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Publications (10 of 122) Show all publications
Lindow, T., Manouras, A., Lindqvist, P., Manna, D., Wieslander, B., Kozor, R., . . . Ugander, M. (2024). Echocardiographic estimation of pulmonary artery wedge pressure: invasive derivation, validation, and prognostic association beyond diastolic dysfunction grading. European Heart Journal Cardiovascular Imaging, 25(4), 498-509
Open this publication in new window or tab >>Echocardiographic estimation of pulmonary artery wedge pressure: invasive derivation, validation, and prognostic association beyond diastolic dysfunction grading
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2024 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 25, no 4, p. 498-509Article in journal (Refereed) Published
Abstract [en]

Background and aims: Grading of diastolic function can be useful, but indeterminate classifications are common.

Objectives: We aimed to invasively derive and validate a quantitative echocardiographic estimation of pulmonary artery wedge pressure (PAWP), and to compare its prognostic performance to diastolic dysfunction grading.

Methods: Echocardiographic measures were used to derive an estimated PAWP (ePAWP) using multivariable linear regression in patients undergoing right heart catheterization (RHC). Prognostic associations were analyzed in the National Echocardiography Database of Australia (NEDA).

Results: In patients who had undergone both RHC and echocardiography within two hours (n=90), ePAWP was derived using left atrial volume index, mitral peak early velocity (E), and pulmonary vein systolic velocity (S). In a separate external validation cohort (n=53, simultaneous echocardiography and RHC), ePAWP showed good agreement with invasive PAWP (mean±SD difference 0.5±5.0 mmHg) and good diagnostic accuracy for estimating PAWP>15mmHg (area under the curve [95% confidence interval] 0.94 [0.88-1.00]). Among patients in NEDA (n=38,856, median [interquartile range] follow-up 4.8 [2.3-8.0] years, 2,756 cardiovascular deaths), ePAWP was associated with cardiovascular death even after adjustment for age, sex, and diastolic dysfunction grading (hazard ratio (HR) 1.08 [1.07-1.09] per mmHg) and provided incremental prognostic information to diastolic dysfunction grading (improved C-statistic from 0.65 to 0.68, p<0.001). Increased ePAWP was associated with worse prognosis across all grades of diastolic function (HR normal: 1.07 [1.06-1.09]; indeterminate: 1.08 [1.07-1.09]; abnormal: 1.08 [1.07-1.09], p<0.001 for all).

Conclusions: Echocardiographic ePAWP is an easily acquired continuous variable with good accuracy that associates with prognosis beyond diastolic dysfunction grading.

Place, publisher, year, edition, pages
Oxford University Press, 2024
Keywords
diastolic dysfunction, echocardiography, heart failure, pulmonary capillary wedge pressure
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-217450 (URN)10.1093/ehjci/jead301 (DOI)001108246300001 ()37949842 (PubMedID)2-s2.0-85184482944 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20160787Swedish Heart Lung Foundation, 20200160Swedish Research Council, 2019-01338
Note

First published online: 9 November 2023

Available from: 2023-12-04 Created: 2023-12-04 Last updated: 2024-04-22Bibliographically approved
Law, L., Lindqvist, P., Liv, P., Hellman, U., Lejon, K., Geijer, M., . . . Forsblad-d'Elia, H. (2024). Increased carotid intima-media thickness in patients with radiographic axial spondyloarthritis compared to controls and associations with markers of inflammation. Clinical Rheumatology, 43(5), 1559-1570
Open this publication in new window or tab >>Increased carotid intima-media thickness in patients with radiographic axial spondyloarthritis compared to controls and associations with markers of inflammation
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2024 (English)In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 43, no 5, p. 1559-1570Article in journal (Refereed) Published
Abstract [en]

Objective: There is an increased risk for cardiovascular disease (CVD) in patients with radiographic axial spondyloarthritis (r-axSpA). In this cross-sectional study, we aimed to, overall and stratified by sex, (i) compare ultrasound derived carotid intima media thickness (cIMT), between patients and controls, and (ii) investigate associations between cIMT, clinical disease activity and inflammation-related laboratory markers in patients with r-axSpA.

Method: In total, 155 patients diagnosed with r-axSpA using the modified New York criteria and 400 controls were included. Bilateral carotid ultrasound, laboratory testing, and questionaries were acquired. Disease-specific assessments were carried out for patients. Linear regression analysis was used to assess associations.

Results: Linear regression analyses showed that patients with r-axSpA had increased mean cIMT compared to controls (mean ± SD, 0.8 ± 0.1 mm vs 0.7± 0.1 mm, respectively, unstandardized β (95% CI) -0.076 (-0.10, -0.052), P < 0.001) adjusted for smoking status and age. Linear regression analyses for patients with r-axSpA showed that only males presented significant associations between cIMT and inflammation-related laboratory markers, white blood cell (WBC) count (mean ± SD, 6.8 ± 1.6 109/L) and monocytes (0.6 ± 0.2 109/L); WBC count (unstandardized β (95% CI) 0.019 (0.0065, 0.031), P = 0.003, R2 = 0.57) and monocytes (0.13 (0.0047, 0.26), P = 0.041, R2 = 0.55), adjusted for age, smoking status, body mass index, hypertension, dyslipidemia, diabetes mellitus, ASDAS-CRP, and treatment with DMARDs and glucocorticoids. No significant association was found between cIMT and clinical disease activity assessed by ASDAS-CRP.

Conclusion: Patients with r-axSpA had significantly increased cIMT compared to controls. In male patients, higher WBC and monocyte count were associated with an increase in cIMT suggesting the role of inflammation in the development of atherosclerosis. 

Place, publisher, year, edition, pages
Springer Nature, 2024
Keywords
Cardiovascular disease (CVD), Carotid intima-media thickness (cIMT), Radiographic axial spondyloarthritis (r-axSpA), Ultrasound
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-221778 (URN)10.1007/s10067-024-06913-8 (DOI)001176391500001 ()38443604 (PubMedID)2-s2.0-85186622797 (Scopus ID)
Funder
Swedish Research CouncilRegion VästerbottenStiftelsen Konung Gustaf V:s 80-årsfond
Available from: 2024-03-06 Created: 2024-03-06 Last updated: 2024-04-18Bibliographically approved
Venkateshvaran, A. & Lindqvist, P. (2024). Mitral E-wave to stroke volume ratio displays stronger diagnostic performance to identify elevated left ventricular filling pressures than mitral E/e' during passive leg lift: a cross-sectional study employing simultaneous echocardiography and catheterization. Echocardiography, 41(2), Article ID e15756.
Open this publication in new window or tab >>Mitral E-wave to stroke volume ratio displays stronger diagnostic performance to identify elevated left ventricular filling pressures than mitral E/e' during passive leg lift: a cross-sectional study employing simultaneous echocardiography and catheterization
2024 (English)In: Echocardiography, ISSN 0742-2822, E-ISSN 1540-8175, Vol. 41, no 2, article id e15756Article in journal (Refereed) Published
Abstract [en]

Background: Elevated filling pressure is a hallmark of heart failure (HF) and portends poor prognosis. Accurate diagnosis is challenging, given that patients with normal filling pressure at rest develop disproportionate elevation with sudden preload increase. We aimed to test the accuracy of the ratio between mitral inflow velocity (E) and left ventricular stroke volume (SV) to identify patients with elevated filling pressure with passive leg lifting (PLL) and compare this with other echocardiographic surrogates of filling pressure.

Methods: Doppler echocardiography and right heart catheterization (RHC) were simultaneously performed in 37 patients (11 males, mean age 67 ± 12 years) with exertional dyspnea. Twenty-six healthy controls (14 males, mean age 60 ± 12 years) were added as reference. SV, cardiac output (CO), tricuspid regurgitation peak gradient (TRG), mitral E-wave (E) and early myocardial velocity (e') were obtained at rest and with PLL. E/SV, E/CO and E/e' were calculated and correlated with invasive pulmonary capillary wedge pressures (PCWP) with PLL.

Results: During PLL, E/SV (AUC = 0.94) displayed stronger diagnostic ability to identify PCWP >15 mmHg than E/e' (AUC = 0.81), mitral E/A ratio (0.76) and resting invasive PCWP (0.84). An E/SV cutoff of >1.0 showed 88% sensitivity and 75% specificity to identify elevated PCWP. Further, 10 patients (27%) were reassigned during PLL from normal to postcapillary pulmonary hypertension (postCPH), and 6 patients (16%) switched diagnosis from precapillary PH (preCPH) to postCPH.

Conclusion: The novel E/SV ratio identifies patients with elevated PCWP with PLL and displays stronger diagnostic performance than routinely utilized echocardiographic measures such as E/e' in addition to resting, catheterization derived PCWP.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
Doppler, filling pressure, heart failure, passive leg lifting, pulmonary hypertension
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-221481 (URN)10.1111/echo.15756 (DOI)38400581 (PubMedID)2-s2.0-85184507860 (Scopus ID)
Funder
Swedish Research Council, 2019-01338Swedish Research Council, 2022-01254Swedish Heart Lung Foundation, 20160787Swedish Heart Lung Foundation, 20200160
Available from: 2024-02-26 Created: 2024-02-26 Last updated: 2024-03-07Bibliographically approved
Gottfridsson, P., Law, L., Aroch, R., Myrberg, T., Hultin, M., Lindqvist, P. & Haney, M. (2023). Left atrial contraction strain during a Valsalva manoeuvre: A study in healthy humans. Clinical Physiology and Functional Imaging, 43(3), 165-169
Open this publication in new window or tab >>Left atrial contraction strain during a Valsalva manoeuvre: A study in healthy humans
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2023 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 43, no 3, p. 165-169Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cardiac mechanics are influenced by loading conditions as well as sympathetic tone. Left atrial (LA) contractile function assessed by two-dimensional (2D) strain has been described in the setting of controlled preload alterations; however, studies show conflicting findings about change or direction of change. We hypothesized that the controlled preload reduction and the sympathetic nervous system activation that occurs during a standardized Valsalva manoeuvre would bring about a change in LA contraction strain.a

METHODS: Healthy young adults of both sexes were recruited. Transthoracic echocardiographic ultrasound images were collected before and during a Valsalva manoeuvre. Standard imaging windows for LA strain assessment were used and the images were copied and stored for later offline analysis. These were assessed for adequate atrial wall visualization in 2D strain assessment. Paired comparisons were carried out using Student's T test.

RESULT: Thirty-eight participants were included and there were 22 complete studies with paired pre- and during Valsalva manoeuvre. LA contraction strain at baseline was 10.5 ± 2.8% (standard deviation) and during the Valsalva manoeuvre 10.6 ± 4.6%, p = 0.86.

CONCLUSION: The Valsalva manoeuvre, a combination of preload reduction and sympathetic nervous system activation, seems not to be associated with a change in LA contraction strain in healthy young individuals. LA contraction strain should be interpreted in the context of both atrial loading conditions and prevailing autonomic nervous system activity.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
contractile function, echocardiography, left atrium, preload, speckle tracking, sympathetic nervous system
National Category
Anesthesiology and Intensive Care Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-202113 (URN)10.1111/cpf.12806 (DOI)000902530500001 ()36533722 (PubMedID)2-s2.0-85145300941 (Scopus ID)
Funder
Region Västerbotten
Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2023-09-05Bibliographically approved
Venkateshvaran, A., Tossavainen, E., Borneteg, C., Oktay Tureli, H., Vanoli, D., Lund, L. H., . . . Lindqvist, P. (2022). A novel echocardiographic estimate of pulmonary vascular resistance employing the hydraulic analogy to Ohm’s law. IJC Heart & Vasculature, 42, Article ID 101121.
Open this publication in new window or tab >>A novel echocardiographic estimate of pulmonary vascular resistance employing the hydraulic analogy to Ohm’s law
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2022 (English)In: IJC Heart & Vasculature, E-ISSN 2352-9067, Vol. 42, article id 101121Article in journal (Refereed) Published
Abstract [en]

Background: Assessment of pulmonary vascular resistance (PVR) is critical for accurate diagnosis and optimal pharmacotherapy in pulmonary hypertension. We aimed to test the diagnostic performance of a novel, Doppler-based method to evaluate PVR based on Ohm’s law (PVRecho) using pragmatic estimates of pulmonary capillary wedge pressure (PCWP).

Methods and results: Simultaneous right heart catheterization (RHC) and echocardiography was performed in a derivation cohort of 111 patients in sinus rhythm referred for PH evaluation and PVRecho independently validated in 238 patients. PVRecho was calculated using pulmonary artery mean pressure estimates (PAMPecho) obtained from peak tricuspid gradient employing a fixed right atrial pressure estimate, PCWPecho was estimated as 10 or 20 mmHg using age-related mitral E/A cut-offs and cardiac output from left ventricular outflow. In the derivation cohort, both PAMPecho and PCWPecho estimates demonstrated excellent agreement with catheterization measurements. PVRecho was highly feasible, demonstrated negligible bias and excellent agreement with PVRRHC (Bias = −0.58, SD 2.2 mmHg) and outperformed the Abbas method to identify PVRRHC > 3WU (AUC = 0.85 vs. 0.70; p = 0.02). In the validation cohort, PVRecho preserved good invasive agreement with negligible bias, displayed strong diagnostic performance (AUC = 0.84) and significant ability to distinguish isolated post-capillary from combined post- and pre-capillary pulmonary hypertension (PH) subgroups (AUC = 0.77).

Conclusion: PVRecho based on Ohm’s law employing pragmatic estimates of PCWPecho demonstrates excellent agreement with invasive reference standard measurements and strong diagnostic ability to identify elevated PVRRHC. This novel approach may be useful during therapy selection to distinguish PH hemodynamic subgroups.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Doppler echocardiography, Right heart catheterization, Pulmonary hypertension, Heart failure
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-199518 (URN)10.1016/j.ijcha.2022.101121 (DOI)000856092100005 ()36118257 (PubMedID)2-s2.0-85137632074 (Scopus ID)
Available from: 2022-09-19 Created: 2022-09-19 Last updated: 2023-09-05Bibliographically approved
Henein, M. Y., Pilebro, B. & Lindqvist, P. (2022). Disease progression in cardiac morphology and function in heart failure: ATTR cardiac amyloidosis versus hypertensive left ventricular hypertrophy. Heart and Vessels, 37, 1562-1569
Open this publication in new window or tab >>Disease progression in cardiac morphology and function in heart failure: ATTR cardiac amyloidosis versus hypertensive left ventricular hypertrophy
2022 (English)In: Heart and Vessels, ISSN 0910-8327, E-ISSN 1615-2573, Vol. 37, p. 1562-1569Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Transthyretin cardiac amyloidosis (ATTR-CA) is today more frequently recognized but the rate of progression of cardiac dysfunction is not well established. The aim of this study is to investigate the nature of cardiac structure and function changes, over time, in a retrospective cohort of ATTR-CA patients.

METHODS: Fifty-one patients with ATTR-CA (mean age 78 ± 7 years, 30 females) were compared with 20 patients with heart failure but no amyloidosis (HFnCA) (mean age 76 ± 7 years, 5 females), all with septal thickness >  = 14 mm. All patients underwent DPD scintigraphy and an echocardiogram (Echo 2) which was compared with a previous echocardiographic examination (Echo 1), performed at least 3 years before.

RESULTS: Over the follow-up period, the interventricular septal thickness (IVST) and relative wall thickness (RWT) in ATTR-CA increased from 16 (4) to 18 (5) mm and from 0.51 (0.17) to 0.62 (0.21) respectively, p < 0.001 for both, by a mean increase of 0.4 mm/year and 0.03 mm/year, (p = 0.009 and p = 0.002 compared with HFnCA), respectively. RWT > 0.45 (AUC = 0.77) and RELAPS > 2.0 (AUC 0.86) both predicted positive DPD diagnosis for ATTR-CA.

CONCLUSION: In ATTR-CA patients, the overtime-increase in RWT and IVST was worse than that seen in patients with heart failure but no cardiac amyloidosis. Also, RWT and relative apical sparing predicted diagnosis of ATTR-CA, thus could strengthen the use of follow-up echocardiographic findings as red flag for the diagnosis of ATTR-CA.

Place, publisher, year, edition, pages
Springer, 2022
Keywords
Cardiac amyloidosis, DPD scintigraphy, Echocardiography, Prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-193208 (URN)10.1007/s00380-022-02048-5 (DOI)000767750300001 ()35275264 (PubMedID)2-s2.0-85126085900 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20160787Swedish Heart Lung Foundation, 20200160Swedish Research Council, 2019–01338
Available from: 2022-03-21 Created: 2022-03-21 Last updated: 2022-11-28Bibliographically approved
Gottfridsson, P., A’Roch, R., Lindqvist, P., Law, L., Myrberg, T., Hultin, M., . . . Haney, M. (2022). Left atrial contraction strain and controlled preload alterations, a study in healthy individuals. Cardiovascular Ultrasound, 20(1), Article ID 8.
Open this publication in new window or tab >>Left atrial contraction strain and controlled preload alterations, a study in healthy individuals
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2022 (English)In: Cardiovascular Ultrasound, E-ISSN 1476-7120, Vol. 20, no 1, article id 8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In order to assess left atrial contractile function in disturbed circulatory conditions, it is necessary to have a clear understanding of how it behaves in a normal resting state with changes in loading conditions. However, currently the understanding of this relationship is incomplete. We hypothesize that in healthy individuals, left atrial contraction strain and its peak strain rate are increased or decreased by increasing or decreasing preload, respectively.

METHODS: Controlled maneuvers used to change preload included continuous positive airway pressure by mask (CPAP 20 cmH2O) for preload decrease, and passive leg raise (15 degrees angle) for preload increase. Cardiac ultrasound 4-chamber views of the left atria and left ventricle were acquired at baseline and during maneuver. Acquired images were post processed and analyzed offline. Comparisons were made using paired t-test and means with 95% confidence interval.

RESULTS: There were 38 participants, complete results were obtained from 23 in the CPAP maneuver and 27 in the passive leg raise maneuver. For the CPAP group, left atrial contraction strain was 11.6% (10.1 to 13.1) at baseline and 12.8% (11.0 to 14.6) during the maneuver (p = 0.16). Left atrial contraction peak strain rate was - 1.7 s- 1 (- 1.8 to - 1.5) at baseline and - 1.8 s- 1 (- 2.0 to - 1.6) during the maneuver (p = 0.29). For the passive leg raise-group, left atrial contraction strain was 10.1% (9.0 to 11.2) at baseline and 10.8% (9.4 to 12.3) during the maneuver (p = 0.28). Left atrial contraction peak strain rate was - 1.5 s- 1 (- 1.6 to - 1.4) at baseline and - 1.6 s- 1 (- 1.8 to - 1.5) during the maneuver (p = 0.29). Left atrial area, an indicator of preload, increased significantly during passive leg raise and decreased during CPAP.

CONCLUSION: In healthy individuals, left atrial contraction strain and its peak strain rate seem to be preload-independent.

TRIAL REGISTRATION: The study was 2018-02-19 registered at clinicaltrials.gov ( NCT03436030 ).

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Contractile function, Echocardiography, Left atrium, Preload, Speckle tracking
National Category
Anesthesiology and Intensive Care Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-193748 (URN)10.1186/s12947-022-00278-1 (DOI)000776052500001 ()35354482 (PubMedID)2-s2.0-85127286852 (Scopus ID)
Note

Errata: Gottfridsson, P., A’Roch, R., Lindqvist, P. et al. Correction to: Left atrial contraction strain and controlled preload alterations, a study in healthy individuals. Cardiovasc Ultrasound 20, 12 (2022). DOI: 10.1186/s12947-022-00281-6

Available from: 2022-04-12 Created: 2022-04-12 Last updated: 2024-01-17Bibliographically approved
Venkateshvaran, A., Tureli, H. O., Ljung Faxén, U., Lund, L. H., Tossavainen, E. & Lindqvist, P. (2022). Left atrial reservoir strain improves diagnostic accuracy of the 2016 ASE/EACVI diastolic algorithm in patients with preserved left ventricular ejection fraction: insights from the KARUM haemodynamic database. European Heart Journal Cardiovascular Imaging, 23(9), 1157-1168
Open this publication in new window or tab >>Left atrial reservoir strain improves diagnostic accuracy of the 2016 ASE/EACVI diastolic algorithm in patients with preserved left ventricular ejection fraction: insights from the KARUM haemodynamic database
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2022 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 23, no 9, p. 1157-1168Article in journal (Refereed) Published
Abstract [en]

AIMS: This study aimed to investigate the incremental value offered by left atrial reservoir strain (LASr) to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) diastolic algorithm to identify elevated left ventricular (LV) filling pressure in patients with preserved ejection fraction (EF).

METHODS AND RESULTS: Near-simultaneous echocardiography and right heart catheterization were performed in 210 patients with EF ≥50% in a large, dual-centre study. Elevated filling pressure was defined as invasive pulmonary capillary wedge pressure (PCWP) ≥15 mmHg. LASr was evaluated using speckle-tracking echocardiography. Diagnostic performance of the ASE/EACVI diastolic algorithm was validated against invasive reference and compared with modified algorithms incorporating LASr. Modest correlation was observed between E/e', E/A ratio, and LA volume index with PCWP (r = 0.46, 0.46, and 0.36, respectively; P < 0.001 for all). Mitral e' and TR peak velocity showed no association. The ASE/EACVI algorithm (89% feasibility, 71% sensitivity, 68% specificity) demonstrated reasonable ability (AUC = 0.69) and 68% accuracy to identify elevated LV filling pressure. LASr displayed strong ability to identify elevated PCWP (AUC = 0.76). Substituting TR peak velocity for LASr in the algorithm (69% sensitivity, 84% specificity) resulted in 91% feasibility, 81% accuracy, and stronger agreement with invasive measurements. Employing LASr as per expert consensus (71% sensitivity, 70% specificity) and adding LASr to conventional parameters (67% sensitivity, 84% specificity) also demonstrated greater feasibility (98% and 90%, respectively) and overall accuracy (70% and 80%, respectively) to estimate elevated PCWP.

CONCLUSIONS: LASr improves feasibility and overall accuracy of the ASE/EACVI algorithm to discern elevated filling pressures in patients with preserved EF.

Place, publisher, year, edition, pages
Oxford University Press, 2022
Keywords
diastolic dysfunction, echo Doppler, left ventricular filling pressure, right heart catheterization, speckle tracking echocardiography
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-192682 (URN)10.1093/ehjci/jeac036 (DOI)000757886300001 ()35182152 (PubMedID)2-s2.0-85128078085 (Scopus ID)
Funder
Swedish Research Council, 2013-23897-104604-23Swedish Research Council, 523-2014- 2336Swedish Heart Lung Foundation, 20100419Swedish Heart Lung Foundation, 20200160Swedish Research Council, 2019-01338
Available from: 2022-02-21 Created: 2022-02-21 Last updated: 2022-12-19Bibliographically approved
Lisi, M., Mandoli, G. E., Cameli, M., Pastore, M. C., Righini, F. M., Benfari, G., . . . Henein, M. Y. (2022). Left atrial strain by speckle tracking predicts atrial fibrosis in patients undergoing heart transplantation. European Heart Journal Cardiovascular Imaging, 23(6), 829-835
Open this publication in new window or tab >>Left atrial strain by speckle tracking predicts atrial fibrosis in patients undergoing heart transplantation
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2022 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 23, no 6, p. 829-835Article in journal (Refereed) Published
Abstract [en]

Aims: In patients with heart failure (HF), chronically raised left ventricular (LV) filling pressures lead to progressive left atrial (LA) dysfunction and fibrosis. We aimed to assess the correlation of LA reservoir strain (peak atrial longitudinal strain, PALS) by speckle tracking echocardiography (STE) and LA fibrosis assessed by myocardial biopsy in patients undergoing heart transplantation (HTx).

Methods and results: Forty-eight patients with advanced HF [mean age 51.2 ± 8.1 years, 29% females; LV ejection fraction ≤25% and New York Heart Association (NYHA) class III–IV] referred for HTx were enrolled and underwent pre-operative echocardiographic evaluation, right heart catheterization, and cardiopulmonary exercise testing. Exclusion criteria were non-sinus rhythm, mechanical ventilation, severe mitral/tricuspid regurgitation, or other valvular disease and poor acoustic window. After HTx, LA bioptic samples were collected and analysed to determine the extent of myocardial fibrosis (%). LA fibrosis showed correlation with PALS (R = −0.88, P < 0.0001), VO2max (R = −0.68, P < 0.0001), NYHA class (R = 0.66, P < 0.0001), LA stiffness (R = 0.58, P = 0.0002), and E/e' (R = 0.44, P = 0.005), while poorly correlated with E/A ratio (R = 0.23, P = 0.21). PALS had a good correlation with NYHA class (R = −0.64, P < 0.0001), PAoP (R = −0.61, P = 0.03) and VO2max (R = 0.57, P = 0.0001). Multivariate regression analysis identified PALS (beta = −0.91, P < 0.001) and LA Volume (beta = −0.19, P = 0.03) as predictors of LA Fibrosis, while E/e’ was not a significant predictor (beta = 0.15, P = 0.08).

Conclusion: Emerging as a possible index of myocardial fibrosis in patients with advanced HF, PALS could help to optimize the management and the selection of those patients with irreversible LA structural damage for advanced therapeutic strategies.

Place, publisher, year, edition, pages
Oxford University Press, 2022
Keywords
left atrial, strain, fibrosis, heart failure, speckle tracking, heart transplantation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-184439 (URN)10.1093/ehjci/jeab106 (DOI)000755796300001 ()34118154 (PubMedID)2-s2.0-85117220542 (Scopus ID)
Available from: 2021-06-14 Created: 2021-06-14 Last updated: 2022-07-12Bibliographically approved
Arnberg, E., Eldhagen, P., Löfbacka, V., Venkateshvaran, A., Pilebro, B. & Lindqvist, P. (2022). RWT/SaVR-A Simple and Highly Accurate Measure Screening for Transthyretin Cardiac Amyloidosis. Journal of Clinical Medicine, 11(14), Article ID 4120.
Open this publication in new window or tab >>RWT/SaVR-A Simple and Highly Accurate Measure Screening for Transthyretin Cardiac Amyloidosis
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2022 (English)In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 11, no 14, article id 4120Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cardiac amyloidosis is an underdiagnosed condition and simple methods for accurate diagnosis are warranted. We aimed to validate a novel, dual-modality approach to identify transthyretin cardiac amyloidosis (ATTR-CA), employing echocardiographic relative wall thickness (RWT), and ECG S-wave from aVR (SaVR), and compare its accuracy with conventional echocardiographic approaches.

MATERIAL AND METHODS: We investigated 102 patients with ATTR-CA and 65 patients with left ventricular hypertrophy (LVH), all with septal thickness &gt; 14 mm. We validated the accuracy of echocardiographic measures, including RWT, RWT/SaVR, posterior wall thickness (PWT), LV mass index (LVMI), left atrial volume index (LAVI), global longitudinal strain (GLS), and relative apical sparing (RELAPS) to identify ATTR-CA diagnosed using DPD-scintigraphy or abdominal fat biopsy.

RESULTS: PWT, RWT, RELAPS, troponin, and RWT/SaVR were significantly higher in ATTR-CA compared to LVH. RWT/SaVR &gt; 0.7 was the most accurate parameter to identify ATTR-CA (sensitivity 97%, specificity 90% and accuracy 91%). RELAPS was found to have much less accuracy (sensitivity 74%, specificity 76% and accuracy 73%).

CONCLUSION: We can confirm the very strong diagnostic accuracy of RWT/SaVR to identify ATTR-CA in patients with septal thickness &gt; 14 mm. Given its high sensitivity and specificity, RWT/SaVR &gt; 0.7 has the potential to implement as a non-invasive, simple, and widely available diagnostic tool when screening for ATTR-CA.

Place, publisher, year, edition, pages
MDPI, 2022
Keywords
ECG, cardiac amyloidosis, left ventricular hypertrophy, relative wall thickness, transthyretin
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-198312 (URN)10.3390/jcm11144120 (DOI)000831448600001 ()35887882 (PubMedID)2-s2.0-85137207829 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20160787Swedish Heart Lung Foundation, 20200160Swedish Research Council, 2019–01338
Available from: 2022-07-28 Created: 2022-07-28 Last updated: 2022-11-03Bibliographically approved
Projects
Novel methods for improving early and accurate diagnosis of transthyretin amyloidosis [2019-01338_VR]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8192-9166

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