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  • 1.
    Tossavainen, Erik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Grönlund, Christer
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Gonzalez, Manuel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Henein, Michael Y
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Lindqvist, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Pulmonary artery acceleration time in identifying pulmonary hypertension patients with raised pulmonary vascular resistance2013In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 14, no 9, 890-897 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In patients with pulmonary hypertension (PH), ascertaining raised vascular resistance as a cause is a clinical objective, for which various Doppler-based measurements have been proposed, but with modest accuracy. We hypothesize that pulmonary acceleration time (PAcT) and the ratio of PAcT/peak pulmonary artery systolic pressure (PASP) reflect better the extent of the vascular resistance, compared with other available methods, and can differentiate accurately between pre- and post-capillary PH.

    METHODS AND RESULTS: We investigated 56 patients (mean age 61 ± 13 years, 23 males) in a simultaneous echocardiography and right heart catheterization (RHC) study. Based on the RHC, pulmonary vascular resistance (PVR), and pulmonary capillary wedge pressure (PCWP), patients were divided into four groups: Group 1 = normal PVR [<3 WU (Wood units)] and PCWP (<12 mmHg), Group 2 = raised PVR but normal PCWP, Group 3 = raised PVR and PCWP; and Group 4 = normal PVR but raised PCWP. We used spectral Doppler to measure PAcT (corrected for heart rate) and to estimate PASP (peak tricuspid regurgitation pressure drop + estimated right atrial pressure of 7 mmHg). We also tested other available methods for assessing PVR. There were small age differences between patient groups but no age difference between Groups 2 and 4. PAcT and PAcT/PASP were both significantly (P = 0.008) reduced in Groups 2 and 3 compared with Groups 1 and 4. PAcT ≤90 had an 84% sensitivity and an 85% specificity in identifying patients with PVR ≥3 WU with a positive and a negative predictive value of 88% and 81%, respectively. The non-linear relationship between PVR and PAcT gave a quadratic r = 0.61, P < 0.001. ROC curve analysis showed PAcT having the best accuracy (83%) in detecting a PVR ≥3 WU.

    CONCLUSION: PAcT <90 ms can serve as a strong non-invasive predictor of PVR >3 WU, which could differentiate patients with pre- and post-capillary PH.

  • 2.
    Vanoli, Davide
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Successful novice’s training in obtaining accurateassessment of carotid IMTusing an automatedultrasound system2014In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 15, no 6, 637-642 p.Article in journal (Other academic)
  • 3.
    Vanoli, Davide
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Lindqvist, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Henein, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Successful novice's training in obtaining accurate assessment of carotid IMT using an automated ultrasound system2014In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 15, no 6, 637-642 p.Article in journal (Refereed)
    Abstract [en]

    Aims The aim of this study was to assess the feasibility and learning curve of training novice operators in using automated ultrasound to achieve satisfactory carotid intima-media thickness (CIMT) measurements. Methods and results Four novices underwent 4 weeks carotid ultrasound training using a newly developed automated ultrasonograph. A longitudinal B-mode image of the distal right common carotid artery (CCA) was acquired in 96 patients. The interoperator CIMT reproducibility was analysed by the coefficient of variation (CV) and intraclass correlation coefficient (ICC) for every week and compared with that from an expert operator. The weekly mean CV of the measurements on the 24 patients made by all novices was consistently reduced: 0.06, 0.05, 0.03, and 0.02, respectively. For the expert, the mean CV was 0.02, 0.02, 0.03, and 0.02, respectively. The novices' standard deviation (SD) of CVs also reduced weekly from 0.04 in the first week to 0.01 in the last week (P < 0.05). The corresponding weekly variation in the SD for the expert was 0.02 for the first week to 0.01 in the last week (P = 0.27). The agreement between measurements made by the novices was expressed by the ICC being 0.97 (P < 0.001) in the first week and increased to 0.99 (P < 0.001) in the fourth week. Conclusion CIMT assessment by novices using an automated ultrasound could be reliably achievable after a short training period. These results may have encouraging implications when designing screening programmes for primary prevention in community health service.

  • 4.
    Zhao, Ying
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Henein, Michael Y
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Mörner, Stellan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Gustavsson, Sandra
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Holmgren, Anders
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Lindqvist, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Residual compromised myocardial contractile reserve after valve replacement for aortic stenosis2012In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 13, no 4, 353-360 p.Article in journal (Refereed)
    Abstract [en]

    Objective: Despite recovery of left ventricular (LV) function and morphology after aortic valve replacement (AVR) for aortic stenosis (AS), its relationship with exercise capacity remains unknown. Twenty-one AVR patients (age 61 +/- 12 years, 14 male) with normal ejection fraction (EF, 64 +/- 7%) and 21 age- and sex-matched controls (57 +/- 9 years, 10 male, EF 68 +/- 8%) were studied.Methods and results: All subjects performed semi-supine bicycle exercise and speckle tracking echocardiography (STE) study. Peak oxygen consumption (pVO(2)) was collected during semi-supine bicycle exercise. Systolic (GLSRs) and early diastolic (GLSRe) longitudinal strain rate using STE and Doppler echocardiographic parameters were measured at rest, submaximal, peak exercise, and 4 min after exercise. The two groups had comparable resting echocardiographic measurements. At peak exercise, pVO(2) was lower in patients than controls (18.5 +/- 4.5 vs. 22.1 +/- 4.3 L/min/kg, P < 0.05). GLSRs (0.98 +/- 0.28 vs. 1.55 +/- 0.30 1/s, P < 0.001), septal Sm (7.9 +/- 1.4 vs. 11.1 +/- 2.3 cm/s, P < 0.001) and their changes between rest and peak exercise (Delta GLSRs: 0.16 +/- 0.33 vs. 0.68 +/- 0.27 1/s, P < 0.001; Delta Sm 2.29 +/- 2.23 vs. 4.63 +/- 2.29 cm/s, P < 0.01) were significantly lower in patients than controls. There was no correlation between pVO(2) and any echocardiographic measurements in controls. In patients, pVO(2) correlated with peak exercise GLSRs (r = 0.60, P = 0.0007), septal Sm (r = 0.65, P = 0.002), and Em (r = 0.57, P = 0.009). In a multivariate model, peak exercise GLSRs (beta = 7.18, P = 0.03) was the only independent predictor of pVO(2) in the patients group.Conclusion: Exercise capacity is subnormal after AVR for AS, irrespective of normal LVEF suggesting residual compromised myocardial functional reserve.

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