- President - European Association of Cardiovascular Imaging (EACVI) 2018-20
- Editorial Board Member: Journal of the American Society of Echorcardiography
- Editorial Board Member: European Heart Journal - Cardiovascular Imaging
- Editorial Board Member: JACCi
- Center Director, Center for Cardiological Innovation - A Center for Research-based Innovation (SFI) funded by Norwegian Research Council (2011-2019)
- Chief Editor, Heart forum (Norwegian)
Publications
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Andresen, Kristoffer; Selmer, Lisa Marie; Espeland, Torvald; Fadnes, Solveig; Løvstakken, Lasse & Beitnes, Jan Otto
[Show all 9 contributors for this article]
(2026).
Mechanical Wave Velocities by High Frame Rate Echocardiography Identifies Myocardial Dysfunction in Acute Coronary Syndrome.
Journal of the American Society of Echocardiography.
ISSN 0894-7317.
doi:
10.1016/j.echo.2026.09.005.
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Background: Mechanical waves propagating within the myocardium offer insight into tissue stiffness that can be measured by high frame rate echocardiography. This may provide information on myocardial tissue properties in acute myocardial infarction (AMI) incremental to traditional echocardiographic metrics. Objectives: To investigate whether natural mechanical wave velocities in the left ventricle (LV) are altered in AMI and to establish the feasibility of measuring mechanical wave velocities in all LV regions in AMI patients. Methods: We examined 60 patients (66±9 years, 72% male) with AMI by high frame rate echocardiography within one day after revascularisation therapy. Natural mechanical waves generated by the atrial kick (AK), mitral valve closure (MVC) and aortic valve closure (AVC) were analysed by clutter filter wave imaging for all LV regions. Results: AK wave velocities were faster in regions with wall motion abnormalities (WMA) compared to regions without (2.9 (2.1-4.6) m/s vs. 2.2 (1.7-2.8) m/s, p=0.004), whereas no differences were observed for MVC or AVC waves. Elevated AK wave velocities were associated with myocardial dysfunction assessed by LV longitudinal strain (β=0.49 (0.26-0.71), p<0.001) and WMA (OR 1.6 (1.3-2.0), p<0.001) by multivariable mixed-model regression analyses adjusting for age, gender and parameters of diastolic function, and for WMA also adjusted for LV longitudinal strain (OR 1.4 (1.0-1.8), p=0.022). Feasibility for measuring AK waves was high in all regions (mean 89%), but lower for MVC/AVC waves (mean 44% and 46%, respectively, p<0.001). Feasibility was lower from basal to apical segments for all wave types (p<0.001). Conclusions: AK wave velocities were faster in infarcted territories of AMI patients and were independently associated with myocardial dysfunction assessed by LV longitudinal strain and WMA. AK waves could be measured with good feasibility in all LV regions. The lower feasibility for MVC and AVC waves suggests differences in propagation dynamics or intrinsic wave properties.
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Madssen, Erik; Sverre, Elise Christine Bjørkholen; Nyen, Johanne E; Holmager, Therese L F; Kristensen, Anna M D & Bakken, Arnhild
[Show all 13 contributors for this article]
(2026).
Beta-blocker therapy and physical activity after myocardial infarction: a preplanned sub-study of the BETAMI trial.
European Journal of Preventive Cardiology (EJPC).
ISSN 2047-4873.
doi:
10.1093/eurjpc/zwag412.
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Abstract Aims To investigate the effect of long-term beta-blocker therapy on physical activity (PA) level after myocardial infarction (MI) in patients without heart failure. Method The BETAMI trial, randomised patients hospitalised with a MI without heart failure (LVEF ≥40%) to beta-blocker or no beta-blocker. In this pre-planned sub-study PA level was assessed by guideline-recommended PA level (≥30 minutes moderate activity ≥5 days/week) or not and self-reported hours/week with light to moderate and vigorous PA. Between-group differences in PA from baseline before randomisation to 18-months were estimated by linear mixed models. Exploratory analysis assessed treatment effects on a composite of all-cause mortality and major adverse cardiovascular events using Cox proportional hazards model. Results Of the 2867 randomised patients, 2185 (76%) responded to the PA questions and were included in this analysis. Mean age was 62.5 (SD 10.1) years, 20.6% were women. No differences in guideline-recommended PA level or mean hours of light to moderate and vigorous PA were reported between the beta-blocker and non-beta-blocker group at baseline or during 18-months follow-up. At 12-month follow-up, 37.0% in the beta-blocker group and 36.7% in the no beta-blocker group reported guideline-recommended PA level (OR 0.97, 95% CI 0.69-1.37). Exploratory, hypothesis-generating analyses did not demonstrate a statistically significant interaction (p for interaction = 0.06) between treatment assignment and baseline PA level for recurrent clinical events. Conclusions Beta-blocker therapy did not result in a change in PA level in post-MI patients without heart failure during the 18 months follow-up.
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Kristensen, Anna Meta Dyrvig; Jortveit, Jarle; Holmager, Therese; Atar, Dan; Olsen, Michael Hecht & Bakken, Arnhild
[Show all 14 contributors for this article]
(2026).
Outcomes in the BETAMI-DANBLOCK trial compared with a Norwegian nationwide myocardial infarction population.
European Heart Journal.
ISSN 0195-668X.
doi:
10.1093/eurheartj/ehag348.
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Abstract Background and Aims In patients with myocardial infarction (MI), no heart failure, and left ventricular ejection fraction (LVEF) ≥ 40%, the combined BETAMI-DANBLOCK trial showed that beta-blockers reduced the risk of all-cause mortality or major adverse cardiovascular events. This study evaluated the representativeness of the trial. Methods Participants in BETAMI (n = 2867) and DANBLOCK (n = 2707) were compared with a cohort of revascularized MI patients with LVEF ≥40%, and no heart failure from the Norwegian Myocardial Infarction Registry (the NORMI cohort)(n = 20 804). Baseline characteristics were evaluated, and absolute risks of all-cause mortality and/or MI were estimated. A transportability analysis was conducted by weighting the BETAMI-DANBLOCK population according to the NORMI cohort. Results Median age was 66 years (interquartile range [IQR]: 57–74) in the NORMI cohort and 63 years (IQR: 55–70) in BETAMI and DANBLOCK. Patients in the NORMI cohort had a higher prevalence of diabetes, previous coronary artery disease, and LVEF 40–49%, compared with trial participants. At 3-year follow-up, the absolute risk of all-cause mortality or MI was 12.0% in the NORMI cohort, 7.7% in BETAMI, and 7.8% in DANBLOCK. Corresponding risks of MI were 6.3%, 5.6%, and 4.3%, respectively. The treatment effects of beta-blockers were similar when the trial population was weighted according to the characteristics of the NORMI cohort. Conclusions Compared with the NORMI cohort, participants in BETAMI and DANBLOCK were younger, had a lower proportion of certain comorbidities, and experienced a lower risk of all-cause mortality and MI. Despite these differences, the effect of beta-blockers remained consistent when the trial population was weighted according to the NORMI cohort.
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Luksic, Vlatka Reskovic; Paakkanen, Riitta; Podlesnikar, Tomaz; Androulakis, Emmanuel; Uusitalo, Valtteri & Moscatelli, Sara
[Show all 10 contributors for this article]
(2025).
EACVI survey on the role, structure, and implementation of heart teams in current cardiology practice.
European Heart Journal – Imaging Methods and Practice (EHJ-IMP).
3(4).
doi:
10.1093/ehjimp/qyaf124.
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Aims The Heart Team (HT) concept is underscored in multiple guidelines, but the practical application is still challenging. Objective This survey, endorsed by the European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee and conducted by the EACVI Leaders of Tomorrow, aimed to explore the structure and dynamics of contemporary HTs in real-life clinical practice. Methods and results The Survey comprised 24 questions, including single-choice, multiple-choice, and open-labeled formats. It addressed all cardiologists and associated specialists involved in the HT meetings via online platform. A total of 233 responses were collected from 48 countries, 203 (87%) from Europe. Most respondents were imaging specialists (38%) and general cardiologists (29%), with 85% actively engaged in HT meetings. Twelve distinct HT configurations were identified. Core HT members included general and interventional cardiologists, cardiac surgeons, and imaging specialists. Complex cases are usually discussed at HT meetings, and ESC guidelines serve as a guiding framework (87%). Leadership within HTs is inconsistent and regular HT audits are lacking in 53% of centers. The Heart Team predominantly focus on treatment planning (97%) rather than outcome review (45%) or education (36%). Key perceived benefits include structured decision-making (74%), optimized management of complex cases (69%), and reduced specialty bias (67%). Recognized barriers included scheduling constraints, resource limitations, and communication inefficiencies. Conclusion This survey shows the important role of multidisciplinary HTs in contemporary clinical practice but reveals several areas of potential improvement. Addressing common challenges could result in more efficient HT practices and improve the care of complex patient cases in various cardiology subspecialty areas.
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Tveten, Ingrid Elisabeth; Nyberg, John; Grue, Jahn Frederik; Helland, Ragnhild Holden; Melichova, Daniela & Nguyen, Thuy Mi
[Show all 13 contributors for this article]
(2025).
Deep Learning Segmentation and Quantification of the Left Ventricle from the Parasternal Short-Axis View in Echocardiography.
Ultrasound in Medicine and Biology.
ISSN 0301-5629.
52(2),
p. 385–400.
doi:
10.1016/j.ultrasmedbio.2025.10.005.
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Objective: Quantitative measurements remain under-used in echocardiography due to measurement variability and time consumption. This study aimed to develop a deep learning (DL) pipeline for the automatic extraction of clinically relevant quantitative measurements from the parasternal short-axis (PSAX) view.
Methods: We trained an nnU-Net model to segment the left ventricle (LV) lumen and myocardium in PSAX images. Based on end-diastole (ED) and end-systole (ES) frames in the echocardiograms, we calculated the LV lumen area, LV fractional area change, mean wall thickness (MWT) and global circumferential strain. Segmentations and measurements were validated through comparison with two manual observers.
Results: Compared with manual references, the nnU-Net model achieved a high grade of similarity for the LV lumen and myocardium, with Dice coefficients of 0.93 ± 0.04 and 0.84 ± 0.08, and 95th percentile Hausdorff distances of 3.2±1.9 mm and 3.4±1.7 mm, respectively. The Dice coefficients and 95th percentile Hausdorff distances were on par or better for the evaluation dataset. DL-based measurements were in line with interobserver precision and variability. Automatic timing of ED and ES frames based on echocardiograms and LV lumen area produced similar results to using manual timing by experts. The subject-level feasibility was 90.4%. Furthermore, DL-based measurement of MWT at ED differentiated subjects with and without hypertension (p < 0.001).
Conclusion: Our DL-based measurement pipeline for PSAX achieved performance comparable to expert annotators, positioning it as a possible substitute for tedious manual measurements. DL-derived MWT was able to differentiate hypertensive from non-hypertensive subjects, which indicates the potential clinical utility of fully automated PSAX measurements.
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Ruddox, Vidar; Norum, Ingvild Billehaug; Hjelmesæth, Jøran Sture; Edvardsen, Thor & Otterstad, Jan Erik
(2025).
The Influence of Gender on Long-Term Cardiovascular Outcomes in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction and the Association with Cardiac Left Ventricular Function.
Diagnostics (Basel).
15(22).
doi:
10.3390/diagnostics15222901.
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Background/Objectives: Traditionally, women have been observed to have older age, more co-morbidities, and poorer long-term clinical outcomes following acute myocardial infarction (AMI) when compared to men. However, age-adjusted analyses have demonstrated that gender differences are often attenuated, and the potential influence of left ventricular function and structure have been infrequently studied. The aim of the present study was to evaluate how LV function could influence gender differences in the long-term incidence of a composite of clinically relevant cardiovascular outcomes. Methods: Patients treated with early PCI for AMI were examined with echocardiography 2–4 days after the index AMI and followed by a mean 73 (±13) months. The primary endpoint was the incidence of a composite of total death, recurrent myocardial infarction, hospitalization for angina pectoris with an angiogram documenting progression of coronary artery stenoses, new heart failure, evidence of stroke/transient ischemic attack (TIA), and ventricular arrhythmia. Results: Among the 236 patients studied, 179 (76%) were men, with an average age of 66 (±11) years, and 57 were women (24%), with an age of 65 (±10) years. Men exhibited a higher incidence of anterior STEMI (p = 0.030), lower left ventricular ejection fraction (LVEF) (p = 0.02), reduced global longitudinal strain (p = 0.001), and larger left ventricular end-systolic volume index (LVESVI) (p = 0.007) compared to women. Both genders had similar peak troponin T values and symptom-to-needle times, as well as an equivalent number of stents implanted, prevalence of co-morbidities, and discharge medication. After sixyears of follow-up, Kaplan–Meier curves revealed better long-term cardiovascular outcome-free survival among women (log-rank p = 0.041). Cox regression analysis indicated that neither age nor LVEF influenced this gender difference, which, however, was reduced and became non-significant when LVESVI was added (HR 1.747 (95% CI 0.89–3.43)). No difference in mortality was observed, but men had significantly higher rates of heart failure (p = 0.03). Conclusions: This study demonstrated that men with a previous PCI-treated AMI had a two-fold (HR 2.155) higher risk of a composite long-term cardiovascular outcome as compared with women. The detrimental effect of male gender remained significant after adjustments for age and LVEF, but the male gender effect was reduced and became insignificant after adjustment for age and LVESVI. In view of this, our findings indicate that higher LVESVI may partly explain the detrimental effect of male gender on cardiovascular outcomes after PCI-treated AMI.
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Melichova, Daniela; Nyberg, John; Nguyen, Thuy Mi; Salte, Ivar Mjåland; Brunvand, Harald & Haugaa, Kristina Ingrid Helena Hermann
[Show all 11 contributors for this article]
(2025).
Clinical validation of a novel fully automated measurement method for echocardiographic mechanical dispersion using deep learning.
European Heart Journal-Cardiovascular Imaging.
ISSN 2047-2404.
26(Supplement_1).
doi:
10.1093/ehjci/jeae333.024.
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Abstract Background Evaluation of left ventricular (LV) function by strain echocardiography and mechanical dispersion (MD) has demonstrated improved prediction of ventricular arrhythmia in patients with heart failure (HF) and reduced ejection fraction. However, analyzing MD is both time consuming and operator dependent, thus its clinical use remains limited. Fully automated measurements of MD using a novel deep learning (DL) method may be a solution to facilitate clinical implementation. Purpose We aimed to validate a novel DL based method for fully automated measurements of MD, by evaluating its correlation and agreement with manual reference measurements in a large cohort of patients with heart failure and left ventricular ejection fraction (LVEF) <40%. Methods In this prospective multicenter follow-up study, we consecutively included patients with recently diagnosed heart failure of all causes with LVEF ≤ 40%. All patients were treated according to contemporary guidelines with optimal medical therapy and revascularization if necessary. Two experienced cardiologists recorded all echocardiograms using Vivid E9 or E95 scanners (GE HealthCare, Horten, Norway). Measurements of MD were performed both by an experienced cardiologist using a commercial semi-automatic method, and an in-house developed fully automated deep learning-based method. Results MD was measured in 200 patients (73 ± 14 years old, 33% females). Mean LVEF was 32% ± 6. Mean MD by reference measurements was 61 ± 17ms and by the deep learning method 63 ± 19 ms . Deep learning-based measurements of MD had excellent agreement with reference, with bias of 2ms and Limits of Agreement only 28ms (Figure 1). The correlation between methods was good, with R2 46%, p<0.001. Calculation time for automated measurements of MD per patient was only 6.4 ± 2.5 seconds per echocardiogram. Conclusion The novel fully automated deep learning-based method provides rapid measurements of MD and excellent agreement with manual reference measurements, and may thus facilitate clinical implementation of MD for improved risk stratification in patients with HF.
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Thomas, James D.; Edvardsen, Thor; Abraham, Theodore; Appadurai, Vinesh; Badano, Luigi & Banchs, Jose
[Show all 24 contributors for this article]
(2025).
Clinical Applications of Strain Echocardiography: A Clinical Consensus Statement From the American Society of Echocardiography Developed in Collaboration With the European Association of Cardiovascular Imaging of the European Society of Cardiology.
Journal of the American Society of Echocardiography.
ISSN 0894-7317.
38(11),
p. 985–1020.
doi:
10.1016/j.echo.2025.07.007.
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Savelev, Aleksei A.; Aabel, Eivind Westrum; Svensson, Anneli; Dahlberg, Pia; Christensen, Alex Hørby & Madsen, Trine
[Show all 14 contributors for this article]
(2025).
Signal‐Averaged ECG in the Diagnostic Workup for Arrhythmogenic Cardiomyopathy: Insights From the Nordic ARVC Registry.
Journal of the American Heart Association (JAHA).
14.
doi:
10.1161/jaha.124.037544.
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Background The diagnostic role of signal‐averaged ECG (SAECG) in arrhythmogenic right ventricular cardiomyopathy (ARVC) has lately been questioned. We assessed the value of SAECG‐derived late ventricular potentials (LP) in ARVC diagnosis and its association with disease manifestations. Methods and Results Patients with definite ARVC diagnosis or genotype‐positive family members who underwent SAECG were included in register‐based observational study (n=357, mean age 41 years, 47% female, 43% probands). LP and terminal activation duration (TAD) were defined by Task Force Criteria 2010. We assessed the association of TAD and LP with structural RV abnormalities and ventricular tachycardia (VT), defined as sustained VT, appropriate implantable cardioverter‐defibrillator shock, aborted cardiac arrest, or sudden cardiac death, at diagnosis. LP were documented in 210 patients (59%) and abnormal TAD in 66 patients (18%). Each of the SAECG parameters was significantly associated with definite ARVC diagnosis in receiver‐operator characteristics curve analysis with area under the curve between 0.67 and 0.74. Exclusion of SAECG from diagnostic workup led to reclassification of 37 patients (16%) from definite to borderline ARVC (13 probands, 9 of whom had prevalent VT). Ninety patients (25%) had history of VT. LP, but not TAD, were associated with VT (adjusted odds ratio [OR adj ], 2.42 [95%CI, 1.07–5.48]). LP had lower specificity (72% versus 97%) but higher sensitivity (71% versus 25%) for association with RV structural abnormalities than TAD. Conclusions In the Nordic ARVC cohort SAECG‐derived LP are associated with VT and structural RV abnormalities and were critical for ascertainment of ARVC diagnosis in 16% of patients with narrow QRS complexes, including 8% of all probands.
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Stokke, Thomas Muri; Haugaa, Kristina Ingrid Helena Hermann; Russell, Kristoffer; Edvardsen, Thor & Sarvari, Sebastian
(2025).
Three-Dimensional Speckle Tracking Echocardiography for Detection of Acute Coronary Occlusions in Non-ST-Elevation Acute Coronary Syndrome Patients.
Diagnostics (Basel).
15(15).
doi:
10.3390/diagnostics15151864.
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Objectives: This study aimed to evaluate the ability of three-dimensional (3D) speckle tracking echocardiography (STE) to detect acute coronary occlusions in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and its potential diagnostic advantage over two-dimensional (2D) STE.
Methods: Fifty-six patients with NSTE-ACS (mean age 64 ± 11 years; 80% male) underwent 2D and 3D transthoracic echocardiography prior to coronary angiography. Global longitudinal strain (GLS), global circumferential strain (GCS), and 3D ejection fraction (EF) were analyzed. Acute coronary occlusion was defined as TIMI flow 0–1 in the presumed culprit artery.
Results: Acute coronary occlusion was present in 16 patients (29%). Patients with occlusion had significantly more impaired strain compared to those without: 3D GLS (−12.5 ± 2.7% vs. −15.5 ± 2.1%, p < 0.001), 2D GLS (−12.6 ± 2.8% vs. −15.6 ± 2.0%, p < 0.001), 3D GCS (−24.8 ± 4.4% vs. −27.8 ± 4.3%, p = 0.02), and 2D GCS (−18.1 ± 5.5% vs. −22.9 ± 4.7%, p = 0.002). In contrast, 3D EF did not differ significantly between groups (52.5 ± 4.7% vs. 54.7 ± 5.7%, p = 0.16). Receiver operating characteristic analysis showed that 3D and 2D GLS had the highest diagnostic performance (AUCs 0.81 and 0.78), while 3D EF had the lowest (AUC 0.61). Feasibility was lower for 3D STE (86%) than for 2D longitudinal strain (95%, p = 0.03).
Conclusions: Both 3D and 2D GLS showed higher diagnostic accuracy than 3D EF in identifying acute coronary occlusion in NSTE-ACS patients. While 3D STE enables simultaneous assessment of multiple parameters, it did not offer incremental diagnostic value over 2D STE and had lower feasibility.
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Munkhaugen, John; Kristensen, Anna Meta D.; Halvorsen, Sigrun; Holmager, Therese; Olsen, Michael Hecht & Bakken, Arnhild
[Show all 64 contributors for this article]
(2025).
Beta-Blockers after Myocardial Infarction in Patients without Heart Failure.
New England Journal of Medicine.
ISSN 0028-4793.
393(19),
p. 1901–1911.
doi:
10.1056/nejmoa2505985.
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Background: The evidence supporting beta-blocker therapy after myocardial infarction was established before the introduction of modern coronary reperfusion therapy and secondary prevention strategies.
Methods: In an open-label, randomized trial with blinded end-point evaluation, conducted in Denmark and Norway, we assigned patients who had had a myocardial infarction and who had a left ventricular ejection fraction of at least 40%, in a 1:1 ratio, to receive long-term beta-blocker therapy within 14 days after the event or no beta-blocker therapy. The primary end point was a composite of death from any cause or major adverse cardiovascular events (new myocardial infarction, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmias).
Results: A total of 5574 patients underwent randomization and were included in the main analyses - 2783 in the beta-blocker group and 2791 in the no-beta-blocker group. After a median follow-up of 3.5 years (interquartile range, 2.2 to 4.6), a primary end-point event had occurred in 394 patients (14.2%) in the beta-blocker group and in 454 patients (16.3%) in the no-beta-blocker group (hazard ratio, 0.85; 95% confidence interval [CI], 0.75 to 0.98; P = 0.03). Death from any cause occurred in 4.2% of the patients in the beta-blocker group and in 4.4% of those in the no-beta-blocker group; myocardial infarction occurred in 5.0% and 6.7%, respectively (hazard ratio, 0.73; 95% CI, 0.59 to 0.92), unplanned coronary revascularization in 3.9% and 3.9%, ischemic stroke in 1.6% and 1.3%, heart failure in 1.5% and 1.9%, and malignant ventricular arrhythmias in 0.5% and 0.6%. No apparent differences in safety outcomes were observed between the groups.
Conclusions: Among patients with a myocardial infarction and a left ventricular ejection fraction of at least 40%, beta-blocker therapy led to a lower risk of death or major adverse cardiovascular events than no beta-blocker therapy
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Grendstad, Halvard; Skarstad, Sigrun Ådnegard; Edvardsen, Thor & Hallén, Jostein
(2025).
A Prospective Study on Maximal Oxygen Uptake and Cardiovascular Functions in 12-Year-Old Endurance Athletes and Their Non-Endurance-Trained Peers.
Scandinavian Journal of Medicine & Science in Sports.
ISSN 0905-7188.
35(1).
doi:
10.1111/sms.70016.
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Sade, Leyla Elif; Faletra, Francesco Fluvio; Pontone, Gianluca; Gerber, Bernhard Lothar Marie; Muraru, Denisa & Edvardsen, Thor
[Show all 27 contributors for this article]
(2025).
The role of multi-modality imaging for the assessment of left atrium and left atrial appendage: a clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC).
European Heart Journal-Cardiovascular Imaging.
ISSN 2047-2404.
26(3),
p. 385–413.
doi:
10.1093/ehjci/jeaf014.
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Tangen, Jorun; Nguyen, Thuy Mi Tran; Melichova, Daniela; Klæboe, Lars Gunnar; Forså, Marianne Inngjerdingen & Andresen, Kristoffer
[Show all 13 contributors for this article]
(2024).
Left atrial volume assessed by echocardiography identifies patients with high risk of adverse outcome after acute myocardial infarction.
Echo Research & Practice.
11(1).
doi:
10.1186/s44156-024-00060-1.
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Background The left atrial (LA) volume has been demonstrated to be an important predictor of adverse outcome in patients with various cardiac conditions, including acute myocardial infarction (AMI). However, new treatment strategies in patients with AMI have led to better patient outcomes. We hypothesised that increased LA size could still predict mortality in patients with AMI despite improved treatment strategies. Methods We included patients with AMI in a prospective multicenter cohort study and the study patients were enrolled from 2014 to 2022. We recorded echocardiographic and clinical data during their index hospitalisation. Indexed LA volume (LAVi) was assessed in all patients and was used as a continuous variable in the univariate and multivariate Cox regression analysis. The study took place over a period of five years and median follow-up time was 3.8 years (range 3.1 to 5.0 years). The primary study outcomes were all-cause mortality and major adverse cardiac events (MACE). MACE was defined as hospital readmission due to myocardial infarction, cardiac arrest, stroke, heart failure, or onset of new atrial fibrillation. Results We included 487 patients (69 ± 12 years old, 26% female) with AMI. During the follow-up period all-cause mortality was 50 (10.3%) and patients who reached the primary outcomes were 153 (31.4%). The deceased patients had higher LAVi compared to survivors (40.0 ± 12.9 mL/m2 vs. 29.7 ± 11.2 mL/m2, p < 0.001). Factors associated with all-cause mortality and MACE were age, year of enrollment, left ventricular (LV) ejection fraction, LV global longitudinal strain (GLS), LV filling pressure, moderate or severe mitral regurgitation and LAVi. GLS and EF were segregated into two distinct models due to their moderately high correlation (r = 0.57, p < 0.001). LAVi remained as an independent echocardiographic predictor of primary outcomes after adjusting for the covariates above in two separates multivariable Cox regression models (hazard ratio 1.02/1.02 mL/m2 [95% CI 1.01–1.03/1.01–1.03], p = 0.006/0.003). Conclusions Our study demonstrated that LA dilatation is an independent echocardiographic predictor of mortality and MACE in patients with AMI despite improved treatment strategies. This finding highlights the potential of using LAVi as a marker for prognostication in these patients.
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Kaya, Esra; Andresen, Kristoffer; Lie, Øyvind Haugen; Aaberge, Lars; Haugaa, Kristina Ingrid Helena Hermann & Edvardsen, Thor
[Show all 7 contributors for this article]
(2024).
Left ventricular mechanical dispersion as a predictor of the need for pacemaker implantation after transcatheter aortic valve implantation: MeDiPace TAVI study.
European Heart Journal-Cardiovascular Imaging.
ISSN 2047-2404.
25(4),
p. 539–547.
doi:
10.1093/ehjci/jead315.
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Aims Permanent pacemaker (PM) implantation is common after transcatheter aortic valve implantation (TAVI). Left ventricular mechanical dispersion (MeDi) by speckle tracking echocardiography is a marker of fibrosis that causes alterations in the conduction system. We hypothesized that MeDi can be a predictor of the need for PM implantation after TAVI. Methods and results Consecutively, 200 TAVI patients were enrolled. Transthoracic echocardiography and electrocardiography examinations were recorded before TAVI to evaluate global longitudinal strain (GLS), MeDi, and conduction disturbances. PM implantation information was obtained 3 months after TAVI. Patients were stratified into PM or no PM group. Mean age was 80 + 7 years (44% women). Twenty-nine patients (16%) received PM. MeDi, QRS duration, existence of right bundle branch abnormality (RBBB), and first-degree atrioventricular (AV) block were significantly different between groups. MeDi was 57 ± 15 ms and 48 ± 12 ms in PM and no PM groups, respectively (P < 0.001). In multivariate analysis, MeDi predicted the need for PM after TAVI independently of GLS, QRS duration, RBBB, and first-degree AV block [odds ratio (OR): 1.73, 95% confidence interval (CI): 1.22–2.45] with an area under the curve (AUC) of 0.68 in receiver operating characteristic (ROC) curves. Moreover, RBBB was an independent predictor of PM need after TAVI (OR: 8.98, 95% CI: 1.78–45.03). When added to RBBB, MeDi had an incremental predictive value with an AUC of 0.73 in ROC curves (P = 0.01). Conclusion MeDi may be used as an echocardiographic functional predictor of the need for PM after TAVI.
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Klæboe, Lars Gunnar; Lie, Øyvind Haugen; Brekke, Pål Haugar; Bosse, Gerhard; Hopp, Einar & Haugaa, Kristina Ingrid Helena Hermann
[Show all 7 contributors for this article]
(2024).
Differentiation of Myocardial Properties in Physiological Athletic Cardiac Remodeling and Mild Hypertrophic Cardiomyopathy.
Biomedicines.
12(2).
doi:
10.3390/biomedicines12020420.
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Clinical differentiation between athletes’ hearts and those with hypertrophic cardiomyopathy (HCM) can be challenging. We aimed to explore the role of speckle tracking echocardiography (STE) and cardiac magnetic resonance imaging (CMR) in the differentiation between athletes’ hearts and those with mild HCM. We compared 30 competitive endurance elite athletes (7% female, age 41 ± 9 years) and 20 mild phenotypic mutation-positive HCM carriers (15% female, age 51 ± 12 years) with left ventricular wall thickness 13 ± 1 mm. Mechanical dispersion (MD) was assessed by means of STE. Native T1-time and extracellular volume (ECV) were assessed by means of CMR. MD was higher in HCM mutation carriers than in athletes (54 ± 16 ms vs. 40 ± 11 ms, p = 0.001). Athletes had a lower native T1-time (1204 (IQR 1191, 1234) ms vs. 1265 (IQR 1255, 1312) ms, p < 0.001) and lower ECV (22.7 ± 3.2% vs. 25.6 ± 4.1%, p = 0.01). MD > 44 ms optimally discriminated between athletes and HCM mutation carriers (AUC 0.78, 95% CI 0.65–0.91). Among the CMR parameters, the native T1-time had the best discriminatory ability, identifying all HCM mutation carriers (100% sensitivity) with a specificity of 75% (AUC 0.83, 95% CI 0.71–0.96) using a native T1-time > 1230 ms as the cutoff. STE and CMR tissue characterization may be tools that can differentiate athletes’ hearts from those with mild HCM.
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Erevik, Christine Bjørkvik; Kleiven, Øyunn; Frøysa, Vidar; Bjørkavoll-Bergseth, Magnus; Chivulescu, Ana Monica & Klæboe, Lars Gunnar
[Show all 14 contributors for this article]
(2024).
Echocardiographic assessment of myocardial efficiency predicts exercise performance.
European Journal of Sport Science (EJSS).
ISSN 1746-1391.
24(3),
p. 319–329.
doi:
10.1002/ejsc.12082.
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Cardiac function is a major determinant of cardiopulmonary fitness. This study aimed to determine if novel echocardiographic myocardial function and efficiency parameters at rest can predict exercise performance during different types of prolonged high-intensity endurance exercise. Echocardiography was performed before exercise in 40 healthy (75% males) 50.3 ± 9.1-year-old recreational athletes. Echocardiographic parameters at rest were compared with exercise performance assessed by power output during two different exercises: A lactate threshold and cardiopulmonary exercise test (La-CPET) and a 91-km mountain bike sport cycling race. The La-CPET had a median duration of 43 (40, 45) minutes and a mean power output of 2.9 ± 0.5 W/kg. The race had a median duration of 236 (214, 268) minutes and a mean power output of 2.1 ± 0.5 W/kg. There was moderate left ventricular (LV) dilatation in individuals with the highest performance. The myocardial efficiency parameter, global wasted work (GWW), was positively correlated with race duration (rho = 0.42, p = 0.008) and negatively correlated with mean power output during both the La-CPET (rho = −0.43, p = 0.007) and the race (rho = −0.44, p = 0.005). In multivariable models, including LV volumes, left GWW remained an independent predictor of race duration (beta = 0.40, p = 0.007) and of mean power output during the La-CPET (beta = −0.40, p = 0.006) and the race (beta = −0.43, p = 0.003). The novel echocardiographic myocardial efficiency parameter, GWW, measured at rest, is an independent predictor of prolonged high-intensity endurance exercise performance in healthy middle-aged athletes. These findings suggest that resting myocardial efficiency parameters may aid the identification of exercise-induced LV dilatation.
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Gregersen, Ida; Scarth, Morgan Elizabeth; Abdullah, Rang; Thorsby, Per Medbøe; Hauger, Lisa Evju & Haugaa, Kristina Ingrid Helena Hermann
[Show all 14 contributors for this article]
(2024).
Elevated interleukin 8 and matrix metalloproteinase 9 levels are associated with myocardial pathology in users of anabolic-androgenic steroids.
European Journal of Preventive Cardiology (EJPC).
ISSN 2047-4873.
31(12),
p. 1469–1476.
doi:
10.1093/eurjpc/zwae126.
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Aims In the current paper, we aim to explore the effect of both current and former long-term anabolic-androgenic steroid (AAS) use on regulation of systemic inflammatory markers and mediators of extracellular matrix (ECM) remodelling and their association with hormones and echocardiographic myocardial pathology in weightlifters. Methods and results In a cross-sectional study, 93 weightlifting AAS users, of whom 62 were current and 31 were past users, with at least 1-year cumulative AAS use (mean 11 ± 7 accumulated years of AAS use), were compared with 54 non-using weightlifting controls (WLCs) using clinical interview, blood pressure measurements, and echocardiography. Serum levels of interleukin (IL)-6, IL-8, tumour necrosis factor (TNF), interferon (IFN)-γ, growth differentiation factor (GDF)-15, and matrix metalloproteinase (MMP)-9, sex hormones, and lipids were analysed. It was found that serum levels of IL-8, GDF-15, and MMP-9 were significantly increased in current AAS users compared with former users and WLCs. Matrix metalloproteinase 9, but not IL-8, correlated consistently with sex hormone levels, and sex hormone levels correlated consistently with mean wall thickness, in current users. Moreover, HDL cholesterol was significantly lower in current vs. former AAS users and significantly inversely correlated with MMP-9 in current users. Further, in current users, MMP-9 and IL-8 correlated with markers of myocardial strain, and MMP-9 also correlated with indices of cardiac mass, which was not seen in former users. Mediation analyses suggested that MMP-9 could partly explain hormone-induced alterations in markers of myocardial damage in current users. Conclusion Long-term AAS is associated with increased levels of markers of inflammation and ECM remodelling, which seems to have a hormone-dependent (MMP-9) and a hormone-independent (IL-8) association with markers of myocardial dysfunction.
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Erevik, Christine Bjørkvik; Kleiven, Øyunn; Frøysa, Vidar; Bjørkavoll-Bergseth, Magnus; Chivulescu, Ana Monica & Klæboe, Lars Gunnar
[Show all 14 contributors for this article]
(2024).
Exercise-Induced Cardiac Troponin I Elevation Is Associated With Regional Alterations in Left Ventricular Strain in High-Troponin Responders.
Journal of the American Heart Association (JAHA).
13(16),
p. e034382–e034382.
doi:
10.1161/JAHA.124.034382.
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Background The implications of exercise‐induced cardiac troponin elevation in healthy individuals are unclear. This study aimed to determine if individuals with a high exercise‐induced cardiac troponin I (cTnI) response have alterations in myocardial function following high‐intensity endurance exercise compared with normal‐cTnI responders. Methods and Results Study individuals were recruited from previous participants in a 91‐km mountain bike cycling race (the North Sea Race) and were classified as high‐ (n=34) or normal‐cTnI responders (n=25) based on maximal cTnI values after the recruitment race. The present study exposed all participants to 2 prolonged high‐intensity exercises: a combined lactate threshold and cardiopulmonary exercise test and repeated participation in the North Sea Race. Echocardiography was performed before, immediately after, and 24 hours following exercise. All study individuals (n=59) had normal coronary arteries, and were aged 51±10 years; 46 (74%) were men. There were no differences in baseline characteristics between the high‐ and normal‐cTnI responders. Maximal cTnI levels 3 hours after exercise were significantly higher in the high‐ compared with normal‐cTnI group (P<0.001–0.027). Following exercise, there were no differences in global ventricular function between the 2 groups. In contrast, high‐cTnI responders had significantly lower regional strain in the anteroseptal segments following exercise, with more profound changes after the race. Conclusions High‐cTnI responders had lower anteroseptal segmental strain shortly after exercise than normal‐cTnI responders. However, there were no permanent alterations in myocardial strain, indicating no short‐ or long‐term adverse consequences of these exercise‐induced alterations in myocardial function.
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Henriksen, Hans Christian Bordado; Havnes, Ingrid Amalia; Jørstad, Marie Lindvik; Abdullah, Rang; Thorsby, Per Medbøe & Hauger, Lisa Evju
[Show all 10 contributors for this article]
(2024).
Treatment-seeking behavior and cardiovascular morbidity among men with anabolic-androgenic steroid use: A cross-sectional study.
Scandinavian Journal of Medicine & Science in Sports.
ISSN 0905-7188.
34(1).
doi:
10.1111/sms.14554.
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Aims To determine associations between anabolic-androgenic steroid (AAS) use-related morbidity including cardiovascular disease (CVD) and engagement to health services. Methods In this cross-sectional study, 90 males with at least 12 months cumulative current or former use of AAS were included. The participants were divided into a treatment-seeking group (TSG) and a non-treatment seeking group (non-TSG) based on their responses to a self-report web questionnaire. All participants were screened for symptoms that could be indicative of CVD through a clinical interview, and examined with blood samples, blood pressure measurements and transthoracic echocardiography. Results In the total sample (n = 90), mean age was 39 ± 11 years with cumulative AAS use of 12 ± 9 years. Among men in the TSG with current use there were higher prevalence of dyspnoea (50% vs 7%) and reduced left ventricular ejection fraction (LVEF) in conjunction with left ventricular hypertrophy (LVH) (36 vs. 9%) and/or high blood pressure (55% vs. 19%) compared to men in the non-TSG. Among men with current AAS use and established LVEF <50% (n = 25) or LVH (n = 21), 44% (11) and 43% (9) respectively, had never engaged health services due to AAS-related adverse effects. Deviant liver- and kidney parameters were frequently observed in the total sample but without between-group differences. Conclusions Treatment-seeking behavior among current AAS users may be associated with increased levels of dyspnoea and established CVD. Despite objective signs of severe CVD among a substantial amount of study participants, it is of great concern that the majority had never sought treatment for AAS-related concerns.
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Otterstad, Jan Erik; Munkhaugen, John; Ruddox, Vidar; Edvardsen, Thor & Hjelmesæth, Jøran Sture
(2024).
Association of normal body mass index and weight loss with long-term major cardiovascular events after PCI for myocardial infarction.
Scandinavian Cardiovascular Journal.
ISSN 1401-7431.
58(1).
doi:
10.1080/14017431.2024.2386984.
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Objectives: To investigate whether normal body mass index (BMI) shortly after percutaneous coronary intervention (PCI) for myocardial infarction is associated with increased risk of long-term major cardiovascular events (MACE), and to explore potential clinical determinants of long-term weight loss (WL) after PCI. Methods: Single-center cohort study with 5-year follow-up of patients treated with PCI for myocardial infarction between 2016 and 2018. Categorical WL was defined as > 0 kg body weight reduction from baseline to end of follow-up. Results: Of 236 patients (24% women), mean age was 64.9 ± 10.2 years and mean BMI within 4 days after PCI was 27.1 ± 4.3 kg/m2. Seventy-five patients (32%) had at least one MACE, equally distributed between those with normal weight (31%), overweight (32%), and obesity (31%). Patients with overweight or obesity had a lower crude mortality rate than their normal weight counterparts (7.4% vs 16.4%, p = 0.049), but the relative hazard of death did not differ from those with normal weight, HR 0.50, 95% CI 0.22-1.15. Patients with either a long-term WL (n = 112) or no WL (n = 95) had a comparable incidence of non-fatal MACE (27% vs 22%, p = 0.518). The proportion of patients reporting unintentional weight loss was significantly higher in the normal weight group (82%) compared with those with overweight (41%) or obesity (28%), p < 0.001. Conclusion: Our results did not confirm any association between normal BMI after PCI and long-term MACE. However, patients with normal BMI at baseline had a higher incidence of unintentional WL than those with elevated BMI. Trial registration: Current research information system in Norway (CRISTIN): ID 542528
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Andresen, Kristoffer; Klæboe, Lars Gunnar; Lie, Øyvind Haugen; Broch, Kaspar; Kvaslerud, Anette Borger & Bosse, Gerhard
[Show all 10 contributors for this article]
(2024).
No adverse association between exercise exposure and diffuse myocardial fibrosis in male endurance athletes.
Scientific Reports.
14(1).
doi:
10.1038/s41598-024-57233-5.
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The potential association between endurance exercise and myocardial fibrosis is controversial. Data on exercise exposure and diffuse myocardial fibrosis in endurance athletes are scarce and conflicting. We aimed to investigate the association between exercise exposure and markers of diffuse myocardial fibrosis by cardiovascular magnetic resonance imaging (CMR) in endurance athletes. We examined 27 healthy adult male competitive endurance athletes aged 41 ± 9 years and 16 healthy controls in a cross sectional study using 3 Tesla CMR including late gadolinium enhancement and T1 mapping. Athletes reported detailed exercise history from 12 years of age. Left ventricular total mass, cellular mass and extracellular mass were higher in athletes than controls (86 vs. 58 g/m2, 67 vs. 44 g/m2 and 19 vs. 13 g/m2, all p < 0.01). Extracellular volume (ECV) was lower (21.5% vs. 23.8%, p = 0.03) and native T1 time was shorter (1214 ms vs. 1268 ms, p < 0.01) in the athletes. Increasing exercise dose was independently associated with shorter native T1 time (regression coefficient − 24.1, p < 0.05), but expressed no association with ECV. Our results indicate that diffuse myocardial fibrosis has a low prevalence in healthy male endurance athletes and do not indicate an adverse dose–response relationship between exercise and diffuse myocardial fibrosis in healthy athletes.
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Bjerring, Anders W.; Smeland, Knut Bjøro; Stokke, Thomas Muri; Haugaa, Kristina Ingrid Helena Hermann; Holte, Espen & Rösner, Assami
[Show all 9 contributors for this article]
(2024).
Long-term cardiac effects of modern treatment for Hodgkin’s lymphoma.
Cardio-Oncology.
10(1).
doi:
10.1186/s40959-024-00222-4.
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Background Hodgkin’s lymphoma (HL) is a hematological malignancy that affects both children and young adults. Traditional treatment is associated with a life-time prevalence of cardiac disease exceeding 50%. In the late 1990s protocols were modified to reduce cancer therapy-related adverse cardiac effects. This study aimed to assess the long-term impact of advances in treatment protocols on the cardiac health of HL survivors (HLS). Methods HLS (n = 246) treated between 1997 and 2007 with anthracycline-based chemotherapy in three centers in Norway were included. Of these, 132 (53%) had also received mediastinal radiotherapy. HLS were compared to controls (n = 58) recruited from the general population and matched for sex, age, smoking status, and heredity for coronary artery disease. All subjects underwent echocardiography, clinical assessment, and blood sampling. Results The HLS were 46 ± 9 years old and had been treated 17 ± 3 years before inclusion in the study. There was no significant difference between HLS and controls in ejection fraction (EF) (58%±5 vs. 59%±4, p = 0.08) or prevalence of heart failure. HLS treated with both anthracyclines and mediastinal radiotherapy (AC + MRT) had slightly worse left ventricular global longitudinal strain than controls (-19.3 ± 2.5% vs. -20.8 ± 2.0%, p < 0.001), but those treated with only anthracyclines did not. HLS treated with AC + MRT had a higher prevalence of valve disease than those treated only with anthracyclines (12% vs. 4%, p < 0.05). Conclusions HLS treated with anthracyclines after the late 1990s have similar cardiac function and morphology as age-matched controls, apart from higher rates of valvular disease in those who also underwent mediastinal radiotherapy.
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Tangen, Jorun; Nguyen, Thuy Mi; Melichova, Daniela; Klæboe, Lars Gunnar; Forså, Marianne Inngjerdingen & Andresen, Kristoffer
[Show all 12 contributors for this article]
(2024).
The Prognostic Value of Left Atrial Function in Patients with Acute Myocardial Infarction.
Diagnostics (Basel).
14(18).
doi:
10.3390/diagnostics14182027.
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The prognostic value of left atrial (LA) volume is well-established in acute myocardial infarction (AMI) patients. LA strain provides further patophysological insights. In the present study, we evaluated LA volume and LA strain in AMI patients including those with atrial fibrillation (AF). The aim of the study was to determine if LA strain provide additional prognostic value. Patients with AMI underwent two-dimensional echocardiography within 72 h of admission. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular events. Cox regression analyses were performed. We included 501 patients and during follow-up, 132 patients (26.4%) met the primary outcome. Left ventricular (LV) global longitudinal strain (GLS) (HR 0.94 [95% CI 0.88–0.99], p = 0.029), indexed LA volume (LAVi) (HR 1.02 [95% CI 1.00–1.04], p = 0.015), and LA reservoir strain (HR 0.96 [95% CI 0.93–0.99], p = 0.017) were all independently associated with the primary outcome. A univariate Cox model conducted on the AF patients (n = 32) revealed that LA reservoir strain remained significantly associated with the primary outcome, while LV GLS and LAVi were not significant. The prognostic value of LA reservoir strain was comparable to LA volume and LV GLS, and might even be better in AF patients.
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Bijl, Pieter Van der; Stassen, Jan; Haugaa, Kristina Ingrid Helena Hermann; Essayagh, Benjamin; Basso, Cristina & Thiene, Gaetano
[Show all 13 contributors for this article]
(2024).
Mitral Annular Disjunction in the Context of Mitral Valve Prolapse: Identifying the At-Risk Patient.
JACC Cardiovascular Imaging.
ISSN 1936-878X.
17(10).
doi:
10.1016/j.jcmg.2024.03.006.
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Mitral annular disjunction (MAD), a separation between the left atrium/mitral valve annulus and the left ventricular myocardium, is frequently seen in patients with arrhythmic mitral valve prolapse. Although an association exists between MAD and ventricular arrhythmias, little is known regarding the identification of individuals at high risk. Multimodality imaging including echocardiography, computed tomography, cardiac magnetic resonance, and positron emission tomography can play an important role in both the diagnosis and risk stratification of MAD. Due to a paucity of data, clinical decision making in a patient with MAD is challenging and remains largely empirical. Although MAD itself can be corrected surgically, the prevention and treatment of associated arrhythmias may require medical therapy, catheter ablation, and an implantable cardioverter-defibrillator. Prospective data are required to define the role of implantable cardioverter-defibrillators, targeted catheter ablation, and surgical correction in selected, at-risk patients.
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Almeida, Ana G.; Grapsa, Julia; Gimelli, Alessia; Bucciarelli-Ducci, Chiara; Gerber, Bernhard & Ajmone-Marsan, Nina
[Show all 26 contributors for this article]
(2024).
Cardiovascular multimodality imaging in women: a scientific statement of the European Association of Cardiovascular Imaging of the European Society of Cardiology.
European Heart Journal-Cardiovascular Imaging.
ISSN 2047-2404.
25(4),
p. E116–E136.
doi:
10.1093/ehjci/jeae013.
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Skulstad, Helge; Andresen, Kristoffer; Aaberge, Lars; Haugaa, Kristina Ingrid Helena Hermann; Edvardsen, Thor & Kaya, Esra
(2024).
Early reverse remodeling by echocardiography after transcatheter aortic valve implantation.
Echocardiography.
ISSN 0742-2822.
41(6).
doi:
10.1111/echo.15865.
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Introduction Oslo University Hospital is a tertiary center conducting a significant number of transcatheter aortic valve implantation (TAVI) procedures per year. In this follow-up MediPace study, we aimed to investigate early echocardiographic changes in systolic and diastolic functions after TAVI in these patients. Methods All patients enrolled in the previous study were contacted 3 months after TAVI for echocardiographic evaluation. Detailed echocardiography was performed 3.5 ± 1.6 months after TAVI, and compared with baseline evaluations. Results A total of 101 patients were analyzed. Mean age was 80.1 ± 6.8 years and 40% of the patients were female. We observed a significant improvement in global longitudinal strain (GLS) (pre-TAVI −16.8 ± 4.1%, post-TAVI −17.8 ± 3.6%, p < .001), with no notable change in LVEF. More than half of the patients (52%) experienced a significant reverse remodeling with ≥10% decrease in left ventricular mass index (LVMi) following TAVI (pre-TAVI 123.6 ± 32.1 vs. 109.7 ± 28.9 g/m2 post-TAVI, p < .001). Pre-TAVI LVMi was a positive predictor, whereas history of HT was a negative predictor of LVMi reduction. There was no significant improvement in diastolic function following TAVI. Highest degree of paravalvular leakage was mild to moderate and was observed in only 2%. Conclusions A significant improvement in GLS and LVMi was found following TAVI. History of hypertension and baseline LVMi were predictors of LVMi change. There was no notable change in diastolic function, including left atrial strain.
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Mirmaksudov, Mirakhmadjon; Ross, Stian Balnagown; Kongsgård, Erik & Edvardsen, Thor
(2024).
Enhancing cardiac pacing strategies: a review of conduction system pacing compared with right and biventricular pacing and their influence on myocardial function.
European Heart Journal-Cardiovascular Imaging.
ISSN 2047-2404.
25(7),
p. 879–887.
doi:
10.1093/ehjci/jeae090.
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Traditional right ventricular pacing (RVP) has been linked to the deterioration of both left ventricular diastolic and systolic function. This worsening often culminates in elevated rates of hospitalization due to heart failure, an increased risk of atrial fibrillation, and increased morbidity. While biventricular pacing (BVP) has demonstrated clinical and echocardiographic improvements in patients afflicted with heart failure and left bundle branch block, it has also encountered significant challenges such as a notable portion of non-responders and procedural failures attributed to anatomical complexities. In recent times, the interest has shifted towards conduction system pacing, initially, His bundle pacing, and more recently, left bundle branch area pacing, which are seen as promising alternatives to established methods. In contrast to other approaches, conduction system pacing offers the advantage of fostering more physiological and harmonized ventricular activation by directly stimulating the His–Purkinje network. This direct pacing results in a more synchronized systolic and diastolic function of the left ventricle compared with RVP and BVP. Of particular note is the capacity of conduction system pacing to yield a shorter QRS, conserve left ventricular ejection fraction, and reduce rates of mitral and tricuspid regurgitation when compared with RVP. The efficacy of conduction system pacing has also been found to have better clinical and echocardiographic improvement than BVP in patients requiring cardiac resynchronization. This review will delve into myocardial function in conduction system pacing compared with that in RVP and BVP.
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Rogstadkjernet, Magnus; Zha, Sigurd Zijun; Klæboe, Lars Gunnar; Larsen, Camilla Kjellstad; Aalen, John & Scheirlynck, Esther
[Show all 14 contributors for this article]
(2024).
A deep learning based method for left ventricular strain measurements: repeatability and accuracy compared to experienced echocardiographers.
BMC Medical Imaging.
24(1).
doi:
10.1186/s12880-024-01470-7.
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Background Speckle tracking echocardiography (STE) provides quantification of left ventricular (LV) deformation and is useful in the assessment of LV function. STE is increasingly being used clinically, and every effort to simplify and standardize STE is important. Manual outlining of regions of interest (ROIs) is labor intensive and may influence assessment of strain values. Purpose We hypothesized that a deep learning (DL) model, trained on clinical echocardiographic exams, can be combined with a readily available echocardiographic analysis software, to automate strain calculation with comparable fidelity to trained cardiologists. Methods Data consisted of still frame echocardiographic images with cardiologist-defined ROIs from 672 clinical echocardiographic exams from a university hospital outpatient clinic. Exams included patients with ischemic heart disease, heart failure, valvular disease, and conduction abnormalities, and some healthy subjects. An EfficientNetB1-based architecture was employed, and different techniques and properties including data set size, data quality, augmentations, and transfer learning were evaluated. DL predicted ROIs were reintroduced into commercially available echocardiographic analysis software to automatically calculate strain values. Results DL-automated strain calculations had an average absolute difference of 0.75 (95% CI 0.58–0.92) for global longitudinal strain (GLS), and 1.16 (95% CI 1.03–1.29) for single-projection longitudinal strain (LS), compared to operators. A Bland–Altman plot revealed no obvious bias, though there were fewer outliers in the lower average LS ranges. Techniques and data properties yielded no significant increase/decrease in performance. Conclusion The study demonstrates that DL-assisted, automated strain measurements are feasible, and provide results within interobserver variation. Employing DL in echocardiographic analyses could further facilitate adoption of STE parameters in clinical practice and research, and improve reproducibility.
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Nyberg, John; Østvik, Andreas; Salte, Ivar Mjåland; Olaisen, Sindre Hellum; Karlsen, Sigve & Dahlslett, Thomas
[Show all 14 contributors for this article]
(2024).
Deep learning improves test–retest reproducibility of regional strain in echocardiography.
European Heart Journal – Imaging Methods and Practice (EHJ-IMP).
2(4).
doi:
10.1093/ehjimp/qyae092.
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Aims: The clinical utility of regional strain measurements in echocardiography is challenged by suboptimal reproducibility. In this study, we aimed to evaluate the test–retest reproducibility of regional longitudinal strain (RLS) per coronary artery perfusion territory (RLSTerritory) and basal-to-apical level of the left ventricle (RLSLevel), measured by a novel fully automated deep learning (DL) method based on point tracking. Methods and results: We measured strain in a dual-centre test–retest data set that included 40 controls and 40 patients with suspected non-ST elevation acute coronary syndrome. Two consecutive echocardiograms per subject were recorded by different operators. The reproducibility of RLSTerritory and RLSLevel measured by the DL method and by three experienced observers using semi-automatic software (2D Strain, EchoPAC, GE HealthCare) was evaluated as minimal detectable change (MDC). The DL method had MDC for RLSTerritory and RLSLevel ranging from 3.6 to 4.3%, corresponding to a 33–35% improved reproducibility compared with the inter- and intraobserver scenarios (MDC 5.5–6.4% and 4.9–5.4%). Furthermore, the DL method had a lower variance of test–retest differences for both RLSTerritory and RLSLevel compared with inter- and intraobserver scenarios (all P < 0.001). Bland–Altman analyses demonstrated superior reproducibility by the DL method for the whole range of strain values compared with the best observer scenarios. The feasibility of the DL method was 93% and measurement time was only 1 s per echocardiogram. Conclusion: The novel DL method provided fully automated measurements of RLS, with improved test–retest reproducibility compared with semi-automatic measurements by experienced observers. RLS measured by the DL method has the potential to advance patient care through a more detailed, more efficient, and less user-dependent clinical assessment of myocardial function.
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Ntaios, George; Baumgartner, Helmut; Doehner, Wolfram; Donal, Erwan; Edvardsen, Thor & Healey, Jeff S.
[Show all 16 contributors for this article]
(2024).
Embolic strokes of undetermined source: a clinical consensus statement of the ESC Council on Stroke, the European Association of Cardiovascular Imaging and the European Heart Rhythm Association of the ESC.
European Heart Journal.
ISSN 0195-668X.
45(19),
p. 1701–1715.
doi:
10.1093/eurheartj/ehae150.
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One in six ischaemic stroke patients has an embolic stroke of undetermined source (ESUS), defined as a stroke with unclear aetiology despite recommended diagnostic evaluation. The overall cardiovascular risk of ESUS is high and it is important to optimize strategies to prevent recurrent stroke and other cardiovascular events. The aim of clinicians when confronted with a patient not only with ESUS but also with any other medical condition of unclear aetiology is to identify the actual cause amongst a list of potential differential diagnoses, in order to optimize secondary prevention. However, specifically in ESUS, this may be challenging as multiple potential thromboembolic sources frequently coexist. Also, it can be delusively reassuring because despite the implementation of specific treatments for the individual pathology presumed to be the actual thromboembolic source, patients can still be vulnerable to stroke and other cardiovascular events caused by other pathologies already identified during the index diagnostic evaluation but whose thromboembolic potential was underestimated. Therefore, rather than trying to presume which particular mechanism is the actual embolic source in an ESUS patient, it is important to assess the overall thromboembolic risk of the patient through synthesis of the individual risks linked to all pathologies present, regardless if presumed causally associated or not. In this paper, a multi-disciplinary panel of clinicians/researchers from various backgrounds of expertise and specialties (cardiology, internal medicine, neurology, radiology and vascular surgery) proposes a comprehensive multi-dimensional assessment of the overall thromboembolic risk in ESUS patients through the composition of individual risks associated with all prevalent pathologies.
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Salte, Ivar Mjåland; Østvik, Andreas; Olaisen, Sindre Hellum; Karlsen, Sigve; Dahlslett, Thomas & Smistad, Erik
[Show all 13 contributors for this article]
(2023).
Deep Learning for Improved Precision and Reproducibility of Left Ventricular Strain in Echocardiography: A Test-Retest Study.
Journal of the American Society of Echocardiography.
ISSN 0894-7317.
36(7),
p. 788–799.
doi:
10.1016/j.echo.2023.02.017.
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Aims Assessment of left ventricular (LV) function by echocardiography is hampered by modest test-retest reproducibility. A novel artificial intelligence (AI) method based on deep learning provides fully automated measurements of LV global longitudinal strain (GLS) and may improve the clinical utility of echocardiography by reducing user-related variability. The aim of this study was to assess within-patient test-retest reproducibility of LV GLS measured by the novel AI method in repeated echocardiograms recorded by different echocardiographers and to compare the results to manual measurements. Methods Two test-retest data sets (n = 40 and n = 32) were obtained at separate centers. Repeated recordings were acquired in immediate succession by 2 different echocardiographers at each center. For each data set, 4 readers measured GLS in both recordings using a semiautomatic method to construct test-retest interreader and intrareader scenarios. Agreement, mean absolute difference, and minimal detectable change (MDC) were compared to analyses by AI. In a subset of 10 patients, beat-to-beat variability in 3 cardiac cycles was assessed by 2 readers and AI. Results Test-retest variability was lower with AI compared with interreader scenarios (data set I: MDC = 3.7 vs 5.5, mean absolute difference = 1.4 vs 2.1, respectively; data set II: MDC = 3.9 vs 5.2, mean absolute difference = 1.6 vs 1.9, respectively; all P < .05). There was bias in GLS measurements in 13 of 24 test-retest interreader scenarios (largest bias, 3.2 strain units). In contrast, there was no bias in measurements by AI. Beat-to-beat MDCs were 1,5, 2.1, and 2.3 for AI and the 2 readers, respectively. Processing time for analyses of GLS by the AI method was 7.9 ± 2.8 seconds. Conclusion A fast AI method for automated measurements of LV GLS reduced test-retest variability and removed bias between readers in both test-retest data sets. By improving the precision and reproducibility, AI may increase the clinical utility of echocardiography.
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Erevik, Christine Bjørkvik; Kleiven, Øyunn; Frøysa, Vidar; Bjørkavoll-Bergseth, Magnus; Chivulescu, Ana Monica & Klæboe, Lars Gunnar
[Show all 14 contributors for this article]
(2023).
Myocardial inefficiency is an early indicator of exercise-induced myocardial fatigue.
Frontiers in Cardiovascular Medicine.
9,
p. 1–12.
doi:
10.3389/fcvm.2022.1081664.
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Background: The effect of prolonged, high-intensity endurance exercise on myocardial function is unclear. This study aimed to determine the left ventricular (LV) response to increased exercise duration and intensity using novel echocardiographic tools to assess myocardial work and fatigue.Materials and methods: LV function was assessed by echocardiography before, immediately, and 24 h after a cardiopulmonary exercise test (CPET) and a 91-km mountain bike leisure race. Cardiac Troponin I (cTnI) was used to assess myocyte stress.Results: 59 healthy recreational athletes, 52 (43–59) years of age, 73% males, were included. The race was longer and of higher intensity generating higher cTnI levels compared with the CPET (p < 0.0001): Race/CPET: exercise duration: 230 (210, 245)/43 (40, 45) minutes, mean heart rate: 154 ± 10/132 ± 12 bpm, max cTnI: 77 (37, 128)/12 (7, 23) ng/L. Stroke volume and cardiac output were higher after the race than CPET (p < 0.005). The two exercises did not differ in post-exercise changes in LV ejection fraction (LVEF) or global longitudinal strain (GLS). There was an increase in global wasted work (p = 0.001) following the race and a persistent reduction in global constructive work 24 h after exercise (p = 0.003).Conclusion: Increased exercise intensity and duration were associated with increased myocardial wasted work post-exercise, without alterations in LVEF and GLS from baseline values. These findings suggest that markers of myocardial inefficiency may precede reduction in global LV function as markers of myocardial fatigue.
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Nguyen, Thuy Mi; Melichova, Daniela; Aabel, Eivind Westrum; Lie, Øyvind Haugen; Klæboe, Lars Gunnar & Grenne, Bjørnar Leangen
[Show all 10 contributors for this article]
(2023).
Mortality in Patients with Acute Coronary Syndrome—A Prospective 5-Year Follow-Up Study.
Journal of Clinical Medicine.
12(20).
doi:
10.3390/jcm12206598.
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Our objective was to compare long-term outcomes in patients with non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) between two time periods in Southern Norway. There are limited contemporary data comparing long-term follow-up after revascularization in the last decades. This prospective follow-up study consecutively included both NSTEMI and STEMI patients during two time periods, 2014–2015 and 2004–2009. Patients were followed up for a period of 5 years. The primary outcome was all-cause mortality after 1 and 5 years. A total of 539 patients with acute myocardial infarction (AMI), 316 with NSTEMI (234 included in 2014 and 82 included in 2007) and 223 with STEMI (160 included in 2014 and 63 included in 2004). Mortality after NSTEMI was high and remained unchanged during the two time periods (mortality rate at 1 year: 3.5% versus 4.9%, p = 0.50; and 5 years: 11.4% versus 14.6%, p = 0.40). Among STEMI patients, all-cause mortality at 1 year was reduced in 2014 compared to 2004 (1.3% versus 11.1%, p < 0.001; and 5 years: 7.0% versus 22.2%, p = 0.004, respectively). Time to coronary angiography in NSTEMI patients remained unchanged between 2014 and 2007 (28.2 h [IQR 18.1–46.3] versus 30.3 h [IQR 18.0–48.3], p = 0.20), while time to coronary angiography in STEMI patients was improved in 2014 compared with 2004 (2.8 h [IQR 2.0–4.8] versus 21.7 h [IQR 5.4–27.1], p < 0.001), respectively. During one decade of AMI treatment, mortality in patients with NSTEMI remained unchanged while mortality in STEMI patients decreased, both at 1 and 5 years.
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Abdullah, Rang; Bjørnebekk, Astrid Kristine; Hauger, Lisa Evju; Hullstein, Ingunn Riise; Edvardsen, Thor & Haugaa, Kristina Ingrid Helena Hermann
[Show all 7 contributors for this article]
(2023).
Severe biventricular cardiomyopathy in both current and former long-term users of anabolic-androgenic steroids.
European Journal of Preventive Cardiology (EJPC).
ISSN 2047-4873.
31(5),
p. 599–608.
doi:
10.1093/eurjpc/zwad362.
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Abstract Aims This study aims to explore the cardiovascular effects of long-term anabolic–androgenic steroid (AAS) use in both current and former weightlifting AAS users and estimate the occurrence of severe reduced myocardial function and the impact of duration and amount of AAS. Methods and results In this cross-sectional study, 101 weightlifting AAS users with at least 1 year cumulative AAS use (mean 11 ± 7 accumulated years of AAS use) were compared with 71 non-using weightlifting controls (WLC) using clinical data and echocardiography. Sixty-nine were current, 30 former (&gt;1 year since quitted), and 2 AAS users were not available for this classification. Anabolic–androgenic users had higher left ventricular mass index (LVMI) (106 ± 26 vs. 80 ± 15 g/m2, P &lt; 0.001), worse left ventricular ejection fraction (LVEF) (49 ±7 vs. 59 ± 5%, P &lt; 0.001) and right ventricular global longitudinal strain (−17.3 ± 3.5 vs. −22.8 ± 2.0%, P &lt; 0.001), and higher systolic blood pressure (141 ± 17 vs. 133 ± 11 mmHg, P &lt; 0.001) compared with WLC. In current users, accumulated duration of AAS use was 12 ± 7 years and in former 9 ± 6 years (quitted 6 ± 6 years earlier). Compared with WLC, LVMI and LVEF were pathological in current and former users (P &lt; 0.05) with equal distribution of severely reduced myocardial function (LVEF ≤40%) (11 vs. 10%, not significant (NS)). In current users, estimated lifetime AAS dose correlated with reduced LVEF and LVGLS, P &lt; 0.05, but not with LVMI, P = 0.12. Regression analyses of the total population showed that the strongest determinant of reduced LVEF was not coexisting strength training or hypertension but history of AAS use (β −0.53, P &lt; 0.001). Conclusion Long-term AAS users showed severely biventricular cardiomyopathy. The reduced systolic function was also found upon discontinued use.
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Forså, Marianne Inngjerdingen; Bjerring, Anders W.; Haugaa, Kristina Ingrid Helena Hermann; Smedsrud, Marit Kristine; Sarvari, Sebastian & Landgraff, Hege Elisabeth W.
[Show all 8 contributors for this article]
(2023).
Young athlete's growing heart: sex differences in cardiac adaptation to exercise training during adolescence.
Open heart.
10(1).
doi:
10.1136/openhrt-2022-002155.
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Background: Athlete’s heart is a condition of exercise-induced cardiac remodelling. Adult male endurance athletes more often remodel beyond reference values. The impact of sex on remodelling through adolescence remains unclear. Paediatric reference values do not account for patient sex or exercise history. We aimed to study the effect of sex on cardiac remodelling throughout adolescence.
Methods: We recruited 76 male (M) and female (F) 12-year-old cross-country skiers in a longitudinal cohort study. Echocardiography was performed and analysed according to guidelines at age 12 (48 M, 28 F), 15 (34 M, 14 F) and 18 (23 M, 11 F). Repeated echocardiographic measurements were analysed by linear mixed model regression.
Results: Males displayed greater indexed left ventricular end-diastolic volumes (LV EDVi) from age 12 (M 81±7 vs F 76±7, mL/m², p≤0.01), and progressed further until follow-up at age 18 (M 2.3±9.7 vs F −3.9±4.5 ΔmL/m², p≤0.01). LV EDVi remained above adult upper reference values in both groups. Males increased LV Mass Index from age 12 to 18 (M 33±27 vs F 4±19, Δg/m², p≤0.01). Males displayed LV mass above paediatric reference values at ages 15 and 18. A subset of males (35%) and females (25%) displayed wall thickness above paediatric reference values at age 12. Cardiac function was normal. There was no sex difference in exercise hours.
Conclusion: Sex-related differences in athlete’s heart were evident from age 12, and progressed throughout adolescence. Remodelling beyond reference values was more frequent than previously reported, particularly affecting males. Age, sex and exercise history may assist clinicians in distinguishing exercise-induced remodelling from pathology in adolescents.
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Forså, Marianne Inngjerdingen; Smedsrud, Marit Kristine; Haugaa, Kristina Ingrid Helena Hermann; Bjerring, Anders W.; Fruh, Andreas & Sarvari, Sebastian
[Show all 9 contributors for this article]
(2023).
Distinguishing left ventricular hypertrophy from hypertrophic cardiomyopathy in adolescents: a longitudinal observation study.
European Journal of Preventive Cardiology (EJPC).
ISSN 2047-4873.
31(5),
p. 591–598.
doi:
10.1093/eurjpc/zwad361.
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Aims: Echocardiographic characteristics to distinguish physiological left ventricular (LV) hypertrophy from pathology are warranted in early adolescent athletes. This study aimed to explore the phenotype, progression, and potential grey zone of LV hypertrophy during adolescence in athletes and hypertrophic cardiomyopathy (HCM) genotype–positive patients. Methods and results: In this longitudinal observation study, we compared seventy-six 12-year-old athletes with 55 age-matched and sex-matched HCM genotype–positive patients. Echocardiographic parameters were evaluated by using paediatric reference values (Z-scores). Hypertrophic cardiomyopathy genotype–positive patients were included if they had no or mild LV hypertrophy [maximum wall thickness <13 mm, Z-score <6 for interventricular septum diameter (ZIVSd), or posterior wall thickness]. We collected clinical data, including data on cardiac events. The mean follow-up-time was 3.2 ± 0.8 years. At baseline, LV hypertrophy was found in 28% of athletes and 21% of HCM genotype–positive patients (P = 0.42). Septum thickness values were similar (ZIVSd 1.4 ± 0.9 vs. 1.0 ± 1.3, P = 0.08) and increased only in HCM genotype–positive patients {ZIVSd progression rate −0.17 [standard error (SE) 0.05], P = 0.002 vs. 0.30 [SE 0.10], P = 0.001}. Left ventricular volume Z-scores (ZLVEDV) were greater in athletes [ZLVEDV 1.0 ± 0.6 vs. −0.1 ± 0.8, P < 0.001; ZLVEDV progression rate −0.05 (SE 0.04), P = 0.21 vs. −0.06 (SE 0.04), P = 0.12]. Cardiac arrest occurred in two HCM genotype–positive patients (ages 13 and 14), with ZIVSd 8.2–11.5. Conclusion: Left ventricular hypertrophy was found in a similar proportion in early adolescence but progressed only in HCM genotype–positive patients. A potential grey zone of LV hypertrophy ranged from a septum thickness Z-score of 2.0 to 3.3. Left ventricular volumes remained larger in athletes. Evaluating the progression of wall thickness and volume may help clinicians distinguish physiological LV hypertrophy from early HCM.
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Zha, Sigurd Zijun; Rogstadkjernet, Magnus; Klæboe, Lars Gunnar; Skulstad, Helge; Singstad, Bjørn-Jostein & Gilbert, Andrew David
[Show all 9 contributors for this article]
(2023).
Deep learning for automated left ventricular outflow tract diameter measurements in 2D echocardiography.
Cardiovascular Ultrasound.
21(1),
p. 1–11.
doi:
10.1186/s12947-023-00317-5.
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Background Measurement of the left ventricular outflow tract diameter (LVOTd) in echocardiography is a common source of error when used to calculate the stroke volume. The aim of this study is to assess whether a deep learning (DL) model, trained on a clinical echocardiographic dataset, can perform automatic LVOTd measurements on par with expert cardiologists. Methods Data consisted of 649 consecutive transthoracic echocardiographic examinations of patients with coronary artery disease admitted to a university hospital. 1304 LVOTd measurements in the parasternal long axis (PLAX) and zoomed parasternal long axis views (ZPLAX) were collected, with each patient having 1–6 measurements per examination. Data quality control was performed by an expert cardiologist, and spatial geometry data was preserved for each LVOTd measurement to convert DL predictions into metric units. A convolutional neural network based on the U-Net was used as the DL model. Results The mean absolute LVOTd error was 1.04 (95% confidence interval [CI] 0.90–1.19) mm for DL predictions on the test set. The mean relative LVOTd errors across all data subgroups ranged from 3.8 to 5.1% for the test set. Generally, the DL model had superior performance on the ZPLAX view compared to the PLAX view. DL model precision for patients with repeated LVOTd measurements had a mean coefficient of variation of 2.2 (95% CI 1.6–2.7) %, which was comparable to the clinicians for the test set. Conclusion DL for automatic LVOTd measurements in PLAX and ZPLAX views is feasible when trained on a limited clinical dataset. While the DL predicted LVOTd measurements were within the expected range of clinical inter-observer variability, the robustness of the DL model requires validation on independent datasets. Future experiments using temporal information and anatomical constraints could improve valvular identification and reduce outliers, which are challenges that must be addressed before clinical utilization. Graphical Abstract
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Baigent, Colin; Windecker, Stephan; Andreini, Daniele; Arbelo, Elena; Barbato, Emanuele & Bartorelli, Antonio L.
[Show all 67 contributors for this article]
(2022).
European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1 - epidemiology, pathophysiology, and diagnosis.
Cardiovascular Research (CVR).
ISSN 0008-6363.
118(6),
p. 1385–1412.
doi:
10.1093/cvr/cvab342.
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Aabel, Eivind Westrum; Chivulescu, Ana Monica; Lie, Øyvind Haugen; Hopp, Einar; Gjertsen, Erik & Ribe, Margareth
[Show all 11 contributors for this article]
(2022).
Ventricular arrhythmias in arrhythmic mitral valve syndrome - a prospective continuous long-term cardiac monitoring study.
Europace.
ISSN 1099-5129.
25(2),
p. 506–516.
doi:
10.1093/europace/euac182.
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Aims Arrhythmic mitral valve syndrome is linked to life-threatening ventricular arrhythmias. The incidence, morphology and methods for risk stratification are not well known. This prospective study aimed to describe the incidence and the morphology of ventricular arrhythmia and propose risk stratification in patients with arrhythmic mitral valve syndrome. Methods Arrhythmic mitral valve syndrome patients were monitored for ventricular tachyarrhythmias by implantable loop recorders (ILR) and secondary preventive implantable cardioverter-defibrillators (ICD). Severe ventricular arrhythmias included ventricular fibrillation, appropriate or aborted ICD therapy, sustained ventricular tachycardia and non-sustained ventricular tachycardia with symptoms of hemodynamic instability. Results During 3.1 years of follow-up, severe ventricular arrhythmia was recorded in seven (12%) of 60 patients implanted with ILR [first event incidence rate 4% per person-year, 95% confidence interval (CI) 2–9] and in four (20%) of 20 patients with ICD (re-event incidence rate 8% per person-year, 95% CI 3–21). In the ILR group, severe ventricular arrhythmia was associated with frequent premature ventricular complexes, more non-sustained ventricular tachycardias, greater left ventricular diameter and greater posterolateral mitral annular disjunction distance (all P < 0.02). Conclusions The yearly incidence of ventricular arrhythmia was high in arrhythmic mitral valve syndrome patients without previous severe arrhythmias using continuous heart rhythm monitoring. The incidence was even higher in patients with secondary preventive ICD. Frequent premature ventricular complexes, non-sustained ventricular tachycardias, greater left ventricular diameter and greater posterolateral mitral annular disjunction distance were predictors of first severe arrhythmic event.
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Benfari, Giovanni; Mandoli, Giulia Elena; Magne, Julien; Miglioranza, Marcelo Haertel; Ancona, Roberta & Luksic, Vlatka Reskovic
[Show all 16 contributors for this article]
(2022).
Left atrial strain determinants and clinical features according to the heart failure stages. New insight from EACVI MASCOT registry.
The International Journal of Cardiovascular Imaging.
ISSN 1569-5794.
doi:
10.1007/s10554-022-02669-x.
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Abstract Few studies analyzed left atrial (LA) peak atrial longitudinal strain (PALS) determinants, particularly across heart failure (HF) stages. We aimed to analyze the pathophysiological and clinical PALS correlates in a large multicentric prospective study. This is a multicenter prospective observational study enrolling 745 patients with HF stages. Data included PALS and left ventricular global longitudinal strain (LV-GLS). Exclusion criteria were: valvular prosthesis; atrial fibrillation; cardiac transplantation; poor acoustic window. Median global PALS was 17% [24–32]. 29% of patients were in HF-stage 0/A, 35% in stage-B, and 36% in stage-C. Together with age, the echocardiographic determinants of PALS were LA volume and LV-GLS (overall model R 2 = 0.50, p < 0.0001). LV-GLS had the strongest association with PALS at multivariable analysis (beta: −3.60 ± 0.20, p < 0.0001). Among HF stages, LV-GLS remained the most important PALS predictor (p < 0.0001) whereas age was only associated with PALS in lower HF-stage 0/A or B (R = − 0.26 p < 0.0001, R = − 0.23 p = 0.0001). LA volume increased its association to PALS moving from stage 0/A (R = − 0.11; P = 0.1) to C (R = − 0.42; P < 0.0001). PALS was the single most potent echocardiographic parameter in predicting the HF stage (AUC for B vs. 0/A 0.81, and AUC vs. 0/A for C 0.76). PALS remained independently associated with HF stages after adjusting for ejection fraction, E/e′ ratio, and mitral regurgitation grade (p < 0.0001). Although influenced by LV-GLS and LA size across HF stages, PALS is incrementally and independently associated with clinical status. LA function may reflect a substantial part of the hemodynamic consequences of ventricular dysfunction.
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Norum, Ingvild Billehaug; Otterstad, Jan Erik; Ruddox, Vidar; Bendz, Bjørn & Edvardsen, Thor
(2022).
Novel regional longitudinal strain by speckle tracking to detect significant coronary artery disease in patients admitted to the emergency department for chest pain suggestive of acute coronary syndrome.
Journal of Echocardiography.
ISSN 1349-0222.
20(3),
p. 166–177.
doi:
10.1007/s12574-022-00568-7.
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Background
Global longitudinal strain has shown variable results in detecting ischemia in patients admitted to the emergency department with chest pain, but without other clear evidence of coronary artery disease (CAD). Our aim was to investigate whether assessment of regional longitudinal myocardial function could assist in detecting significant CAD in these patients.
Methods
Clinical evaluation, electrocardiogram, echocardiogram and troponin T were evaluated in 126 patients admitted with chest pain. A subsequent invasive coronary angiography divided patients into two groups: significant CAD (CAD+) or non-significant CAD (CAD−). Global and regional myocardial function were evaluated by speckle tracking echocardiography. Regional longitudinal strain was defined as the highest longitudinal strain values in four adjacent left ventricular segments and termed 4AS.
Results
CAD+ was found in 37 patients (29%) of which 51% had elevated troponin. Mean 4AS was − 13.1% (± 3.5) in the CAD+ and − 15.2% (± 2.7) (p = 0.002) in the CAD− group. Predictors for CAD+ were age [OR 1.06 (1.01–1.11, p = 0.026)], smoking [OR 3.39 (1.21–9.51, p = 0.020)], troponin [OR 3.32 (1.28–8.60, p = 0.014)) and 4AS (OR 1.24 (1.05–1.46, p = 0.010)]. A cutoff for 4AS of > − 15% showed the best diagnostic performance with event-reclassification of 0.41 (p < 0.001), non-event-reclassification of − 0.34 (p < 0.001) and net reclassification improvement 0.07 (p = 0.60).
Conclusion
Decreased myocardial function in four adjacent LV segments assessed by strain has the potential to detect significant CAD in patients admitted with chest pain and negative/slightly elevated initial troponin.
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Edvardsen, Thor
(2026).
Norske eksperter krever strengere hjertescreening for idrettsutøvere.
[Radio].
Dagbladet.
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Etter Olaf Tuftes plutselige død, oppfordrer norske hjertespesialister til en mer målrettet hjertescreening av toppidrettsutøvere for å forhindre hjertestans.
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Sverre, Elise Christine Bjørkholen; Madssen, Erik; Kristensen, A M D; Nyen, J E; Bakken, Arnhild & Holmager, T
[Show all 12 contributors for this article]
(2026).
Effect of long-term beta-blocker therapy on physical activity after myocardial infarction: a post hoc analysis of the BETAMI trial.
European Journal of Preventive Cardiology (EJPC).
ISSN 2047-4873.
33(Supplement_2).
doi:
10.1093/eurjpc/zwag249.065.
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Abstract Introduction The BETAMI-DANBLOCK trial recently found that beta-blockers reduced the risk of all-cause death or major adverse cardiovascular events in patients with a recent myocardial infarction (MI) without heart failure symptoms and left ventricular ejection fraction ≥40%. Some observational data and small intervention studies indicate a possible negative relationship between beta-blocker therapy and physical activity (PA) levels. However, it is still unclear how beta-blocker treatment influences PA after an acute MI. Purpose To investigate the effect of long-term beta-blocker therapy on PA level after MI in patients without heart failure. Method In this post-hoc analysis of the multicentre, randomized, open-label BETAMI trial with blinded endpoint evaluation, patients hospitalized with a MI and without heart failure were assigned to beta-blocker therapy within seven days after the event or no beta-blocker therapy. PA levels were assessed prior to randomization and at 1-, 6-, 12- and 18-months follow-up by self-reported questionnaires. The main endpoints were between-group changes in hours/week of light- (e.g., walking, dancing, cycling) and vigorous PA (e.g., brisk uphill walking, running) from baseline to 18 months, estimated by linear mixed models. Additionally, we assessed between-group differences in the proportion with guideline-recommended PA level (≥30 minutes of moderate activity on ≥5 days/week) and the participation rates in cardiac rehabilitation or organized PA programs. Results Of the 2867 patients, 2148 (75%) responded to the questions regarding PA in the follow-up period. Median age was 62 (IQR 55-70) years, and 19.6% were women. The median beta-blocker dose in the intervention arm was equivalent to metoprolol depot 50 mg/day. No differences in mean hours of light and vigorous physical activity were reported between the beta-blocker and non-beta-blocker groups at baseline, and these remained comparable throughout the 18 months follow-up (Figure 1). At baseline 31.2% met the guideline-recommended level of PA. This proportion increased to 39.2% at 6 months, with no significant differences between treatment arms at any time point (Figure 2). We found no effect of beta-blocker dose on the PA level. Participation in cardiac rehabilitation or organized PA at 12 months follow-up was 43.6% in the beta-blocker group and 42.3% in the non-beta-blocker group. Conclusions Beta-blocker therapy did not affect the PA level in post-MI patients without heart failure during 18 months follow-up.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.
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Tveten, Ingrid Elisabeth; Nyberg, John; Grue, Jahn Frederik; Helland, Ragnhild Holden; Melichova, Daniela & Nguyen, Thuy Mi
[Show all 13 contributors for this article]
(2026).
Deep learning segmentation and quantification of the left ventricle from the parasternal short axis view.
European Heart Journal-Cardiovascular Imaging.
ISSN 2047-2404.
27(Supplement_1).
doi:
10.1093/ehjci/jeaf367.131.
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Background: Although parasternal short-axis (PSAX) images are routinely acquired during echocardiographic examinations, they remain under-utilized for quantitative analysis of the left ventricle (LV) morphology and function. This is even though PSAX offers a complete cross-sectional view of the LV myocardium, providing complementary information to apical views. The limited use of quantitative PSAX measurements is largely due to time-consuming manual workflows and inter-observer variability. Automated methods could help overcome these barriers and facilitate broader use of PSAX-based measurements in clinical practice.
Purpose: To develop and evaluate a fully automated deep learning (DL) method for quantification of LV morphology and function from PSAX images.
Methods: Two clinicians manually annotated the LV lumen and myocardium in PSAX images from 384 subjects for model development and 47 subjects for evaluation. A segmentation model based on nnU-Net was trained to delineate the LV lumen and myocardium. Model performance was assessed using Dice coefficients and the 95th percentile Hausdorff distance (HD95). Based on the segmentations, we calculated the cross-sectional lumen area and mean wall thickness (MWT) at end-diastole (ED) and end-systole (ES), LV fractional area change (LVFAC), and global circumferential strain (GCS). Agreement between DL-based and clinician-derived measurements was assessed and compared to inter-observer variability. We compared MWT at ED between subjects with hypertension (systolic blood pressure ≥ 160 mmHg or use of antihypertensive medication) and those without hypertension.
Results: The nnU-Net model achieved Dice coefficients of 0.94±0.03 and 0.86±0.07, and HD95s of 3.0±1.6 mm and 3.3±1.5 mm, for the lumen and myocardium, respectively. The nnU-Net outperformed inter-observer Dice (0.93±0.04 and 0.82±0.07) and HD95 (3.7±1.5 mm and 4.2±1.4 mm). Feasibility of the measurement pipeline was 90%. Agreement between DL-based measurements and observers was similar for GCS. For all other measurements, DL−observer agreement exceeded inter-observer agreement. For MWT ED the agreement with the mean of two observers (bias -0.4 mm and limits of agreement (LoA) -1.8 to 1.0 mm) was in line with the inter-observer comparison (bias 1.7 mm and LoA -0.2 to 3.5 mm). MWT at ED was significantly higher in subjects with hypertension than in those without (p < 0.001).
Conclusion: The proposed DL-based measurement pipeline for PSAX enables automatic measurements of LV cross-sectional area, wall thickness and subsequent functional measurements. Agreement with manual measurements was high, and the method was able to detect structural differences associated with hypertension. These results highlight the potential of DL to unlock the value of PSAX analysis in comprehensive LV assessment.|
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Edvardsen, Thor & Selmer, Lisa Marie
(2025).
Shear wave elastography in cardiac imaging: promise and questions ahead.
European Heart Journal-Cardiovascular Imaging.
ISSN 2047-2404.
26(9),
p. 1548–1548.
doi:
10.1093/ehjci/jeaf208.
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Edvardsen, Thor & Klæboe, Lars Gunnar
(2025).
Assessment of Diastolic Function: Is It Time to Relax? Rethinking Echocardiographic Approaches.
Journal of the American Society of Echocardiography.
ISSN 0894-7317.
38(5),
p. 378–379.
doi:
10.1016/j.echo.2025.02.004.
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Edvardsen, Thor
(2024).
Multimodality Imaging in Arrhythmogenic Cardiomyopathies. Cardiac imaging in clinical practice.
Full text in Research Archive
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Edvardsen, Thor
(2024).
Echocardiographic risk prediction in ventricular arrhythmias - the role of mechanical dispersion.
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Edvardsen, Thor
(2024).
Echocardiographic workup for HCM – making the diagnosis and evaluation of cardiac function.
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Muraru, Denisa; Pontone, Gianluca; Jurcut, Ruxandra; Magne, Julien; Donal, Erwan & Stankovic, Ivan
[Show all 28 contributors for this article]
(2024).
How to conduct clinical research in cardiovascular imaging: a primer for clinical cardiologists and researchers-a statement of the European Association of Cardiovascular Imaging (EACVI) of the ESC.
European Heart Journal-Cardiovascular Imaging.
ISSN 2047-2404.
26(1),
p. 4–21.
doi:
10.1093/ehjci/jeae238.
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Almaas, Vibeke Marie; Abdullah, Rang; Edvardsen, Thor; Haugaa, Kristina Ingrid Helena Hermann & Bjørnebekk, Astrid Kristine
(2024).
Comment on 'Anabolic-androgenic steroids and cardiac function.
European Journal of Preventive Cardiology (EJPC).
ISSN 2047-4873.
31(13),
p. e97–e98.
doi:
10.1093/eurjpc/zwae183.
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Edvardsen, Thor; Asch, Federico M.; Davidson, Brian; Delgado, Victoria; DeMaria, Anthony & Dilsizian, Vasken
[Show all 20 contributors for this article]
(2022).
Non-Invasive Imaging in Coronary Syndromes: Recommendations of The European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with The American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance.
Journal of the American Society of Echocardiography.
ISSN 0894-7317.
35(4),
p. 329–354.
doi:
10.1016/j.echo.2021.12.012.
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Edvardsen, Thor; Asch, Federico M.; Davidson, Brian; Delgado, Victoria; DeMaria, Anthony & Dilsizian, Vasken
[Show all 20 contributors for this article]
(2022).
Non-Invasive Imaging in Coronary Syndromes: Recommendations of The European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with The American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance.
Journal of cardiovascular computed tomography.
ISSN 1934-5925.
16(4),
p. 362–383.
doi:
10.1016/j.jcct.2022.05.006.
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Forså, Marianne Inngjerdingen; Edvardsen, Thor; Haugaa, Kristina Ingrid Helena Hermann & Smedsrud, Marit Kristine
(2026).
The growing heart – from normal to pathology. Impact of exercise and genetics.
Universitetet i Oslo.
ISSN 9788234808258.
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Athlete’s heart is a physiological cardiac adaptation to exercise, characterized by increased wall thickness and chamber size. These changes may overlap with early signs of hypertrophic cardiomyopathy, a genetic disease associated with ventricular arrhythmias and sudden cardiac death. Distinguishing between the two conditions is crucial, yet data on paediatric athletes remain limited. Similarly, arrhythmogenic right ventricular cardiomyopathy has mainly been studied in adults, leaving paediatric patients underrepresented.
In the thesis The growing heart – from normal to pathology. Impact of exercise and genetics, Marianne Inngjerdingen Forså and co-authors investigate cardiac development in adolescent athletes and paediatric cardiomyopathy patients. The work is based on three longitudinal cohort studies.
The authors describe signs of athlete’s heart in both males and females from age 12, with increasing sex differences during adolescence. Athletes of both sexes displayed wall thickness beyond upper reference values, suggesting a potential grey zone of left ventricular hypertrophy. Compared with age- and sex-matched genotype-positive hypertrophic cardiomyopathy patients, the athletes showed symmetrical cardiac growth and relative normalization of wall thickness as body size increased. In contrast, genotype-positive hypertrophic cardiomyopathy patients showed increasingly asymmetrical wall thickness. Two cases of cardiac arrest occurred after rapid disease progression.
The thesis further examines arrhythmogenic right ventricular cardiomyopathy in children and adolescents. Previous guidelines recommended cardiac evaluation of genotype-positive children from age 10–12 years. Forså and co-authors found high disease penetrance and a malignant phenotype before age 12, with progression to heart failure in early-onset disease. Arrhythmias were more frequent in adolescence. The thesis highlights the limitations of extrapolating findings from adults to paediatric populations.
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Published
Apr. 13, 2011 2:55 PM
- Last modified
May 11, 2024 11:05 PM
