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  • 1.
    Johansson Blixt, Patrik
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    Nguyen, Maxime
    Dijon Univ Hosp, France.
    Cholley, Bernard
    Hop Europeen Georges Pompidou, France; Univ Paris, France.
    Hammarskjold, Fredrik
    Ryhov Cty Hosp, Sweden.
    Toiron, Alois
    Hop Europeen Georges Pompidou, France.
    Bouhemad, Belaid
    Dijon Univ Hosp, France.
    Lee, Shaun
    St George Hosp, England.
    de Geer, Lina
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    Andersson, Henrik
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    Åström, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Engvall, Jan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Chew, Michelle
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    Association between left ventricular systolic function parameters and myocardial injury, organ failure and mortality in patients with septic shock2024Ingår i: Annals of Intensive Care, ISSN 2110-5820, E-ISSN 2110-5820, Vol. 14, nr 1, artikel-id 12Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundLeft 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.MethodsA 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.ResultsLVLS, 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.ConclusionsMAPSE 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.ConclusionsMAPSE 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.

  • 2.
    Ohlsson, Linus
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Thorax-kärlkliniken i Östergötland. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Papageorgiou, Joanna-Maria
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Ebbers, Tino
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Åström, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Tamas, Eva
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Thorax-kärlkliniken i Östergötland. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Granfeldt, Hans
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Thorax-kärlkliniken i Östergötland.
    Echocardiographic haemodynamic monitoring in the context of HeartMate 3™ therapy: a systematic review2024Ingår i: ESC Heart Failure, E-ISSN 2055-5822Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimsWhile echocardiography remains essential within haemodynamic monitoring of durable mechanical circulatory support, previous echocardiographic guidelines are missing scientific evidence for the novel HeartMate 3 (TM) (HM3) system. Accordingly, this review aims to summarize available echocardiographic evidence including HM3.Methods and resultsThis systematic review adhered to the PRISMA 2020 guidelines. Searches were conducted during August 2023 across PubMed, Embase, and Google Scholar using specific echocardiographic terms combined with system identifiers. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and Critical Appraisal Instrument (PCAI) for cross-sectional studies. Nine studies met the inclusion criteria, of which eight cohort studies and one cross-sectional study. Aortic regurgitation (AR) prevalence at approximately 12 months of support exhibited heterogenicity (33.5% (Delta 33%)) in a limited number of studies (n = 3). Several studies (n = 5) demonstrated an increasing prevalence and severity of AR during HM3 support, generating moderate to high level of evidence. One AR study showed a higher cumulative incidence of death and heart failure (HF) readmission compared with those without significant AR, hazard ratio 3.42 (95% CI 1.48-8.76). A second study showed that a worsening AR group had significantly lower survival-free from HF readmission (59% vs. 89%, P = 0.023) with a hazard ratio of 5.18 (95% CI 1.07-25.0), while a third study did not reveal any differences in cardiac-related hospitalizations in the 12 months follow-up or non-cardiac-related hospitalization. Mitral regurgitation (MR) prevalence at approximately 12 months of support exhibited good consistency 15.0% (Delta 0.8%) in both included studies, which did not reveal any significant pattern of changing prevalence over time. Tricuspid regurgitation (TR) prevalence at approximately 12 months of support exhibited fair consistency 28.5% (Delta 8.3%) in a limited number of studies (n = 2); both studies showed a statistically un-confirmed trend of increased TR prevalence over time. The evidence of general prevalence of right ventricular dysfunction (RVD) was insufficient due to lack of studies.ConclusionsThere are few methodologically consistent studies with focus on long-term haemodynamic effects. Aortic regurgitation still seems to be a prevalent and potentially significant finding. The available evidence concerning right heart function is limited despite clinical relevance and potential prognostic value. Potential interventricular and haemodynamic interplay are identified as a white field for future research.

  • 3.
    Boano, Gabriella
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Thorax-kärlkliniken i Östergötland.
    Vanky, Farkas
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Thorax-kärlkliniken i Östergötland.
    Åström, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Effect of cryothermic and radiofrequency Cox-Maze IV ablation on atrial size and function assessed by 2D and 3D echocardiography, a randomized trial. To freeze or to burn2023Ingår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 43, nr 6, s. 431-440Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundAtrial linear scars in Cox-Maze IV procedures are achieved using Cryothermy (Cryo) or radiofrequency (RF) techniques. The subsequent postoperative left atrial (LA) reverse remodelling is unclear. We used 2- and 3-dimensional echocardiography (2-3DE) to compare the impact of Cryo and RF procedures on LA size and function 1 year after Cox-maze IV ablation concomitant with Mitral valve (MV) surgery. MethodsSeventy-two patients with MV disease and AF were randomized to Cryo (n = 35) or RF (n = 37) ablation. Another 33 patients were enroled without ablation (NoMaze). All patients underwent an echocardiogram the day before and 1 year after surgery. The LA function was assessed on 2D strain by speckle tracking and 3DE. ResultsForty-two ablated patients recovered sinus rhythm (SR) 1 year after surgery. They had comparable left and right systolic ventricular function, LA volume index (LAVI), and 2D reservoir strain before surgery. At follow-up, the 3DE extracted reservoir and booster function were higher after RF (37 & PLUSMN; 10% vs. 26 & PLUSMN; 6%; p < 0.001) than Cryo ablation (18 & PLUSMN; 9 vs. 7 & PLUSMN; 4%; p < 0.001), while passive conduit function was comparable between groups (24 & PLUSMN; 11 vs. 20 & PLUSMN; 8%; p = 0.17). The extent of LAVI reduction depended on the duration of AF preoperatively. ConclusionsSR restoration after MV surgery and maze results in LA size reduction irrespective of the energy source used. Compared to RF, the extension of ablation area produced by Cryo implies a structural LA remodelling affecting LA systolic function.

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  • 4.
    Forsberg, Lena
    et al.
    Karolinska universitetssjukhuset, Sverige.
    Maret, Eva
    Karolinska institutet, Sverige.
    Rickenlund, Anette
    Karolinska universitetssjukhuset, Sverige.
    Åström Aneq, Meriam
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Bröstimplantat kan försvåra diagnostik av hjärtsjukdomar: Inför kirurgi bör patienten informeras om vilka konsekvenser bröstimplantat kan ha för framtida hjärtdiagnostik [Cosmetic breast implants can influence cardiac imaging]2022Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 119, artikel-id 21231Artikel, forskningsöversikt (Refereegranskat)
    Abstract [sv]

    Bröstimplantat kan negativt påverka de diagnostiska möjligheterna vid flera undersökningar av hjärtat. Inför bröstkirurgi med implantat bör patienten muntligt och skriftligt informeras om långsiktiga konsekvenser för hjärtdiagnostik. 

    Vid vilo-EKG kan en förskjutning av elektrodernas placering efter operationen ge en felaktig bild av genomgången myokardskada.

    Vid ekokardiografi kan vänstersidiga bröstimplantat försämra bildkvalitet i parasternal och apikal projektion, vilka båda är fundamentala för bedömning av hjärtfunktionen. 

    Bröstimplantat kan dämpa isotopsignalen från myokardiet vid myokardskintigrafi och orsaka avvikelser som kan misstas för myokardskada. 

    Vid MR hjärta kan bröstimplantatet inverka på kamerans magnetfält och orsaka artefakter. 

  • 5.
    Chew, Michelle
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    Jansson, Saga
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Engvall, Jan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Definition and evolution of right ventricular dysfunction in critically ill COVID-19 patients: Authors reply2022Ingår i: Annals of Intensive Care, ISSN 2110-5820, E-ISSN 2110-5820, Vol. 12, nr 1, artikel-id 83Artikel i tidskrift (Övrigt vetenskapligt)
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  • 6.
    Jansson, Saga
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    Blixt Johansson, Patrik
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi.
    Didriksson, Helen
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi.
    Jonsson, Carina
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    Andersson, Henrik
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    Hedström, Cassandra
    Linköpings universitet, Institutionen för hälsa, medicin och vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Engvall, Jan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Åstrom Aneq, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Chew, Michelle S
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    Incidence of acute myocardial injury and its association with left and right ventricular systolic dysfunction in critically ill COVID-19 patients2022Ingår i: Annals of Intensive Care, ISSN 2110-5820, E-ISSN 2110-5820, Vol. 12, nr 1, artikel-id 56Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

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  • 7.
    Baturova, Maria A.
    et al.
    Department of Cardiology, Clinical Sciences, Lund University, Sweden; Research Park, Saint Petersburg State University, Russia.
    Svensson, Anneli
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Svendsen, Jesper H.
    Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
    Risum, Niels
    Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
    Sherina, Valeriia
    Department of Biostatistics and Computational Biology, School of Medicine and Dentistry, University of Rochester Medical Center, USA.
    Bundgaard, Henning
    Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
    Meurling, Carl
    Department of Cardiology, Clinical Sciences, Lund University, Sweden.
    Lundin, Catarina
    Department of Clinical Genetics and Pathology, Division of Laboratory Medicine, Sweden.
    Carlson, Jonas
    Department of Cardiology, Clinical Sciences, Lund University, Sweden.
    Platonov, Pyotr G.
    Department of Cardiology, Clinical Sciences, Lund University, Sweden.
    Evolution of P-wave indices during long-term follow-up as markers of atrial substrate progression in arrhythmogenic right ventricular cardiomyopathy2021Ingår i: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 23, nr Supplement_1, s. i29-i37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: Patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) have increased prevalence of atrial arrhythmias indicating atrial involvement in the disease. We aimed to assess the long-term evolution of P-wave indices as electrocardiographic (ECG) markers of atrial substrate during ARVC progression.

    METHODS AND RESULTS: We included 100 patients with a definite ARVC diagnosis according to 2010 Task Force criteria [34% females, median age 41 (inter-quartile range 30-55) years]. All available sinus rhythm ECGs (n = 1504) were extracted from the regional electronic ECG databases and automatically processed using Glasgow algorithm. P-wave duration, P-wave area, P-wave frontal axis, and prevalence of abnormal P terminal force in lead V1 (aPTF-V1) were assessed and compared at ARVC diagnosis, 10 years before and up to 15 years after diagnosis.Prior to ARVC diagnosis, none of the P-wave indices differed significantly from the data at ARVC diagnosis. After ascertainment of ARVC diagnosis, P-wave area in lead V1 decreased from -1 to -30 µV ms at 5 years (P = 0.002). P-wave area in lead V2 decreased from 82 µV ms at ARVC diagnosis to 42 µV ms 10 years after ARVC diagnosis (P = 0.006). The prevalence of aPTF-V1 increased from 5% at ARVC diagnosis to 18% by the 15th year of follow-up (P = 0.004). P-wave duration and frontal axis did not change during disease progression.

    CONCLUSION: Initial ARVC progression was associated with P-wave flattening in right precordial leads and in later disease stages an increased prevalence of aPTF-V1 was seen.

  • 8.
    Blixt Johansson, Patrik
    et al.
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi.
    Chew, Michelle
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    Åhman, Rasmus
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    de Geer, Lina
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    Blomqwist, Lill
    Skane Univ Hosp, Sweden.
    Åström, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Engvall, Jan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Andersson, Henrik
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    Left ventricular longitudinal wall fractional shortening accurately predicts longitudinal strain in critically ill patients with septic shock2021Ingår i: Annals of Intensive Care, ISSN 2110-5820, E-ISSN 2110-5820, Vol. 11, nr 1, artikel-id 52Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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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  • 9.
    Kalantarian, Shadi
    et al.
    University of California, San Francisco, USA.
    Åström Aneq, Meriam
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Svetlichnaya, Jana
    Kaiser Permanente, San Francisco, USA.
    Sharma, Shikha
    University of California, San Francisco, USA.
    Vittinghoff, Eric
    University of California, San Francisco, USA.
    Klein, Liviu
    University of California, San Francisco, USA.
    Scheinman, Melvin M
    University of California, San Francisco, USA.
    Long-Term Electrocardiographic and Echocardiographic Progression of Arrhythmogenic Right Ventricular Cardiomyopathy and Their Correlation With Ventricular Tachyarrhythmias.2021Ingår i: Circulation Heart Failure, ISSN 1941-3289, E-ISSN 1941-3297, Vol. 14, nr 9, artikel-id e008121Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Prior studies of structural and electrocardiographic changes in arrhythmogenic right ventricular (RV) cardiomyopathy and their role in predicting ventricular arrhythmias (ventricular tachycardia) have shown conflicting results.

    METHODS: We reviewed 405 ECGs, 315 transthoracic echocardiographies, and 441 implantable cardioverter defibrillator interrogations in 64 arrhythmogenic RV cardiomyopathy patients (56% men, mean age [SD], 44.2 [14.6] years) over a mean follow-up of 10 (range, 2.3-19) years. Generalized estimating equations were used to identify the association between ECG abnormalities, clinical variables, and transthoracic echocardiographic measurements (>mild degree of tricuspid regurgitation, RV outflow tract diameter in parasternal long axis and short axis, RV end-diastolic area, fractional area change).

    RESULTS: There was a 4.65 (95% CI, 0.51%-8.8%) increase in RV end-diastolic area, a 3.75 (95% CI, 1.17%-6.34%) decrease in fractional area change, and 1.9 (95% CI, 1.3-2.8) higher odds (odds ratio) of RV wall motion abnormality with every 5-year increase in age after patients' first transthoracic echocardiography. >Mild tricuspid regurgitation was an independent predictor of RV enlargement and dysfunction (hazard ratio of >10% drop in fractional area change from baseline [95% CI], 3.51 [1.77-6.95] and hazard ratio of >10% increase in RV end-diastolic area from baseline [95% CI], 4.90 [2.52-9.52]). Patients with implantable cardioverter defibrillator were more likely to develop >mild tricuspid regurgitation and larger structural and functional disease progression. More pronounced increase in RV end-diastolic area was translated into higher rates of any ventricular tachycardia. Inferior T-wave inversions and sum of R waves (mm) in V1 to V3 were predictors of RV enlargement and dysfunction with the former also predicting risk of any ventricular tachycardia.

    CONCLUSIONS: Arrhythmogenic RV cardiomyopathy is a progressive disease. Tricuspid regurgitation is an independent predictor of structural disease progression, which may be exacerbated by use of a transvenous implantable cardioverter defibrillator lead.

  • 10.
    Engvall, Jan
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Åström, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Nylander, Eva
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Brudin, Lars
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten.
    Maret, Eva
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Moderately trained male football players, compared to sedentary male adults, exhibit anatomical but not functional cardiac remodelling, a cross-sectional study2021Ingår i: Cardiovascular Ultrasound, E-ISSN 1476-7120, Vol. 19, artikel-id 36Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Elite athletes have been the subject of great interest, but athletes at an intermediate level of physical activity have received less attention in respect to the presence of cardiac enlargement and/or hypertrophy. We hypothesized that playing football, often defined as demanding less endurance components than running or cycling, would still induce remodelling similar to sports with a dominating endurance component. Methods 23 male football players, age 25+/- 3.9 yrs. underwent exercise testing, 2D- and 3D- echocardiography and cardiac magnetic resonance (CMR). The results were compared with a control group of engineering students of similar age. The athletes exercised 12 h/week and the control subjects 1 h/week, p < 0.001. Results The football players achieved a significantly higher maximal load at the exercise test (380 W vs 300 W, p < 0.001) as well as higher calculated maximal oxygen consumption, (49.7 vs 37.4 mL x kg(- 1) x min(- 1), p < 0.001) compared to the sedentary group. All left ventricular (LV) volumes assessed by 3DEcho and CMR, as well as CMR left atrial (LA) volume were significantly higher in the athletes (3D-LVEDV 200 vs 154 mL, CMR-LVEDV 229 vs 185 mL, CMR-LA volume 100 vs 89 mL, p < 0.001, p = 0.002 and p = 0.009 respectively). LVEF and RVEF, LV strain by CMR or by echo did not differentiate athletes from sedentary participants. Right ventricular (RV) longitudinal strain, LA and right atrial (RA) strain by CMR all showed similar results in the two groups. Conclusion Moderately trained intermediate level football players showed anatomical but not functional cardiac remodelling compared to sedentary males.

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  • 11.
    Stokke, Mathis K.
    et al.
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Castrini, Anna I.
    Oslo Univ Hosp, Norway.
    Åström, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Jensen, Henrik K.
    Aarhus Univ Hosp, Denmark; Aarhus Univ, Denmark.
    Madsen, Trine
    Aalborg Univ Hosp, Denmark.
    Hansen, Jim
    Univ Copenhagen, Denmark.
    Bundgaard, Henning
    Univ Copenhagen, Denmark.
    Gilljam, Thomas
    Univ Gothenburg, Sweden.
    Platonov, Pyotr G.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Svendsen, Jesper Hastrup
    Univ Copenhagen, Denmark; Univ Copenhagen, Denmark.
    Edvardsena, Thor
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Haugaa, Kristina H.
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Reply to: TFC ECG in arrhythmogenic cardiomyopathy: Inadequate mixture of criteria?2021Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 323, s. 203-203Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 12.
    Stokke, Mathis K
    et al.
    Institute of Clinical Medicine, University of Oslo, Norway.
    Castrini, Anna I.
    Oslo University Hospital, Norway.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Jensen, Henrik Kjærulf
    Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.
    Madsen, Trine
    Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Denmark.
    Hansen, Jim
    Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
    Bundgaard, Henning
    University of Copenhagen, Denmark; Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
    Gilljam, Thomas
    Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Platonov, Pyotr G.
    Lund University and Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden..
    Svendsen, Jesper Hastrup
    Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
    Edvardsen, Thor
    Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
    Haugaa, Kristina H
    Oslo University Hospital, Rikshospitalet, Norway; University of Oslo, Oslo, Norway.
    Absence of ECG task force criteria does not rule out structural changes in genotype positive ARVC patients2020Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 317, s. 152-158Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: In Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), electrophysiological pathology has been claimed to precede morphological and functional pathology. Accordingly, an ECG without ARVC markers should be rare in ARVC patients with pathology identified by cardiac imaging. We quantified the prevalence of ARVC patients with evidence of structural disease, yet without ECG Task Force Criteria (TFC).

    METHODS AND RESULTS: We included 182 probands and family members with ARVC-associated mutations (40 ± 17 years, 50% women, 73% PKP2 mutations) from the Nordic ARVC Registry in a cross-sectional analysis. For echocardiography and cardiac MR (CMR), we differentiated between "abnormalities" and TFC. "Abnormalities" were defined as RV functional or structural measures outside TFC reference values, without combinations required to fulfill TFC. ECG TFC were used as defined, as these are not composite parameters. We found that only 4% of patients with ARVC fulfilled echocardiographic TFC without any ECG TFC. However, importantly, 38% of patients had imaging abnormalities without any ECG TFC. These results were supported by CMR data from a subset of 51 patients: 16% fulfilled CMR TFC without fulfilling ECG TFC, while 24% had CMR abnormalities without any ECG TFC. In a multivariate analysis, echocardiographic TFC were associated with arrhythmic events.

    CONCLUSION: More than one third of ARVC genotype positive patients had subtle imaging abnormalities without fulfilling ECG TFC. Although most patients will have both imaging and ECG abnormalities, structural abnormalities in ARVC genotype positive patients cannot be ruled out by the absence of ECG TFC.

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  • 13.
    Boano, Gabriella
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Thorax-kärlkliniken i Östergötland.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Spyrou, Giannis
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi. Linköpings universitet, Medicinska fakulteten.
    Enocsson, Helena
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Charitakis, Emmanouil
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Vánky, Farkas
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Thorax-kärlkliniken i Östergötland.
    Biochemical response to cryothermal and radiofrequency exposure of the human myocardium at surgical ablation of atrial fibrillation: a randomized controlled trial2020Ingår i: Translational Medicine Communications, ISSN 2396-832X, Vol. 5, artikel-id 11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Surgical cryothermia and radiofrequency (RF) ablations for atrial fibrillation (AF) seem to result in similar sinus rhythm restoration, but the biochemical consequences of the two methods are unclear. We aimed to compare the biochemical responses to the two ablative methods in concomitant mitral valve surgery (MVS).

    Methods: Sixty mitral valve surgery patients with AF were prospectively included. Forty-one patients planned for ablation were randomized to cryothermia (n = 20) or radiofrequency (n = 21) ablation and 19 served as controls. Markers for myocardial injury, inflammation, cell stress, apoptosis, and heart failure were analyzed pre- and postoperatively at different time points.

    Results: Troponin T and creatine kinase isoenzyme MB (CK-MB) peak levels were significantly higher in the cryothermia group compared with the RF group (12,805 [6140–15,700] vs. 2790 [1880–4180] ng/L; P = 0.002 and 271 [217–357] vs. 79 [66–93] μg/L; P < 0.001, respectively). Both groups had significantly higher levels than the no-ablation group. There were no group differences in C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), but there were correlations between pre- and postoperative levels of both CRP (rs = 0.41, P = 0.001) and NT-proBNP (rs = 0.48, P < 0.001). Protease-activated receptor 1 (PAR-1) and heat shock protein 27 (HSP27) were significantly increased in the cryoablation group.

    Conclusions: Cryoablation results in a larger myocardial injury and possibly more elevated apoptotic activity and cell stress compared with the RF technique. The type of ablation device did not have any significant influence on the postoperative inflammatory response nor on the early postoperative levels of NT-proBNP.

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  • 14.
    Eze-Nliam, Chete
    et al.
    Cleveland Clinic, Cleveland, OH. USA.
    Schiller, Nelson B
    University of California San Francisco, CA. USA.
    Hayami, Doug
    Queen Elisabeth II Helath Sciences, Halifax, NS. Canada.
    Ghahghaie, Farzin
    University of California San Francisco, CA. USA.
    Bibby, Dwight
    University of California San Francisco, CA. USA.
    Fang, Qizhi
    University of California San Francisco, CA. USA.
    Marcus, Gregory M
    University of California San Francisco, CA. USA.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Endurance exercise in seniors: Tonic, toxin or neither?2020Ingår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 40, nr 5, s. 320-327Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Cardiac adaptation to sustained exercise in the athletes is established. However, exercise-associated effect on the cardiac function of the elderly has to be elucidated. The aim of this study was to analyse left (LV) and right ventricular (RV) characteristics at different levels of chronic exercise in the senior heart.

    MATERIALS AND METHODS: We studied 178 participants in the World Senior Games (mean age 68 ± 8 years, 86 were men; 48%). Three groups were defined based on the type and intensity of sports: low-, moderate- and high-intensity level. Exclusion criteria were coronary artery disease, atrial fibrillation, valvular heart disease or uncontrolled hypertension. LV and RV size and function were evaluated with an echocardiogram.

    RESULTS: LV trans-mitral inflow deceleration time decreased in parallel to the intensity of chronic exercise: 242 ± 54 ms in low-, 221 ± 52 ms in moderate- and 215 ± 58 ms in high-intensity level, p = .03. Left atrial volume index (LAVI) was larger in high-intensity group, p = .001. The LAVI remained significantly larger when adjusting for age, gender, heart rate, hypertension and diabetes (p = .002). LV and RV sizes were larger in the high-intensity group. LV ejection fraction and RV systolic function evaluated by tissue Doppler velocity, atrioventricular plane displacement and strain did not differ between groups.

    CONCLUSION: Left ventricular diastolic filling is not only preserved, but may also be enhanced in long-term, top-level senior athletes. Moreover, LV and RV systolic function remain unchanged at different levels of exercise. This supports the beneficial effects of endurance exercise participation in senior hearts.

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  • 15.
    Platonov, Pyotr G
    et al.
    Department of Cardiology, Clinical Sciences, Lund University, 22185 Lund, Sweden.
    Castrini, Anna I
    Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for clinical Medicine, University of Oslo, Oslo, Norway.
    Svensson, Anneli
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Christiansen, Morten K
    Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
    Gilljam, Thomas
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Bundgaard, Henning
    Department of Cardiology, Centre of Cardiac-, Vascular-, Pulmonary- and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Madsen, Trine
    Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
    Heliö, Tiina
    Department of Cardiology, Helsinki University Hospital, Helsinki, Finland.
    Christensen, Alex H
    Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Carlson, Jonas
    Department of Cardiology, Clinical Sciences, Lund University, 22185 Lund, Sweden.
    Edvardsen, Thor
    Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for clinical Medicine, University of Oslo, Oslo, Norway.
    Jensen, Henrik K
    Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
    Haugaa, Kristina H
    Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for clinical Medicine, University of Oslo, Oslo, Norway.
    Svendsen, Jesper H
    Department of Cardiology, Centre of Cardiac-, Vascular-, Pulmonary- and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Pregnancies, ventricular arrhythmias, and substrate progression in women with arrhythmogenic right ventricular cardiomyopathy in the Nordic ARVC Registry2020Ingår i: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 23, nr 12, s. 1873-1879Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: Women with arrhythmogenic right ventricular cardiomyopathy (ARVC) are at relatively lower risk of ventricular arrhythmias (VAs) than men, but the physical burden associated with pregnancy on VA risk remains insufficiently studied. We aimed to assess the risk of VA in relation to pregnancies in women with ARVC.

    METHODS AND RESULTS: We included 199 females with definite ARVC (n = 121) and mutation-positive family members without ascertained ARVC diagnosis (n = 78), of whom 120 had at least one childbirth. Ventricular arrhythmia-free survival after the latest childbirth was compared between women with one (n = 20), two (n = 67), and three or more (n = 37) childbirths. Cumulative probability of VA for each pregnancy (n = 261) was assessed from conception through 2 years after childbirth and compared between those pregnancies that occurred before (n = 191) or after (n = 19) ARVC diagnosis and in mutation-positive family members (n = 51). The nulliparous women had lower median age at ARVC diagnosis (38 vs. 42 years, P < 0.001) and first VA (22 vs. 41 years, P < 0.001). Ventricular arrhythmia-free survival after the latest childbirth was not related to the number of pregnancies. No pregnancy-related VA was reported among the family members. Women who gave birth after ARVC diagnosis had elevated risk of VA postpartum (hazard ratio 13.74, 95% confidence interval 2.9-63, P = 0.001), though only two events occurred during pregnancies.

    CONCLUSION: In women with ARVC, pregnancy was uneventful for the overwhelming majority and the number of prior completed pregnancies was not associated with VA risk. Pregnancy-related VA was primarily related to the phenotypical severity rather than pregnancy itself.

  • 16.
    Roberts, Jason D.
    et al.
    Western Univ, Canada; UCSF, CA USA.
    Murphy, Nathaniel P.
    Ohio State Univ, OH 43210 USA.
    Hamilton, Robert M.
    Hosp Sick Children, Canada; Univ Toronto, Canada.
    Lubbers, Ellen R.
    Ohio State Univ, OH 43210 USA.
    James, Cynthia A.
    Johns Hopkins Univ, MD USA.
    Kline, Crystal F.
    Ohio State Univ, OH 43210 USA.
    Gollob, Michael H.
    Univ Toronto, Canada.
    Krahn, Andrew D.
    Univ British Columbia, Canada.
    Sturm, Amy C.
    Geisinger, PA USA.
    Musa, Hassan
    Ohio State Univ, OH 43210 USA.
    El-Refaey, Mona
    Ohio State Univ, OH 43210 USA.
    Koenig, Sara
    Ohio State Univ, OH 43210 USA.
    Åström, Meriam
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Hoorntje, Edgar T.
    Netherlands Heart Inst, Netherlands; Univ Groningen, Netherlands.
    Graw, Sharon L.
    Univ Colorado Denver, CO USA.
    Davies, Robert W.
    Hosp Sick Children, Canada; Hosp Sick Children, Canada.
    Rafiq, Muhammad Arshad
    Hosp Sick Children, Canada; Hosp Sick Children, Canada; Univ Toronto, Canada; COMSATS Univ, Pakistan.
    Koopmann, Tamara T.
    Hosp Sick Children, Canada; Univ Toronto, Canada.
    Aafaqi, Shabana
    Hosp Sick Children, Canada; Univ Toronto, Canada.
    Fatah, Meena
    Hosp Sick Children, Canada; Univ Toronto, Canada.
    Chiasson, David A.
    Hosp Sick Children, Canada.
    Taylor, Matthew R. G.
    Univ Colorado Denver, CO USA; Univ Colorado Denver, CO USA.
    Simmons, Samantha L.
    Ohio State Univ, OH 43210 USA; Ohio State Univ, OH 43210 USA; Ohio State Univ, OH 43210 USA; Ohio State Univ, OH 43210 USA.
    Han, Mei
    Ohio State Univ, OH 43210 USA; Ohio State Univ, OH 43210 USA; Ohio State Univ, OH 43210 USA; Ohio State Univ, OH 43210 USA.
    van Opbergen, Chantal J. M.
    Univ Utrecht, Netherlands.
    Wold, Loren E.
    Ohio State Univ, OH 43210 USA.
    Sinagra, Gianfranco
    ASUITS Univ Trieste, Italy.
    Mittal, Kirti
    Hosp Sick Children, Canada; Univ Toronto, Canada.
    Tichnell, Crystal
    Johns Hopkins Univ, MD USA.
    Murray, Brittney
    Johns Hopkins Univ, MD USA.
    Codima, Alberto
    Univ Sao Paulo, Brazil.
    Nazer, Babak
    Oregon Hlth and Sci Univ, OR 97201 USA.
    Nguyen, Duy T.
    Univ Colorado, CO USA.
    Marcus, Frank I.
    Univ Arizona, AZ USA.
    Sobriera, Nara
    Johns Hopkins Univ, MD USA.
    Lodder, Elisabeth M.
    Univ Amsterdam, Netherlands.
    van den Berg, Maarten P.
    Univ Groningen, Netherlands.
    Spears, Danna A.
    Univ Toronto, Canada.
    Robinson, John F.
    Western Univ, Canada.
    Ursell, Philip C.
    UCSF, CA USA.
    Gréen, Anna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk genetik.
    Skanes, Allan C.
    Western Univ, Canada.
    Tang, Anthony S.
    Western Univ, Canada.
    Gardner, Martin J.
    Dalhousie Univ, Canada.
    Hegele, Robert A.
    Western Univ, Canada.
    van Veen, Toon A. B.
    Univ Utrecht, Netherlands.
    Wilde, Arthur A. M.
    Univ Amsterdam, Netherlands.
    Healey, Jeff S.
    McMaster Univ, Canada.
    Janssen, Paul M. L.
    Ohio State Univ, OH 43210 USA.
    Mestroni, Luisa
    Univ Colorado Denver, CO USA.
    van Tintelen, J. Peter
    Univ Groningen, Netherlands; Univ Amsterdam, Netherlands; UMCU, Netherlands.
    Calkins, Hugh
    Johns Hopkins Univ, MD USA.
    Judge, Daniel P.
    Johns Hopkins Univ, MD USA; Med Univ South Carolina, SC 29425 USA.
    Hund, Thomas J.
    Ohio State Univ, OH 43210 USA.
    Scheinman, Melvin M.
    UCSF, CA USA.
    Mohler, Peter J.
    Ohio State Univ, OH 43210 USA.
    Ankyrin-B dysfunction predisposes to arrhythmogenic cardiomyopathy and is amenable to therapy2019Ingår i: Journal of Clinical Investigation, ISSN 0021-9738, E-ISSN 1558-8238, Vol. 129, nr 8, s. 3171-3184Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Arrhythmogenic cardiomyopathy (ACM) is an inherited arrhythmia syndrome characterized by severe structural and electrical cardiac phenotypes, including myocardial fibrofatty replacement and sudden cardiac death. Clinical management of ACM is largely palliative, owing to an absence of therapies that target its underlying pathophysiology, which stems partially from our limited insight into the condition. Following identification of deceased ACM probands possessing ANK2 rare variants and evidence of ankyrin-B loss of function on cardiac tissue analysis, an ANK2 mouse model was found to develop dramatic structural abnormalities reflective of human ACM, including biventricular dilation, reduced ejection fraction, cardiac fibrosis, and premature death. Desmosomal structure and function appeared preserved in diseased human and murine specimens in the presence of markedly abnormal beta-catenin expression and patterning, leading to identification of a previously unknown interaction between ankyrin-B and beta-catenin. A pharmacological activator of the WNT/beta-catenin pathway, SB-216763, successfully prevented and partially reversed the murine ACM phenotypes. Our findings introduce what we believe to be a new pathway for ACM, a role of ankyrin-B in cardiac structure and signaling, a molecular link between ankyrin-B and beta-catenin, and evidence for targeted activation of the WNT/beta-catenin pathway as a potential treatment for this disease.

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  • 17.
    Cardona-Guarache, Ricardo
    et al.
    Univ Calif San Francisco, CA 94143 USA.
    Åström-Aneq, Meriam
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Oesterle, Adam
    Univ Calif San Francisco, CA 94143 USA.
    Asirvatham, Roshini
    Univ Calif San Francisco, CA 94143 USA.
    Svetlichnaya, Jana
    Kaiser Permanente, CA USA.
    Marcus, Gregory M.
    Univ Calif San Francisco, CA 94143 USA.
    Gerstenfeld, Edward P.
    Univ Calif San Francisco, CA 94143 USA.
    Klein, Liviu
    Univ Calif San Francisco, CA 94143 USA.
    Scheinman, Melvin M.
    Univ Calif San Francisco, CA 94143 USA.
    Atrial arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy: Prevalence, echocardiographic predictors, and treatment2019Ingår i: Cardiovascular Electrophysiology, ISSN 1045-3873, E-ISSN 1540-8167, Vol. 30, nr 10, s. 1801-1810Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction

    The clinical role of atrial arrhythmias (AA) in arrhythmogenic right ventricular cardiomyopathy (ARVC) and the echocardiographic variables that predict them are not well defined. We describe the prevalence, types, echocardiographic predictors, and management of AA in patients with ARVC.

    Methods

    We retrospectively evaluated medical records of 117 patients with definite ARVC (2010 Task Force Criteria) from two tertiary care centers. We identified those patients with sustained AA (>30 seconds), including atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT). We collected demographic, genetic, and clinical data. The median follow‐up was 3.4 years (interquartile range = 2.0‐5.7).

    Results

    Total 26 patients (22%) had one or more types of AA: AF (n = 19), AFL (n = 9), and AT (n = 8). We performed genetic testing on 84 patients with ARVC (71.8%). Two patients with AA (8%) had peripheral emboli, and one patient (4%) suffered inappropriate implantable cardioverter‐defibrillator shock. We performed catheter ablation of AA in eight patients (31%), with no procedural complications. Right atrial area and left atrial volume index were independently associated with increased odds of AA; odds ratio (OR), 1.1 (95% confidence interval [CI]:1.02‐1.16) (P = .01) and OR, 1.1 (95% CI:1.03‐1.15) (P = .003), respectively. An increase in tricuspid annular plane peak systolic excursion was independently associated with reduced odds; OR, 0.3 (95% CI: 0.1‐0.94) (P = .003).

    Conclusions

    Atrial arrhythmias (AA) are common in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Inappropriate shocks and systemic emboli may be associated with AA. Atrial size and right ventricular dysfunction may help identify patients with ARVC at increased odds of AA.

  • 18.
    Carlén, Anna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Gustafsson, Mikael
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Åström, Meriam
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Nylander, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Exercise-induced ST depression in an asymptomatic population without coronary artery disease2019Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 53, nr 4, s. 206-212Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives. Exercise electrocardiogram (ExECG) in low risk populations frequently generates false positive ST depression. We aimed to characterize factors that are associated with exercise-induced ST depression in asymptomatic men without coronary artery disease. Design. Cycle ergometer exercise tests from 509 male firefighters without imaging proof of significant coronary artery disease were analysed. Analysed test data included heart rate at rest before exercise, and workload, blood pressure, heart rate, ST depression and ST segment slope at peak exercise. ST depression of amp;gt;0.1 mV was considered significant (STdep). With a mean follow-up of 6.1 +/- 1.7 years, medical records were reviewed for cardiovascular diagnoses, hyperlipidemia and diabetes. Logistic regression analysis was used for risk assessment. Results. In total, 22% had STdep in amp;gt;= 1 lead. Subjects with STdep were older than those with normal ExECG (p amp;lt; .001). Downsloping STdep was more common in extremity leads (9%) than in precordial leads (2%). STdep was categorized according to location (precordial/extremity) and slope direction into eight categories. Larger age-adjusted heart rate increase predicted STdep in seven categories (p amp;lt; .05). Age-adjusted peak heart rate correlated with STdep in five categories, predominantly where the ST slope was positive. Peak blood pressure and exercise capacity were both associated with STdep in few categories. We found no association between STdep and hypertension, hyperlipidemia or diabetes (all p amp;gt; .05). Conclusions. In asymptomatic men with a physically demanding occupation and no coronary artery disease, both age and heart rate response were associated with ST depression, whereas common cardiovascular risk factors, blood pressure response and exercise capacity were not.

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  • 19.
    Carlén, Anna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Nylander, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Gustafsson, Mikael
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    ST/HR variables in firefighter exercise ECG: relation to ischemic heart disease2019Ingår i: Physiological Reports, E-ISSN 2051-817X, Vol. 7, nr 2, artikel-id e13968Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Exercise electrocardiography (ExECG) is regularly performed by Swedish firefighters by law. Heart rate-corrected analysis of ST segment variables (ST/HR) has shown improved prediction of ischemic heart disease (IHD) compared to ST depression alone. This has not previously been extensively studied in asymptomatic persons with a low probability of IHD. We therefore evaluated the predictive performance of ST/HR analysis in firefighter ExECG. ExECG was studied in 521 male firefighters. During 8.4 ± 2.1 years, 2.3% (n = 12) were verified with IHD by catheterization or myocardial scintigraphy (age 51.5 ± 5.5 years) and were compared with firefighters without imaging proof of IHD (44.2 ± 10.1 years). The predictive value of ST depression, ST/HR index, ST/HR slope, and area and rotation of the ST/HR loop was calculated as age-adjusted odds ratios (OR), in 10 ECG leads. Predictive accuracy was analyzed with receiver operating characteristics (ROC) analysis. ST/HR index ≤-1.6 μV/bpm and ST/HR slope ≤-2.4 μV/bpm were associated with increased IHD risk in three individual leads (all OR > 1.0, P < 0.05). ST/HR loop area lower than the fifth percentile of non-IHD subjects indicated IHD risk in V4, V5, aVF, II, and -aVR (P < 0.05). ST depression ≤-0.1 mV was associated with IHD only in V4 (OR, 9.6, CI, 2.3-40.0). ROC analysis of each of these variables yielded areas under the curve of 0.72 or lower for all variables and leads. Clockwise-rotated ST/HR loops was associated with increased risk in most leads compared to counterclockwise rotation. The limited clinical value of ExECG in low-risk populations was emphasized, but if performed, ST/HR analysis should probably be given more importance.

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  • 20.
    Åström Aneq, Meriam
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Maret, Eva
    Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
    Brudin, Lars
    Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden.
    Svensson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Right ventricular systolic function and mechanical dispersion identify patients with arrhythmogenic right ventricular cardiomyopathy.2018Ingår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 38, nr 5, s. 779-787Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To assess right ventricular (RV) regional and global systolic function using feature tracking (FT) in patients with a definite diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) and to investigate if changes in strain amplitude and mechanical dispersion indicate a propensity for arrhythmia.

    MATERIALS AND METHODS: Twenty-seven patients fulfilling Task Force Criteria for ARVC and 24 healthy volunteers underwent MR at 1·5 Tesla. Steady-state free precession cine of long-axis slices and a short-axis stack of the RV was acquired. Segmental longitudinal systolic strain amplitude and time-to-peak (TTP) strain were measured in the four- and two-chamber views of the RV.

    RESULTS: Compared to controls, patients with ARVC had lower RV ejection fraction (RVEF), (53% vs 57%, P = 0·012) and lower longitudinal strain amplitude in the RV free wall (-20·6 vs -26·3%, P = 0·014) and in the basal part of the RV (-22·8 vs -31·7%, P<0·001). Mechanical dispersion, defined as the standard deviation (SD) of TTP of RV segments, was larger in patients with ARVC (48 ms [21-74] vs 35 ms [13-66 ms], P = 0·02). Patients with ventricular tachycardia (VT) or non-sustained VT had lower RVEF (46% vs 55%, P = 0·008), but did not have significantly lower RV strain amplitude (-19·5% vs 21·0%, P = 0·073) and no signs of mechanical dispersion (49 ms vs 48 ms, P = 0·861) compared to patients without arrhythmia.

    CONCLUSION: ARVC patients had lower longitudinal absolute strain amplitude in basal RV segments and increased mechanical dispersion compared to healthy volunteers, but the presence of mechanical dispersion was not predictive of ventricular arrhythmia.

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  • 21.
    Rudski, Lawrence G.
    et al.
    McGill Univ, Canada.
    Gargani, Luna
    CNR, Italy.
    Armstrong, William F.
    Univ Michigan, MI 48109 USA.
    Lancellotti, Patrizio
    Univ Liege Hosp, Belgium.
    Lester, Steven J.
    Mayo Clin, AZ USA.
    Grunig, Ekkehard
    Univ Hosp Heidelberg, Germany.
    DAlto, Michele
    Univ Naples 2, Italy.
    Åström, Meriam
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Ferrara, Francesco
    Univ Hosp, Italy.
    Saggar, Rajeev
    Univ Arizona, AZ USA.
    Saggar, Rajan
    Univ Calif Los Angeles, CA 90095 USA.
    Naeije, Robert
    Free Univ Brussels, Belgium.
    Picano, Eugenio
    CNR, Italy.
    Schiller, Nelson B.
    Univ Calif San Francisco, CA 94143 USA.
    Bossone, Eduardo
    Univ Hosp, Italy.
    Stressing the Cardiopulmonary Vascular System: The Role of Echocardiography2018Ingår i: Journal of the American Society of Echocardiography, ISSN 0894-7317, E-ISSN 1097-6795, Vol. 31, nr 5, s. 527-+Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The cardiopulmonary vascular system represents a key determinant of prognosis in several cardiorespiratory diseases. Although right heart catheterization is considered the gold standard for assessing pulmonary hemodynamics, a comprehensive noninvasive evaluation including left and right ventricular reserve and function and cardiopulmonary interactions remains highly attractive. Stress echocardiography is crucial in the evaluation of many cardiac conditions, typically coronary artery disease but also heart failure and valvular heart disease. In stress echocardiographic applications beyond coronary artery disease, the assessment of the cardiopulmonary vascular system is a cornerstone. The possibility of coupling the left and right ventricles with the pulmonary circuit during stress can provide significant insight into cardiopulmonary physiology in healthy and diseased subjects, can support the diagnosis of the etiology of pulmonary hypertension and other conditions, and can offer valuable prognostic information. In this state-of-the-art document, the topic of stress echocardiography applied to the cardiopulmonary vascular system is thoroughly addressed, from pathophysiology to different stress modalities and echocardiographic parameters, from clinical applications to limitations and future directions.

  • 22.
    Boano, Gabriella
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland. Linköpings universitet, Medicinska fakulteten.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Linköpings universitet, Medicinska fakulteten.
    Kemppi, Jennie
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Linköpings universitet, Medicinska fakulteten.
    Vánky, Farkas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland. Linköpings universitet, Medicinska fakulteten.
    Cox-maze IV cryoablation and postoperative heart failure in mitral valve surgery patients2017Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 51, nr 1, s. 15-20Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The indications for and the risk and benefit of concomitant surgical ablation for atrial fibrillation (AF) have not been fully delineated. Our aim was to survey whether the Cox-maze IV procedure is associated with postoperative heart failure (PHF) or other adverse short-term outcomes after mitral valve surgery (MVS).

    DESIGN: Consecutive patients with AF undergoing MVS with (n = 50) or without (n = 66) concomitant Cox-maze IV cryoablation were analysed regarding perioperative data and one-year mortality.

    RESULTS: The patients in the Maze group were younger, were in lower NYHA classes, had better right ventricular function and had lower pulmonary artery pressure. The Maze group had 30 min longer median cross-clamp time (CCT) and 50% had PHF compared with 33% in the No-maze group, p = 0.09. Two patients in the No-maze group died within one year of surgery. Congestive heart failure (OR 4.3 [CI 95%: 1.8-10], p < 0.0001) and CCT (OR 1.03 [CI 95%: 1.01-1.04], p = 0.001) were associated with PHF.

    CONCLUSION: The current data cannot exclude that concomitant cryoablation increases the risk for PHF, possibly by increasing the cross clamp time.

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  • 23.
    Karlsson, Daniel
    et al.
    Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten.
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Alfoldine Ando, Agota
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Åstrom Aneq, Meriam
    Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Exercise testing for long-term follow-up in arrhythmogenic right ventricular cardiomyopathy2017Ingår i: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 50, nr 2, s. 176-183Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: We investigated arrhythmia, electrocardiography and physical work capacity (PWC) in the follow-up of ARVC. Design: Twenty-three patients (13 men; age 41 +/- 12 years) fulfilling diagnostic criteria were re-investigated after at least five years. Results: Ventricular arrhythmia during exercise testing (ET) was present in 14 patients (61%) and showed variation between examinations. In eleven (48%), complex ventricular ectopic activity was observed at peak exercise or immediately thereafter. Mutations known to be pathogenic in ARVC were present in 13 patients (57%) of which 11 developed complex ventricular arrhythmia at ET. PWC at baseline was 190 +/- 66 W (104 +/- 26%) decreasing to 151 +/- 61 W (91 +/- 23%, p = 0.008) after 10.7 years. Conclusion: The appearance of ventricular arrhythmia during exercise testing showed temporal variation but was.frequent in patients with relevant genetic mutation. Physical exercise capacity decreased over time in patients with ARVC in excess to the age-related deterioration and regardless of medication. (C) 2016 Elsevier Inc. All rights reserved.

  • 24.
    Carlén, Anna
    et al.
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin.
    Åström Aneq, Meriam
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin.
    Nylander, Eva
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin.
    Gustafsson, Mikael
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin.
    Loaded treadmill walking and cycle ergometry to assess work capacity: a retrospective comparison in 424 firefighters.2017Ingår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 37, nr 1, s. 37-44Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The fitness of firefighters is regularly evaluated using exercise tests. We aimed to compare, with respect to age and body composition, two test modalities for the assessment work capacity. A total of 424 Swedish firefighters with cycle ergometer (CE) and treadmill (TM) tests available from Jan 2004 to Dec 2010 were included. We compared results from CE (6 min at 200 W, 250 W or incremental ramp exercise) with TM (6 min at 8° inclination, 4·5 km h(-1) or faster, wearing 24-kg protective equipment). Oxygen requirements were estimated by prediction equations. It was more common to pass the TM test and fail the supposedly equivalent CE test (20%), than vice versa (0·5%), P<0·001. Low age and tall stature were significant predictors of passing both CE and TM tests (P<0·05), while low body mass predicted accomplishment of TM test only (P = 0·006). Firefighters who passed the TM but failed the supposedly equivalent CE test within 12 months had significantly lower body mass, lower BMI, lower BSA and shorter stature than did those who passed both tests. Calculated oxygen uptake was higher in TM tests compared with corresponding CE tests (P<0·001). Body constitution affected approval differently depending on the test modality. A higher approval rate in TM testing suggests lower cardiorespiratory requirements compared with CE testing, even though estimated oxygen uptake was higher during TM testing. The relevance of our findings in relation to the occupational demands needs reconsidering.

  • 25.
    Åström Aneq, Meriam
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    The Presence of an Implantable Cardioverter Defibrillator (ICD) May Accelerate the Progression of Right Ventricular Structural Changes in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D). Jana Svetlichnaya; Meriam Åström Aneq; Liviu Klein; Melvin Scheinman. HRS Congress, chicago, 20172017Ingår i: Heart rythm Society Congress, chicago, May 10 - 13, 2017, 2017Konferensbidrag (Övrigt vetenskapligt)
  • 26.
    Svensson, Anneli
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Medicinska fakulteten.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Linköpings universitet, Medicinska fakulteten.
    Widlund, Kjerstin Ferm
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk patologi och klinisk genetik.
    Fluur, Christina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Green, Anna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk patologi och klinisk genetik.
    Rehnberg, Malin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk patologi och klinisk genetik.
    Gunnarsson, Cecilia
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk patologi och klinisk genetik.
    Arrhythmogenic Right Ventricular Cardiomyopathy - 4 Swedish families with an associated PKP2 c.2146-1G>C variant.2016Ingår i: American journal of cardiovascular disease, ISSN 2160-200X, Vol. 6, nr 2, s. 55-65Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this study, the genotype-phenotype correlations in four unrelated families with a PKP2 c.2146-1G>C gene variant were studied. Our primary aim was to determine the carriers that fulfilled the arrhythmogenic right ventricular cardiomyopathy (ARVC) diagnostic criteria of 2010. Our secondary aim was to investigate whether any specific clinical characteristics can be attributed to this particular gene variant. Index patients were assessed using next generation ARVC panel sequencing technique and their family members were assessed by Sanger sequencing targeted at the PKP2 c.2146-1G>C variant. The gene variant carriers were offered a clinical follow-up, with evaluation based on the patient's history and a standard set of non-invasive testing. The PKP2 c.2146-1G>C gene variant was found in 23 of 41 patients who underwent the examination. Twelve of the 19 family members showed "possible ARVC". One with "borderline ARVC" and the rest with "definite ARVC" demonstrated re-polarization disturbances, but arrhythmia was uncommon. A lethal event occurred in a 14-year-old boy. In the present study, no definitive genotype-phenotype correlations were found, where the majority of the family members carrying the PKP2 c.2146-1G>C gene variant were diagnosed with "possible ARVC". These individuals should be offered a long-term follow-up since they are frequently symptomless but still at risk for insidious sudden cardiac death due to ventricular arrhythmia.

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  • 27.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Linköpings universitet, Medicinska fakulteten.
    Arytmogen högerkammarkardiomyopati2016Ingår i: Idrott och hjärtat / [ed] Mats Börjesson, Mikael Dellborg, Studentlitteratur, 2016, Vol. 1, s. 141-150Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 28.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Progression of Right Ventricular Structural Changes and Ventricular Arrhythmias in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D).J Svetlichnaya, M Astrom Aneq, S Sharma1, M Scheinman, L Klein.2015Ingår i: Heart Rythm Society Congress; Boston, May 13-15, 2015, 2015Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by progressive right ventricular (RV) enlargement and systolic dysfunction. Implantation of an transvenous cardioverter-defibrillator (ICD) is frequently used to treat ventricular arrhythmias in ARVC but its effect on RV structural and functional changes has not been investigated.  Objective: We studied whether an ICD might affect the rate of RV structure and functional changes in patients with ARVC.  Methods: In a two-center multinational cohort of 46 pts (37±12 years, 50% men) with definite ARVC by revised 2010 Task Force Criteria, we reviewed 3.5±1.6 serial echocardiograms (range 2-11) over a mean follow-up of 6.7±3.5 years. Echocardiographic measurements included RV outflow tract (RVOT) proximal diameter in parasternal long axis (PLAX) and distal diameter in short axis (PSAX), RV-end diastolic area (RVEDA) and fractional area change (FAC). Statistical analysis was performed using t-tests for continuous and chi-squared test for categorical variables. Results: ICDs were present in 29 pts (63%). All pts enrolled at US site were encouraged to have an ICD as compared to the European site (96 vs 24%, p<0.001). In the European site, only those judged to be at high risk underwent included ICD insertion for ventricular arrhythmia (X) and/or for severe RV dysfunction (Y). Patients were evenly matched with respect to age, gender, presence of a desmosomal genetic mutation and baseline medical therapy (Table 1). The mean RVEDA and RVOT PLAX were similar in pts with and without ICDs but baseline RVOT PSAX was higher in the ICD group and FAC was substantially lower (36±10 vs 46±10%, p=0.001). When adjusted for baseline values, there was a nearly 2-fold increase in the rate of annual RVEDA increase (0.9 vs 0.5 cm2/year p=0.235) and a significant increase in rate of annual PLAX enlargement (0.07 vs 0.01 cm/year, p=0.013). All patients with ICDs had 1.2+ T.R. Conclusions: Although ICDs were implanted in pts with lower baseline RV systolic function, after adjustment for baseline values, pts with ICDs had more rapid progression of RV enlargement. We hypothesize that the RV lead with attendant tricuspid regurgitation leads to further deterioration in RV structure and function.  

  • 29.
    Åström Aneq, Meriam
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Right Atrial Size and Function Responds to Exercise in Parallel to the Degree of Effort: The Health eHeart Study. Arjun Sinh. Meriam Astrom Aneq, Nelson B. Schiller.2015Ingår i: American Society of Echography Congress, June 12-16, 2015, 2015Konferensbidrag (Övrigt vetenskapligt)
  • 30.
    Åström Aneq, Meriam
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Right Ventricular Structure and Function during Exercise in Healthy Subjects. Meriam Åström Aneq, Arjun Sinha, Julia McClellan, Melvin Scheinman, Nelson B Schiller.2015Ingår i: American Society of Echocardiography Congress; Boston, 12-16 June 2015, 2015Konferensbidrag (Övrigt vetenskapligt)
  • 31.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Right Ventricular Longitudinal Strain based on Magnetic Resonance Feature Tracking in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy2014Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Introduction:Arrhythmogenic right ventricular cardiomyopathy (ARVC) causes fibro-fatty substitution of the myocardium in the right ventricle (RV). Cardiovascular magnetic resonance imaging (CMR) is the gold standard for visualization and volume quantification of the RV, but the assessment of wall motion, is still based on qualitative “eye-balling”. Previous studies have shown the successful application of feature tracking (CMR-FT) to the left ventricle. The aim of this study was to test the feasibility of CMR-FT to assess RV strain in patients (P) with ARVC and in healthy controls(C).Methods: Thirteen patients fulfilling Task Force Criteria for ARVC and twenty healthy subjects underwent cardiac MRI at 1,5 Tesla. Steady-state free precession cine of six long axis slices was acquired by rotating the cut planes around the long axis of the RV. The 3-, 4- and 2-chamber views of the RV were identified. Segmental longitudinal strain was measured and re-calculated in terms of regional strain for the base (B), mid (M) and apical (A) levels of the RV and for the anterior, inferior, septal and free walls. Results: RV end systolic volume was significantly higher and ejection fraction lower in patients (104-82 ml, 49- 56%).  Longitudinal strain decreased from base to apex in both groups (P:-25%, -22%, -19%, C:-31%, -24%, -20%). In a wall based analysis, the absolute strain values were significantly lower in patient lateral (P-24%, C -32%) and anterior walls (P -22%, C-28 %) but not in inferior (P-26%, C -27%) and septal walls (P -15%, C -18%). Conclusion: Feature tracking was successfully applied to the RV in this cohort of ARVC patients. Longitudinal absolute strain was lower in the basal segments, the anterior and the free walls compared to controls. This supports previous reports on the uneven regional distribution of ARVC.

  • 32.
    Åström, Meriam Aneq
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet.
    Brudin, Lars
    Kalmar County Hospital, Sweden .
    Nylander, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Evaluation of right and left ventricular function using speckle tracking echocardiography in patients with arrhythmogenic right ventricular cardiomyopathy and their first degree relatives2012Ingår i: Cardiovascular Ultrasound, E-ISSN 1476-7120, Vol. 10, nr 37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction and aim: The identification of right ventricular abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) in early stages is still difficult. The aim of this study was to investigate if longitudinal strain based on speckle tracking can detect subtle right (RV) or left ventricular (LV) dysfunction as an early sign of ARVC. Methods and results: Seventeen male patients, fulfilling Task force criteria for ARVC, 49 (32-70) years old, nineteen male first degree relatives 29 (19-73) y.o. and twenty-two healthy male volunteers 36 (24-66) y.o participated in the study. Twelve-lead and signal-averaged electrocardiograms were recorded. All subjects underwent echocardiography. LV and RV diameters, peak systolic velocity from tissue Doppler and longitudinal strain based on speckle tracking were measured from the basal and mid segments in both ventricles. RV longitudinal strain measurement was successful in first degree relatives and controls (95 resp. 86%) but less feasible in patients (59%). Results were not systematically different between first degree relatives and controls. Using discriminant analysis, we then developed an index based on echocardiographic parameters. All normal controls had an index less thanl while patients with abnormal ventricles had an index between 1-4. Some of the first degree relatives deviated from the normal pattern. Conclusion: Longitudinal strain of LV and RV segments was significantly lower in patients than in relatives and controls. An index was developed incorporating dimensional and functional echocardiographic parameters. In combination with genetic testing this index might help to detect early phenotype expression in mutation carriers.

    Ladda ner fulltext (pdf)
    fulltext
  • 33.
    Aneq Åström, Meriam
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Fluur, Christina
    Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Rehnberg, Malin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Söderkvist, Peter
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Cellbiologi. Linköpings universitet, Hälsouniversitetet.
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Nylander, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Gunnarsson, Cecilia
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Diagnostikcentrum, Klinisk patologi och klinisk genetik.
    Novel plakophilin2 mutation. Three generation family with arrhythmogenic right ventricular cardiomyopathy2012Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 46, nr 2, s. 72-75Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The autosomal dominant form of arrhythmogenic right ventricular cardiomyopathy (ARVC)has been linked to mutations in desmosomal proteins. Different studies have shown that amutation in plakophilin-2 (PKP 2) is a frequent genetic cause for ARVC. We describe a newmutation in the PKP2 gene, the genotype-phenotype variation in this mutation and its clinicalconsequences.

    Design: Individuals in a three generation family were investigated after the sudden cardiac death of a young male. Clinical evaluation, electrocardiography, echocardiography, magnetic resonance imaging, endomyocardial biopsy and genetic testing were performed.

    Results: A novel heterozygote mutation, a c.368G>A transition, located in exon 3 of the PKP2 gene was found (p.Trp123X). The phenotype was characterized by arrhythmia at an early age in some individuals, with mild abnormalities on imaging. However a relative carrying this mutation, with positive findings on endomyocardial biopsy had an otherwise normal phenotype, for 16 years, whereas a relative fulfilling the modified Task Force Criteria for ARVC turned out to be a non-carrier.

    Conclusions: This shows the variable penetrance and phenotypic expression in ARVC and highlights the need of genetic testing as well as a thorough phenotype examination as a part of the investigations in ARVC pedigrees.

  • 34. Beställ onlineKöp publikationen >>
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Arrhythmogenic right ventricular cardiomyopathy: Is it right?2011Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart disease, where sudden cardiac death in young seemingly healthy persons may be the first symptom. There is a need for more sensitive and accurate diagnostic methods to detect signs of disease, at an early stage and in relatives of affected individuals. The aim of this thesis is the evaluation of new non-invasive modalities in assessment of right ventricular (RV) volume and function with focus on patients with ARVC.

    Clinical and non-invasive follow-up of fifteen patients with ARVC during a mean period of 8 years permitted the evaluation of disease progression. RV volume analysis by magnetic resonance imaging relies on short axis (SA) views. A new axially rotated modality acquisition was tested and its feasibility in assessment of RV volume was evaluated. This acquisition seems to be able to improve the assessment of RV volume and function by reducing the uncertainty in defining the basal slice of the RV. A third study concentrated on analysis of RV regional and general function by echocardiography, using tissue Doppler imaging as well as two dimensional (2D) longitudinal strain based on speckle tracking in patients with ARVC, their first degree relatives and in healthy subjects. 2D strain showed a good feasibility in analysis of the RV function in relatives and controls but less in ARVC patients probably due to the progressive myocardial cell death with fibro-fatty replacement of the RV wall. In order to detect and follow up echocardiographic changes an index was developed combining dimensional and functional parameters for the left and for the right ventricle. Advances in the molecular genetics of ARVC have provided new insights into the understanding of the disease. Hitherto, 9 candidate genes have been identified. A new mutation in the plakophilin 2 gene was detected in a three generation family. The clinical phenotype related to this mutation was investigated.

    The studies have evaluated and developed methods for studying the right ventricle with special emphasis on ARVC. With the ultimate goal of preventing sudden death in ARVC, a combination of genetic testing and improved diagnostic methods may create an improved algorithm for risk stratification and selection to prophylactic treatment.

    Delarbeten
    1. Long-term follow-up in arrhythmogenic right ventricular cardiomyopathy using Tissue Doppler Imaging
    Öppna denna publikation i ny flik eller fönster >>Long-term follow-up in arrhythmogenic right ventricular cardiomyopathy using Tissue Doppler Imaging
    2008 (Engelska)Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, nr 6, s. 368-374Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aim: To study patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and describe different echocardiographic parameters and their change over time during almost 10 years follow-up period.

    Methods: Fifteen patients (9 male, 6 female), aged 22-58 years (mean 40) with a diagnosis of ARVC, were followed up for a period of 6-10 years (mean 8.7). Twelve-lead and a signal- averaged ECG was recorded. Tricuspid and mitral annular motion and tissue Doppler imaging were registered by echocardiography. Wall motion score index (WMSI) was calculated for the left and right ventricles.

    Results: We registered significant reduction in systolic tissue velocity on right ventricle free wall between the first and last investigations: 7-17cm/s (mean 11.8) to 4-15 (mean 9.1), p=0.005. WMSI increased by at least 0.2 in 10/14 patients for the right and in 8/15 patients for the left ventricle. A decrease in velocity time integral for the left ventricular outflow was observed (16-30 to 13-21, p=0.009).

    Conclusion: ARVC is a progressive disease with individual variation. Left ventricular involvement may occur early in the disease. Tissue Doppler imaging is a useful tool to follow-up right ventricular abnormalities.

    Nyckelord
    Arrhythmogenic right ventricular cardiomyopathy, Doppler tissue imaging, progression, right ventricular function
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-16180 (URN)10.1080/14017430802372384 (DOI)
    Tillgänglig från: 2009-01-09 Skapad: 2009-01-09 Senast uppdaterad: 2017-12-14
    2. Determination of right ventricular volume and function using multiple axially rotated MRI slices
    Öppna denna publikation i ny flik eller fönster >>Determination of right ventricular volume and function using multiple axially rotated MRI slices
    2011 (Engelska)Ingår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 31, nr 3, s. 233-239Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Pandgt;Background: The conventional magnetic resonance imaging (MRI) method for right ventricular (RV) volume and motion, using short-axis (SA) orientation, is limited by RV anatomy and shape. We suggest an orientation based on six slices rotated around the long axis of the RV, rotated long axis (RLA). Materials and methods: Three phantoms were investigated in SA and RLA using cine balanced steady-state free precession MRI. Volumes were calculated based on segmentation and checked against true volumes. In 23 healthy male volunteers, we used six long-axis planes from the middle of the tricuspid valve to the RV apex, rotated in 30 degrees increments. For comparison, short-axis slices were acquired. Imaging parameters were identical in both acquisitions. Results: Right ventricular end-diastolic (EDV), end-systolic (ESV) and stroke volumes (SV) determined in the RLA 179 center dot 1 +/- 29 center dot 3; 80 center dot 1 +/- 17 center dot 1; 99 center dot 3 +/- 16 center dot 9 ml and in the SA were 174 center dot 0 +/- 21 center dot 1; 78 center dot 8 +/- 13 center dot 6; 95 center dot 3 +/- 14 center dot 5 ml with P-values for the difference from 0 center dot 17 to 0 center dot 64 (ns). Interobserver variability ranged between 3 center dot 2% and 6 center dot 6% and intraobserver variability between 2 center dot 8% and 6 center dot 8%. In SA views, consensus for the definition of the basal slice was necessary in 39% of the volunteers for whom the average volume change was 20% in ESV and 10% in EDV. Conclusions: The RLA method results in better visualization and definition of the RV inflow, outflow and apex. Accurate measurement of RV volumes for diagnosis and follow-up of cardiac diseases are enhanced by the RLA orientation, even though additional acquisition time is required.

    Ort, förlag, år, upplaga, sidor
    Blackwell Publishing Ltd, 2011
    Nyckelord
    axial rotation, cine MRI, heart volumes, methodological comparison, normal values
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-67837 (URN)10.1111/j.1475-097X.2011.01006.x (DOI)000289258100012 ()
    Anmärkning
    This is the authors’ version of the following article: Meriam Aneq Åström, Eva Nylander, Tino Ebbers and Jan Engvall, Determination of right ventricular volume and function using multiple axially rotated MRI slices, 2011, CLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, (31), 3, 233-239. which has been published in final form at: http://dx.doi.org/10.1111/j.1475-097X.2011.01006.x Copyright: Blackwell Publishing Ltd http://eu.wiley.com/WileyCDA/Brand/id-35.htmlTillgänglig från: 2011-04-29 Skapad: 2011-04-29 Senast uppdaterad: 2021-12-28Bibliografiskt granskad
    3. Evaluation of Right and Left Ventricular Function Using Speckle Tracking Echocardiography in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy and Their First Degree Relatives
    Öppna denna publikation i ny flik eller fönster >>Evaluation of Right and Left Ventricular Function Using Speckle Tracking Echocardiography in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy and Their First Degree Relatives
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Introduction and aim: The identification of right ventricular abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) in early stages is still difficult. The aim of this study was to investigate if longitudinal strain based on speckle tracking can detect subtle right (RV) or left ventricular (LV) dysfunction as an early sign of ARVC.

    Methods and results: Seventeen male patients, fulfilling Task force criteria for ARVC, 49 (32-70) years old, nineteen male first degree relatives 29 (19-73) y.o. and twenty-two healthy male volunteers 36 (24-66) y.o participated in the study. Twelve-lead and signal-averaged electrocardiograms were recorded. All subjects underwent echocardiography. LV and RV diameters, peak systolic velocity from tissue Doppler and longitudinal strain based on speckle tracking were measured from the basal and mid segments in both ventricles. RV longitudinal strain measurement was successful in first degree relatives and controls (95 resp. 86%) but less feasible in patients (59%). Results were not systematically different between first degree relatives and controls. Using discriminant analysis, we then developed an index based on echocardiographic parameters. All normal controls had an index <l while patients with abnormal ventricles had an index between 1-4. Some of the first degree relatives deviated from the normal pattern.

    Conclusion: Longitudinal strain of LV and RV segments was significantly lower in patients than in relatives and controls. An index was developed incorporating dimensional and functional echocardiographic parameters. In combination with genetic testing this index might help to detect early phenotype expression in mutation carriers.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-70401 (URN)
    Tillgänglig från: 2011-09-06 Skapad: 2011-09-06 Senast uppdaterad: 2021-12-28Bibliografiskt granskad
    4. Novel plakophilin2 mutation. Three generation family with arrhythmogenic right ventricular cardiomyopathy
    Öppna denna publikation i ny flik eller fönster >>Novel plakophilin2 mutation. Three generation family with arrhythmogenic right ventricular cardiomyopathy
    Visa övriga...
    2012 (Engelska)Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 46, nr 2, s. 72-75Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objectives: The autosomal dominant form of arrhythmogenic right ventricular cardiomyopathy (ARVC)has been linked to mutations in desmosomal proteins. Different studies have shown that amutation in plakophilin-2 (PKP 2) is a frequent genetic cause for ARVC. We describe a newmutation in the PKP2 gene, the genotype-phenotype variation in this mutation and its clinicalconsequences.

    Design: Individuals in a three generation family were investigated after the sudden cardiac death of a young male. Clinical evaluation, electrocardiography, echocardiography, magnetic resonance imaging, endomyocardial biopsy and genetic testing were performed.

    Results: A novel heterozygote mutation, a c.368G>A transition, located in exon 3 of the PKP2 gene was found (p.Trp123X). The phenotype was characterized by arrhythmia at an early age in some individuals, with mild abnormalities on imaging. However a relative carrying this mutation, with positive findings on endomyocardial biopsy had an otherwise normal phenotype, for 16 years, whereas a relative fulfilling the modified Task Force Criteria for ARVC turned out to be a non-carrier.

    Conclusions: This shows the variable penetrance and phenotypic expression in ARVC and highlights the need of genetic testing as well as a thorough phenotype examination as a part of the investigations in ARVC pedigrees.

    Ort, förlag, år, upplaga, sidor
    Informa Healthcare, 2012
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-70402 (URN)10.3109/14017431.2011.636068 (DOI)000301496200002 ()
    Anmärkning
    Funding agencies|FORSS||Medical Research Council of Southeast Sweden| 12043 |Swedish Heart-Lung foundation| 20070864 |Tillgänglig från: 2011-09-06 Skapad: 2011-09-06 Senast uppdaterad: 2021-12-28Bibliografiskt granskad
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    Arrhythmogenic right ventricular cardiomyopathy: Is it right?
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    omslag
  • 35.
    Aneq Åström, Meriam
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Nylander, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Ebbers, Tino
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicin och hälsa, Fysiologi. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Mekanisk värmeteori och strömningslära.
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Determination of right ventricular volume and function using multiple axially rotated MRI slices2011Ingår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 31, nr 3, s. 233-239Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Pandgt;Background: The conventional magnetic resonance imaging (MRI) method for right ventricular (RV) volume and motion, using short-axis (SA) orientation, is limited by RV anatomy and shape. We suggest an orientation based on six slices rotated around the long axis of the RV, rotated long axis (RLA). Materials and methods: Three phantoms were investigated in SA and RLA using cine balanced steady-state free precession MRI. Volumes were calculated based on segmentation and checked against true volumes. In 23 healthy male volunteers, we used six long-axis planes from the middle of the tricuspid valve to the RV apex, rotated in 30 degrees increments. For comparison, short-axis slices were acquired. Imaging parameters were identical in both acquisitions. Results: Right ventricular end-diastolic (EDV), end-systolic (ESV) and stroke volumes (SV) determined in the RLA 179 center dot 1 +/- 29 center dot 3; 80 center dot 1 +/- 17 center dot 1; 99 center dot 3 +/- 16 center dot 9 ml and in the SA were 174 center dot 0 +/- 21 center dot 1; 78 center dot 8 +/- 13 center dot 6; 95 center dot 3 +/- 14 center dot 5 ml with P-values for the difference from 0 center dot 17 to 0 center dot 64 (ns). Interobserver variability ranged between 3 center dot 2% and 6 center dot 6% and intraobserver variability between 2 center dot 8% and 6 center dot 8%. In SA views, consensus for the definition of the basal slice was necessary in 39% of the volunteers for whom the average volume change was 20% in ESV and 10% in EDV. Conclusions: The RLA method results in better visualization and definition of the RV inflow, outflow and apex. Accurate measurement of RV volumes for diagnosis and follow-up of cardiac diseases are enhanced by the RLA orientation, even though additional acquisition time is required.

    Ladda ner fulltext (pdf)
    fulltext
  • 36.
    Åström Aneq, Meriam
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Lindström, Lena
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Nylander, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Long-term follow-up in arrhythmogenic right ventricular cardiomyopathy using Tissue Doppler Imaging2008Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, nr 6, s. 368-374Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To study patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and describe different echocardiographic parameters and their change over time during almost 10 years follow-up period.

    Methods: Fifteen patients (9 male, 6 female), aged 22-58 years (mean 40) with a diagnosis of ARVC, were followed up for a period of 6-10 years (mean 8.7). Twelve-lead and a signal- averaged ECG was recorded. Tricuspid and mitral annular motion and tissue Doppler imaging were registered by echocardiography. Wall motion score index (WMSI) was calculated for the left and right ventricles.

    Results: We registered significant reduction in systolic tissue velocity on right ventricle free wall between the first and last investigations: 7-17cm/s (mean 11.8) to 4-15 (mean 9.1), p=0.005. WMSI increased by at least 0.2 in 10/14 patients for the right and in 8/15 patients for the left ventricle. A decrease in velocity time integral for the left ventricular outflow was observed (16-30 to 13-21, p=0.009).

    Conclusion: ARVC is a progressive disease with individual variation. Left ventricular involvement may occur early in the disease. Tissue Doppler imaging is a useful tool to follow-up right ventricular abnormalities.

  • 37.
    Aneq Åström, Meriam
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Brudin, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Nylander, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Evaluation of Right and Left Ventricular Function Using Speckle Tracking Echocardiography in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy and Their First Degree RelativesManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Introduction and aim: The identification of right ventricular abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) in early stages is still difficult. The aim of this study was to investigate if longitudinal strain based on speckle tracking can detect subtle right (RV) or left ventricular (LV) dysfunction as an early sign of ARVC.

    Methods and results: Seventeen male patients, fulfilling Task force criteria for ARVC, 49 (32-70) years old, nineteen male first degree relatives 29 (19-73) y.o. and twenty-two healthy male volunteers 36 (24-66) y.o participated in the study. Twelve-lead and signal-averaged electrocardiograms were recorded. All subjects underwent echocardiography. LV and RV diameters, peak systolic velocity from tissue Doppler and longitudinal strain based on speckle tracking were measured from the basal and mid segments in both ventricles. RV longitudinal strain measurement was successful in first degree relatives and controls (95 resp. 86%) but less feasible in patients (59%). Results were not systematically different between first degree relatives and controls. Using discriminant analysis, we then developed an index based on echocardiographic parameters. All normal controls had an index <l while patients with abnormal ventricles had an index between 1-4. Some of the first degree relatives deviated from the normal pattern.

    Conclusion: Longitudinal strain of LV and RV segments was significantly lower in patients than in relatives and controls. An index was developed incorporating dimensional and functional echocardiographic parameters. In combination with genetic testing this index might help to detect early phenotype expression in mutation carriers.

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