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  • 1.
    Brandberg, Joakim
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Chew, Michelle
    University of Aarhus Denmark.
    Hasenkam, Michael
    Aarhus University Hospital Aarhus, Denmark.
    Ask, Per
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Janerot-Sjöberg, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Cardiac output measurement using ultrasound in a paediatric model: In-vivo validation of the surface integration of velocity vectros (SIVV) technique1999In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 19, no 3, p. 198-198Article in journal (Refereed)
  • 2.
    Carlhäll, Carljohan
    et al.
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Lindström, Lena
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Wranne, Bengt
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Atrioventricular plane displacement correlates closely to circulatory dimensions but not to ejection fraction in normal young subjects2001In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 21, no 5, p. 621-628Article in journal (Refereed)
    Abstract [en]

    Aims Mitral atrioventricular plane displacement (AVPD) provides information about left ventricular systolic function. M-mode of systolic annulus amplitude or tissue Doppler imaging of systolic annulus velocity are the current methods of evaluating AVPD. A correlation to ejection fraction (EF) has been demonstrated in patients with coronary artery disease and left ventricular dysfunction. Our aim was (i) to investigate the mitral AVPD of normal subjects with different physical work capacities and (ii) to further evaluate AVPD as an index of left ventricular systolic function.

    Methods and results Twenty-eight healthy men mean age 28 years (20–39) were included: endurance trained (ET) (n=10), strength trained (ST) (n=9) and untrained (UT) (n=9). The systolic AVPD was recorded at four sites, septal, lateral, anterior and posterior, using M-mode. Left ventricular volumes were calculated according to Simpson’s rule. Systolic AVPD was higher in endurance trained, 16·9 ± 1·5 mm, as compared with both strength trained, 13 ± 1·6 (P<0·001) and untrained, 14 ± 1·6 (P<0·001). Left ventricular systolic AVPD correlated strongly with end-diastolic volume (r=0·82), stroke volume (r=0·80) and maximal oxygen consumption per body weight (r=0·72). The correlation between AVPD and EF was poor (r=0·22).

    Conclusion  In the subjects studied, with a range of normal cardiac dimensions, AVPD correlated to stroke volume, end-diastolic volume and maximal oxygen consumption per body weight, but not to EF. On theoretical grounds, it also seems reasonable that a dimension like AVPD is related to other cardiac dimensions and volumes, rather than to a fraction, like EF. AVPD is one parameter that is useful for evaluation of left ventricular systolic function but is not interchangeable with other measurements such as EF.

  • 3.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Sweden.
    Brudin, Lars
    Department of Clinical Physiology, County Hospital, Kalmar, Sweden.
    Wandt, Birger
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Sweden.
    The mode of left ventricular pumping: is there an outer contour change in addition to the atrioventricular plane displacement?2001In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 21, no 4, p. 437-446Article in journal (Refereed)
    Abstract [en]

    The outer contour of the heart has in some studies been shown to be constant during the heart cycle and the epicardial apex almost stationary whilst the base of the ventricles moves towards apex during systole. The base of the left ventricle has been regarded as a cylinder with constant cross-sectional area with changes in height during the heart cycle, the latter corresponding to the amplitude of mitral annulus motion (MAM). In this echocardiographic study, including 20 healthy adults, the stroke volume calculated by the cylinder model was significantly lower than by a reference method (modified Simpson’s rule). MAM explained 82% of the stroke volume and 18% must, therefore, be explained by an inward motion of the outer left ventricular wall. A mean outer diameter shortening of about 3% (about 2 mm) was calculated.

  • 4.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Sweden .
    Wandt, Birger
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Sweden .
    The relation between ejection fraction and mitral annulus motion before and after direct-current electrical cardioversion2000In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 20, no 3, p. 218-224Article in journal (Refereed)
    Abstract [en]

    Mitral annulus motion (MAM) and the relation between left ventricular ejection fraction (EF) and MAM has been shown to differ between patients with sinus rhythm and patients with atrial fibrillation. However, it has not been investigated how the relation between EF and MAM changes on direct-current (DC) electrical cardioversion to sinus rhythm. Therefore, 31 consecutive patients on the waiting list for DC electrical cardioversion were examined by echocardiography before DC electrical cardioversion, and those who maintained sinus rhythm (13 patients) were examined again 4–8 weeks after cardioversion. The conversion factor (CF) (ratio EF/MAM) decreased from 8·4 ± 1·7 before to 5·8 ± 0·8 SD after cardioversion (P<0·001). The EF increased slightly (P<0·05) but the MAM had a much greater increase (P<0·001), resulting in the decrease in CF. There was no significant difference in CF between patients after cardioversion and age- and gender-matched control patients with sinus rhythm, indicating that CF is normalized or almost normalized 4–8 weeks after cardioversion. This indicates that when MAM is used for investigation of the left ventricular function, and the function is expressed as EF, the same CF as in other patients with sinus rhythm can be used 4–8 weeks after DC electrical cardioversion.

  • 5.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Sweden .
    Wandt, Birger
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Sweden .
    The relation between mitral annulus motion and ejection fraction changes with age and heart size2000In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 20, no 1, p. 38-43Article in journal (Refereed)
    Abstract [en]

    Mitral annulus motion (MAM) has recently been introduced as an index of left ventricular function. Several echocardiographic studies have shown good agreement between ejection fraction (EF) and MAM × 5, where MAM is the total mitral annulus motion, measured in mm, and EF is expressed as a percentage. This means that if MAM is used for estimation of left ventricular function, the conversion factor 5 is used, if the function is expressed as EF. In these studies, the mean age of the patients was over 60 years. The present study, including 102 patients, shows that in patients aged 20–40 years, the conversion factor is about 4·3, in patients aged 41–60 years it is about 4·6 and in patients aged 61–80 years it is about 5·0. It was also found that the ratio EF/MAM decreases with increasing height and left ventricular diameter, both variables closely connected to heart size. The results suggest that when MAM is used in assessment of left ventricular function, it is unwise to express the function in terms of EF. It is preferable to use MAM as a direct index of ventricular function, using reference values referred to aged and height. If the estimated function is expressed in terms of EF, different converting factors must be used depending on the age of the patients.

  • 6.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Sweden .
    Wandt, Birger
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Sweden .
    The relation between mitral annulus motion and left ventricular ejection fraction in atrial fibrillation2000In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 20, no 1, p. 44-49Article in journal (Refereed)
    Abstract [en]

    Mitral annulus motion (MAM) has recently been introduced as an index of left ventricular function. Previous studies have shown a good agreement between MAM (mm) × 5 and ejection fraction in middle-aged and elderly patients. These studies only included patients with sinus rhythm, while patients with atrial fibrillation were excluded. In the present study, MAM was reduced in patients with atrial fibrillation while ejection fraction (EF) did not differ from age-matched control patients with sinus rhythm. The ‘conversion factor’ (EF/MAM) was 7·2 in the group with atrial fibrillation and 5·1 in controls with sinus rhythm. This difference must be taken into account when MAM is used to estimate left ventricular function in patients with atrial fibrillation. Patients with atrial fibrillation had lower stroke volume and higher heart rate than patients with sinus rhythm. A decreased systolic long-axis shortening was found (P<0·005) compared to patients with sinus rhythm, but no difference in short-axis diameter shortening.

  • 7.
    Janerot-Sjöberg, Birgitta
    et al.
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
    Ekberg, Stefan
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics UHL.
    Areskog, M.
    Department of Clinical Physiology, Kalmar Regional Hospital.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Quantitative digital evaluation of myocardial exercise thallium-201 single-photon emission tomography in post-menopausal women1998In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 18, no 3, p. 169-177Article in journal (Refereed)
    Abstract [en]

    Quantitative computerized analysis of data from myocardial thallium-201 (201Tl) single-photon emission tomography (SPET) may improve the diagnostic accuracy of coronary heart disease. The reference ranges for post-menopausal women are, however, limited and obtained mainly from patients. To compare reference values from healthy post-menopausal women and to improve the quantitative analysis, 20 women (10 patients with coronary heart disease and previous infarction and 10 age-matched healthy volunteers) were examined immediately post exercise and after a delay. A nine-segment 'bull's-eye' model was used for analysis. At visual evaluation, reproducibility was high (93%), no false-positive results were obtained and in 70% of the patients the SPET was interpreted as abnormal. Using reported reference values for quantitative analysis, all the healthy women had an abnormal result. New reference values based on three different methods of 'normalization' were calculated: the relative activity of segment 3 set to 100%, the segment with the highest activity set to 100% and a least-squares method. They all differed significantly from those that had previously been reported. The frequencies of agreement between visual and quantitative analysis were 84-92% and were highest when segment 3 was used as a reference, but in this case only 40% of the patients with coronary heart disease had an abnormal SPET. Using the least-squares method for handling digital information, the SD of the normal values decreased and 90% of the patients with coronary heart disease were accurately diagnosed. These results provide quantitative digital reference values for healthy post-menopausal women. They verify that quantitative analysis is in diagnostic agreement with visual evaluation, stress the need for local verification of reference ranges and suggest a least-square normalization method for the analysis.

  • 8.
    Larsson, Barbro
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Karlberg, Christian
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine.
    Elert, Jessica
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Reproducibility of surface EMG during dynamic shoulder forward flexions: A study of clinically healthy subjects.1999In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 19, p. 433-439Article in journal (Refereed)
  • 9.
    Lindström, Lena
    et al.
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Wranne, Bengt
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Pulsed tissue Doppler evaluation of mitral annulus motion: A new window to assessment of diastolic function1999In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 19, no 1, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Diastolic dysfunction is an important cause of cardiac heart failure. To date detailed assessment of diastolic left ventricular (LV) function has required invasive methods which are impractical in the clinical routine. The prevailing non-invasive method has been Doppler echocardiography with use of mitral inflow and pulmonary vein inflow parameters, measurements providing no direct assessment of either ventricular relaxation or compliance, and influenced by multiple haemodynamic factors. We sought to determine the tissue Doppler pattern from the mitral annulus motion in normals and in patients with expected LV-diastolic dysfunction. Using pulsed tissue Doppler we recorded peak velocities from the mitral annulus motion in 16 young normals, 10 older normals and in two groups of patients expected to have an LV-diastolic relaxation abnormality, i.e. 15 patients with systemic hypertension and 10 patients with significant aortic stenosis. The peak early diastolic (E) annulus velocity was significantly (< 0·001) lower in older normals compared with young, and the late diastolic velocity (A) was higher (< 0·01). Compared with the older normals, patients showed significantly lower E-velocities (< 0·05 hypertensive patients), more pronounced in the patients with aortic stenosis (< 0·001), but the A-velocities were not higher. In systole a decrease in peak velocity was noted with increasing age and in patients with aortic stenosis. In conclusion, pulsed tissue Doppler measurement of annulus motion seems to provide valuable and easily obtainable information about LV-diastolic function, and furthermore there is a striking change in velocity pattern with increasing age which necessitates age-matched reference values.

  • 10.
    Samuelsson, Per Johan
    et al.
    IMT LiU.
    Gill, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Lassvik, Clas
    Klin Fys, US .
    Linnarsson, Dag
    KI Stockholm.
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Ramp-function work test suitable for automatic computation1986In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 6, p. 53-62Article in journal (Refereed)
  • 11.
    Strömberg, Tomas
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation.
    Adams, J.A
    Mt Sinai Med Center Miami Beach, FL, USA.
    Respiratory drive during carbachol challenge in allergic sheep2001In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 21, no 1, p. 93-99Article in journal (Refereed)
    Abstract [en]

    Diaphragmatic activity is the standard assessment of respiratory neural output but is difficult to measure and cannot be used for long-term clinical monitoring. The tidal breathing minute ventilation (V»') and mean inspiratory flow (VT/tI) reflect respiratory drive and can be monitored non-invasively using respiratory inductive plethysmography (RIP). Recent findings indicate that peak inspiratory acceleration (PIA) correlates to diaphragmatic activity during CO2 rebreathing in piglets. The aim of the present study was to assess whether tidal breathing peak inspiratory acceleration reflects respiratory drive during carbachol challenge. Aerosolized carbachol was administered to 15 allergic sheep until pulmonary resistance increased by at least 400%. After threshold dose, slight increases in V»' and VT/tI were seen (8 and 5%, respectively, P = NS), while PIA increased by 30% (P<0.05). The change in PIA was closely correlated to changes in V»' and VT/tI (r = 0.73, P<0.01 and r = 0.88, P<0.001, respectively). In conclusion, peak inspiratory acceleration reflected respiratory drive during bronchoprovocation. Further, this new measure of drive has the potential to accurately estimate drive in chronic obstructive lung disease where intrinsic positive end expiratory pressure prevents accurate selection of beginning inspiration necessary for computation of, e.g. VT/tI.

  • 12.
    Strömberg, Tomas
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation.
    Nelson, Nina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Thoracoabdominal asynchrony in small children with lung disease - methodological aspects and the relationship to lung mechanics1998In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 18, p. 447-456Article in journal (Refereed)
  • 13.
    Wigström, Lars
    et al.
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Lindström, Lena
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Sjöqvist, Lars
    Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics. Linköping University, Faculty of Health Sciences.
    Thuomas, K. Å.
    Linköping University, Department of Medicine and Care, Radiology. Linköping University, Faculty of Health Sciences.
    Wranne, Bengt
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    M-mode magnetic resonance imaging: a new modality for assessing cardiac function1995In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 15, no 4, p. 397-407Article in journal (Refereed)
    Abstract [en]

    Magnetic resonance imaging (MRI) studies of the heart have been used for some years, but there are few tools available to quantify cardiac motion. A method has been developed that creates an M-mode MRI image, analogous to the one used in echocardiography, to display motion along a line as a function of time. The M-mode image is created from MRI images acquired with an ordinary gradient echo cine sequence. In a cinematographic display of the images, a cursor line can be positioned in order to determine the orientation of the measurement. A resampling algorithm then calculates the appearance of the M-mode image along the cursor line. The MRI method has been compared to echocardiographic M-mode in a phantom study and by measuring mitral and tricuspid annulus motion in 20 normal subjects. The phantom study showed no significant differences between MRI and echocardiographic M-mode measurements (difference mm). The annulus motion exhibits a similar pattern using both methods and the measured amplitudes are in close agreement. M-mode MRI provides similar information to echocardiography, but the cursor line can be placed arbitrarily within the image plane and the method is thus not limited to certain acoustic windows. This makes M-mode MRI a promising technique for assessing cardiac motion.

  • 14.
    Wranne, Bengt
    et al.
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Ask, Per
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Loyd, Dan
    Linköping University, Department of Management and Engineering, Applied Thermodynamics and Fluid Mechanics. Linköping University, The Institute of Technology.
    Quantification of heart valve regurgitation: a critical analysis from a theoretical and experimental point of view.1985In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 5, no 1, p. 81-88Article in journal (Refereed)
    Abstract [en]

    A theoretical analysis is presented regarding factors of importance for the determination of distance of intrusion of the regurgitant jet in heart valve regurgitation. The analysis is based on hydrodynamic theory. In the idealized model situation, for a circular hole, the intrusion of the regurgitant jet is linearly related to the product of the fluid mean velocity in the orifice and the diameter of the orifice. This was also shown to be true in an experimental fluid model. Thus, volume regurgitation cannot be quantified by the measurement of distance of intrusion of the regurgitant jet alone. On the other hand, an estimate of volume regurgitation can, in the idealized situation, be obtained if mean fluid velocity in the orifice, distance of intrusion of the jet and regurgitation time are known.

  • 15. Xiong, C
    et al.
    Hök, Bertil
    Strömberg, Tomas
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation.
    Loyd, Dan
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Applied Thermodynamics and Fluid Mechanics.
    Wranne, Bengt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Ask, Per
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    A bioacoustic method for timing of respiration at cardiac investigations1995In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 15, p. 151-157Article in journal (Refereed)
  • 16.
    Zachrisson, Helene
    et al.
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Volkmann, R
    Bergerheim, T
    Holm, J
    Selectivity of superficial vein occlusion at the ankle and calf level: a methodological study in healthy volunteers.1998In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 18, no 1, p. 55-60Article in journal (Refereed)
    Abstract [en]

    Judgement of deep venous function may be necessary before surgery for superficial vein incompetence is performed. Assessment of deep venous function needs selective entrapment of superficial venous compartments between the ankle and knee, which may not be guaranteed if conventional tourniquets are used. This study was, therefore, aimed at modifying the technique of selective compression of superficial vein compartments. Twenty apparently normal legs of 10 volunteers were investigated on two study days. The subjects were in a supine position with the feet resting 30 cm above heart level. Ankle cuffs (3 cm wide) were placed just above the malleoli and stepwise inflated with air. The steady-state venous volume of the forefoot as a function of the pressure within the ankle cuff was measured with a mercury-in-rubber strain gauge. The maximum venous outflow velocity from the foot was also measured at each cuff pressure step after the addition of conventional thigh vein occlusion. The same protocol was used on the second study day: calf cuffs (3 cm wide) were then used instead of the ankle cuffs. In the forefoot, venous volume increased and the maximum venous outflow velocity decreased significantly either at ankle cuff pressures > 30 mmHg or at calf cuff pressures of > 60 mmHg. By using small cuffs, selective superficial vein occlusion seems to occur at cuff pressures ranging between 10 and 30 mmHg (ankle) and between 30 and 60 mmHg (calf), provided the feet are 30 cm above heart level. Higher cuff pressures seem to interact with deep venous function.

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