umu.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Arvidsson, Sandra
Alternative names
Publications (10 of 13) Show all publications
Pilebro, B., Arvidsson, S., Lindqvist, P., Sundström, T., Westermark, P., Antoni, G., . . . Sörensen, J. (2018). Positron emission tomography (PET) utilizing Pittsburgh compound B (PIB) for detection of amyloid heart deposits in hereditary transthyretin amyloidosis (ATTR). Journal of Nuclear Cardiology, 25(1), 240-248
Open this publication in new window or tab >>Positron emission tomography (PET) utilizing Pittsburgh compound B (PIB) for detection of amyloid heart deposits in hereditary transthyretin amyloidosis (ATTR)
Show others...
2018 (English)In: Journal of Nuclear Cardiology, ISSN 1071-3581, E-ISSN 1532-6551, Vol. 25, no 1, p. 240-248Article in journal (Refereed) Published
Abstract [en]

Background: DPD scintigraphy has been advocated for imaging cardiac amyloid in ATTR amyloidosis. PET utilizing 11C-Pittsburgh compound B (PIB) is the gold standard for imaging brain amyloid in Alzheimer’s disease. PIB was recently shown to identify cardiac amyloidosis in both AL and ATTR amyloidosis. In the ATTR population, two types of amyloid fibrils exist, one containing fragmented and full-length TTR (type A) and the other only full-length TTR (type B). The aim of this study was to further evaluate PIB-PET in patients with hereditary ATTR amyloidosis.

Methods: Ten patients with biopsy-proven V30M ATTR amyloidosis and discrete or no signs of cardiac involvement were included. Patients were grouped according to TTR-fragmentation. All underwent DPD scintigraphy, echocardiography, and PIB-PET. A left ventricular PIB-retention index (PIB-RI) was established and compared to five normal volunteers.

Results: PIB-RI was increased in all patients (P < 0.001), but was significantly higher in type B than in type A (0.129 ± 0.041 vs 0.040 ± 0.006 min−1, P = 0.009). Cardiac DPD uptake was elevated in group A and absent in group B.

Conclusion: PIB-PET, in contrast to DPD scintigraphy, has the potential to specifically identify cardiac amyloid depositions irrespective of amyloid fibril composition. The heart appears to be a target organ for amyloid deposition in ATTR amyloidosis.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Cardiomyopathy, amyloidosis, Pittsburgh compound B
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-127300 (URN)10.1007/s12350-016-0638-5 (DOI)000423585200038 ()27645889 (PubMedID)2-s2.0-84988421982 (Scopus ID)
Available from: 2016-11-07 Created: 2016-11-07 Last updated: 2019-05-21Bibliographically approved
Arvidsson, S., Henein, M. Y., Wikström, G., Suhr, O. B. & Lindqvist, P. (2018). Right ventricular involvement in transthyretin amyloidosis. Amyloid: Journal of Protein Folding Disorders, 25(3), 160-166
Open this publication in new window or tab >>Right ventricular involvement in transthyretin amyloidosis
Show others...
2018 (English)In: Amyloid: Journal of Protein Folding Disorders, ISSN 1350-6129, E-ISSN 1744-2818, Vol. 25, no 3, p. 160-166Article in journal (Refereed) Published
Abstract [en]

Background: The extent of right ventricular (RV) involvement in transthyretin amyloidosis (ATTR) is unknown.

Objectives: This study sought to establish the degree of RV involvement in ATTR amyloidosis, and compare findings with RV involvement in hypertrophic cardiomyopathy (HCM).

Methods: Forty-two patients with ATTR amyloidosis and echocardiographic evidence of cardiac amyloidosis (cardiac ATTR), 19 ATTR patients with normal left ventricular (LV) wall thickness (non-cardiac ATTR), 25 patients with diagnosed HCM and 30 healthy controls were included in this study. Echocardiographic measurements for conventional parameters, as well as RV global and segmental strain, were recorded.

Results: When comparing RV structure and function between cardiac ATTR amyloidosis and HCM patients, only segmental strain differed between the two groups. In cardiac ATTR amyloidosis, we found an RV apex-to-base strain gradient with highest deformation in the apex. This pattern was reversed in patients with HCM.

Conclusions: RV involvement is common in cardiac ATTR patients. The present study also detected an RV apical sparing pattern in patients with ATTR cardiomyopathy, similar to what has previously been described for the left ventricle in these patients. This pattern was not seen in HCM patients. Further studies are needed to assess the clinical importance of these findings.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Hypertrophic cardiomyopathy, apical sparing, strain, amyloid cardiomyopathy, right ventricle
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-113889 (URN)10.1080/13506129.2018.1493989 (DOI)000451980700004 ()30193533 (PubMedID)
Note

Originally included in thesis in manuscript form.

Available from: 2016-01-04 Created: 2016-01-04 Last updated: 2019-05-17Bibliographically approved
Arvidsson, S. (2016). Cardiac function in hereditary transthyretin amyloidosis: an echocardiographic study. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Cardiac function in hereditary transthyretin amyloidosis: an echocardiographic study
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Hjärtfunktion vid ärftlig transtyretin-amyloidos : en ekokardiografisk studie
Abstract [en]

Background: Hereditary transthyretin amyloidosis (ATTR) is a lethal disease in which misfolded transthyretin (TTR) proteins accumulate as insoluble aggregates in tissues throughout the body. A common mutation is the exchange of valine to methionine at place 30 (TTR V30M), a form endemically found in the northern parts of Sweden. The main treatment option for ATTR amyloidosis is liver transplantation as the procedure halts production of mutated transthyretin. The disease is associated with marked phenotypic diversity ranging from predominant cardiac complications to pure neuropathy. Two different types of fibril composition – one in which both fragmented and full-length TTR are present (type A) and one consisting of only full-length TTR (type B) have been suggested to account for some phenotypic differences. Cardiac amyloidosis is associated with increased myocardial thickness and the disease could easily be mistaken for other entities characterised by myocardial thickening, such as sarcomeric hypertrophic cardiomyopathy (HCM). The aims in this thesis were to investigate echocardiographic characteristics in Swedish ATTR amyloidosis patients, and to identify markers aiding in differentiating ATTR heart disease from HCM. Another objective was to examine the impact of fibril composition and sex on the phenotypic variation in amyloid heart disease.

Methods: A total of 122 ATTR amyloidosis patients that had undergone thorough echocardiographic examinations were included in the studies. Analyses of ventricular geometry as well as assessment of systolic and diastolic function were performed, using both conventional echocardiographic methods and speckle tracking technique. ECG analysis was conducted in study I, allowing measurement of QRS voltage. In study I and study II ATTR patients were compared to patients with HCM. In addition, 30 healthy controls were added to study II.

Results: When parameters from ECG and echocardiography were investigated, the results revealed that the combination of QRS voltage <30 mm (<3 mV) and an interventricular/posterior wall thickness quotient <1.6 could differentiate cardiac ATTR amyloidosis from HCM. Differences in degree of right ventricular involvement were also demonstrated between HCM and ATTR amyloidosis, where ATTR patients displayed a right ventricular apical sparing pattern whereas the inverse pattern was found in HCM. Analysis of fibril composition revealed increased LV wall thickness in type A patients compared to type B, but in addition type A women displayed both lower myocardial thickness and more preserved systolic function as compared to type A males. When cardiac geometry and function were evaluated pre and post liver transplantation in type A and B patients, significant deterioration was detected in type A but not in type B patients after liver transplantation.

Conclusions: Increasing awareness of typical cardiac amyloidotic signs by echocardiography is important to reduce the risk of delayed diagnosis. Our classification model based on ECG and echocardiography could aid in differentiating ATTR amyloidosis from HCM. Furthermore, the apical sparing pattern found in the right ventricle may pose another clue for amyloid heart disease, although it requires to be studied further. Furthermore, we disclosed that type A fibrils, male sex and increasing age were important determinants of increased myocardial thickness. As type A fibril patients displayed rapid cardiac deterioration after liver transplantation other treatment options should probably be sought for this group of patients.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2016. p. 56
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1774
Keywords
Amyloid, echocardiography, ECG, HCM, fibril type, strain, ATTR, cardiomyopathy, speckle tracking
National Category
Cardiac and Cardiovascular Systems Other Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-113891 (URN)978-91-7601-399-1 (ISBN)
Public defence
2016-01-29, Hörsal Betula Unod L0, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-01-08 Created: 2016-01-04 Last updated: 2018-06-07Bibliographically approved
Henein, M., Arvidsson, S., Pilebro, B., Backman, C., Mörner, S. & Lindqvist, P. (2016). Long mitral valve leaflets determine left ventricular outflow tract obstruction during exercise in hypertrophic cardiomyopathy. International Journal of Cardiology, 212, 47-53
Open this publication in new window or tab >>Long mitral valve leaflets determine left ventricular outflow tract obstruction during exercise in hypertrophic cardiomyopathy
Show others...
2016 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 212, p. 47-53Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Development of left ventricular outflow tract obstruction (LVOTO) in patients with hypertrophic cardiomyopathy (HCM) is important for explaining symptoms and designing management. LVOTO is mostly caused by a combination of septal hypertrophy and systolic anterior movement of the mitral valve (SAM). The aim of the present study was to determine predictors of exercise induced LVOTO in a group of HCM patients.

METHODS: We performed supine exercise Doppler echocardiography, including measurements of LV morphology and function and anterior mitral leaflet length, in 51 mildly symptomatic HCM (septal thickness≥15mm) and compared them with 50 healthy controls. Measurements were made at 1) rest, 2) Valsalva maneuver, 3) peak exercise and 4) post exercise. LVOTO was diagnosed as a LVOT gradient of >30mmHg at rest, after Valsalva and after exercise or ≥50mmHg at peak exercise.

RESULTS: All patients stopped exercise because of exhaustion. 35% of the patients had resting LVOTO and 48% during Valsalva. At peak exercise, only 37% had LVOTO, who increased to 64% post exercise. Patients who developed LVOTO at peak exercise were more prone to continue having it post exercise (p<0.001), to have attenuated systolic blood pressure rise (p=0.011) and to have long anterior mitral valve leaflets (p<0.001). Backward multiple regression analysis showed the anterior mitral leaflet length as the strongest single independent predictor (β=0.36, p=0.010) for increased LVOT velocities, followed by basal septal thickness.

CONCLUSION: In patients with HCM, LV outflow tract obstruction seems to be relatively uncommon during exercise but rather occurring minutes after stopping exercise. Exercise LVOTO seems to be determined by long anterior mitral leaflets in addition to the well established septal hypertrophy.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
transthyretin, Amyloidosis hereditary, echocardiography, scintigraphy, amyloid cardiomyopathy, VEREUX RB, 1986, AMERICAN JOURNAL OF CARDIOLOGY, V57, P450 bue G, 2003, AMYLOID-JOURNAL OF PROTEIN FOLDING DISORDERS5th Int Symp on Familial yloidotic Polyneuropathy and Other Transthyretin Related Disorders/4th Int Workshop on Liver ansplantation in Familial Amyloid Polyneuropathy, SEP 24-27, 2002, MATSUMOTO, JAPAN, V10, P32 gueh Sherif F., 2009, EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY, V10, P165 ille M, 2002, EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING, V29, P376
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-119478 (URN)10.1016/j.ijcard.2016.03.041 (DOI)000374474600012 ()27031819 (PubMedID)
Available from: 2016-04-20 Created: 2016-04-20 Last updated: 2018-06-07Bibliographically approved
Arvidsson, S., Pilebro, B., Westermark, P., Lindqvist, P. & Suhr, O. B. (2015). Amyloid Cardiomyopathy in Hereditary Transthyretin V30M Amyloidosis - Impact of Sex and Amyloid Fibril Composition. PLoS ONE, 10(11), Article ID e0143456.
Open this publication in new window or tab >>Amyloid Cardiomyopathy in Hereditary Transthyretin V30M Amyloidosis - Impact of Sex and Amyloid Fibril Composition
Show others...
2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 11, article id e0143456Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Transthyretin V30M (ATTR V30M) amyloidosis is a phenotypically diverse disease with symptoms ranging from predominant neuropathy to exclusive cardiac manifestations. The aims of this study were to determine the dispersion of the two types of fibrils found in Swedish ATTR V30M patients -Type A consisting of a mixture of truncated and full length ATTR fibrils and type B fibrils consisting of full length fibrils, and to estimate the severity of cardiac dysfunction in relation to fibril composition and sex.

MATERIAL AND METHODS: Echocardiographic data were analysed in 107 Swedish ATTR V30M patients with their fibril composition determined as either type A or type B. Measurements of left ventricular (LV) dimensions and evaluation of systolic and diastolic function including speckle tracking derived strain were performed. Patients were grouped according to fibril type and sex. Multivariate linear regression was utilised to determine factors of significant impact on LV thickness.

RESULTS: There was no significant difference in proportions of the two types of fibrils between men and women. In patients with type A fibrils, women had significantly lower median septal (p = 0.007) and posterior wall thicknesses (p = 0.010), lower median LV mass indexed to height (p = 0.008), and higher septal strain (p = 0.037), as compared to males. These differences were not apparent in patients with type B fibrils. Multiple linear regression analysis revealed that fibril type, sex and age all had significant impact on LV septal thickness.

CONCLUSION: This study demonstrates a clear difference between sexes in the severity of amyloid heart disease in ATTR V30M amyloidosis patients. Even though type A fibrils were associated with more advanced amyloid heart disease compared to type B, women with type A fibrils generally developed less cardiac infiltration than men. The differences may explain the better outcome for liver transplanted late-onset female patients compared to males.

Keywords
gender, fibril, ATTR, transthyretin, cardiac amyloidosis, age
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-113831 (URN)10.1371/journal.pone.0143456 (DOI)000365853900127 ()
Available from: 2016-01-04 Created: 2016-01-04 Last updated: 2018-06-07Bibliographically approved
Ramzy, I. S., Gustafsson, S., Holmgren, A. & Henein, M. Y. (2015). Early effect of surgical revascularisation on left ventricular twist function. International Cardiovascular Forum Journal, 4, 16-23
Open this publication in new window or tab >>Early effect of surgical revascularisation on left ventricular twist function
2015 (English)In: International Cardiovascular Forum Journal, ISSN 2410-2636, Vol. 4, p. 16-23Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Barcaray Publishing, 2015
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-55469 (URN)10.17987/icfj.v4i0.125 (DOI)
Available from: 2012-05-16 Created: 2012-05-16 Last updated: 2018-11-28Bibliographically approved
Gustavsson, S., Pilebro, B., Westermark, P., Lindqvist, P. & Suhr, O. B. (2015). Gender related differences in cardiac function in patients with hereditary transthyretin amyloidosis. European Journal of Heart Failure, 17, 64-65
Open this publication in new window or tab >>Gender related differences in cardiac function in patients with hereditary transthyretin amyloidosis
Show others...
2015 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 17, p. 64-65Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-113880 (URN)000366200401188 ()
Note

Supplement: 1, Special Issue: SI, Meeting Abstract: P300

Available from: 2016-01-07 Created: 2016-01-04 Last updated: 2018-06-07Bibliographically approved
Gustafsson, S., Granåsen, G., Wiklund, U., Grönlund, C., Suhr, O. B. & Lindqvist, P. (2014). Discriminating hereditary transthyretin cardiomyopathy from hypertrophic cardiomyopathy using an echocardiographic and ECG based classification tree. Paper presented at Congress of the European-Society-of-Cardiology (ESC), AUG 30-SEP 03, 2014, Barcelona, SPAIN. European Heart Journal, 35(Supplement 1, Meeting abstract P5254), 929-929
Open this publication in new window or tab >>Discriminating hereditary transthyretin cardiomyopathy from hypertrophic cardiomyopathy using an echocardiographic and ECG based classification tree
Show others...
2014 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P5254, p. 929-929Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2014
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-97261 (URN)000343001305297 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 30-SEP 03, 2014, Barcelona, SPAIN
Available from: 2014-12-15 Created: 2014-12-12 Last updated: 2018-06-07Bibliographically approved
Gustafsson, S., Grönlund, C., Mörner, S., Suhr, O. & Lindqvist, P. (2013). Can echocardiography differentiate hereditary transthyretin amyloidosis from hypertrophic cardiomyopathy?. Paper presented at Congress of the European-Society-of-Cardiology (ESC), AUG 31-SEP 04, 2013, Amsterdam, NETHERLANDS. European Heart Journal, 34(Supplement: 1), 213-213
Open this publication in new window or tab >>Can echocardiography differentiate hereditary transthyretin amyloidosis from hypertrophic cardiomyopathy?
Show others...
2013 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no Supplement: 1, p. 213-213Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Purpose: Hereditary transthyretin amyloidosis (ATTR) andhypertrophic cardiomyopathy (HCM) have many phenotypic similarities when examined by echocardiography. As the two conditions have different treatment strategies it is of importance to accurately diagnose these patients early in the disease. This study aimed to identify the most accurate echocardiographic method in differentiating these two conditions by using traditional and speckle tracking echocardiographyas well as myocardial texture analysis.

Methods: We investigated 40 healthy controls, 33 patients with biopsy proven ATTR and 20 with HCM. All patients had septal thickness >12 mm. We measured left ventricular (LV) global strain as intrinsic systolic function and LV E/e' to estimate filling pressures. We also tested septal cyclic integrated backscatter (cIBS) and septal entropy as both being measures for myocardial highly reflection pattern whereas cIBS showing motion of highly reflective echoes and entropy the distribution of highly reflective echoes.

Results: LV global strain, cIBS and E/e' were not useful in differentiating ATTR from HCM. However, septal entropy was found to be significantly different and showed an area under the curve from ROC analysis of 0.66 separating ATTR from HCM.

Conclusion: After using detailed analysis of different aspects of LV morphology and function we found that myocardial texture behavior from entropy analysis was the only method useful in differentiating patients with ATTR fromHCM.

Place, publisher, year, edition, pages
Oxford University Press, 2013
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-85325 (URN)10.1093/eurheartj/eht308.P1195 (DOI)000327744601221 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 31-SEP 04, 2013, Amsterdam, NETHERLANDS
Available from: 2014-02-04 Created: 2014-01-31 Last updated: 2018-06-08Bibliographically approved
Grönlund, C., Albano, A., Gustavsson, S., Wiklund, U., Henein, M. Y. & Lindqvist, P. (2013). Significant beat-to-beat variability of E/e’ irrespective of respiration. International cardiovascular forum, 1(2), 88-89
Open this publication in new window or tab >>Significant beat-to-beat variability of E/e’ irrespective of respiration
Show others...
2013 (English)In: International cardiovascular forum, ISSN 2409-3424, Vol. 1, no 2, p. 88-89Article in journal (Refereed) Published
Abstract [en]

The E/e’ ratio is commonly used in Doppler echocardiographic examinations to estimate the pulmonary capillary wedge pressure. The rationale of using this ratio is to combine left ventricular (LV) filling (E) and relaxation (e’) velocities to indirectly assess left atrial pressure. However, the accuracy of this index has recently been questioned, particularly in patients with controlled heart failure. Likewise, the potential beat-to-beat variability of such measurements remains undetermined. The cardiovascular system is subject to several oscillations with the potential of influencing LV function and its intra-cavitary pressures, hence measurements of its filling and relaxation velocities. The aim of this pilot study was to assess the beat-to-beat variability of the E/e’ ratio in one minute long examination in healthy subjects, and patients with various severity of amyloid heart disease. The results show that despite critical application of the standard echocardiographic recording recommendations, E/e’ beat-to-beat variability was 36 % (22 to 50%) in healthy subjects and 17 % (11-26%) in patients, and where the most severe amyloid heart disease had the least variability. Thus, clinical use of a single or few cardiac beats might not necessarily reflect an accurate ratio between the two velocities, and hence casts doubt over their diagnostic value.

Place, publisher, year, edition, pages
Barcaray Publishing, 2013
Keywords
Echocardiography, E/e’, variability, Amyloid, color Doppler
National Category
Medical Engineering Medical Image Processing Cardiac and Cardiovascular Systems
Research subject
Cardiology; Medicine, cardiovascular disease
Identifiers
urn:nbn:se:umu:diva-94196 (URN)10.17987/icfj.v1i2.27 (DOI)
Available from: 2014-10-06 Created: 2014-10-06 Last updated: 2018-06-07Bibliographically approved
Organisations

Search in DiVA

Show all publications