). The patient recovered and has been referred for surgery. Discussion This case illustrates a CTVA and a forme fruste type SVD resulting in a severe complication in a healthy adult. We highlight the diagnostic challenges posed, suggest early usage of agitated saline studies, and discuss the rationale for surgical correction of this patient.
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Affiliation(s)
- Staffan Pettersson
- Department of Cardiology, Linkoping University Hospital, 58185 Linkoping, Sweden
| | | | - Jan Engvall
- Department of Clinical Physiology, Prof. Linkoping University Hospital, 58185 Linkoping, Sweden
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23
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Änghagen O, Engvall J, Gottvall T, Nelson N, Nylander E, Bang P. Developmental Differences in Left Ventricular Strain in IUGR vs. Control Children the First Three Months of Life. Pediatr Cardiol 2022; 43:1286-1297. [PMID: 35333947 PMCID: PMC9293814 DOI: 10.1007/s00246-022-02850-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/10/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) may directly affect cardiovascular function in early life. Longitudinal data on left ventricular longitudinal strain (LVLS), a key measure of cardiac function independent of body size, is not available. We hypothesize impaired cardiac function among IUGR newborns and persistence of the impairment until age 3 months. METHOD This is a prospective cohort study of consecutive pregnancies where IUGR was identified at 18-38 weeks gestational age (GA) with healthy controls randomly selected at 18-20 weeks GA. Echocardiograms were performed at birth and at age 3-4 months, and then compared. RESULTS At birth, mean (SD) LVLS did not differ between the IUGR group [N = 19; - 15.76 (3.12) %] and controls [N = 35; - 15.53 (3.56) %]. The IUGR group demonstrated no significant change in LVLS at age 3-4 months [- 17.80 (3.82) %], while the control group [- 20.91 (3.31) %] showed a significant increase (P < 0.001). Thus, LVLS was lower in the IUGR group at age 3-4 months (P = 0.003). CONCLUSION The lack of increase in LVLS may suggest that IUGR has a direct impact on cardiac function as early as during the first months of life. Trial registration Clinical trials.gov Identifier: NCT02583763, registration October 22, 2015. Retrospectively registered September 2014-October 2015, thereafter, registered prospectively.
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Affiliation(s)
- Olov Änghagen
- Crown Princess Victoria's Child and Youth Hospital, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. .,Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | - Jan Engvall
- grid.5640.70000 0001 2162 9922Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Tomas Gottvall
- grid.5640.70000 0001 2162 9922Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nina Nelson
- grid.5640.70000 0001 2162 9922Crown Princess Victoria’s Child and Youth Hospital, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden ,grid.24381.3c0000 0000 9241 5705National Highly Specialized Care, Karolinska University Hospital Stockholm, Stockholm, Sweden ,grid.5640.70000 0001 2162 9922Division of Children’s and Women’s Health, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Nylander
- grid.5640.70000 0001 2162 9922Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Bang
- grid.5640.70000 0001 2162 9922Crown Princess Victoria’s Child and Youth Hospital, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Division of Children’s and Women’s Health, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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24
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Gauffin E, Chisalita SI, Engvall J, Nyström FH, Östgren CJ. Plasma mid-regional pro-atrial natriuretic peptide predicts cardiovascular events in patients with type 2 diabetes independently of subclinical organ damage. Diabetes Res Clin Pract 2021; 182:109095. [PMID: 34662688 DOI: 10.1016/j.diabres.2021.109095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 07/29/2021] [Revised: 10/02/2021] [Accepted: 10/13/2021] [Indexed: 12/28/2022]
Abstract
AIM The aim of this study was to investigate the association between plasma MR-proANP and cardiovascular disease (CVD) in a middle-aged population with type 2 diabetes. METHODS MR-proANP was measured in 690 patients with type 2 diabetes participating in the epidemiological study CARDIPP (Cardiovascular Risk Factors in Patients with Diabetes-a Prospective Study in Primary Care). The outcome variables were incident major adverse cardiovascular events (MACE) and all-cause mortality. Patients were followed using the national Swedish Cause of Death Registry and the Inpatient Register. RESULTS During the mean follow-up period of 10.8 years, MACE occurred in 111 patients and 102 patients died. The hazard ratio for an increment of MR-proANP of 1 pmol/l adjusted for sex, age, current smoking, previous CVD, HbA1c, serum cholesterol, eGFR, systolic blood pressure, C-reactive protein, aortic pulse wave velocity, left ventricular mass and intima media thickness in the carotid arteries was 1.007 (95% CI 1.000-1.013, P = 0.042) for MACE and 1.008 (95% CI 1.001-1.014, P = 0.017) for all-cause mortality. CONCLUSIONS Elevated MR-proANP levels predict an increased risk for MACE and all-cause mortality in patients with type 2 diabetes independently of CVD risk factors and markers for subclinical organ damage.
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Affiliation(s)
- Emilia Gauffin
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Simona I Chisalita
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Endocrinology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Jan Engvall
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Fredrik H Nyström
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Endocrinology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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25
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Åström Malm I, De Basso R, Engvall J, Blomstrand P. Males with abdominal aortic aneurysm have reduced left ventricular systolic and diastolic function. Clin Physiol Funct Imaging 2021; 42:1-7. [PMID: 34541748 DOI: 10.1111/cpf.12728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) increases the risk of chronic heart failure and other major cardiovascular events. Knowledge about left ventricular function in patients with AAA is lacking. This echocardiographic study aimed to investigate whether AAA is associated with left ventricular systolic and diastolic dysfunction. METHODS Echocardiography was performed in 307 males (199 AAA and 108 controls) recruited from a regional ultrasound surveillance programme of known AAA, or from an ongoing ultrasound screening programme, during 2011-2016. RESULTS Subjects with AAA had thicker septal and posterior walls and a reduced left ventricular function compared to controls. Left ventricular ejection fraction (AAA 55 ± 8%, controls 57 ± 7%) and global longitudinal strain (AAA 19 ± 3%, controls 20 ± 3%) were lower in the group with AAA (both p < 0·05). Moreover, decreased mitral annular plane systolic excursion (12 ± 2 mm versus 13 ± 2 mm) and higher E/e' (13 ± 5 versus 11 ± 4) were observed in subjects with AAA (both p < 0·05). The aortic sinus (38 ± 4 mm versus 35 ± 2 mm) and ascending aorta (36 ± 4 mm versus 34 ± 5 mm) were also wider in the AAA group compared to controls (both p < 0·01). CONCLUSION AAAs are associated with reduced left ventricular systolic and diastolic function in males. The larger diameter of the aortic sinus and ascending aorta among AAA patients suggests that AAA is a general aortic disease.
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Affiliation(s)
- Ida Åström Malm
- Department of Natural Sciences and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Rachel De Basso
- Department of Natural Sciences and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Peter Blomstrand
- Department of Natural Sciences and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Clinical Physiology, County Hospital Ryhov, Jönköping, Sweden
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26
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Tornhammar P, Jernberg T, Bergström G, Blomberg A, Engström G, Engvall J, Fall T, Gisslén M, Janson C, Lind L, Sköld CM, Sundström J, Söderberg S, Zaigham S, Östgren CJ, Andersson DP, Ueda P. Association of cardiometabolic risk factors with hospitalisation or death due to COVID-19: population-based cohort study in Sweden (SCAPIS). BMJ Open 2021; 11:e051359. [PMID: 34475186 PMCID: PMC8413466 DOI: 10.1136/bmjopen-2021-051359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the association of cardiometabolic risk factors with hospitalisation or death due to COVID-19 in the general population. DESIGN, SETTING AND PARTICIPANTS Swedish population-based cohort including 29 955 participants. EXPOSURES Cardiometabolic risk factors assessed between 2014 and 2018. MAIN OUTCOME MEASURES Hospitalisation or death due to COVID-19, as registered in nationwide registers from 31 January 2020 through 12 September 2020. Associations of cardiometabolic risk factors with the outcome were assessed using logistic regression adjusted for age, sex, birthplace and education. RESULTS Mean (SD) age was 61.2 (4.5) and 51.5% were women. 69 participants experienced hospitalisation or death due to COVID-19. Examples of statistically significant associations between baseline factors and subsequent hospitalisation or death due to COVID-19 included overweight (adjusted OR (aOR) vs normal weight 2.73 (95% CI 1.25 to 5.94)), obesity (aOR vs normal weight 4.09 (95% CI 1.82 to 9.18)), pre-diabetes (aOR vs normoglycaemia 2.56 (95% CI 1.44 to 4.55)), diabetes (aOR vs normoglycaemia 3.96 (95% CI 2.13 to 7.36)), sedentary time (aOR per hour/day increase 1.10 (95% CI 1.02 to 1.17)), grade 2 hypertension (aOR vs normotension 2.44 (95% CI 1.10 to 5.44)) and high density lipoprotein cholesterol (aOR per mmol/L increase 0.33 (95% CI 0.17 to 0.65)). Statistically significant associations were not observed for grade 1 hypertension (aOR vs normotension 1.03 (95% CI 0.55 to 1.96)), current smoking (aOR 0.56 (95% CI 0.24 to 1.30)), total cholesterol (aOR per mmol/L increase 0.90 (95% CI 0.71 to 1.13)), low density lipoprotein cholesterol (aOR per mmol/L increase 0.90 (95% CI 0.69 to 1.15)) and coronary artery calcium score (aOR per 10 units increase 1.00 (95% CI 0.99 to 1.01)). CONCLUSIONS In a large population-based sample from the general population, several cardiometabolic risk factors were associated with hospitalisation or death due to COVID-19.
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Affiliation(s)
- Per Tornhammar
- Functional Area of Emergency Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Göran Bergström
- Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Jan Engvall
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
| | - C Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Suneela Zaigham
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Daniel Peter Andersson
- Department of Medicine Huddinge H7, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Ueda
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Henriksson L, Woisetschläger M, Alfredsson J, Janzon M, Ebbers T, Engvall J, Persson A. The transluminal attenuation gradient does not add diagnostic accuracy to coronary computed tomography. Acta Radiol 2021; 62:867-874. [PMID: 32722968 DOI: 10.1177/0284185120943042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A method for improving the accuracy of coronary computed tomography angiography (CCTA) is highly sought after as it would help to avoid unnecessary invasive coronary angiographies. Measurement of the transluminal attenuation gradient (TAG) has been proposed as an alternative to other existing methods, i.e. CT perfusion and CT fractional flow reserve (FFR). PURPOSE To evaluate the incremental value of three types of TAG in high-pitch spiral CCTA with invasive FFR measurements as reference. MATERIAL AND METHODS TAG was measured using two semi-automatic methods and one manual method. A receiver operating characteristic (ROC) analysis was made to determine the usefulness of TAG alone as well as TAG combined with CCTA for detection of significant coronary artery stenoses defined by an invasive FFR value ≤0.80. RESULTS A total of 51 coronary vessels in 37 patients were included in this retrospective study. Hemodynamically significant stenoses were found in 13 vessels according to FFR. The ROC analysis TAG alone resulted in areas under the curve (AUCs) of 0.530 and 0.520 for the semi-automatic TAG and 0.557 for the manual TAG. TAG and CCTA combined resulted in AUCs of 0.567, 0.562 for semi-automatic TAG, and 0.569 for the manual TAG. CONCLUSION The results from our study showed no incremental value of TAG measured in single heartbeat CCTA in determining the severity of coronary artery stenosis degrees.
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Affiliation(s)
- Lilian Henriksson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiology, Department of Health, Medicine and Caring Sciences and, Linköping University, Linköping, Sweden
| | - Mischa Woisetschläger
- Department of Radiology, Department of Health, Medicine and Caring Sciences and, Linköping University, Linköping, Sweden
| | - Joakim Alfredsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Magnus Janzon
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Clinical Physiology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Persson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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28
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Toren K, Schiöler L, Lindberg A, Andersson A, Behndig AF, Bergström G, Blomberg A, Caidahl K, Engvall J, Eriksson M, Hamrefors V, Janson C, Kylhammar D, Lindberg E, Lindén A, Malinovschi A, Persson HL, Sandelin M, Eriksson Ström J, Tanash HA, Vikgren J, Östgren CJ, Wollmer P, Sköld CM. Chronic airflow limitation and its relation to respiratory symptoms among ever-smokers and never-smokers: a cross-sectional study. BMJ Open Respir Res 2021; 7:7/1/e000600. [PMID: 32759170 PMCID: PMC7409993 DOI: 10.1136/bmjresp-2020-000600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The diagnosis of chronic obstructive pulmonary disease is based on the presence of persistent respiratory symptoms and chronic airflow limitation (CAL). CAL is based on the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1:FVC) after bronchodilation, and FEV1:FVC less than the fifth percentile is often used as a cut-off for CAL. The aim was to investigate if increasing percentiles of FEV1:FVC were associated with any respiratory symptom (cough with phlegm, dyspnoea or wheezing) in a general population sample of never-smokers and ever-smokers. METHODS In a cross-sectional study comprising 15 128 adults (50-64 years), 7120 never-smokers and 8008 ever-smokers completed a respiratory questionnaire and performed FEV1 and FVC after bronchodilation. We calculated their z-scores for FEV1:FVC and defined the fifth percentile using the Global Lung Function Initiative (GLI) reference value, GLI5 and increasing percentiles up to GLI25. We analysed the associations between different strata of percentiles and prevalence of any respiratory symptom using multivariable logistic regression for estimation of OR. RESULTS Among all subjects, regardless of smoking habits, the odds of any respiratory symptom were elevated up to the GLI15-20 strata. Among never-smokers, the odds of any respiratory symptom were elevated at GLI<5 (OR 3.57, 95% CI 2.43 to 5.23) and at GLI5-10 (OR 2.57, 95% CI 1.69 to 3.91), but not at higher percentiles. Among ever-smokers, the odds of any respiratory symptom were elevated from GLI<5 (OR 4.64, 95% CI 3.79 to 5.68) up to GLI≥25 (OR 1.33, 95% CI 1.00 to 1.75). CONCLUSIONS The association between percentages of FEV1:FVC and respiratory symptoms differed depending on smoking history. Our results support a higher percentile cut-off for FEV1:FVC for never-smokers and, in particular, for ever-smokers.
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Affiliation(s)
- Kjell Toren
- Occupational and Environmental Medicine/School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden .,Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine/School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden
| | - Anne Lindberg
- Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Anders Andersson
- COPD center, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Göran Bergström
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Blomberg
- Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Kenneth Caidahl
- Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan Engvall
- Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden.,Clinical Physiology, Linköping University, Linköping, Sweden
| | - Maria Eriksson
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Viktor Hamrefors
- Clinical Sciences, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory Medicine, Uppsala University, Uppsala, Sweden
| | - David Kylhammar
- Clinical Physiology, Linköping University, Linköping, Sweden
| | - Eva Lindberg
- Department of Medical Sciences: Respiratory Medicine, Uppsala University, Uppsala, Sweden
| | - Anders Lindén
- Unit for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Hans Lennart Persson
- Department of Respiratory Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Martin Sandelin
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Jonas Eriksson Ström
- Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Hanan A Tanash
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Jenny Vikgren
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carl Johan Östgren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Per Wollmer
- Clinical Physiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C Magnus Sköld
- Department of Medicine, Respiratory Medicine Unit, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Solna, Sweden
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29
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Zaigham S, Östgren CJ, Persson M, Muhammad IF, Nilsson PM, Wollmer P, Engvall J, Engström G. The association between carotid-femoral pulse-wave velocity and lung function in the Swedish CArdioPulmonary bioImage study (SCAPIS) cohort. Respir Med 2021; 185:106504. [PMID: 34139577 DOI: 10.1016/j.rmed.2021.106504] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Arterial ageing is characterised by degradation of elastic fibres and increased stiffness of elastic arteries. Although low lung function and arterial stiffness are strongly related to age, the association between lung function and arterial ageing has not been widely explored. We used a large population-based study of 50-64 year olds to assess the association between lung function (measured by spirometry and CO diffusing capacity (DLCO)) and arterial stiffness (measured by carotid-femoral pulse-wave velocity (c-f PWV)). METHODS Participants from the Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort with information on spirometry (n = 8941) and DLCO (n = 8616) were included. General linear models (lung function quartiles) and linear regression was used to determine the association between lung function and c-f PWV. RESULTS FEV1 (L), FVC (L), DLCO (mmol/(min kPa)) and DLCO/VA (mmol/(min kPa L)) were significantly and inversely associated with c-f PWV after adjustments; mean PWV (m/s) in Q1 (highest lung function) vs Q4: FEV1; 8.45 vs 8.60, p-value 0.001; FVC; 8.45 vs 8.57, p-value 0.018; DLCO; 8.46 vs 8.60, p-value 0.002; and DLCO/VA; 8.47 vs 8.58, p-value 0.001. In sex-stratified analyses, significant findings were reflected for FEV1 and DLCO in men only. The results remained significant for DLCO in all never smokers and in all participants without COPD or airflow limitation on spirometry. CONCLUSIONS A reduction in spirometry and DLCO is associated with elevated arterial stiffness in middle-aged men. A reduction in DLCO is associated with higher c-f PWV even in never smokers and in those without COPD or airflow limitation on spirometry.
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Affiliation(s)
- Suneela Zaigham
- Department of Clinical Sciences Malmö, Lund University, Sweden.
| | - Carl-Johan Östgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden.
| | | | | | - Peter M Nilsson
- Department of Clinical Sciences Malmö, Lund University, Sweden; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
| | - Per Wollmer
- Department of Clinical Sciences Malmö, Lund University, Sweden; Department of Translational Medicine, Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Sweden.
| | - Jan Engvall
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden; Centre of Medical Image Science and Visualization, Linkoping University, Sweden; Department of Clinical Physiology, Linköping University, Sweden.
| | - Gunnar Engström
- Department of Clinical Sciences Malmö, Lund University, Sweden.
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30
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Johansson Blixt P, Chew MS, Åhman R, de Geer L, Blomqwist L, Åström Aneq M, Engvall J, Andersson H. Left ventricular longitudinal wall fractional shortening accurately predicts longitudinal strain in critically ill patients with septic shock. Ann Intensive Care 2021; 11:52. [PMID: 33782770 PMCID: PMC8007689 DOI: 10.1186/s13613-021-00840-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background Left ventricular longitudinal strain (LVLS) may be a sensitive indicator of left ventricular (LV) systolic function in patients with sepsis, but is dependent on high image quality and analysis software. Mitral annular plane systolic excursion (MAPSE) and the novel left ventricular longitudinal wall fractional shortening (LV-LWFS) are bedside echocardiographic indicators of LV systolic function that are less dependent on image quality. Both are sparsely investigated in the critically ill population, and may potentially be used as surrogates for LVLS. We assessed if LVLS may be predicted by LV-LWFS and MAPSE in patients with septic shock. We also assessed the repeatability and inter-rater agreement of LVLS, LV-LWFS and MAPSE measurements. Results 122 TTE studies from 3 echocardiographic data repositories of patients admitted to ICU with septic shock were retrospectively assessed, of which 73 were suitable for LVLS analysis using speckle tracking. The correlations between LVLS vs. LV-LWFS and LVLS vs. MAPSE were 0.89 (p < 0.001) and 0.81 (p < 0.001) with mean squared errors of 5.8% and 9.1%, respectively. Using the generated regression equation, LV-LWFS predicted LVLS with a high degree of accuracy and precision, with bias and limits of agreement of -0.044 ± 4.7% and mean squared prediction error of 5.8%. Interobserver repeatability was good, with high intraclass correlation coefficients (0.96–0.97), small bias and tight limits of agreement (≤ 4.1% for all analyses) between observers for all measurements. Conclusions LV-LWFS may be used to estimate LVLS in patients with septic shock. MAPSE also performed well, but was slightly inferior compared to LV-LWFS in estimating LVLS. Feasibility of MAPSE and LV-LWFS was excellent, as was interobserver repeatability.
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Affiliation(s)
- Patrik Johansson Blixt
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden.
| | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden
| | - Rasmus Åhman
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden
| | - Lina de Geer
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden
| | - Lill Blomqwist
- Department of Anaesthesiology and Intensive Care, Skane University Hospital, Malmö, Sweden
| | - Meriam Åström Aneq
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Henrik Andersson
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden
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Ziegler M, Alfraeus J, Bustamante M, Good E, Engvall J, de Muinck E, Dyverfeldt P. Automated segmentation of the individual branches of the carotid arteries in contrast-enhanced MR angiography using DeepMedic. BMC Med Imaging 2021; 21:38. [PMID: 33639893 PMCID: PMC7912466 DOI: 10.1186/s12880-021-00568-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background Non-invasive imaging is of interest for tracking the progression of atherosclerosis in the carotid bifurcation, and segmenting this region into its constituent branch arteries is necessary for analyses. The purpose of this study was to validate and demonstrate a method for segmenting the carotid bifurcation into the common, internal, and external carotid arteries (CCA, ICA, ECA) in contrast-enhanced MR angiography (CE-MRA) data. Methods A segmentation pipeline utilizing a convolutional neural network (DeepMedic) was tailored and trained for multi-class segmentation of the carotid arteries in CE-MRA data from the Swedish CardioPulmonsary bioImage Study (SCAPIS). Segmentation quality was quantitatively assessed using the Dice similarity coefficient (DSC), Matthews Correlation Coefficient (MCC), F2, F0.5, and True Positive Ratio (TPR). Segmentations were also assessed qualitatively, by three observers using visual inspection. Finally, geometric descriptions of the carotid bifurcations were generated for each subject to demonstrate the utility of the proposed segmentation method. Results Branch-level segmentations scored DSC = 0.80 ± 0.13, MCC = 0.80 ± 0.12, F2 = 0.82 ± 0.14, F0.5 = 0.78 ± 0.13, and TPR = 0.84 ± 0.16, on average in a testing cohort of 46 carotid bifurcations. Qualitatively, 61% of segmentations were judged to be usable for analyses without adjustments in a cohort of 336 carotid bifurcations without ground-truth. Carotid artery geometry showed wide variation within the whole cohort, with CCA diameter 8.6 ± 1.1 mm, ICA 7.5 ± 1.4 mm, ECA 5.7 ± 1.0 mm and bifurcation angle 41 ± 21°. Conclusion The proposed segmentation method automatically generates branch-level segmentations of the carotid arteries that are suitable for use in further analyses and help enable large-cohort investigations.
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Affiliation(s)
- Magnus Ziegler
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden. .,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Jesper Alfraeus
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mariana Bustamante
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Elin Good
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Cardiology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ebo de Muinck
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Cardiology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Petter Dyverfeldt
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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32
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Ziegler M, Alfraeus J, Good E, Engvall J, de Muinck E, Dyverfeldt P. Exploring the Relationships Between Hemodynamic Stresses in the Carotid Arteries. Front Cardiovasc Med 2021; 7:617755. [PMID: 33614742 PMCID: PMC7886794 DOI: 10.3389/fcvm.2020.617755] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Atherosclerosis manifests as a focal disease, often affecting areas with complex hemodynamics such as the carotid bifurcation. The magnitude and regularity of the hemodynamic shear stresses acting on the vessel wall are thought to generate risk patterns unique to each patient and play a role in the pathogenesis of atherosclerosis. The involvement of different expressions of shear stress in the pathogenesis of carotid atherosclerosis highlights the need to characterize and compare the differential impact of the various expressions of shear stress in the atherosclerotic carotid bifurcation. Therefore, the aim of this study is to characterize and compare hemodynamic wall shear stresses (WSS) in the carotid arteries of subjects with asymptomatic atherosclerotic plaques. Shear stresses were also compared against vessel diameter and bifurcation angle to examine the relationships with the geometry of the carotid bifurcation. Methods: 4D Flow MRI and contrast-enhanced MRA data were acquired for 245 subjects with atherosclerotic plaques of at least 2.7 mm in conjunction with the Swedish CArdioPulmonary bioImage Study (SCAPIS). Following automatic segmentation and geometric analysis, time-resolved WSS and near-wall turbulent kinetic energy (nwTKE) were derived from the 4D Flow data. Whole-cycle parameters including time-averaged WSS and nwTKE, and the oscillatory shear index (OSI) were calculated. Pairwise Spearman rank-correlation analyses were used to investigate relationships among the hemodynamic as well as geometric parameters. Results: One hundred and seventy nine subjects were successfully segmented using automated tools and subsequently geometric and hemodynamic analyses were performed. Temporally resolved WSS and nwTKE were strongly correlated, ρ = 0.64. Cycle-averaged WSS and nwTKE were moderately correlated, ρ = 0.57. Cycle-average nwTKE was weakly correlated to OSI (ρ = -0.273), revealing that nwTKE provides information about disturbed flow on the vessel wall that OSI does not. In this cohort, there was large inter-individual variation for both WSS and nwTKE. Both WSS and nwTKE varied most within the external carotid artery. WSS, nwTKE, and OSI were weakly correlated to vessel diameter and bifurcation angle. Conclusion: The turbulent and mean component of WSS were examined together in vivo for the first time, and a strong correlation was found between them. nwTKE presents the opportunity to quantify turbulent wall stresses in vivo and gain insight into the effects of disturbed flow on the vessel wall. Neither vessel diameter nor bifurcation angle were found to be strongly correlated to the turbulent or mean component of WSS in this cohort.
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Affiliation(s)
- Magnus Ziegler
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Jesper Alfraeus
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Elin Good
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ebo de Muinck
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
| | - Petter Dyverfeldt
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Sundin J, Engvall J, Nylander E, Ebbers T, Bolger AF, Carlhäll CJ. Improved Efficiency of Intraventricular Blood Flow Transit Under Cardiac Stress: A 4D Flow Dobutamine CMR Study. Front Cardiovasc Med 2020; 7:581495. [PMID: 33324686 PMCID: PMC7724031 DOI: 10.3389/fcvm.2020.581495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/16/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction: The effects of heart rate, inotropy, and lusitropy on multidimensional flow patterns and energetics within the human heart remain undefined. Recently, reduced volume and end-diastolic kinetic energy (KE) of the portion of left ventricular (LV) inflow passing directly to outflow, Direct flow (DF), have been shown to reflect inefficient LV pumping and to be a marker of LV dysfunction in heart failure patients. In this study, we hypothesized that increasing heart rate, inotropy, and lusitropy would result in an increased efficiency of intraventricular blood flow transit. Therefore, we sought to investigate LV 4D blood flow patterns and energetics with dobutamine infusion. Methods: 4D flow and morphological cardiovascular magnetic resonance (CMR) data were acquired in twelve healthy subjects: at rest and with dobutamine infusion to achieve a target heart rate ~60% higher than the resting heart rate. A previously validated method was used for flow analysis: pathlines were emitted from the end-diastolic (ED) LV blood volume and traced forward and backward in time to separate four functional LV flow components. For each flow component, KE/mL blood volume at ED was calculated. Results: With dobutamine infusion there was an increase in heart rate (64%, p < 0.001), systolic blood pressure (p = 0.02) and stroke volume (p = 0.01). Of the 4D flow parameters, the most efficient flow component (DF), increased its proportion of EDV (p < 0.001). The EDV proportion of Residual volume, the blood residing in the ventricle over at least two cardiac cycles, decreased (p < 0.001). The KE/mL at ED for all flow components increased (p < 0.001). DF had the largest absolute and relative increase while Residual volume had the smallest absolute and relative increase. Conclusions: This study demonstrates that it is feasible to compare 4D flow patterns within the normal human heart at rest and with stress. At higher heart rate, inotropy and lusitropy, elicited by dobutamine infusion, the efficiency of intraventricular blood flow transit improves, as quantified by an increased relative volume and pre-systolic KE of the most efficient DF component of the LV volume. The change in these markers may allow a novel assessment of LV function and LV dysfunction over a range of stress.
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Affiliation(s)
- Jonathan Sundin
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Nylander
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ann F Bolger
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Carl-Johan Carlhäll
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Trzebiatowska-Krzynska A, Swahn E, Wallby L, Nielsen NE, Carlhäll CJ, Engvall J. Three-dimensional echocardiography to identify right ventricular dilatation in patients with corrected Fallot anomaly or pulmonary stenosis. Clin Physiol Funct Imaging 2020; 41:51-61. [PMID: 32976680 PMCID: PMC7756640 DOI: 10.1111/cpf.12665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 07/05/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022]
Abstract
Background 3‐Dimensional Echocardiography allows measuring volumes and parameters of myocardial deformation (strain). Myocardial strain has been suggested to be superior to conventional echo parameters in the assessment of right ventricular (RV) function. Myocardial strain can be assessed by cardiac magnetic resonance (CMR) or two‐ and three‐dimensional echocardiography (2D and 3DEcho). We performed a comprehensive assessment of the RV based on 3DEcho and compared the results with those based on CMR and 2DEcho. Methods 36 patients with corrected heart defects underwent CMR and 3DEcho to assess RV volume, strain and cardio pulmonary exercise testing with peak VO2 measurement. 2DEcho was used for reference. Results There was a moderate correlation between 3DEcho and CMR for measuring RV end‐diastolic and end‐systolic volumes (r = .82 and .72). 3DEcho tended to underestimate the RV volumes, mean difference EDV 8.5 ± 33 ml (CI −2.8; 19.7 ml) and ESV 13.2 ± 29 ml (CI 3.3; 23 ml). According to method‐specific reference values for RVEDV, 34/35 (3DEcho) and 29/36 (CMR) were dilated. Among those dilated according to CMR, all were identified by 3DEcho. The coefficient of correlation between RV atrioventricular plane displacement measured by CMR and tricuspid annular plane systolic excursion measured by 3D and 2DEcho was r = .6 for both. 2DEcho measured lower LV volumes than CMR. LVEF and GLS were similar in 2DEcho, 3DEcho and CMR. Patients with CMR‐determined RV free wall strain ≤ −14% tended to have lower peak VO2. Conclusions Although 3DEcho underestimated RV volumes, it successfully identified all patients with RV dilatation based on method‐specific reference values.
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Affiliation(s)
| | - Eva Swahn
- Department of Cardiology and Department of Medicine and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Lars Wallby
- Department of Cardiology and Department of Medicine and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Niels Erik Nielsen
- Department of Cardiology and Department of Medicine and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Carl Johan Carlhäll
- Department of Clinical Physiology and Department of Medicine and Health Sciences, Linkoping University, Linkoping, Sweden.,CMIV - Center for Medical Image Science and Visualization, Linkoping University, Linkoping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology and Department of Medicine and Health Sciences, Linkoping University, Linkoping, Sweden.,CMIV - Center for Medical Image Science and Visualization, Linkoping University, Linkoping, Sweden
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Blomstrand P, Engvall J. Effects of a single exercise workout on memory and learning functions in young adults—A systematic review. Transl Sports Med 2020. [DOI: 10.1002/tsm2.190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Peter Blomstrand
- Department of Clinical Physiology County Hospital Ryhov Jönköping Sweden
- Department of Natural Science and Biomedicine School of Health and Welfare Jönköping University Jönköping Sweden
| | - Jan Engvall
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
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Ziegler M, Good E, Engvall J, Warntjes M, de Muinck E, Dyverfeldt P. Towards Automated Quantification of Vessel Wall Composition Using MRI. J Magn Reson Imaging 2020; 52:710-719. [PMID: 32154973 DOI: 10.1002/jmri.27116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND MRI can be used to generate fat fraction (FF) and R2* data, which have been previously shown to characterize the plaque compositional features lipid-rich necrotic core (LRNC) and intraplaque hemorrhage (IPH) in the carotid arteries (CAs). Previously, these data were extracted from CA plaques using time-consuming manual analyses. PURPOSE To design and demonstrate a method for segmenting the CA and extracting data describing the composition of the vessel wall. STUDY TYPE Prospective. SUBJECTS 31 subjects from the Swedish CArdioPulmonary bioImage Study (SCAPIS). FIELD STRENGTH/SEQUENCES T1 -weighted (T1 W) quadruple inversion recovery, contrast-enhanced MR angiography (CE-MRA), and 4-point Dixon data were acquired at 3T. ASSESSMENT The vessel lumen of the CA was automatically segmented using support vector machines (SVM) with CE-MRA data, and the vessel wall region was subsequently delineated. Automatically generated segmentations were quantitatively measured and three observers visually compared the segmentations to manual segmentations performed on T1 w images. Dixon data were used to generate FF and R2* maps. Both manually and automatically generated segmentations of the CA and vessel wall were used to extract compositional data. STATISTICAL TESTS Two-tailed t-tests were used to examine differences between results generated using manual and automated analyses, and among different configurations of the automated method. Interobserver agreement was assessed with Fleiss' kappa. RESULTS Automated segmentation of the CA using SVM had a Dice score of 0.89 ± 0.02 and true-positive ratio 0.93 ± 0.03 when compared against ground truth, and median qualitative score of 4/5 when assessed visually by multiple observers. Vessel wall regions of 0.5 and 1 mm yielded compositional information similar to that gained from manual analyses. Using the 0.5 mm vessel wall region, the mean difference was 0.1 ± 2.5% considering FF and 1.1 ± 5.7[1/s] for R2*. LEVEL OF EVIDENCE 1. TECHNICAL EFFICACY STAGE 1. J. Magn. Reson. Imaging 2020;52:710-719.
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Affiliation(s)
- Magnus Ziegler
- Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Elin Good
- Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Linköping University, Linköping, Sweden
| | - Marcel Warntjes
- Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Ebo de Muinck
- Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
| | - Petter Dyverfeldt
- Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Ahlander BM, Engvall J, Ericsson E. Anxiety during magnetic resonance imaging of the spine in relation to scanner design and size. Radiography (Lond) 2020; 26:110-116. [PMID: 32052788 DOI: 10.1016/j.radi.2019.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Magnetic resonance imaging in closed-bore scanners sometimes provokes anxiety but closed-bore designs have gradually become wider and shorter. Open scanners may be easier to tolerate. The aim was to compare patient anxiety during MRI between bore diameters of 60 cm and 70 cm, and to determine the current level of patient anxiety and experience in open scanners in a clinical setrting. METHODS Consecutive patients referred for examination of the spine in 60 cm and 70 cm bores and one open scanner participated. Four established/validated questionnaires, answered before, directly after (N = 155) and one week after (N = 109) the MRI-examination were used, measuring anxiety, fear and depression. RESULTS No difference was found in the patient scores of anxiety between the 60 cm and the 70 cm scanners on the examination day. At follow-up, patients in the 70 cm bore rated their examination experience better (p < 0.025), compared to patients in the 60 cm bore. Patients in the open scanner rated higher levels of anxiety (p < 0.001) before, directly after and one week after the examination, compared to the closed bore scanners. CONCLUSION Scanners with a 70 cm diameter bore seem more tolerable than those with a 60 cm bore. Patients referred to the open scanner had on average a higher tendency to express anxiety. Still, patient anxiety in MRI is challenging and further research required. IMPLICATIONS FOR PRACTICE Patients prefer to be examined in 70 cm bore scanners compared with 60 cm. If open scanners aren't available extended support may be necessary for the most anxious patients.
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Affiliation(s)
- B M Ahlander
- Ryhov County Hospital, SE-551 85 Jönköping, Sweden.
| | - J Engvall
- Department of Clinical Physiology, Linköping University, SE-581 83 Linköping, Sweden; Center of Medical Image Science and Visualization, Linköping University, SE-581 83 Linköping, Sweden.
| | - E Ericsson
- Faculty of Medicine and Health, School of Health Science, Örebro University, SE-701 82 Örebro, Sweden.
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Sandstedt M, Henriksson L, Janzon M, Nyberg G, Engvall J, De Geer J, Alfredsson J, Persson A. Evaluation of an AI-based, automatic coronary artery calcium scoring software. Eur Radiol 2019; 30:1671-1678. [PMID: 31728692 PMCID: PMC7033052 DOI: 10.1007/s00330-019-06489-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/26/2019] [Accepted: 10/09/2019] [Indexed: 11/04/2022]
Abstract
Objectives To evaluate an artificial intelligence (AI)–based, automatic coronary artery calcium (CAC) scoring software, using a semi-automatic software as a reference. Methods This observational study included 315 consecutive, non-contrast-enhanced calcium scoring computed tomography (CSCT) scans. A semi-automatic and an automatic software obtained the Agatston score (AS), the volume score (VS), the mass score (MS), and the number of calcified coronary lesions. Semi-automatic and automatic analysis time were registered, including a manual double-check of the automatic results. Statistical analyses were Spearman’s rank correlation coefficient (⍴), intra-class correlation (ICC), Bland Altman plots, weighted kappa analysis (κ), and Wilcoxon signed-rank test. Results The correlation and agreement for the AS, VS, and MS were ⍴ = 0.935, 0.932, 0.934 (p < 0.001), and ICC = 0.996, 0.996, 0.991, respectively (p < 0.001). The correlation and agreement for the number of calcified lesions were ⍴ = 0.903 and ICC = 0.977 (p < 0.001), respectively. The Bland Altman mean difference and 1.96 SD upper and lower limits of agreements for the AS, VS, and MS were − 8.2 (− 115.1 to 98.2), − 7.4 (− 93.9 to 79.1), and − 3.8 (− 33.6 to 25.9), respectively. Agreement in risk category assignment was 89.5% and κ = 0.919 (p < 0.001). The median time for the semi-automatic and automatic method was 59 s (IQR 35–100) and 36 s (IQR 29–49), respectively (p < 0.001). Conclusions There was an excellent correlation and agreement between the automatic software and the semi-automatic software for three CAC scores and the number of calcified lesions. Risk category classification was accurate but showing an overestimation bias tendency. Also, the automatic method was less time-demanding. Key Points • Coronary artery calcium (CAC) scoring is an excellent candidate for artificial intelligence (AI) development in a clinical setting. • An AI-based, automatic software obtained CAC scores with excellent correlation and agreement compared with a conventional method but was less time-consuming.
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Affiliation(s)
- Mårten Sandstedt
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden. .,Department of Radiology and Department of Medical and Health Sciences, University Hospital of Linköping, Linköping University, SE-581 85, Linköping, Sweden.
| | - Lilian Henriksson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology and Department of Medical and Health Sciences, University Hospital of Linköping, Linköping University, SE-581 85, Linköping, Sweden
| | - Magnus Janzon
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Gusten Nyberg
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology and Department of Medical and Health Sciences, University Hospital of Linköping, Linköping University, SE-581 85, Linköping, Sweden
| | - Jan Engvall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jakob De Geer
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology and Department of Medical and Health Sciences, University Hospital of Linköping, Linköping University, SE-581 85, Linköping, Sweden
| | - Joakim Alfredsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anders Persson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology and Department of Medical and Health Sciences, University Hospital of Linköping, Linköping University, SE-581 85, Linköping, Sweden
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Lindenberger M, Fedorowski A, Melander O, Gallo W, Engvall J, Skoog J. Cardiovascular biomarkers and echocardiographic findings at rest and during graded hypovolemic stress in women with recurrent vasovagal syncope. J Cardiovasc Electrophysiol 2019; 30:2936-2943. [DOI: 10.1111/jce.14207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/19/2019] [Accepted: 09/26/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Marcus Lindenberger
- Department of CardiologyLinköping University HospitalLinköping Sweden
- Department of Medical and Health SciencesLinköping UniversityLinköping Sweden
| | - Arthur Fedorowski
- Department of Clinical SciencesLund UniversityMalmö Sweden
- Department of CardiologySkåne University HospitalMalmö Sweden
| | - Olle Melander
- Department of Clinical SciencesLund UniversityMalmö Sweden
| | - Widet Gallo
- Department of Clinical SciencesLund UniversityMalmö Sweden
| | - Jan Engvall
- Department of Medical and Health SciencesLinköping UniversityLinköping Sweden
| | - Johan Skoog
- Department of Medical and Health SciencesLinköping UniversityLinköping Sweden
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Lekedal H, Engvall J, Swahn E, Jonasson L. P2785Persons with dilated aorta ascendens - who are they? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1100] [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
Dilation of the ascending aorta (AscA) may result in life-threatening events. However, it often remains asymptomatic and undiagnosed until the catastrophic complication occurs. The prevalence of dilated AscA in the general population is largely unknown. It is also unclear whether traditional cardiovascular risk factors are associated with dilated AscA.
Purpose
The aim was to study the prevalence of dilated AscA and its determinants with focus on cardiovascular risk factors in a middle-aged population.
Methods
Five thousand subjects from the Swedish CardioPulmonary BioImage Study (SCAPIS), aged 50–65 years, underwent transthoracic echocardiography (echo) and coronary CT angiography. Subjects with dilated AscA (diameter ≥40 mm) were identified. Two age- and gender-matched controls with normal AscA diameter were selected per case. Presence of carotid artery plaques was determined by duplex ultrasound.
Results
Seventy one cases (16 women, 55 men) and 142 controls were included. In cases, echo and CT measurements were 42 (41–43) and 42 (41–45) mm, respectively. Body surface area-adjusted AscA diameters were higher in female than in male cases, 22,7 (21,9–23,6) vs 20,2 (19,0–20,8) mm/m2 (p<0,001), see Figure. Bicuspid aortic valves and mild aortic regurditation were more common in cases than in controls (12% vs 0% and 30% vs 11%). The use of antihypertensive drugs was higher among cases, 47% vs 32%, p=0.035. There were no differences in body size, smoking status, diabetes, history of cardiovascular disease or presence of carotid plaques between cases and controls.
Conclusions
The prevalence of dilated AscA was 1.4% in a Swedish middle-aged population. Dilated AscA was associated with male sex, aortic valve pathology and antihypertensive medication. Whether dilated AscA is associated with impaired regulation of blood pressure and vascular function deserves further investigation. Also, data raise the intriguing question that a 40 mm cut-off value may not be appropriate for the diagnosis in women.
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Affiliation(s)
- H Lekedal
- Linkoping University Hospital, Linkoping, Sweden
| | - J Engvall
- Linkoping University Hospital, Linkoping, Sweden
| | - E Swahn
- Linkoping University Hospital, Linkoping, Sweden
| | - L Jonasson
- Linkoping University Hospital, Linkoping, Sweden
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Kylhammar D, Hult L, Blomstrand P, Engstrom G, Johnson J, Ostgren CJ, Engvall J. 3075Global longitudinal strain and mechanical dispersion in the general population aged 50–64 years – results from the echocardiography study of the Swedish CArdioPulmonary bioImage Study (SCAPIS). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0031] [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
Background
The Swedish CArdioPulmonary bioImage Study (SCAPIS) was initiated to improve understanding of underlying mechanisms in order to prevent cardiovascular and pulmonary disease. 30 000 individuals aged 50–64 years, randomly selected from the general population, were included in the study. Six-thousand-eight-hundred of the individuals underwent transthoracic echocardiography.
Global longitudinal strain (GLS) and mechanical dispersion (MD) are novel echocardiographic measures of left ventricular (LV) systolic function and electrical instability reflecting risk for malignant arrhythmia, respectively. Previous studies suggest that the limit of normal for GLS is −16% and that MD >70 ms may be associated with increased risk for malignant arrhythmias. GLS and MD have, however, not before been investigated in a large population-based study.
Purpose
The purpose of this first project within the SCAPIS echocardiography study is to determine the prevalence of impaired GLS and MD in the general population aged 50–64 years.
Methods
GLS and MD, defined as mean peak longitudinal strain of the 18 LV segments and standard deviation of time-to-peak strain for the 18 LV segments, respectively, were analysed using a commercially available software. For group comparisons, the independent-samples t-test, the Mann-Whitney U-test or One Way Analysis of Variance with the Bonferroni post hoc test were performed. Values are mean±standard deviation.
Results
1850 examinations have so far been reviewed, whereof image quality was considered adequate for strain analysis in 1480 individuals (80%). Image quality, assessed as the number of visually assessable LV segments, was better for the second half of the examinations, as compared to the first half (p<0.001). Of the 1480 individuals where GLS and MD were assessed, 51% were women and mean age was 57±4.4 years with no difference in age between the sexes (p=ns). Mean GLS was −20±2% and men had significantly more negative (p<0.001) GLS values than women (−21±2% vs. −19±2%). There was no significant difference (p=ns) in GLS when comparing individuals aged 50–54, 55–59 or 60–64 years, respectively. GLS values were less negative than −16% in 1.9% of the study population. Mean MD was 41±12 ms with no significant difference (p=ns) between the sexes. MD was significantly lower (p<0.001) among individuals aged 50–54 years, as compared to those aged 55–59 or 60–64 years, respectively. MD was >70 ms in 1.6% of the study population.
Conclusions
These preliminary data from the SCAPIS echocardiography study suggest that, in the general population aged 50–64 years, 1.9% have impaired GLS and 1.6% have increased MD, which is possibly associated with a higher risk for malignant arrhythmias. Men had more negative GLS values than women and MD was lower in the lowest age tertile. Further analyses are ongoing.
Acknowledgement/Funding
The Swedish Heart and Lung Foundation. Grants from Linkoping University. ALF-grants from the Swedish government (LIO-700841).
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Affiliation(s)
- D Kylhammar
- Linkoping University, Department of Medical and Health Sciences and Department of Clinical Physiology, Linkoping, Sweden
| | - L Hult
- Jonkoping University, Department of Natural Science and Biomedicine, School of Health and Welfare, Jonkoping, Sweden
| | - P Blomstrand
- Jonkoping University, Department of Natural Science and Biomedicine, School of Health and Welfare, Jonkoping, Sweden
| | - G Engstrom
- Lund University, Department of Clinical Sciences in Malmo, Clinical Research Centre, Malmo, Sweden
| | - J Johnson
- Karolinska Institute, Department of Obstetrics and Gynecology, Stockholm, Sweden
| | - C J Ostgren
- Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden
| | - J Engvall
- Linkoping University, Department of Medical and Health Sciences and Department of Clinical Physiology, Linkoping, Sweden
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Stokke TM, Sarvari SI, Bjerring AW, Haugaa KH, Elahi MT, Hoedemakers SI, Rademakers F, Monaghan M, Sicari R, Engvall J, Nagel E, Zamorano JL, Ukkonen H, D'hooge J, Edvardsen T. P606High intermodality variability in ejection fraction measured by echocardiography, cardiac magnetic resonance and single photon emission computed tomography in chronic coronary artery disease patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0215] [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
Clinical treatment strategies are often based on measurement of left ventricular ejection fraction (LVEF). There is limited evidence about variations in LVEF when measured by different imaging modalities.
Purpose
To investigate the intermodality variability of LVEF measured by two-dimensional echocardiography (2DE), three-dimensional echocardiography (3DE), cardiac magnetic resonance (CMR), and single photon emission computed tomography (SPECT) in patients with chronic coronary artery disease (CAD).
Methods
Patients from a multicenter study (DOPPLER-CIP – Determining optimal noninvasive parameters for the prediction of left ventricular remodeling in chronic ischemic patients) with chronic CAD were included. LVEF was measured by CMR and at least one additional modality. In each modality, LVEF was measured by a core laboratory independently of the other modalities. Measurements of LVEF by CMR were compared to 2DE, 3DE and SPECT using correlation and Bland-Altman plots.
Results
A total of 343 patients were included. Mean age was 63.9±8.3 years and 253 (74%) were males. Mean LVEF by CMR was 61.8±11.6%. Correlations between CMR LVEF and other modalities were moderate for 2DE and 3DE, and good for SPECT (Figure A-C). CMR had significantly greater correlation to SPECT, compared to 2DE and 3DE. Bland-Altman plots indicated relatively wide limits of agreement between all modalities, ranging from 31% to 42% (Figure, D-F). Mean absolute difference of LVEF between CMR and other modalities were 8.5% for 2DE, 9.0% for 3DE, and 8.3% for SPECT. The percentage of measurements that fell within a range of 5% difference compared to CMR LVEF was 41% for 2DE, 34% for 3DE and 37% for SPECT (all p>0.05).
Conclusions
In a multicenter study with chronic CAD patients, LVEF assessed by CMR had better correlation to SPECT, compared to 2DE and 3DE. However, there was considerable variability among all three modalities that were compared to CMR. Awareness of these variations are important in clinical management.
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Affiliation(s)
- T M Stokke
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - S I Sarvari
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - A W Bjerring
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - K H Haugaa
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - M T Elahi
- KU Leuven, Lab on Cardiovascular Imaging and Dynamics, Leuven, Belgium
| | - S I Hoedemakers
- KU Leuven, Lab on Cardiovascular Imaging and Dynamics, Leuven, Belgium
| | - F Rademakers
- University Hospitals (UZ) Leuven, Department of Cardiovascular Sciences and KU Leuven, Leuven, Belgium
| | - M Monaghan
- Kings College Hospital, Department of Non-invasive Cardiology, London, United Kingdom
| | - R Sicari
- Institute of Clinical Physiology (IFC), Pisa, Italy
| | - J Engvall
- Linkoping University, Department of Clinical Physiology and Department of Medical and Health Sciences, Linkoping, Sweden
| | - E Nagel
- University Hospital Frankfurt, Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt am Main, Germany
| | - J L Zamorano
- University Hospital Ramon y Cajal de Madrid, Cardiovascular Imaging Unit, Madrid, Spain
| | - H Ukkonen
- Turku University Hospital, Department of Medicine, Turku, Finland
| | - J D'hooge
- KU Leuven, Lab on Cardiovascular Imaging and Dynamics, Leuven, Belgium
| | - T Edvardsen
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital and University of Oslo, Oslo, Norway
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Toren KO, Schiöler L, Lindberg A, Andersson A, Behndig A, Bergström G, Blomberg A, Caidahl K, Engvall J, Eriksson M, Hamrefors V, Janson C, Johnsson Å, Lindberg E, Lindén A, Malinovschi A, Persson L, Tanash H, Vikgren J, Östgren CJ, Wollmer P, Sandelin M, Ström J, Sköld M. Chronic airflow limitation and respiratory symptoms among smokers and never smokers. Epidemiology 2019. [DOI: 10.1183/13993003.congress-2019.pa3320] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ekström M, Blomberg A, Bergström G, Brandberg J, Caidahl K, Engström G, Engvall J, Eriksson M, Gränsbo K, Hansen T, Jernberg T, Nilsson L, Nilsson U, Olin AC, Persson L, Rosengren A, Sandelin M, Sköld M, Sundström J, Swahn E, Söderberg S, Tanash H, Torén K, Östgren CJ, Lindberg E. Body mass index, weight gain and activity-related breathlessness: the Swedish CArdioPulmonary bioImage Study. Epidemiology 2019. [DOI: 10.1183/13993003.congress-2019.oa1584] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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45
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Ekström MP, Blomberg A, Bergström G, Brandberg J, Caidahl K, Engström G, Engvall J, Eriksson M, Gränsbo K, Hansen T, Jernberg T, Nilsson L, Nilsson U, Olin AC, Persson L, Rosengren A, Sandelin M, Sköld M, Sundström J, Swahn E, Söderberg S, Tanash HA, Torén K, Östgren CJ, Lindberg E. The association of body mass index, weight gain and central obesity with activity-related breathlessness: the Swedish Cardiopulmonary Bioimage Study. Thorax 2019; 74:958-964. [DOI: 10.1136/thoraxjnl-2019-213349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 11/03/2022]
Abstract
IntroductionBreathlessness is common in the population, especially in women and associated with adverse health outcomes. Obesity (body mass index (BMI) >30 kg/m2) is rapidly increasing globally and its impact on breathlessness is unclear.MethodsThis population-based study aimed primarily to evaluate the association of current BMI and self-reported change in BMI since age 20 with breathlessness (modified Research Council score ≥1) in the middle-aged population. Secondary aims were to evaluate factors that contribute to breathlessness in obesity, including the interaction with spirometric lung volume and sex.ResultsWe included 13 437 individuals; mean age 57.5 years; 52.5% women; mean BMI 26.8 (SD 4.3); mean BMI increase since age 20 was 5.0 kg/m2; and 1283 (9.6%) reported breathlessness. Obesity was strongly associated with increased breathlessness, OR 3.54 (95% CI, 3.03 to 4.13) independent of age, sex, smoking, airflow obstruction, exercise level and the presence of comorbidities. The association between BMI and breathlessness was modified by lung volume; the increase in breathlessness prevalence with higher BMI was steeper for individuals with lower forced vital capacity (FVC). The higher breathlessness prevalence in obese women than men (27.4% vs 12.5%; p<0.001) was related to their lower FVC. Irrespective of current BMI and confounders, individuals who had increased in BMI since age 20 had more breathlessness.ConclusionBreathlessness is independently associated with obesity and with weight gain in adult life, and the association is stronger for individuals with lower lung volumes.
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Sandstedt M, De Geer J, Henriksson L, Engvall J, Janzon M, Persson A, Alfredsson J. Long-term prognostic value of coronary computed tomography angiography in chest pain patients. Acta Radiol 2019; 60:45-53. [PMID: 29742921 DOI: 10.1177/0284185118773551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) is increasingly used to detect coronary artery disease (CAD), but long-term follow-up studies are still scarce. PURPOSE To evaluate the prognostic value of CCTA in patients with suspected CAD. MATERIAL AND METHODS A total of 1205 consecutive CCTA patients with chest pain were classified as normal coronary arteries, non-obstructive CAD, or obstructive CAD. The primary outcome was major adverse cardiac event (MACE), defined as a composite outcome including cardiac death, myocardial infarction, unstable angina pectoris, or late revascularization (after >90 days). RESULTS Over 7.5 years follow-up (median = 3.1 years), Kaplan-Meier estimates demonstrated a MACE in 1.0%, 4.6%, and 20.7% in normal coronary arteries, non-obstructive CAD, and obstructive CAD, respectively. Log rank test for pairwise comparisons showed significant differences between non-obstructive CAD and normal coronary arteries ( P = 0.023) and between obstructive CAD and normal coronary arteries ( P < 0.001). In a multivariable analysis, adjusting for classical risk factors, non-obstructive CAD and obstructive CAD were independent predictors of MACE, with hazard ratios (HR) of 3.22 ( P = 0.041) and 25.18 ( P < 0.001), respectively. CONCLUSION Patients with normal coronary arteries have excellent long-term prognosis, but the risk for MACE increases with non-obstructive and obstructive CAD. Both non-obstructive and obstructive CAD are independently associated with future ischemic events.
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Affiliation(s)
- Mårten Sandstedt
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jakob De Geer
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lilian Henriksson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Magnus Janzon
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anders Persson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Joakim Alfredsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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47
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Bustamante M, Gupta V, Forsberg D, Carlhäll CJ, Engvall J, Ebbers T. Automated multi-atlas segmentation of cardiac 4D flow MRI. Med Image Anal 2018; 49:128-140. [DOI: 10.1016/j.media.2018.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 08/07/2018] [Accepted: 08/10/2018] [Indexed: 11/16/2022]
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48
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Blomstrand P, Sjöblom P, Nilsson M, Wijkman M, Engvall M, Länne T, Nyström FH, Östgren CJ, Engvall J. Overweight and obesity impair left ventricular systolic function as measured by left ventricular ejection fraction and global longitudinal strain. Cardiovasc Diabetol 2018; 17:113. [PMID: 30107798 PMCID: PMC6090791 DOI: 10.1186/s12933-018-0756-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/03/2018] [Indexed: 12/29/2022] Open
Abstract
Aims Obesity is associated with type 2 diabetes mellitus, left ventricular diastolic dysfunction and heart failure but it is unclear to which extent it is related to left ventricular systolic dysfunction. The aim of the study was to explore the effects of overweight and obesity on left ventricular systolic function in patients with type 2 diabetes mellitus and a control group of non-diabetic persons. Methods We prospectively investigated 384 patients with type 2 diabetes mellitus, and 184 controls who participated in the CARDIPP and CAREFUL studies. The participants were grouped according to body mass index (normal weight < 25 kg/m2, overweight 25–29 kg/m2, and obesity ≥ 30 kg/m2). Echocardiography was performed at the beginning of the study and after 4-years in the patient group. Results Univariable and multivariable regression analysis revealed that variations in left ventricular ejection fraction, global longitudinal strain, left ventricular mass and diastolic function expressed as E/é (the ratio between early diastolic mitral flow and annular motion velocities) all are related to body mass index. The mean and standard deviation of left ventricular ejection fraction and global longitudinal strain values were 57% (8%) vs. − 18.6% (2.3%) for normal weight patients, 53% (8%) vs. − 17.5% (2.3%) for overweight, and 49% (9%) vs. − 16.2% (3.0%) for obese (p < 0.05 vs. p < 0.05). Corresponding results in the control group were 58% (6%) vs. − 22.3% (3.0%), 55% (7%) vs. − 20.8% (3.1%) and 54% (8%) − 19.6% (4.0%) (p < 0.05 vs. p < 0.05). Patients who gained weight from baseline to follow-up changed left ventricular ejection fraction (median and interquartile range) by − 1.0 (9.0) % (n = 187) and patients who lost weight changed left ventricular ejection fraction by 1.0 (10.0) % (n = 179) (p < 0.05). Conclusion Overweight and obesity impair left ventricular ejection fraction and global longitudinal strain in both patients with type 2 diabetes mellitus and non-diabetic persons. Trial registration ClinicalTrials.gov identifier NCT 01049737
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Affiliation(s)
- Peter Blomstrand
- Department of Clinical Physiology, County Hospital Ryhov, Jönköping, Sweden. .,Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Peter Sjöblom
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Primary Health Care and Department of Medical and Health Sciences, Linköping University, Finspång, Sweden
| | - Mats Nilsson
- Futurum, Academy for Health and Care, Jönköping, Sweden
| | - Magnus Wijkman
- Department of Internal Medicine and Department of Medical and Health Sciences, Linköping University, Norrköping, Sweden
| | - Martin Engvall
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Toste Länne
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Fredrik H Nyström
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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49
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Rundqvist L, Engvall J, Faresjö M, Blomstrand P. Left ventricular diastolic function is enhanced after peak exercise in endurance-trained adolescents as well as in their non-trained controls. Clin Physiol Funct Imaging 2018; 38:1054-1061. [PMID: 29947056 DOI: 10.1111/cpf.12534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/29/2018] [Indexed: 11/30/2022]
Abstract
The aims of the study were to explore the temporal change of cardiac function after peak exercise in adolescents, and to investigate how these functional changes relate to maximal oxygen uptake (VO2max ). The cohort consisted of 27 endurance-trained adolescents aged 13-19 years, and 27 controls individually matched by age and gender. Standard echocardiography and colour tissue Doppler were performed at rest, and immediately after as well as 15 min after a maximal cardio pulmonary exercise test (CPET) on a treadmill. The changes in systolic and diastolic parameters after exercise compared to baseline were similar in both groups. The septal E/e'-ratio increased immediately after exercise in both the active and the control groups (from 9·2 to 11·0; P<0·001, and from 8·7 to 10·2; P = 0·008, respectively). In a comparison between the two groups after CPET, the septal E/e'-ratio was higher in the active group both immediately after exercise and 15 min later compared to the control group (P = 0·007 and P = 0·006, respectively). We demonstrated a positive correlation between VO2max and cardiac function including LVEF and E/e' immediately after CPET, but the strongest correlation was found between VO2max and LVEDV (r = 0·67, P<0·001) as well as septal E/e' (r = 0·34, P = 0·013). Enhanced diastolic function was found in both groups, but this was more pronounced in active adolescents. The cardiac functional response to exercise, in terms of LVEF and E/e', correlates with the increase in VO2 uptake. These findings in trained as well as un-trained teenagers have practical implications when assessing cardiac function.
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Affiliation(s)
- Louise Rundqvist
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Maria Faresjö
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- The Academy of Health and Care, Region Jönköping County, Jönköping, Sweden
| | - Peter Blomstrand
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Clinical Physiology, Region Jönköping County, Jönköping, Sweden
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50
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Rundqvist L, Engvall J, Faresjö M, Carlsson E, Blomstrand P. Regular endurance training in adolescents impacts atrial and ventricular size and function. Eur Heart J Cardiovasc Imaging 2018; 18:681-687. [PMID: 27406576 DOI: 10.1093/ehjci/jew150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 03/04/2016] [Accepted: 06/23/2016] [Indexed: 12/24/2022] Open
Abstract
Aims The aims of the study were to explore the effects of long-term endurance exercise on atrial and ventricular size and function in adolescents and to examine whether these changes are related to maximal oxygen uptake (VO2max). Methods and results Twenty-seven long-term endurance-trained adolescents aged 13-19 years were individually matched by age and gender with 27 controls. All participants, 22 girls and 32 boys, underwent an echocardiographic examination at rest, including standard and colour tissue Doppler investigation. VO2max was assessed during treadmill exercise. All heart dimensions indexed for body size were larger in the physically active group compared with controls: left ventricular end-diastolic volume 60 vs. 50 mL/m2 (P <0.001), left atrial volume 27 vs. 19 mL/m2 (P < 0.001), and right ventricular (RV) and right atrial area 15 vs. 13 and 9 vs. 7 cm2/m2, respectively (P <0.001 for both). There were strong associations between the size of the cardiac chambers and VO2max. Further, we found improved systolic function in the active group compared with controls: left ventricular ejection fraction 61 vs. 59% (P= 0.036), tricuspid annular plane systolic excursion 12 vs. 10 mm/m2 (P= 0.008), and RV early peak systolic velocity s' 11 vs. 10 cm/s (P = 0.031). Conclusion Cardiac remodelling to long-term endurance exercise in adolescents is manifested by an increase in atrial as well as ventricular dimensions. The physically active group also demonstrated functional remodelling with an increase in TAPSE and systolic RV wall velocity. These findings have practical implications when assessing cardiac enlargement and function in physically active youngsters.
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Affiliation(s)
- Louise Rundqvist
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, P.O Box 1026, Jönköping SE-551 11, Sweden
| | - Jan Engvall
- Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Maria Faresjö
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, P.O Box 1026, Jönköping SE-551 11, Sweden
| | - Emma Carlsson
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, P.O Box 1026, Jönköping SE-551 11, Sweden
| | - Peter Blomstrand
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, P.O Box 1026, Jönköping SE-551 11, Sweden
- Department of Clinical Physiology, Region Jönköping County, Jönköping, Sweden
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