Helge Skulstad

• Andresen, Kristoffer; Selmer, Lisa Marie; Espeland, Torvald; Fadnes, Solveig; Løvstakken, Lasse & Beitnes, Jan Otto [Vis alle 9 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Hammersbøen, Lars Egil Reine; Bøe, Espen Andreas Matthew; Duchenne, Jürgen; Aalen, John; Odland, Hans Henrik & Villegas-Martinez, Manuel [Vis alle 17 forfattere av denne artikkelen] (2025). Noninvasive Pressure-Volume Analysis by Three-Dimensional Echocardiography: A Novel Powerful Method for Evaluating Left Ventricular Function. Journal of the American Society of Echocardiography. ISSN 0894-7317. 38(10), s. 946–958. doi: 10.1016/j.echo.2025.05.008. Fulltekst i vitenarkiv Vis sammendrag

  Background Pressure-volume (PV) analysis is the gold standard for evaluating left ventricular (LV) function but is rarely used clinically due to its invasiveness. We validated a noninvasive method for PV analysis by three-dimensional (3D) echocardiography against invasive reference measurements and a novel index of LV efficiency against LV efficiency derived from metabolism by positron emission tomography-computed tomography (PET-CT). Methods In 22 canines, LV volume was measured invasively using piezoelectric crystals and LV pressure by micromanometer. Echocardiography and peak pressure were used to obtain 3D LV volume traces and LV pressure trace estimates. Stroke work, single-beat contractility indices, arterial elastance, and an index of LV efficiency were derived from echocardiography and compared with their invasively measured counterparts at baseline and different interventions. In 12 sheep, the LV efficiency index was compared with efficiency calculated as stroke work divided by total LV glucose metabolism from PET-CT. The sheep underwent 8 weeks of rapid dyssynchronous pacing to induce heart failure (HF). Recordings were performed during synchronous and dyssynchronous electrical activation, at baseline, and after 8 weeks of pacing-induced HF. Results In canines, there was a very good correlation and agreement between noninvasive and invasive measurements of LV stroke work (r = 0.98, P < .0001; difference 237 ± 212 mm Hg × mL, mean ± SD). The noninvasive and invasive efficiency indices also showed very good agreement (r = 0.95, P < .0001; difference 0.4% ± 3.4%). The changes in LV function by the different interventions resulted in similar changes in the noninvasive and invasive PV indices (all P < .001). In sheep, the efficiency index showed similar decline compared to efficiency by PET-CT after induction of HF and after switching from synchronous to dyssynchronous electrical activation (r = 0.67, P < .001 for all interventions). Conclusions Noninvasive PV analysis by three-dimensional echocardiography is feasible and accurate, making PV loop parameters for evaluating LV function accessible for clinical use. Further studies should explore the clinical utility of this method.

• Holt, Margrethe Flesvig; Flø, August Magnus Stensrød; Kaya, Esra; Kløve, Sophie Foss; Martinsen, Hege & Amlie, Kristine [Vis alle 16 forfattere av denne artikkelen] (2025). Transthyretin amyloid cardiomyopathy in aortic stenosis patients scheduled for transcatheter aortic valve implantation. ESC Heart Failure. 12(4), s. 2467–2476. doi: 10.1002/ehf2.15258. Fulltekst i vitenarkiv Vis sammendrag

  Aims The prevalences of aortic stenosis (AS) and transthyretin amyloid cardiomyopathy (ATTR-CM) increase with age. Identification of occult ATTR-CM in patients with AS can help explain out-of-proportion myocardial dysfunction, aid in prognostication and prompt initiation of disease-modifying treatment. Studies have suggested that many patients referred for transcatheter aortic valve implantation (TAVI) have concomitant ATTR-CM, but some have included unverified ATTR-CM in patients with ambiguous scintigrams. We aimed to assess the co-occurrence of ATTR-CM in patients scheduled for TAVI. Methods In patients accepted for TAVI for severe AS, we used bone scintigraphy to screen for ATTR-CM. We defined ATTR-CM as a cardiac tracer uptake ≥ Perugini Grade 2 in the absence of abnormal monoclonal protein or abnormal free light chain ratio. We offered bioptic verification to patients with Grade 1 or ambiguous DPD uptake. Results We included 171 consecutive patients aged 79 ± 7 years, 57% were male. Six patients (3.5%) had cardiac bone tracer uptake ≥ Perugini Grade 2 and no abnormal monoclonal protein/free light chains. Endomyocardial biopsies confirmed the diagnosis in two additional patients (1.2%), whereas five patients with low-grade uptake did not have ATTR-CM. In total, 8/171 patients (4.7%) were diagnosed with concomitant AS and ATTR-CM. Most of the patients with concomitant ATTR-CM had low-flow low-gradient (LFLG) AS, and 25% had a history of carpal tunnel syndrome. Conclusions We found concomitant AS and ATTR-CM in 5% of our TAVI patients. Carpal tunnel syndrome and LFLG AS suggest concomitant ATTR.

• Tangen, Jorun; Nguyen, Thuy Mi Tran; Melichova, Daniela; Klæboe, Lars Gunnar; Forså, Marianne Inngjerdingen & Andresen, Kristoffer [Vis alle 13 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Kaya, Esra; Andresen, Kristoffer; Lie, Øyvind Haugen; Aaberge, Lars; Haugaa, Kristina Ingrid Helena Hermann & Edvardsen, Thor [Vis alle 7 forfattere av denne artikkelen] (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), s. 539–547. doi: 10.1093/ehjci/jead315. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Tangen, Jorun; Nguyen, Thuy Mi; Melichova, Daniela; Klæboe, Lars Gunnar; Forså, Marianne Inngjerdingen & Andresen, Kristoffer [Vis alle 12 forfattere av denne artikkelen] (2024). The Prognostic Value of Left Atrial Function in Patients with Acute Myocardial Infarction. Diagnostics (Basel). 14(18). doi: 10.3390/diagnostics14182027. Fulltekst i vitenarkiv Vis sammendrag

  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.

• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Inoue, Katsuji; Andersen, Øyvind Stenvik; Remme, Espen; Khan, Faraz Hameed; Andreassen, Arne K. & Skulstad, Helge [Vis alle 8 forfattere av denne artikkelen] (2024). Echocardiographic Evaluation of Left Ventricular Filling Pressure in Patients With Pulmonary Hypertension. JACC Cardiovascular Imaging. ISSN 1936-878X. 17(5). doi: 10.1016/j.jcmg.2023.12.004. Fulltekst i vitenarkiv
• Khan, Faraz Hameed; Zhao, Debbie; Ha, Jong-Won; Nagueh, Sherif F.; Voigt, Jens-Uwe & Klein, Allan L. [Vis alle 28 forfattere av denne artikkelen] (2024). Evaluation of left ventricular filling pressure by echocardiography in patients with atrial fibrillation. Echo Research & Practice. 11(1). doi: 10.1186/s44156-024-00048-x. Fulltekst i vitenarkiv Vis sammendrag

  Background Echocardiography is widely used to evaluate left ventricular (LV) diastolic function in patients suspected of heart failure. For patients in sinus rhythm, a combination of several echocardiographic parameters can differentiate between normal and elevated LV filling pressure with good accuracy. However, there is no established echocardiographic approach for the evaluation of LV filling pressure in patients with atrial fibrillation. The objective of the present study was to determine if a combination of several echocardiographic and clinical parameters may be used to evaluate LV filling pressure in patients with atrial fibrillation. Results In a multicentre study of 148 atrial fibrillation patients, several echocardiographic parameters were tested against invasively measured LV filling pressure as the reference method. No single parameter had sufficiently strong association with LV filling pressure to be recommended for clinical use. Based on univariate regression analysis in the present study, and evidence from existing literature, we developed a two-step algorithm for differentiation between normal and elevated LV filling pressure, defining values ≥ 15 mmHg as elevated. The parameters in the first step included the ratio between mitral early flow velocity and septal mitral annular velocity (septal E/e’), mitral E velocity, deceleration time of E, and peak tricuspid regurgitation velocity. Patients who could not be classified in the first step were tested in a second step by applying supplementary parameters, which included left atrial reservoir strain, pulmonary venous systolic/diastolic velocity ratio, and body mass index. This two-step algorithm classified patients as having either normal or elevated LV filling pressure with 75% accuracy and with 85% feasibility. Accuracy in EF ≥ 50% and EF < 50% was similar (75% and 76%). Conclusions In patients with atrial fibrillation, no single echocardiographic parameter was sufficiently reliable to be used clinically to identify elevated LV filling pressure. An algorithm that combined several echocardiographic parameters and body mass index, however, was able to classify patients as having normal or elevated LV filling pressure with moderate accuracy and high feasibility.

• Sletten, Ole Jakob; Aalen, John; Smiseth, Otto Armin; Khan, Faraz Hameed; Fosså, Alexander & Kiserud, Cecilie E. [Vis alle 10 forfattere av denne artikkelen] (2023). Mental Stress Reduces Left Ventricular Strain: Can It Lead to Misinterpretation of Cancer Therapy–Related Cardiac Dysfunction? Journal of the American Society of Echocardiography. ISSN 0894-7317. doi: 10.1016/j.echo.2023.11.010. Fulltekst i vitenarkiv
• Grønningsæter, Lasse; Langesæter, Eldrid; Sørbye, Ingvil Krarup; Quattrone, Alessia; Almaas, Vibeke Marie & Skulstad, Helge [Vis alle 7 forfattere av denne artikkelen] (2023). High prevalence of pre-eclampsia in women with coarctation of the aorta. European Heart Journal Open (EHJ Open). 3(4). doi: 10.1093/ehjopen/oead072. Fulltekst i vitenarkiv Vis sammendrag

  Aims The aim was to study pregnancy outcomes in women with coarctation of the aorta (CoA) and associations to hypertensive disorders of pregnancy. Maternal morbidity and mortality are higher in women with heart disease and pre-eclampsia. Chronic hypertension, frequently encountered in CoA, is a risk factor for pre-eclampsia. Methods and results Clinical data from the National Unit for Pregnancy and Heart Disease database was reviewed for pregnant women with CoA from 2008 to 2021. The primary outcome was hypertensive pregnancy disorders. The secondary outcomes were other cardiovascular, obstetric, and foetal complications. Seventy-six patients were included, with a total of 87 pregnancies. Seventeen (20%) patients were treated for chronic hypertension before pregnancy. Fifteen (20%) patients developed pre-eclampsia, and 5 (7%) had pregnancy-induced hypertension. Major adverse cardiac events developed in four (5%) patients, with no maternal or foetal mortality. Maternal age at first pregnancy [odds ratio (OR) 1.37], body mass index before first pregnancy (OR 1.77), and using acetylsalicylic acid from the first trimester (OR 0.22) were statistically significantly associated with pre-eclampsia. At follow-up (median) 8 years after pregnancy, 29 (38%) patients had anti-hypertensive treatment, an increase of 16% compared to pre-pregnancy. Five (7%) patients had progression of aorta ascendens dilatation to >40 mm, seven (9%) had an upper to lower systolic blood pressure gradient >20 mmHg, and six (8%) had received CoA re-intervention. Conclusion Pre-eclampsia occurred in 20% of women with CoA in their first pregnancy. All pre-eclamptic patients received adequate anti-hypertensive treatment. All CoA patients were provided multi-disciplinary management, including cardiologic follow-up, to optimize maternal–foetal outcomes.

• Grønningsæter, Lasse; Estensen, Mette-Elise; Skulstad, Helge; Langesæter, Eldrid & Edvardsen, Elisabeth (2023). Cardiorespiratory fitness in women after severe pre-eclampsia. Hypertension in Pregnancy. ISSN 1064-1955. 42(1), s. 1–10. doi: 10.1080/10641955.2023.2245054. Fulltekst i vitenarkiv Vis sammendrag

  Aims: To objectively study cardiorespiratory fitness (CRF) and physical activity (PA) and to evaluate limiting factors of exercise intolerance associated with poor CRF after severe pre-eclampsia. Methods: In this single-centre, cross-sectional study, CRF was measured as peak oxygen uptake (VO2peak) during a cardiopulmonary exercise test (CPET) on a treadmill in women 7 years after severe pre-eclampsia. Ninety-six patients and 65 controls were eligible to participate. Cardiac output (CO) was measured by impedance cardiography. PA was measured using accelerometers. Results: In 62 patients and 35 controls (mean age 40 ± 3 years), the VO2peak (in mL·kg–1·min–1) values were 31.4 ± 7.2 and 39.1 ± 5.4, respectively (p<0.01). In the patients, the COpeak was (9.6 L·min-1), 16% lower compared to controls (p<0.01). Twelve patients (19%) had a cardiac limitation to CPET. Twenty-three (37%) patients and one (3%) control were classed as unfit, with no cardiopulmonary limitations. The patients demonstrated 25% lower PA level (in counts per minute; p<0.01) and 14% more time being sedentary (p<0.01), compared with the controls. Twenty-one patients (34%) compared with four (17%) controls did not meet the World Health Organization’s recommendations for PA (p=0.02). Body mass index and PA level accounted for 65% of the variability in VO2peak. Conclusion: Significantly lower CRF and PA levels were found in patients on long-term follow-up after severe pre-eclampsia. CPET identified cardiovascular limitations in one third of patients. One third appeared unfit, with adiposity and lower PA levels. These findings highlight the need for clinical follow-up and exercise interventions after severe pre-eclampsia.

• Zha, Sigurd Zijun; Rogstadkjernet, Magnus; Klæboe, Lars Gunnar; Skulstad, Helge; Singstad, Bjørn-Jostein & Gilbert, Andrew David [Vis alle 9 forfattere av denne artikkelen] (2023). Deep learning for automated left ventricular outflow tract diameter measurements in 2D echocardiography. Cardiovascular Ultrasound. 21(1), s. 1–11. doi: 10.1186/s12947-023-00317-5. Fulltekst i vitenarkiv Vis sammendrag

  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

• Grønningsæter, Lasse; Skulstad, Helge; Quattrone, Alessia; Langesæter, Eldrid & Estensen, Mette-Elise (2022). Reduced left ventricular function and sustained hypertension in women seven years after severe preeclampsia. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 56(1), s. 292–301. doi: 10.1080/14017431.2022.2099012. Fulltekst i vitenarkiv Vis sammendrag

  Objective. To study left ventricular (LV) function and blood pressure (BP) at a long-term follow-up in women after severe pre-eclampsia. Design. In this single-centre, cross-sectional study, 96 patients were eligible for inclusion. LV function was examined by transthoracic echocardiography including tissue Doppler echocardiography and speckle tracking. BP was measured at rest using repeated non-invasive techniques. Results. We compared 36 patients with early-onset and 33 patients with late-onset pre-eclampsia with 28 healthy controls. Mean age (40 ± 3 years) and median time since delivery (7 ± 2 years) were similar across the study groups. The patients had 18% higher systolic BP (139 ± 15 mmHg) and 24% higher diastolic BP (87 ± 19 mmHg) than controls (p < .01). Hypertension was present in 23 patients (33%), where the estimated LV mass was 16% higher (p = .05) than in controls. The LV ejection fraction was 19% lower in the early-onset group (51 ± 4%; p = .01) and 14% lower in the late-onset group (54 ± 6; p = .04) compared with controls. LV global longitudinal strain was 18% lower in the patient group (–17.7 ± 2.1%) compared with controls (p = .01). Indicative of a more restrictive filling pattern, the diastolic indices showed a lower e′ mean (p < .01) and subsequently higher E/e′ ratio (p < .01). There were no significant differences in BP, systolic or diastolic function indices between the patient groups. Conclusion. We found sustained hypertension, higher LV mass and reduced LV systolic and diastolic function 7 y after severe pre-eclampsia. Our findings emphasize the importance of early risk stratification and clinical counselling, and follow-up for such cases.

• Wisløff-Aase, Kristin; Skulstad, Helge; Beitnes, Jan Otto; Lundblad, Runar; Halvorsen, Per Steinar & Fiane, Arnt Eltvedt [Vis alle 7 forfattere av denne artikkelen] (2022). Left Ventricular Function Changes Induced by Moderate Hypothermia Are Rapidly Reversed after Rewarming - A Clinical Study. Critical Care Medicine. ISSN 0090-3493. 50(1), s. E52–E60. doi: 10.1097/CCM.0000000000005170. Fulltekst i vitenarkiv
• Jensen, Annette Schophuus; Jørgensen, Troels Højsgaard; Christersson, Christina; Nagy, Edit; Sinisalo, Juha & Furenäs, Eva [Vis alle 19 forfattere av denne artikkelen] (2022). Cause-Specific Mortality in Patients During Long-Term Follow-Up After Atrial Switch for Transposition of the Great Arteries. Journal of the American Heart Association (JAHA). 11(14). doi: 10.1161/JAHA.121.023921. Fulltekst i vitenarkiv Vis sammendrag

  Background Little is known about the cause of death (CoD) in patients with transposition of the great arteries palliated with a Mustard or Senning procedure. The aim was to describe the CoD for patients with the Mustard and Senning procedure during short‐ (<10 years), mid‐ (10–20 years), and long‐term (>20 years) follow‐up after the operation. Methods and Results This is a retrospective, descriptive multicenter cohort study including all Nordic patients (Denmark, Finland, Norway, and Sweden) who underwent a Mustard or Senning procedure between 1967 and 2003. Patients who died within 30 days after the index operation were excluded. Among 968 patients with Mustard/Senning palliated transposition of the great arteries, 814 patients were eligible for the study, with a mean follow‐up of 33.6 years. The estimated risk of all‐cause mortality reached 36.0% after 43 years of follow‐up, and the risk of death was highest among male patients as compared with female patients (P=0.004). The most common CoD was sudden cardiac death (SCD), followed by heart failure/heart transplantation accounting for 29% and 27%, respectively. During short‐, mid‐, and long‐term follow‐up, there was a change in CoD with SCD accounting for 23.7%, 46.6%, and 19.0% (P=0.002) and heart failure/heart transplantation 18.6%, 22.4%, and 46.6% (P=0.0005), respectively. Conclusions Among patients corrected with Mustard or Senning transposition of the great arteries, the most common CoD is SCD followed by heart failure/heart transplantation. The CoD changes as the patients age, with SCD as the most common cause in adolescence and heart failure as the dominant cause in adulthood. Furthermore, the risk of all‐cause mortality, SCD, and death attributable to heart failure or heart transplantation was increased in men >10 years after the Mustard/Senning operation.

• Wisløff-Aase, Kristin; Skulstad, Helge; Haugaa, Kristina Ingrid Helena Hermann; Lingaas, Per Snorre; Beitnes, Jan Otto & Halvorsen, Per Steinar [Vis alle 7 forfattere av denne artikkelen] (2022). Myocardial electrophysiological and mechanical changes caused by moderate hypothermia—A clinical study. Physiological Reports. 10:e15259(8), s. 1–10. doi: 10.14814/phy2.15259. Fulltekst i vitenarkiv Vis sammendrag

  Moderate hypothermia has been used to improve outcomes in comatose out-of-hospital cardiac arrest survivors during the past two decades, although the effects remain controversial. We have recently shown in an experimental study that myocardial electrophysiological and mechanical relationships were altered during moderate hypothermia. Electromechanical window positivity increased, and electrical dispersion of repolarization decreased, both of which are changes associated with decreased arrhythmogenicity in clinical conditions. Mechanical dispersion, a parameter also linked to arrhythmic risk, remained unaltered. Whether corresponding electrophysiological and mechanical changes occur in humans during moderate hypothermia, has not been previously explored. Twenty patients with normal left ventricular function were included. Measurements were obtained at 36 and 32°C prior to ascending aortic repair while on partial cardiopulmonary bypass and at 36°C after repair. Registrations were performed in the presence of both spontaneous and comparable paced heart rate during standardized loading conditions. The following electrical and mechanical parameters were explored: (1) Electromechanical window, measured as time difference between mechanical and electrical systole, (2) dispersion of repolarization from ECG T-wave, and (3) mechanical dispersion, measured as segmental variation in time to peak echocardiographic strain. At moderate hypothermia, mechanical systolic prolongation (425 ± 43–588 ± 67 ms, p < 0.001) exceeded electrical systolic prolongation (397 ± 49–497 ± 79 ms, p < 0.001), whereby, electromechanical window positivity increased (29 ± 30–86 ± 50 ms, p < 0.001). Dispersion of repolarization and mechanical dispersion remained unchanged. Corresponding electrophysiological and mechanical relationships were present at comparable paced heart rates. After rewarming, the increased electromechanical window was reversed in the presence of both spontaneous and paced heart rates. Moderate hypothermia increased electromechanical window positivity, while dispersion of repolarization and mechanical dispersion remained unchanged. This impact of hypothermia may be clinically relevant for selected groups of patients after cardiac arrest.

• Schalit, Itai; Espinoza, Andreas Westenvik; Pettersen, Fred-Johan; Skulstad, Helge; Fosse, Erik & Fiane, Arnt Eltvedt [Vis alle 7 forfattere av denne artikkelen] (2022). Improved Detection of Thromboembolic Complications in Left Ventricular Assist Device by Novel Accelerometer-Based Analysis. ASAIO journal (1992). ISSN 1058-2916. 68(9), s. 1117–1125. doi: 10.1097/MAT.0000000000001654. Fulltekst i vitenarkiv
• Castrini, Anna Isotta; Skjølsvik, Eystein Theodor Ek; Estensen, Mette-Elise; Almaas, Vibeke Marie; Skulstad, Helge & Lyseggen, Erik [Vis alle 11 forfattere av denne artikkelen] (2022). Pregnancy and progression of cardiomyopathy in women With LMNA genotype-positive. Journal of the American Heart Association (JAHA). 11:e024960(8), s. 1–12. doi: 10.1161/JAHA.121.024960. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Mehilli, Julinda; Cassese, Salvatore; Hall, Trygve Sørdahl; Schirmer, Henrik & Atar, Dan [Vis alle 7 forfattere av denne artikkelen] (2022). 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. European Heart Journal. ISSN 0195-668X. doi: 10.1093/eurheartj/ehac270. Fulltekst i vitenarkiv
• Quattrone, Alessia; Lie, Øyvind Haugen; Nestaas, Eirik; Lange, Charlotte de; Try, Kirsti & Lindberg, Harald L [Vis alle 11 forfattere av denne artikkelen] (2021). Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot. Open heart. 8(1). doi: 10.1136/openhrt-2020-001400. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Patients with tetralogy of Fallot (TOF) have high survival rates 30 years after surgical repair. Many patients experience pregnancy; however, the effects of pregnancy on the long-term cardiovascular outcome are not well known. We investigated the association of pregnancy and cardiac function with occurrence of ventricular arrhythmia (VA) in women with TOF. Methods: We recruited 80 women with repaired TOF from the national database. Holter monitoring or implanted devices detected VA, defined as non-sustained or sustained ventricular tachycardia or aborted cardiac arrest. All patients underwent echocardiography. Blood tests included NT-proBNP (N-terminal pro-brain natriuretic peptide). Results: 55 (69%) women had experienced pregnancy. Mean age was lower in nulliparous compared with those with children (30±9 vs 40±9, p<0.01).VA had occurred in 17 (21%) women. Prevalence of VA was higher in women who had experienced pregnancy (n=16, 94%) compared with nulliparous (n=1, 6%) (p=0.02), also when adjusted for age (OR 12.9 (95% CI 1.5 to 113.2), p=0.02).Right ventricular mechanical dispersion was more pronounced in patients with VA (50±8 ms vs 39±14 ms, p=0.01, age-adjusted OR 2.1 (95% CI 1.3 to 7.5), p=0.01). NT-proBNP was also a marker of VA (211 ng/L (127 to 836) vs 139 ng/L (30 to 465), p=0.007). NT-proBNP >321 ng/L (normal values <170 ng/L) detected women with VA (p=0.019), also independent of age (OR 7.2 (95% CI 1.7 to 30.1), p=0.007). Conclusion: Pregnancy was associated with higher prevalence of VA among women with TOF. Right ventricular mechanical dispersion and NT-proBNP were age-independent markers of VA. These may have importance for pregnancy counselling and risk stratification. Keywords: Fallots tetralogy; arrhythmias; echocardiography

• Storm, Benjamin; Halvorsen, Per Steinar; Skulstad, Helge; Dybwik, Knut Gustav; Schjalm, Camilla & Christiansen, Dorte [Vis alle 11 forfattere av denne artikkelen] (2021). Open chest and pericardium facilitate transpulmonary passage of venous air emboli. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 65(5), s. 648–655. doi: 10.1111/aas.13796. Fulltekst i vitenarkiv Vis sammendrag

  Background Transpulmonary passage of air emboli can lead to fatal brain- and myocardial infarctions. We studied whether pigs with open chest and pericardium had a greater transpulmonary passage of venous air emboli than pigs with closed thorax. Methods We allocated pigs with verified closed foramen ovale to venous air infusion with either open chest with sternotomy and opening of the pleura and pericardium (n = 8) or closed thorax (n = 16). All pigs received a five-hour intravenous infusion of ambient air, starting at 4-6 mL/kg/h and increased by 2 mL/kg/h each hour. We assessed transpulmonary air passage by transesophageal M-mode echocardiography and present the results as median with inter-quartile range (IQR). Results Transpulmonary air passage occurred in all pigs with open chest and pericardium and in nine pigs with closed thorax (56%). Compared to pigs with closed thorax, pigs with open chest and pericardium had a shorter to air passage (10 minutes (5-16) vs. 120 minutes (44-212), P < .0001), a smaller volume of infused air at the time of transpulmonary passage (12 mL (10-23) vs.170 mL (107-494), P < .0001), shorter time to death (122 minutes (48-185) vs 263 minutes (248-300, P = .0005) and a smaller volume of infused air at the time of death (264 mL (53-466) vs 727 mL (564-968), P = .001). In pigs with open chest and, infused air and time to death correlated strongly (r = 0.95, P = .001). Conclusion Open chest and pericardium facilitated the transpulmonary passage of intravenously infused air in pigs.

• Sletten, Ole Jakob; Aalen, John M.; Izci, Hava; Duchenne, Jürgen; Remme, Espen W. & Larsen, Camilla Kjellstad [Vis alle 14 forfattere av denne artikkelen] (2021). Lateral Wall Dysfunction Signals Onset of Progressive Heart Failure in Left Bundle Branch Block. JACC Cardiovascular Imaging. ISSN 1936-878X. 14(11), s. 2059–2069. doi: 10.1016/j.jcmg.2021.04.017. Fulltekst i vitenarkiv Vis sammendrag

  Objectives This study sought to investigate if contractile asymmetry between septum and left ventricular (LV) lateral wall drives heart failure development in patients with left bundle branch block (LBBB) and whether the presence of lateral wall dysfunction affects potential for recovery of LV function with cardiac resynchronization therapy (CRT). Background LBBB may induce or aggravate heart failure. Understanding the underlying mechanisms is important to optimize timing of CRT. Methods In 76 nonischemic patients with LBBB and 11 controls, we measured strain using speckle-tracking echocardiography and regional work using pressure-strain analysis. Patients with LBBB were stratified according to LV ejection fraction (EF) ≥50% (EFpreserved), 36% to 49% (EFmid), and ≤35% (EFlow). Sixty-four patients underwent CRT and were re-examined after 6 months. Results Septal work was successively reduced from controls, through EFpreserved, EFmid, and EFlow (all p < 0.005), and showed a strong correlation to left ventricular ejection fraction (LVEF; r = 0.84; p < 0.005). In contrast, LV lateral wall work was numerically increased in EFpreserved and EFmid versus controls, and did not significantly correlate with LVEF in these groups. In EFlow, however, LV lateral wall work was substantially reduced (p < 0.005). There was a moderate overall correlation between LV lateral wall work and LVEF (r = 0.58; p < 0.005). In CRT recipients, LVEF was normalized (≥50%) in 54% of patients with preserved LV lateral wall work, but only in 13% of patients with reduced LV lateral wall work (p < 0.005). Conclusions In early stages, LBBB-induced heart failure is associated with impaired septal function but preserved lateral wall function. The advent of LV lateral wall dysfunction may be an optimal time-point for CRT.

• Tangen, Jorun; Aukrust, Pål; Barratt-Due, Andreas; Skulstad, Helge & Edvardsen, Thor (2021). Reduced cardiac function by echocardiography in a minority of COVID-19 patients three months after hospitalization. Journal of the American Society of Echocardiography. ISSN 0894-7317. doi: 10.1016/j.echo.2021.10.014. Fulltekst i vitenarkiv
• Kvaslerud, Anette Borger; Hussain, Amjad Iqbal; Auensen, Andreas; Fiane, Arnt E; Skulstad, Helge & Aaberge, Lars [Vis alle 8 forfattere av denne artikkelen] (2021). Outcomes in asymptomatic, severe aortic stenosis. PLOS ONE. doi: 10.1371/journal.pone.0249610. Fulltekst i vitenarkiv Vis sammendrag

  Background and aim of the study Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms. Materials and methods We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement. Results Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients. Conclusions In this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement.

• Quattrone, Alessia; Lie, Øyvind Haugen; Nestaas, Eirik; Lange, Charlotte de; Try, Kirsti & Lindberg, Harald L [Vis alle 11 forfattere av denne artikkelen] (2021). Long-term follow-up and sex differences in adults operated for tetralogy of Fallot. Open heart. 8(2). doi: 10.1136/openhrt-2021-001738. Fulltekst i vitenarkiv Vis sammendrag

  Objective Adults operated for tetralogy of Fallot (TOF) have high risk of ventricular arrhythmias (VA). QRS duration >180 ms is an established risk factor for VA. We aimed to investigate heart function, prevalence of arrhythmias and sex differences in patients with TOF at long-term follow-up. Methods We included TOF-operated patients≥18 years from our centre’s registry. We reviewed medical records and the most recent echocardiographic exam. VA was recorded on ECGs, 24-hour Holter registrations and from implantable cardioverter defibrillator. Results We included 148 patients (age 37±10 years). Left ventricular global longitudinal strain (LV GLS, −15.8±3.1% vs −18.8±3.2%, p=0.001) and right ventricular (RV) GLS (−15.8±3.9% vs −19.1±4.1%, p=0.001) were lower in men at all ages compared with women. Higher RV D1 (4.3±0.5 cm vs 4.6±0.6 cm, p=0.01), lower ejection fraction (55%±8% vs 50%±9%, p=0.02), lower RV GLS (−18.1±4.0 ms vs −16.1±4.8 ms, p=0.04) and N-terminal pro-brain natriuretic peptide (NT-proBNP) over reference range (n=27 (23%) vs n=8 (77%), p<0.001) were associated with higher incidence of VA. QRS duration was longer in men (151±30 ms vs 128±25 ms, p<0.001). No patients had QRS duration >180 ms. QRS duration did not differ in those with and without VA (143±32 ms vs 137±28 ms, p=0.06). Conclusions Our results confirmed reduced RV function in adults operated for TOF. Male patients had impaired LV and RV function expressed by lower LV and RV GLS values at all ages. Reduced cardiac function and elevated NT-proBNP were associated with higher incidence of VA and may be important in risk assessment.

• Andersen, Øyvind Senstad; Krogh, Magnus Reinsfelt; Bøe, Espen Andreas Matthew; Storsten, Petter; Aalen, John & Larsen, Camilla Kjellstad [Vis alle 10 forfattere av denne artikkelen] (2020). Left bundle branch block increases left ventricular diastolic pressure during tachycardia due to incomplete relaxation. Journal of applied physiology. ISSN 8750-7587. 128(4), s. 729–738. doi: 10.1152/japplphysiol.01002.2018. Fulltekst i vitenarkiv Vis sammendrag

  We investigated whether tachycardia in left bundle branch block (LBBB) decreases left ventricular (LV) diastolic distensibility and increases diastolic pressures due to incomplete relaxation, and if cardiac resynchronization therapy (CRT) modifies this response. Thirteen canines were studied at baseline heart rate (120 beats/min) and atrial paced tachycardia (180 beats/min) before and after induction of LBBB and during CRT. LV and left atrial pressures (LAP) were measured by micromanometers and dimensions by sonomicrometry. The time constant τ of exponential pressure decay and degree of incomplete relaxation at mitral valve opening (MVO) and end diastole (ED) based on extrapolation of the exponential decay were assessed. Changes in LV diastolic distensibility were investigated using the LV transmural pressure-volume (PV) relation. LBBB caused prolongation of τ ( P &lt; 0.03) and increased the degree of incomplete relaxation during tachycardia at MVO ( P &lt; 0.001) and ED ( P = 0.08) compared with normal electrical activation. This was associated with decreased diastolic distensibility seen as upward shift of the PV relation at MVO by 18.4 ± 7.0 versus 12.0 ± 5.0 mmHg, at ED by 9.8 ± 2.3 versus 4.7 ± 2.3 mmHg, and increased mean LAP to 11.4 ± 2.7 versus 8.5 ± 2.6 mmHg, all P &lt; 0.006. CRT shifted the LV diastolic PV relation downwards during tachycardia, reducing LAP and LV diastolic pressures ( P &lt; 0.03). Tachycardia in LBBB reduced LV diastolic distensibility and increased LV diastolic pressures due to incomplete relaxation, whereas CRT normalized these effects. Clinical studies are needed to determine whether a similar mechanism contributes to dyspnea and exercise intolerance in LBBB and if effects of CRT are heart rate dependent. NEW &amp; NOTEWORTHY Compared with normal electrical conduction, tachycardia in left bundle branch block resulted in incomplete relaxation during filling, particularly of the late activated left ventricular lateral wall. This further resulted in reduced left ventricular diastolic distensibility and elevated diastolic pressures and thus amplified the benefits of cardiac resynchronization therapy in this setting.

• Chivulescu, Ana Monica; Lie, Øyvind Haugen; Popescu, Bogdan A.; Skulstad, Helge; Edvardsen, Thor & Jurcut, Ruxandra [Vis alle 7 forfattere av denne artikkelen] (2020). High penetrance and similar disease progression in probands and in family members with arrhythmogenic cardiomyopathy. European Heart Journal. ISSN 0195-668X. 41(14), s. 1401–1410. doi: 10.1093/eurheartj/ehz570. Fulltekst i vitenarkiv Vis sammendrag

  Aims We aimed to assess structural progression in arrhythmogenic cardiomyopathy (AC) patients and mutation-positive family members and its impact on arrhythmic outcome in a longitudinal cohort study. Methods and results Structural progression was defined as the development of new Task Force imaging criteria from inclusion to follow-up and progression rates as annual changes in imaging parameters. We included 144 AC patients and family members (48% female, 47% probands, 40 ± 16 years old). At genetic diagnosis and inclusion, 58% of family members had penetrant AC disease. During 7.0 [inter-quartile range (IQR) 4.5–9.4] years of follow-up, 47% of family members without AC at inclusion developed AC criteria, resulting in a yearly new AC penetrance of 8%. Probands and family members had a similar progression rate of right ventricular outflow tract diameter (0.5 mm/year vs. 0.6 mm/year, P = 0.28) by mixed model analysis of 598 echocardiographic examinations. Right ventricular fractional area change progression rate was even higher in family members (−0.6%/year vs. −0.8%/year, P < 0.01). Among 86 patients without overt structural disease or arrhythmic history at inclusion, a first severe ventricular arrhythmic event occurred in 8 (9%), of which 7 (88%) had concomitant structural progression. Structural progression was associated with higher incidence of severe ventricular arrhythmic events adjusted for age, sex, and proband status (HR 21.24, 95% CI 2.47–182.81, P < 0.01). Conclusion More than half of family members had AC criteria at genetic diagnosis and yearly AC penetrance was 8%. Structural progression was similar in probands and family members and was associated with higher incidence of severe ventricular arrhythmic events.

• Wisløff-Aase, Kristin; Kerans, Viesturs; Haugaa, Kristina; Halvorsen, Per Steinar; Skulstad, Helge & Espinoza, Andreas Westenvik (2020). Changes in left ventricular electromechanical relations during targeted hypothermia. Intensive Care Medicine Experimental. 8(1). doi: 10.1186/s40635-020-00363-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Targeted hypothermia, as used after cardiac arrest, increases electrical and mechanical systolic duration. Differences in duration of electrical and mechanical systole are correlated to ventricular arrhythmias. The electromechanical window (EMW) becomes negative when the electrical systole outlasts the mechanical systole. Prolonged electrical systole corresponds to prolonged QT interval, and is associated with increased dispersion of repolarization and mechanical dispersion. These three factors predispose for arrhythmias. The electromechanical relations during targeted hypothermia are unknown. We wanted to explore the electromechanical relations during hypothermia at 33 °C. We hypothesized that targeted hypothermia would increase electrical and mechanical systolic duration without more profound EMW negativity, nor an increase in dispersion of repolarization and mechanical dispersion. Methods In a porcine model (n = 14), we registered electrocardiogram (ECG) and echocardiographic recordings during 38 °C and 33 °C, at spontaneous and atrial paced heart rate 100 beats/min. EMW was calculated by subtracting electrical systole; QT interval, from the corresponding mechanical systole; QRS onset to aortic valve closure. Dispersion of repolarization was measured as time from peak to end of the ECG T wave. Mechanical dispersion was calculated by strain echocardiography as standard deviation of time to peak strain. Results Electrical systole increased during hypothermia at spontaneous heart rate (p < 0.001) and heart rate 100 beats/min (p = 0.005). Mechanical systolic duration was prolonged and outlasted electrical systole independently of heart rate (p < 0.001). EMW changed from negative to positive value (− 20 ± 19 to 27 ± 34 ms, p = 0.001). The positivity was even more pronounced at heart rate 100 beats/min (− 25 ± 26 to 41 ± 18 ms, p < 0.001). Dispersion of repolarization decreased (p = 0.027 and p = 0.003), while mechanical dispersion did not differ (p = 0.078 and p = 0.297). Conclusion Targeted hypothermia increased electrical and mechanical systolic duration, the electromechanical window became positive, dispersion of repolarization was slightly reduced and mechanical dispersion was unchanged. These alterations may have clinical importance. Further clinical studies are required to clarify whether corresponding electromechanical alterations are accommodating in humans.

• Espinoza, Andreas Westenvik; Kerans, Viesturs; Bugge, Jan F; Skulstad, Helge & Halvorsen, Per Steinar (2020). Left Ventricular Function During Epinephrine Stimulation and Hypothermia: Effects at Spontaneous and Paced Heart Rates in a Porcine Model. Therapeutic Hypothermia and Temperature Management. ISSN 2153-7658. s. 35–44. doi: 10.1089/ther.2019.0035. Fulltekst i vitenarkiv
• Skulstad, Helge; Cosyns, Bernard; Popescu, Bogdan A.; Galderisi, Maurizio; Salvo, Giovanni Di & Donal, Erwan [Vis alle 23 forfattere av denne artikkelen] (2020). COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 21(6), s. 592–598. doi: 10.1093/ehjci/jeaa072. Fulltekst i vitenarkiv
• Storsten, Petter; Aalen, John; Bøe, Espen Andreas Matthew; Remme, Espen W.; Gjesdal, Ola & Larsen, Camilla Kjellstad [Vis alle 13 forfattere av denne artikkelen] (2020). Mechanical effects on right ventricular function from left bundle branch block and cardiac resynchronization therapy. JACC Cardiovascular Imaging. ISSN 1936-878X. 13(7), s. 1475–1484. doi: 10.1016/j.jcmg.2019.11.016. Fulltekst i vitenarkiv Vis sammendrag

  Objectives The purpose of this study was to investigate how LBBB and CRT modify RV free wall function by direct ventricular interaction. Background Right ventricular (RV) function influences prognosis in patients with left bundle branch block (LBBB) and cardiac resynchronization therapy (CRT). There is, however, limited insight into how LBBB and CRT affect RV function. Methods In 24 patients with LBBB with nonischemic cardiomyopathy, RV and left ventricular (LV) strain by speckle-tracking echocardiography was measured before and after CRT. Underlying mechanisms were studied in 16 anesthetized dogs with ultrasonic dimension crystals and micromanometers. Results Patients with LBBB demonstrated distinct early systolic shortening in the RV free wall, which coincided with the typical abnormal early systolic septal shortening. In animals, this RV free wall contraction pattern resulted in reduced myocardial work as a large portion of the shortening occurred against low pressure during early systole, coinciding with abnormal leftward septal motion. RV systolic function was maintained by vigorous contraction in the late-activated LV lateral wall, which pushed the septum toward the RV. CRT reduced abnormal septal motion and increased RV free wall work because there was less inefficient shortening against low pressure. Conclusions LBBB reduces workload on the RV free wall because of abnormal septal motion and delayed activation of the LV lateral wall. Restoring septal and LV function by CRT increases workload in RV free wall and may explain why patients with RV failure respond poorly to CRT. (Contractile Reserve in Dyssynchrony: A Novel Principle to Identify Candidates for Cardiac Resynchronization Therapy [CRID-CRT]; NCT02525185)

• Muthiah, Anujan; Beitnes, Jan Otto & Skulstad, Helge (2020). Patients with infective endocarditis referred to Division of Cardiovascular and Pulmonary Diseases at Oslo University Hospital between 2014 and 2017. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 54(4), s. 258–264. doi: 10.1080/14017431.2020.1734232. Fulltekst i vitenarkiv Vis sammendrag

  Objectives. Infective endocarditis has potential for severe complications and high mortality. The number of patients with prosthetic valves has risen, and an increase in incidence of infective endocarditis has been suggested. We aimed to examine the epidemiology, etiology, treatment and outcome of patients admitted to Division of Cardiovascular and Pulmonary Diseases at Oslo University Hospital, and explore changes in incidence over the last four years. Design. We conducted a retrospective study including all patients admitted to a tertiary hospital in Oslo, Norway, and diagnosed with infective endocarditis according to ICD-10 between 2014 and 2017. Results. Two hundred and ninety-one patients ≥18 years were included (61.3 ± 13.8 years, 75.6% men). 36.4% had previous valve surgery and this proportion decreased during the period. The aortic valve was most commonly affected (51.9%). Streptococci were the most frequent microorganisms (35.1%), while staphylococci accounted for 26.8%. 81.8% were treated surgically, at a median of 6.5 (0–120) days after admission. Hemodynamic changes or instability was the primary surgical indication (51.5%). One-year mortality was 20.6%. Surgery within a week after admission resulted in poorer 1-year prognosis than surgery after one week. Also, surgically treated patients who died were significantly older than those who survived. Conclusions. In this cohort, streptococci were the most common causative microorganism. Approximately, one-third of the patients had prosthetic valves. Mortality remains high, underscoring the need for continuous medical awareness. A high number of streptococcus infections in this cohort suggest dental origin.

• Schalit, Itai; Espinoza, Andreas Westenvik; Pettersen, Fred-Johan; Snartland, Steinar; Ringdal, Mari-Anne I Lindstein & Nilsen-Hoel, Tom [Vis alle 10 forfattere av denne artikkelen] (2020). Detection of thromboembolic events and pump thrombosis in heartware HVAD using accelerometer in a porcine model. ASAIO journal (1992). ISSN 1058-2916. s. 38–48. doi: 10.1097/MAT.0000000000000954. Fulltekst i vitenarkiv
• Pischke, Søren; Hestenes, Siv Merete; Johansen, Harald Thidemann; Fure, Hilde; Bugge, Jan F & Espinoza, Andreas Westenvik [Vis alle 12 forfattere av denne artikkelen] (2019). Sepsis causes right ventricular myocardial inflammation independent of pulmonary hypertension in a porcine sepsis model. PLOS ONE. 14:e0218624(6). doi: 10.1371/journal.pone.0218624. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Right ventricular (RV) myocardial dysfunction is a common feature in septic shock. It can worsen outcome, but the etiology is poorly understood. Pulmonary artery hypertension (PAH) plays a part in the pathogenesis of the right heart dysfunction in sepsis but its importance is unknown. In pigs, PAH in sepsis is substantial and the translational value of porcine sepsis models therefore questioned. We hypothesized that porcine sepsis causes a myocardial inflammatory response which leads to myocardial dysfunction independent of PAH. Materials and methods Sepsis was induced by Escherichia coli-infusion in 10 pigs resulting in PAH and increased right ventricular pressure (RVP). The same degree of RVP was achieved by external pulmonary artery banding (PAB) in a consecutive series of 6 animals. Results Sepsis, but not PAB, led to increase in endothelial damage marker PAI-1 and cytokines TNF and IL-6 (all p<0.05) in plasma. In myocardium, TNF and IL-6 were significantly elevated in sepsis, TNF in both ventricles and IL-6 mostly in RV, while IL-1β, IL-18 and C5a were significantly higher in RV compared to LV after PAB (all p<0.05). Myocardial mRNA levels of IL-1β, IL-6, IL-18, IP-10, E-selectin and PAI-1 were significantly elevated in RV and LV during sepsis compared to PAB, while Caspase-1 was decreased in septic compared to PAB animals (all p<0.05). Cathepsin L activity was increased in RV by PAB, while sepsis inhibited this response. Escherichia coli-induced sepsis caused myocardial inflammation independent of PAH. Conclusion Prominent PAH should therefore not exclude porcine sepsis models to further our understanding of human sepsis.

• Aalen, John; Remme, Espen W.; Larsen, Camilla Kjellstad; Andersen, Øyvind Senstad; Krogh, Magnus Reinsfelt & Duchenne, Jürgen [Vis alle 16 forfattere av denne artikkelen] (2019). Mechanism of abnormal septal motion in left bundle branch block: Role of left ventricular wall interactions and myocardial scar. JACC Cardiovascular Imaging. ISSN 1936-878X. 12(12), s. 2402–2413. doi: 10.1016/j.jcmg.2018.11.030. Fulltekst i vitenarkiv Vis sammendrag

  Objectives This study sought to investigate how regional left ventricular (LV) function modifies septal motion in left bundle branch block (LBBB). Background In LBBB, the interventricular septum often has marked pre-ejection shortening, followed by immediate relengthening (rebound stretch). This motion, often referred to as septal flash, is associated with positive response to cardiac resynchronization therapy (CRT). Methods In 10 anesthetized dogs, we induced LBBB by radiofrequency ablation and occluded the circumflex (CX) (n = 10) and left anterior descending (LAD) (n = 6) coronary arteries, respectively. Myocardial dimensions were measured by sonomicrometry and myocardial work by pressure-segment length analysis. In 40 heart failure patients with LBBB, including 20 with post-infarct scar and 20 with nonischemic cardiomyopathy, myocardial strain was measured by speckle-tracking echocardiography and myocardial work by pressure-strain analysis. Scar was assessed by cardiac magnetic resonance imaging with late gadolinium enhancement. Results During LBBB, each animal showed typical septal flash with pre-ejection shortening and rebound stretch, followed by reduced septal systolic shortening (p < 0.01). CX occlusion caused LV lateral wall dysfunction and abolished septal flash due to loss of rebound stretch (p < 0.0001). Furthermore, CX occlusion restored septal systolic shortening to a similar level as before induction of LBBB and substantially improved septal work (p < 0.001). LAD occlusion, however, accentuated septal flash by increasing rebound stretch (p < 0.05). Consistent with the experimental findings, septal flash was absent in patients with LV lateral wall scar due to lack of rebound stretch (p < 0.001), and septal systolic shortening and septal work far exceeded values in nonischemic cardiomyopathy (p < 0.0001). Septal flash was present in most patients with anteroseptal scar. Conclusions LV lateral wall dysfunction and scar abolished septal flash and markedly improved septal function in LBBB. Therefore, function and scar in the LV lateral wall should be taken into account when septal motion is used to evaluate dyssynchrony.

• Smiseth, Otto A.; Kjeldsen, Sverre; Andersen, Øyvind Senstad; Mistry, Nisha; Westheim, Arne & Skulstad, Helge [Vis alle 7 forfattere av denne artikkelen] (2019). Hjertesvikt med normal ejeksjonsfraksjon. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 139(6), s. 522–527. doi: 10.4045/tidsskr.18.0523. Fulltekst i vitenarkiv
• Bøe, Espen Andreas Matthew; Skulstad, Helge & Smiseth, Otto A. (2019). Myocardial work by echocardiography: A novel method ready for clinical testing. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 20(1), s. 18–20. doi: 10.1093/ehjci/jey156. Fulltekst i vitenarkiv
• Bøe, Espen Andreas Matthew; Smiseth, Otto A.; Storsten, Petter; Andersen, Øyvind Senstad; Aalen, John & Eriksen, Morten [Vis alle 10 forfattere av denne artikkelen] (2019). Left ventricular end-systolic volume is a more sensitive marker of acute response to cardiac resynchronization therapy than contractility indices: Insights from an experimental study. Europace. ISSN 1099-5129. 21(2), s. 347–355. doi: 10.1093/europace/euy221. Fulltekst i vitenarkiv Vis sammendrag

  Aims There are conflicting data and no consensus on how to measure acute response to cardiac resynchronization therapy (CRT). This study investigates, which contractility indices are best markers of acute CRT response. Methods and results In eight anaesthetized dogs with left bundle branch block, we measured left ventricular (LV) pressure by micromanometer and end-diastolic volume (EDV) and end-systolic volume (ESV) by sonomicrometry. Systolic function was measured as LV ejection fraction (EF), peak rate of LV pressure rise (LV dP/dtmax) and as a gold standard of contractility, LV end-systolic elastance (Ees), and volume axis intercept (V0) calculated from end-systolic pressure–volume relations (ESPVR). Responses to CRT were compared with inotropic stimulation by dobutamine. Both CRT and dobutamine caused reduction in ESV (P < 0.01) and increase in LV dP/dtmax (P < 0.05). Both interventions shifted the ESPVR upwards indicating increased contractility, but CRT which reduced V0 (P < 0.01), caused no change in Ees. Dobutamine markedly increased Ees, which is the typical response to inotropic stimulation. Preload (EDV) was decreased (P < 0.01) by CRT, and there was no change in EF. When adjusting for the reduction in preload, CRT increased EF (P = 0.02) and caused a more marked increase in LV dP/dtmax (P < 0.01). Conclusion Increased contractility by CRT could not be identified by Ees, which is a widely used reference method for contractility. Furthermore, reduction in preload by CRT attenuated improvement in contractility indices such as EF and LV dP/dtmax. These results suggest that changes in LV volume may be more sensitive markers of acute CRT response than conventional contractility indices.

• Bergan, Harald Arne; Halvorsen, Per Steinar; Espinoza, Andreas Westenvik; Kerans, Viesturs; Skulstad, Helge & Fosse, Erik [Vis alle 7 forfattere av denne artikkelen] (2018). Left ventricle function during therapeutic hypothermia with beta&lt;sub&gt;1&lt;/sub&gt;-adrenergic receptor blockade. Therapeutic Hypothermia and Temperature Management. ISSN 2153-7658. 8(3), s. 156–164. doi: 10.1089/ther.2017.0051. Fulltekst i vitenarkiv
• Aalen, John; Storsten, Petter; Remme, Espen W.; Sirnes, Per A.; Gjesdal, Ola & Larsen, Camilla Kjellstad [Vis alle 11 forfattere av denne artikkelen] (2018). Afterload hypersensitivity in patients with left bundle branch block. JACC Cardiovascular Imaging. ISSN 1936-878X. s. 1–11. doi: 10.1016/j.jcmg.2017.11.025. Fulltekst i vitenarkiv
• Storsten, Petter; Eriksen, Morten; Remme, Espen W.; Bøe, Espen Andreas Matthew; Erikssen, Gunnar & Smiseth, Otto A. [Vis alle 7 forfattere av denne artikkelen] (2018). Dysfunction of the systemic right ventricle after atrial switch: physiological implications of altered septal geometry and load. Journal of applied physiology. ISSN 8750-7587. 125(5), s. 1482–1489. doi: 10.1152/japplphysiol.00255.2018. Fulltekst i vitenarkiv Vis sammendrag

  Atrial switch operation in patients with transposition of the great arteries (TGA) leads to leftward shift and changes the geometry of the interventricular septum. By including the implications of regional work and septal curvature, this study investigates if changes in septal function and geometry contribute to reduced function of the systemic right ventricle (RV) in adult TGA patients. Regional myocardial work estimation has been possible by applying a recently developed method for noninvasive work calculation based on echocardiography. In 14 TGA patients (32 ± 6 yr, means ± SD) and 14 healthy controls, systemic ventricular systolic strains were measured by speckle tracking echocardiography and regional work was calculated by pressure-strain analysis. In TGA patients, septal longitudinal strain was reduced to −14 ± 2 vs. −20 ± 2% in controls ( P &lt; 0.01) and septal work was reduced from 2,046 ± 318 to 1,146 ± 260 mmHg·% ( P &lt; 0.01). Septal circumferential strain measured in a subgroup of patients was reduced to −11 ± 3 vs. −27 ± 3% in controls ( P &lt; 0.01), and a reduction of septal work (540 ± 273 vs. 2,663 ± 459 mmHg·%) was seen ( P &lt; 0.01). These reductions were in part attributed to elevated afterload due to increased radius of curvature of the leftward shifted septum. To conclude, in this mechanistic study we demonstrate that septal dysfunction contributes to failure of the systemic RV after atrial switch in TGA patients. This is potentially a long-term response to increased afterload due to a flatter septum and suggests that medical therapy that counteracts septal flattening may improve function of the systemic RV. NEW &amp; NOTEWORTHY We have demonstrated that transposition of the great arteries patients with systemic right ventricles (RVs) have reduced function of the interventricular septum (IVS). Since the IVS is constructed to eject into the systemic circulation, it may seem unexpected that it does not maintain function when being part of the systemic RV. By applying the principles of regional work, wall tension, and geometry, we have identified unfavorable working conditions for the IVS when the RV adapts to systemic pressures.

• Erikssen, Gunnar; Aboulhosn, Jamil; Lin, Jeannette; Liestøl, Knut; Estensen, Mette-Elise & Gjesdal, Ola [Vis alle 9 forfattere av denne artikkelen] (2018). Survival in patients with univentricular hearts: The impact of right versus left ventricular morphology. Open heart. 5:e000902(2), s. 1–9. doi: 10.1136/openhrt-2018-000902. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Patients with univentricular hearts (UVH) have high mortality despite modern treatment, and better methods to identify patients at highest risk are needed. We wanted to improve risk stratification in patients with UVH by focusing on the prognostic significance of single right versus single left ventricular morphology (SRV vs SLV). Methods: All 395 patients with UVH operated at our centre were prospectively included from 1972 to 2016 (195 SRV, 166 SLV, 34 mixed or indeterminate ventricular morphology). Diagnoses, UVH morphology, types of all operations and time and causes of death or heart transplantation (HTX) were recorded. The primary endpoint was death or HTX. Results: Among the 111 non-Fontan patients, 88 died (SRV 62 vs SLV 20; p<0.0001), 32 due to heart failure (SRV 23 vs SLV 5; p=0.0012). Twenty-five  years of cumulative SRV versus SLV survival among the 284 Fontan patients (41 deaths/HTX) was 66.9% vs 87.9% (p=0.0027), partly explained by more deaths/HTX due to heart failure among patients with SRV (p=0.0006). Survival in patients with SRV with and without hypoplastic left heart syndrome (HLHS) was similar. SRV versus SLV was a strong predictor of death/HTX in multivariable proportional hazards analyses (RR 3.3, 95% CI 1.6 to 6.6). Conclusion: SRV versus SLV is a strong short-term and long-term predictor of survival among patients with UVH, mainly explained by higher rates of death/HTX due to heart failure in the SRV group. Our findings apply to patients with SRV both with and without HLHS.

• Hyler, Stefan; Espinoza, Andreas Westenvik; Skulstad, Helge; Fosse, Erik & Halvorsen, Per Steinar (2018). Corrigendum to ‘Left ventricular function can be continuously monitored with an epicardially attached accelerometer sensor’ [Eur J Cardiothorac Surg 2014;46:313–20]. European Journal of Cardio-Thoracic Surgery. ISSN 1010-7940. 54(5), s. 968–968. doi: 10.1093/ejcts/ezy340. Fulltekst i vitenarkiv
• Pischke, Søren Erik; Gustavsen, Alice; Orrem, Hilde Lang; Egge, Kjetil Hagene; Courivaud, Fredric A A & Fontenelle, Hugues [Vis alle 15 forfattere av denne artikkelen] (2017). Complement factor 5 blockade reduces porcine myocardial infarction size and improves immediate cardiac function. Basic Research in Cardiology. ISSN 0300-8428. 112:20(3). doi: 10.1007/s00395-017-0610-9. Fulltekst i vitenarkiv Vis sammendrag

  Inhibition of complement factor 5 (C5) reduced myocardial infarction in animal studies, while no benefit was found in clinical studies. Due to lack of cross-reactivity of clinically used C5 antibodies, different inhibitors were used in animal and clinical studies. Coversin (Ornithodoros moubata complement inhibitor, OmCI) blocks C5 cleavage and binds leukotriene B4 in humans and pigs. We hypothesized that inhibition of C5 before reperfusion will decrease infarct size and improve ventricular function in a porcine model of myocardial infarction. In pigs (Sus scrofa), the left anterior descending coronary artery was occluded (40 min) and reperfused (240 min). Coversin or placebo was infused 20 min after occlusion and throughout reperfusion in 16 blindly randomized pigs. Coversin significantly reduced myocardial infarction in the area at risk by 39% (p = 0.03, triphenyl tetrazolium chloride staining) and by 19% (p = 0.02) using magnetic resonance imaging. The methods correlated significantly (R = 0.92, p < 0.01). Tissue Doppler echocardiography showed increased systolic displacement (31%, p < 0.01) and increased systolic velocity (29%, p = 0.01) in coversin treated pigs. Interleukin-1β in myocardial microdialysis fluid was significantly reduced (31%, p < 0.05) and tissue E-selectin expression was significantly reduced (p = 0.01) in the non-infarcted area at risk by coversin treatment. Coversin ablated plasma C5 activation throughout the reperfusion period and decreased myocardial C5b-9 deposition, while neither plasma nor myocardial LTB4 were significantly reduced. Coversin substantially reduced the size of infarction, improved ventricular function, and attenuated interleukin-1β and E-selectin in this porcine model by inhibiting C5. We conclude that inhibition of C5 in myocardial infarction should be reconsidered.

• Grymyr, Ole-Johannes; Beitnes, Jan Otto; Eidet, Jo; Tølløfsrud, Stein G.; Fiane, Arnt E & Skulstad, Helge [Vis alle 8 forfattere av denne artikkelen] (2017). Detection of intraoperative myocardial dysfunction by accelerometer during aortic valve replacement. Interactive Cardiovascular and Thoracic Surgery. ISSN 1569-9293. 24(2), s. 188–195. doi: 10.1093/icvts/ivw326. Fulltekst i vitenarkiv
• Bergan, Harald Arne; Halvorsen, Per Steinar; Skulstad, Helge; Fosse, Erik & Bugge, Jan F (2016). Does therapeutic hypothermia during extracorporeal cardiopulmonary resuscitation preserve cardiac function? Journal of Translational Medicine. 14(1). doi: 10.1186/s12967-016-1099-y. Fulltekst i vitenarkiv Vis sammendrag

  Background Extracorporeal cardiopulmonary resuscitation (E-CPR) is increasingly used as a rescue method in the management of cardiac arrest and provides the opportunity to rapidly induce therapeutic hypothermia. The survival after a cardiac arrest is related to post-arrest cardiac function, and the application of therapeutic hypothermia post-arrest is hypothesized to improve cardiac outcome. The present animal study compares normothermic and hypothermic E-CPR considering resuscitation success, post-arrest left ventricular function and magnitude of myocardial injury. Methods After a 15-min untreated ventricular fibrillation, the pigs (n = 20) were randomized to either normothermic (38 °C) or hypothermic (32–33 °C) E-CPR. Defibrillation terminated ventricular fibrillation after 5 min of E-CPR, and extracorporeal support continued for 2 h, followed by warming, weaning and a stabilization period. Magnetic resonance imaging and left ventricle pressure measurements were used to assess left ventricular function pre-arrest and 5 h post-arrest. Myocardial injury was estimated by serum concentrations of cardiac TroponinT and Aspartate transaminase (ASAT). Results E-CPR resuscitated all animals and the hypothermic strategy induced therapeutic hypothermia within minutes without impairment of the resuscitation success rate. All animals suffered a severe global systolic left ventricular dysfunction post-arrest with 50–70% reductions in stroke volume, ejection fraction, wall thickening, strain and mitral annular plane systolic excursion. Serum concentrations of cardiac TroponinT and ASAT increased considerably post-arrest. No significant differences were found between the two groups. Conclusions Two-hour therapeutic hypothermia during E-CPR offers an equal resuscitation success rate, but does not preserve the post-arrest cardiac function nor reduce the magnitude of myocardial injury, compared to normothermic E-CPR. Trial registration FOTS 4611/13 registered 25 October 2012

• Erikssen, Gunnar; Liestøl, Knut; Seem, Egil; Birkelance, Sigurce; Saatvedt, Kjell & Nilsen-Hoel, Tom [Vis alle 11 forfattere av denne artikkelen] (2015). Achievements in congenital heart defect surgery: A prospective, 40-year study of 7038 patients. Circulation. ISSN 0009-7322. 131, s. 337–346. doi: 10.1161/CIRCULATIONAHA.114.012033. Fulltekst i vitenarkiv
• Pischke, Søren Erik; Hyler, Stefan; Tronstad, Christian; Bergsland, Jacob; Fosse, Erik & Halvorsen, Per Steinar [Vis alle 8 forfattere av denne artikkelen] (2015). Myocardial tissue CO2 tension detects coronary blood flow reduction after coronary artery bypass in real-time. British Journal of Anaesthesia. ISSN 0007-0912. 114(3), s. 414–422. doi: 10.1093/bja/aeu381. Fulltekst i vitenarkiv
• Kerans, Viesturs; Espinoza, Andreas Westenvik; Skulstad, Helge; Halvorsen, Per Steinar; Edvardsen, Thor & Bugge, Jan F (2015). Systolic left ventricular function is preserved during therapeutic hypothermia, also during increases in heart rate with impaired diastolic filling. Intensive Care Medicine Experimental. 3(1), s. 1–17. doi: 10.1186/s40635-015-0041-6. Fulltekst i vitenarkiv Vis sammendrag

  Background Systolic left ventricular function during therapeutic hypothermia is found both to improve and to decline. We hypothesized that this discrepancy would depend on the heart rate and the variables used to assess systolic function. Methods In 16 pigs, cardiac performance was assessed by measurements of invasive pressures and thermodilution cardiac output and with 2D strain echocardiography. Left ventricle (LV) volumes, ejection fraction (EF), transmitral flow, and circumferential and longitudinal systolic strain were measured. Miniaturized ultrasonic transducers were attached to the epicardium of the LV to obtain M-mode images, systolic thickening, and diastolic thinning velocities and to determine LV pressure-wall dimension relationships. Preload recruitable stroke work (PRSW) was calculated. Measurements were performed at 38 and 33°C at spontaneous and paced heart rates, successively increased in steps of 20 up to the toleration limit. Effects of temperature and heart rate were compared in a mixed model analysis. Results Hypothermia reduced heart rate from 87 ± 10 (SD) to 76 ± 11 beats/min without any changes in LV stroke volume, end-diastolic volume, EF, strain values, or PRSW. Systolic wall thickening velocity (S′) and early diastolic wall thinning velocity decreased by approximately 30%, making systolic duration longer through a prolonged and slow contraction and changing the diastolic filling pattern from predominantly early towards late. Pacing reduced diastolic duration much more during hypo- than during normothermia, and combined with slow myocardial relaxation, incomplete relaxation occurred with all pacing rates. Pacing did not affect S′ or PRSW at physiological heart rates, but stroke volume, end-diastolic volume, and strain were reduced as a consequence of reduced diastolic filling and much more accentuated during hypothermia. At the ultimate tolerable heart rate during hypothermia, S′ decreased, probably as a consequence of myocardial hypoperfusion due to sustained ventricular contraction throughout a very short diastole. Conclusions Systolic function was maintained at physiological heart rates during therapeutic hypothermia. Reduced tolerance to increases in heart rate was caused by lack of ventricular filling due to diastolic dysfunction and shorter diastolic duration.

• Grymyr, Ole-Johannes; Remme, Espen W.; Espinoza, Andreas Westenvik; Skulstad, Helge; Elle, Ole Jakob & Fosse, Erik [Vis alle 7 forfattere av denne artikkelen] (2015). Assessment of 3D motion increases the applicability of accelerometers for monitoring left ventricular function. Interactive Cardiovascular and Thoracic Surgery. ISSN 1569-9293. 20(3), s. 329–337. doi: 10.1093/icvts/ivu404. Fulltekst i vitenarkiv
• Bøe, Espen; Russell, Kristoffer; Eek, Christian; Eriksen, Morten; Remme, Espen W. & Smiseth, Otto A. [Vis alle 7 forfattere av denne artikkelen] (2015). Non-invasive myocardial work index identifies acute coronary occlusion in patients with non-STsegment elevation-acute coronary syndrome. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 16(11), s. 1247–1255. doi: 10.1093/ehjci/jev078. Fulltekst i vitenarkiv
• Opdahl, Anders; Helle-Valle, Thomas Michael; Skulstad, Helge & Smiseth, Otto A. (2015). Strain, strain rate, torsion, and twist: echocardiographic evaluation. Current Cardiology Reports. ISSN 1523-3782. 17(3), s. 1–14. doi: 10.1007/s11886-015-0568-x. Fulltekst i vitenarkiv
• Smedsrud, Marit Kristine; Gravning, Jørgen A.; Omland, Torbjørn; Eek, Christian; Mørkrid, Lars & Skulstad, Helge [Vis alle 10 forfattere av denne artikkelen] (2015). Sensitive cardiac troponins and N-terminal pro-B-type natriuretic peptide in stable coronary artery disease: correlation with left ventricular function as assessed by myocardial strain. The International Journal of Cardiovascular Imaging. ISSN 1569-5794. 31(5), s. 967–973. doi: 10.1007/s10554-015-0646-6. Fulltekst i vitenarkiv
• Hyler, Stefan; Pischke, Søren Erik; Halvorsen, Per Steinar; Espinoza, Andreas Westenvik; Bergsland, Jacob & Tønnessen, Tor Inge [Vis alle 8 forfattere av denne artikkelen] (2015). Continuous monitoring of regional function by a miniaturized ultrasound transducer allows early quantification of low-grade myocardial ischemia. Journal of the American Society of Echocardiography. ISSN 0894-7317. 28(4), s. 486–494. doi: 10.1016/j.echo.2014.12.014. Fulltekst i vitenarkiv
• Grymyr, Ole-Johannes; Thai, Anh Tuan Nguyen; Tjulkins, Fjodors; Espinoza, Andreas Westenvik; Remme, Espen W. & Skulstad, Helge [Vis alle 9 forfattere av denne artikkelen] (2015). Continuous monitoring of cardiac function by 3-dimensional accelerometers in a closed-chest pig model. Interactive Cardiovascular and Thoracic Surgery. ISSN 1569-9293. 21(5), s. 573–582. doi: 10.1093/icvts/ivv191. Fulltekst i vitenarkiv Vis sammendrag

  OBJECTIVES Cardiac wall motions reflect systolic and diastolic function. We have previously demonstrated the ability of a miniaturized three-axis (3D) accelerometer to monitor left ventricular function in experimental models and in patients. The main aim of this study was to investigate the clinical utility of the method for monitoring the left and right ventricular function during changes in global and regional cardiac function in a postoperative closed-chest situation. METHODS In 13 closed-chest pigs, miniaturized 3D accelerometers were placed on the left ventricle in the apical and basal regions and in the basal region of the right ventricle. An epicardial 3D motion vector was calculated from the acceleration signals in each heart region. Peak systolic velocity along this 3D vector (3D Vsys) was compared with the positive time derivative of the left and right ventricular pressure and with cardiac index during changes in global LV function (unloading, fluid loading, esmolol, dobutamine) and with ultrasound during regional left ventricular dysfunction (3-min occlusion of the left anterior descending coronary artery). RESULTS Significant and typical changes in accelerometer 3D Vsys were seen in all heart regions during changes in global cardiac function. 3D Vsys reflected the left and right ventricular contractility via significant correlations with the positive time derivative of the left and right ventricular pressure, r = 0.86 and r = 0.72, and with cardiac index r = 0.82 and r = 0.73 (all P < 0.001), respectively. The miniaturized accelerometers also detected regional dysfunction, but showed reduced ability to localize ischaemia as the 3D Vsys in all heart regions showed similar reductions during coronary artery occlusion. CONCLUSIONS Miniaturized 3D accelerometers placed on the heart can assess global and regional function in a closed-chest model. The technique may be used for continuous postoperative monitoring after cardiac surgery.

• Bergan, Harald Arne; Halvorsen, Per Steinar; Skulstad, Helge; Edvardsen, Thor; Fosse, Erik & Bugge, Jan F (2015). Successful ECMO-cardiopulmonary resuscitation with the associated post-arrest cardiac dysfunction as demonstrated by MRI. Intensive Care Medicine Experimental. 3. doi: 10.1186/s40635-015-0061-2. Fulltekst i vitenarkiv Vis sammendrag

  Background Veno-arterial extracorporeal membrane oxygenation (ECMO-CPR) is a life-saving rescue for selected patients when standard cardiopulmonary resuscitation fails. The use is increasing although the treatment modality is not fully established. Resuscitated patients typically develop a detrimental early post-arrest cardiac dysfunction that also deserves main emphasis. The present study investigates an ECMO-CPR strategy in pigs and assesses early post-arrest left ventricular function in detail. We hypothesised that a significant dysfunction could be demonstrated with this model using magnetic resonance imaging (MRI), not previously used early post-arrest. Methods In eight anaesthetised pigs, a 15-min ventricular fibrillation was resuscitated by an ECMO-CPR strategy of 150-min veno-arterial ECMO aiming at high blood flow rate and pharmacologically sustained aortic blood pressure and pulse pressure of 50 and 15 mmHg, respectively. Pre-arrest cardiac MRI and haemodynamic measurements of left ventricular function were compared to measurements performed 300-min post-arrest. Results All animals were successfully resuscitated, weaned from the ECMO circuit, and haemodynamically stabilised post-arrest. Cardiac output was maintained by an increased heart rate post-arrest, but left ventricular ejection fraction and stroke volume were decreased by approximately 50 %. Systolic circumferential strain and mitral annular plane systolic excursion as well as the left ventricular wall thickening were reduced by approximately 50–70 % post-arrest. The diastolic function variables measured were unchanged. Conclusions The present animal study demonstrates a successful ECMO-CPR strategy resuscitating long-lasting cardiac arrest with adequate post-arrest haemodynamic stability. The associated severe systolic left ventricular dysfunction could be charted in detail by MRI, a valuable tool for future cardiac outcome assessments in resuscitation research.

• Hestenes, Siv Merete; Halvorsen, Per Steinar; Skulstad, Helge; Remme, Espen; Espinoza, Andreas Westenvik & Hyler, Stefan [Vis alle 10 forfattere av denne artikkelen] (2014). Advantages of strain echocardiography in assessment of myocardial function in severe sepsis: An experimental study. Critical Care Medicine. ISSN 0090-3493. 42(6), s. e432–e440. doi: 10.1097/CCM.0000000000000310. Fulltekst i vitenarkiv
• Hyler, Stefan; Espinoza, Andreas Westenvik; Skulstad, Helge; Fosse, Erik & Halvorsen, Per Steinar (2014). Left ventricular function can be continuously monitored with an epicardially attached accelerometer sensor. European Journal of Cardio-Thoracic Surgery. ISSN 1010-7940. 46(2), s. 313–320. doi: 10.1093/ejcts/ezt653. Fulltekst i vitenarkiv
• Bøe, Espen; Russell, Kristoffer; Remme, Espen; Gjesdal, Ola; Smiseth, Otto A. & Skulstad, Helge (2014). Cardiac responses to left ventricular pacing in hearts with normal electrical conduction: Beneficial effect of improved filling is counteracted by dyssynchrony. American Journal of Physiology. Heart and Circulatory Physiology. ISSN 0363-6135. 307(3), s. H370–H378. doi: 10.1152/ajpheart.00089.2014. Fulltekst i vitenarkiv
• Dahlslett, Thomas; Karlsen, Sigve; Grenne, Bjørnar; Eek, Christian; Sjøli, Benthe & Skulstad, Helge [Vis alle 9 forfattere av denne artikkelen] (2014). Early Assessment of Strain Echocardiography Can Accurately Exclude Significant Coronary Artery Stenosis in Suspected Non-ST-Segment Elevation Acute Coronary Syndrome. Journal of the American Society of Echocardiography. ISSN 0894-7317. 27(5), s. 512–519. doi: 10.1016/j.echo.2014.01.019. Fulltekst i vitenarkiv
• Zahid, Wasim; Eek, Christian; Remme, Espen W.; Skulstad, Helge; Fosse, Erik & Edvardsen, Thor (2014). Early systolic lengthening may identify minimal myocardial damage in patients With non-ST-elevation acute coronary syndrome. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. s. 1152–1160. doi: 10.1093/ehjci/jeu101. Fulltekst i vitenarkiv
• Zahid, Wasim; Johnson, Jonas; Westholm, Carl; Eek, Christian; Haugaa, Kristina & Smedsrud, Marit Kristine [Vis alle 10 forfattere av denne artikkelen] (2013). Mitral Annular Displacement by Doppler Tissue Imaging May Identify Coronary Occlusion and Predict Mortality in Patients with Non-ST-Elevation Myocardial Infarction. Journal of the American Society of Echocardiography. ISSN 0894-7317. 26(8), s. 875–884. doi: 10.1016/j.echo.2013.05.011. Fulltekst i vitenarkiv
• Russell, Kristoffer; Eriksen, Morten; Aaberge, Lars; Wilhelmsen, Nils Einar; Skulstad, Helge & Gjesdal, Ola [Vis alle 8 forfattere av denne artikkelen] (2013). Assessment of wasted myocardial work: a novel method to quantify energy loss due to uncoordinated left ventricular contractions. American Journal of Physiology. Heart and Circulatory Physiology. ISSN 0363-6135. 305(7), s. H996–H1003. doi: 10.1152/ajpheart.00191.2013. Fulltekst i vitenarkiv
• Espinoza, Andreas Westenvik; Kerans, Viesturs; Opdahl, Anders; Skulstad, Helge; Halvorsen, Per Steinar & Bugge, Jan F [Vis alle 8 forfattere av denne artikkelen] (2013). Effects of Therapeutic Hypothermia on Left Ventricular Function Assessed by Ultrasound Imaging. Journal of the American Society of Echocardiography. ISSN 0894-7317. 26(11), s. 1353–1363. doi: 10.1016/j.echo.2013.06.021. Fulltekst i vitenarkiv
• Gravning, Jørgen A.; Smedsrud, Marit Kristine; Omland, Torbjørn; Eek, Christian; Skulstad, Helge & Aaberge, Lars [Vis alle 10 forfattere av denne artikkelen] (2013). Sensitive troponin assays and N-terminal pro-B-type natriuretic peptide in acute coronary syndrome: Prediction of significant coronary lesions and long-term prognosis. American Heart Journal. ISSN 0002-8703. 165(5), s. 716–724. doi: 10.1016/j.ahj.2013.02.008. Fulltekst i vitenarkiv
• Skulstad, Helge & Aakhus, Svend (2012). Stressekkokardiografi med liggesykkel. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 132(19), s. 2175–2178. doi: 10.4045/tidsskr.11.1538. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn. Belastningsrelaterte symptomer er ofte årsaken til at pasienter med hjertesykdommer henvises til vurdering med ekkokardiografi. Vi presenterer en metode for evaluering med ekkokardiografi under samtidig fysiologisk belastning der pasienten undersøkes på liggesykkel i halvt sittende skråleie. Kunnskapsgrunnlag. Artikkelen er bygd på litteratursøk gjennom PubMed og egen erfaring med metoden. Resultater. Ergometrisk stressekkokardiografi kan brukes ved en rekke kardiale tilstander der man ønsker å vurdere kardial og hemodynamisk respons på fysiologisk belastning. Utredning og oppfølging av pasienter med hypertrofisk kardiomyopati, koarktasjon/rekoarktasjon, mitralklafflidelser og aortaklafflidelser har til nå vært de viktigste gruppene. Metoden kan også gi viktig informasjon ved pulmonal hypertensjon og medfødte hjertefeil. Fortolkning. Ergometrisk stressekkokardiografi er en ikke-invasiv metode med liten risiko. Dette er en relativt lett gjennomførbar undersøkelse og utgjør et viktig supplement til invasive metoder.

• Smiseth, Otto A.; Russell, Kristoffer & Skulstad, Helge (2012). The role of echocardiography in quantification of left ventricular dyssynchrony: state of the art and future directions. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 13(1), s. 61–68. doi: 10.1093/ehjci/jer243. Fulltekst i vitenarkiv
• Broch, Kaspar; Eek, Christian; Wergeland, Ragnhild; Ueland, Thor; Skårdal, Rita & Aukrust, Pål [Vis alle 8 forfattere av denne artikkelen] (2012). NT-proBNP predicts myocardial recovery after non-ST-elevation acute coronary syndrome. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 46(2), s. 65–71. doi: 10.3109/14017431.2011.652981. Fulltekst i vitenarkiv
• Russell, Kristoffer; Eriksen, Morten; Aaberge, Lars; Wilhelmsen, Nils Einar; Skulstad, Helge & Remme, Espen W. [Vis alle 12 forfattere av denne artikkelen] (2012). A novel clinical method for quantification of regional left ventricular pressure-strain loop area: a non-invasive index of myocardial work. European Heart Journal. ISSN 0195-668X. 33(6), s. 724–733. doi: 10.1093/eurheartj/ehs016. Fulltekst i vitenarkiv
• Grenne, Bjørnar Leangen; Eek, Christian; Sjøli, Benthe; Dahlslett, Thomas; Hol, Per Kristian & Ørn, Stein [Vis alle 10 forfattere av denne artikkelen] (2011). Mean Strain Throughout the Heart Cycle by Longitudinal Two-Dimensional Speckle-Tracking Echocardiography Enables Early Prediction of Infarct Size. Journal of the American Society of Echocardiography. ISSN 0894-7317. 24(10), s. 1118–1125. doi: 10.1016/j.echo.2011.06.002. Fulltekst i vitenarkiv
• Russell, Kristoffer; Smiseth, Otto A.; Gjesdal, Ola; Qvigstad, Eirik; Norseng, Per Andreas & Sjaastad, Ivar [Vis alle 10 forfattere av denne artikkelen] (2011). Mechanism of prolonged electromechanical delay in late activated myocardium during left bundle branch block. American Journal of Physiology. Heart and Circulatory Physiology. ISSN 0363-6135. 301, s. H2334–H2343. doi: 10.1152/ajpheart.00644.2011. Fulltekst i vitenarkiv
• Gjesdal, Ola; Remme, Espen; Opdahl, Anders; Skulstad, Helge; Russell, Kristoffer & Kongsgård, Erik [Vis alle 8 forfattere av denne artikkelen] (2011). Mechanisms of Abnormal Systolic Motion of the Interventricular Septum During Left Bundle-Branch Block. Circulation Cardiovascular Imaging. ISSN 1941-9651. 4(3), s. 264–U109. doi: 10.1161/CIRCIMAGING.110.961417. Fulltekst i vitenarkiv
• Haugaa, Kristina; Bergestuen, Deidi Ann; Shahakyan, Laura G; Skulstad, Helge; Aakhus, Svend & Thiis-Evensen, Espen [Vis alle 7 forfattere av denne artikkelen] (2011). Evaluation of Right Ventricular Dysfunction by Myocardial Strain Echocardiography in Patients with Intestinal Carcinoid Disease. Journal of the American Society of Echocardiography. ISSN 0894-7317. 24(6), s. 644–650. doi: 10.1016/j.echo.2011.02.009. Fulltekst i vitenarkiv
• Espinoza, Andreas Westenvik; Halvorsen, Per Steinar; Skulstad, Helge; Lundblad, Runar; Bugge, Jan Frederik & Hoff, Lars [Vis alle 8 forfattere av denne artikkelen] (2011). Automated detection of myocardial ischaemia by epicardial miniature ultrasound transducers - a novel tool for patient monitoring during cardiac surgery. European Journal of Cardio-Thoracic Surgery. ISSN 1010-7940. 39(1), s. 53–59. doi: 10.1016/j.ejcts.2010.03.067. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: Early detection of myocardial ischaemia in cardiac surgery is important. We have developed an ultrasonic system for continuous myocardial monitoring by use of miniature transducers. The aim of this study was to investigate the system's ability to detect ischaemia in patients undergoing off-pump coronary artery bypass grafting (CABG), and whether automated signal analysis could detect ischaemia. Methods: In 10 patients scheduled for CABG, ultrasound transducers were fixed to the epicardium in the area supplied by left anterior descending artery (LAD), and in a remote area for control. M-mode images with measurements of wall-thickening velocities were presented in real time and systolic (S?) and post-systolic velocities (PSVs) were recorded. An automated algorithm for ischaemia detection was developed, using end-systolic wall thickening as a fraction of total wall thickening. Registrations were made at baseline and during LAD occlusion. Echocardiographic strain was used as reference. Results: Nine of 10 patients developed ischaemia during LAD occlusion, with resulting decrease in systolic and increase in post-systolic wall-thickening velocities (P < 0.001). In these nine patients, Vdiff shifted below zero with no overlap between baseline and LAD occlusion (P < 0.001). The automated wall-thickening fraction was reduced from 0.93 ± 0.05 to 0.57 ± 0.15 (P = 0.001). A cut-off value of 0.85 could completely separate normal from ischaemic myocardium in all patients. Conclusion: The ultrasonic system detected regional ischaemia during LAD occlusion. An automated analysis algorithm demonstrated excellent ability to detect ischaemia. This technology can develop into a useful tool to detect ischaemia in cardiac surgery.

• Eek, Christian; Grenne, Bjørnar Leangen; Brunvand, Harald; Aakhus, Svend; Endresen, Knut & Smiseth, Otto A. [Vis alle 8 forfattere av denne artikkelen] (2011). Postsystolic shortening is a strong predictor of recovery of systolic function in patients with non-ST-elevation myocardial infarction. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 12(7), s. 483–489. doi: 10.1093/ejechocard/jer055. Fulltekst i vitenarkiv
• Espinoza, Andreas Westenvik; Halvorsen, Per Steinar; Hoff, Lars; Skulstad, Helge; Fosse, Erik & Ihlen, Halfdan [Vis alle 7 forfattere av denne artikkelen] (2010). Detecting myocardial ischaemia using miniature ultrasonic transducers - a feasibility study in a porcine model. European Journal of Cardio-Thoracic Surgery. ISSN 1010-7940. 37(1), s. 119–126. doi: 10.1016/j.ejcts.2009.05.013. Fulltekst i vitenarkiv Vis sammendrag

  Background: Detection of myocardial ischaemia during and after cardiac surgery remains a challenge. Echocardiography is more sensitive in ischaemia detection than echocardiography (ECG) and haemodynamic monitoring, but demands repeated examinations for monitoring over time. We have developed and validated an ultrasonic system that permits continuous real-time assessment of myocardial ischaemia using miniature epicardial ultrasound transducers. Methods: In an open-chest porcine model (n = 8), prototype ultrasound transducers were fixed on the epicardium in the left anterior descending and circumflex coronary artery supply regions, providing continuous measurement of transmural myocardial velocities. Peak systolic velocity and post-systolic velocity were recorded simultaneously with ECG, left ventricular pressure and arterial pressure. Two-dimensional (2D) echocardiographic strain was used as a reference. Global changes were induced by infusing fluid, epinephrine, nitroprusside and esmolol. Regional changes were induced by occluding the left anterior descending coronary artery (LAD). Subsequent LAD stenosis was performed in a subgroup, with flow reduction to 50% of baseline level and further to occlusion. Results: Systolic velocity in the LAD region decreased during LAD occlusion (0.9 +/- 0.1 to 0.1 +/- 0.1 cm s¯¹, P < 0.01), whereas post-systolic velocity increased (0.3 +/- 0.1 to 2.3 +/- 0.1 cm s¯¹, P < 0.01). No changes occurred in the circumflex coronary artery (CX) region. Severe ischaemia was confirmed by reduction in 2D echocardiography strain calculations. Changes in myocardial velocities assessed by miniature transducer during ischaemia differed from changes during all global interventions. Significant reduction in systolic velocity occurred at 50% LAD flow (0.9 +/- 0.1 to 0.5 +/- 0.1 cm s¯¹, P = 0.02) with further decrease on following occlusion (0.0 +/- 0.0 cm s¯¹, P < 0.01). Post-systolic velocity increased both from baseline to 50% LAD flow, and further to occlusion. Conclusion: The epicardial transducers provided continuous assessment of regional myocardial function and detected ischaemia with high sensitivity and specificity. Further development of this system may provide a useful tool for myocardial monitoring during and after cardiac surgery. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

• Grenne, Bjørnar Leangen; Eek, Christian; Sjøli, Benthe; Dahlslett, Thomas; Uchto, Michael & Hol, Per Kristian [Vis alle 10 forfattere av denne artikkelen] (2010). Acute coronary occlusion in non-ST-elevation acute coronary syndrome: outcome and early identification by strain echocardiography. Heart. ISSN 1355-6037. 96(19), s. 1550–1556. doi: 10.1136/hrt.2009.188391. Fulltekst i vitenarkiv
• Eek, Christian; Grenne, Bjørnar Leangen; Brunvand, Harald; Aakhus, Svend; Endresen, Knut & Smiseth, Otto A. [Vis alle 8 forfattere av denne artikkelen] (2010). Strain echocardiography predicts acute coronary occlusion in patients with non-ST-segment elevation acute coronary syndrome. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 11(6), s. 501–508. doi: 10.1093/ejechocard/jeq008. Fulltekst i vitenarkiv
• Halvorsen, Per Steinar; Remme, Espen W.; Espinoza, Andreas Westenvik; Skulstad, Helge; Lundblad, Runar & Bergsland, Jacob [Vis alle 11 forfattere av denne artikkelen] (2010). Automatic real-time detection of myocardial ischemia by epicardial accelerometer. Journal of Thoracic and Cardiovascular Surgery. ISSN 0022-5223. 139(4), s. 1026–1032. doi: 10.1016/j.jtcvs.2009.05.031. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Myocardial ischemia may be detected with epicardial accelerometers. We developed and tested automated algorithms for real-time detection of myocardial ischemia by accelerometer measurements in both experimental and clinical settings. Methods: In 10 pigs, an accelerometer was fixed to the epicardium in the area perfused by left anterior descending coronary artery. Acceleration and electrocardiogram were simultaneously recorded, and the QRS complex was automatically detected for exact timing of systole. Peak circumferential velocity and displacement were automatically calculated from epicardial acceleration signal within 150 milliseconds after peak R on electrocardiography. Global myocardial function was reduced by esmolol infusion, and regional function was altered by temporary left anterior descending occlusion. Automated ischemia detection analyses were tested in 7 patients during off-pump coronary artery bypass grafting. Left anterior descending coronary artery was occluded for 3 minutes before grafting. In both models, echocardiographic myocardial circumferential strain was used to confirm ischemia. Results: Systolic displacement changed most during left anterior descending occlusion. Negative displacement during ischemia was found in pigs (11.5 ± 2.3 to ?1.2 ± 2.8 mm, P < .01); regional hypokinesia was found in clinical study (12.8 ± 8.1 to 3.5 ± 4.4 mm, P < .01). Ischemia was confirmed by echocardiography in both settings. Esmolol infusion induced smaller changes in automated accelerometer measurements than did left anterior descending occlusion (P < .01). Conclusions: Automatic real-time detection of myocardial ischemia with epicardial accelerometer was feasible. Automated ischemia detection analysis may be used for continuous monitoring of myocardial ischemia during cardiac surgery.

• Grenne, Bjørnar Leangen; Eek, Christian; Sjøli, Benthe; Skulstad, Helge; Aakhus, Svend & Smiseth, Otto A. [Vis alle 8 forfattere av denne artikkelen] (2010). Changes of Myocardial Function in Patients with Non-ST-Elevation Acute Coronary Syndrome Awaiting Coronary Angiography. American Journal of Cardiology. ISSN 0002-9149. 105(9), s. 1212–1218. doi: 10.1016/j.amjcard.2009.12.036. Fulltekst i vitenarkiv
• Eek, Christian; Grenne, Bjørnar Leangen; Brunvand, Harald; Aakhus, Svend; Endresen, Knut & Hol, Per Kristian [Vis alle 10 forfattere av denne artikkelen] (2010). Strain Echocardiography and Wall Motion Score Index Predicts Final Infarct Size in Patients With Non-ST-Segment-Elevation Myocardial Infarction. Circulation Cardiovascular Imaging. ISSN 1941-9651. 3(2), s. 187–194. doi: 10.1161/CIRCIMAGING.109.910521. Fulltekst i vitenarkiv
• Russell, Kristoffer; Opdahl, Anders; Remme, Espen W.; Gjesdal, Ola; Skulstad, Helge & Kongsgård, Erik [Vis alle 8 forfattere av denne artikkelen] (2010). Evaluation of Left Ventricular Dyssynchrony by Onset of Active Myocardial Force Generation A Novel Method That Differentiates Between Electrical and Mechanical Etiologies. Circulation Cardiovascular Imaging. ISSN 1941-9651. 3(4), s. 405–414. doi: 10.1161/CIRCIMAGING.109.905539. Fulltekst i vitenarkiv

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• Witso, M; Luo, H; Frostelid, V; Selmer, Lisa Marie; Sørensen, Kristian & Fadnes, Solveig [Vis alle 13 forfattere av denne artikkelen] (2026). Changes in the basal-to-apical pressure drop estimated by blood speckle tracking reflect changes in left ventricular diastolic function. doi: 10.1093/ehjci/jeaf367.149. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Introduction Blood speckle tracking (BST) is a imaging modality which includes a new method for noninvasive estimation of pressure differences. The magnitude of the early diastolic left ventricular (LV) basal-to-apical intra-ventricular pressure drop (IVPD) is in part determined by relaxation rate and restoring forces. Noninvasive estimation of the IVPD by BST may therefore be of clinical interest. Purpose We performed interventions to vary relaxation rate and restoring forces and investigated if estimated IVPD by BST corresponded with invasively measured IVPD and varied according to these changes in diastolic function. Methods Apical BST images of LV inflow were acquired using a GE Vivid E95 ultrasound scanner and the M5Sc probe in pigs (n=4, 50-58 kg) (Figure 1, top panel). Calibrated microtip pressure catheters were placed basally in the mitral inflow region and apically in the LV. LV volume was measured from implanted sonomicrometric crystals. Recordings were performed with respirator on during baseline, esmolol infusion and dobutamine infusion. Custom software was utilised to analyse the BST images and estimate IVPD (IVPD = apical – basal pressure). Relaxation rate was quantified as the exponential time-constant, tau, of isovolumic pressure decay. Changes in restoring forces were reflected by changes in end-systolic volume (ESV). Results Esmolol infusion significantly reduced noninvasive and invasive IVPD, and significantly reduced relaxation rate (i.e. higher tau) and restoring forces (i.e. higher ESV), while dobutamine infusion had opposite effects (p&lt;0.001, Figure 1). Noninvasive IVPD correlated well with invasive IVPD (r=0.93) (Figure 2). Conclusions In this small sample size study, estimation of LV IVPD by BST corresponded well with invasively measured IVPD. Estimated IVPD captured the changes in diastolic function assessed as relaxation rate and restoring forces. This encourages further research to investigate its ability to detect impaired left ventricular relaxation and restoring forces, for which there are currently no established clinical markers.  

• Witsø, Marit Helene Langset; Luo, H; Holm, T; Kristiansen, H M; Frostelid, V C & Aalen, J [Vis alle 15 forfattere av denne artikkelen] (2025). Feasibility of non-invasive echocardiographic estimates of intraventricular pressure differences by blood speckle tracking in adults. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 26(Supplement_1). doi: 10.1093/ehjci/jeae333.081. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Introduction Non-invasive estimation of the intraventricular pressure difference (IVPD) in early diastole using high-frame-rate ultrasound-based blood speckle tracking (BST) has been reported in pediatric cardiology of various pathologies. This novel echocardiographic technology has recently become available in probes suitable for the adult population. Purpose We tested the feasibility by analyzing intra- and interobserver variability and investigating if IVPD in the left ventricular inflow exhibited the expected differences in controls vs a group of heart failure patients to indicate the ability of this new index to assess diastolic function. Methods Apical BST images of LV inflow were acquired using a GE Vivid E95 ultrasound scanner and the M5Sc probe in healthy volunteers (n=9) and patients with heart failure and left bundle branch block (LBBB) (n=15) implanted with cardiac resynchronization therapy (CRT) 6±2 months (mean±SD) earlier. Echocardiography was performed both with CRT turned on and off. IVPD was analyzed from the BST acquisitions using custom software (Figure 1). Blinded intra- and interobserver variability analysis were performed on the measurements from the healthy controls with the same observer and two other observers, respectively. Results All the controls and 11 of the 15 patients had BST acquisitions eligible for IVPD-analysis, giving a total feasibility of 83%. Intraobserver reliability was excellent (intraclass correlation coefficient 0.96 [0.85, 0.99], mean and 95% CI) and interobserver reliability was good (intraclass correlation coefficient 0.88 [0.59, 0.97] and 0.84 [0.48, 0.96]) respectively. IVPD was highest in controls (-1.7±0.5 mmHg), and higher with CRT on (-1.3±0.7 mmHg, p=NS vs controls) than off (-0.9±0.5 mmHg, p&lt;0.05 compared to both on and controls) in the patients. Conclusions Estimating the intracavitary pressure difference that accelerates blood into the LV during early filling seems feasible and reproducible in adult hearts by BST. IVPD is reduced in patients with heart failure and LBBB, and increases in patients with LBBB when treated with CRT. IVPD based on BST is a potential new echocardiographic method to evaluate diastolic function. Future improvements of the technology are warranted for widespread use.

• Smiseth, Otto A.; Aalen, John & Skulstad, Helge (2021). Heart failure and systolic function: time to leave diagnostics based on ejection fraction? European Heart Journal. ISSN 0195-668X. 42(7), s. 786–788. doi: 10.1093/eurheartj/ehaa979. Fulltekst i vitenarkiv
• Tangen, Jorun; Aukrust, Pål; Barrat-Due, A; Trøseid, Marius; Olsen, Inge Christoffer & Nezvalova-Henriksen, Katerina [Vis alle 15 forfattere av denne artikkelen] (2021). Cardiac function is normal in most patients recovered from COVID-19. Fulltekst i vitenarkiv
• Smiseth, Otto A.; Edvardsen, Thor & Skulstad, Helge (2013). Cardioprotection during chemotherapy. Journal of the American College of Cardiology. ISSN 0735-1097. 61(23), s. 2363–2364. doi: 10.1016/j.jacc.2013.02.073. Fulltekst i vitenarkiv
• Skulstad, Helge; Erikssen, Gunnar; Estensen, Mette-Lise & Lindberg, Harald L (2013). Insufficient long term follow up and risk for aneurism in patients operated with Dacron patch for coarctatio aortae. European Heart Journal. ISSN 0195-668X. 34, s. 377–377. Fulltekst i vitenarkiv
• Boe, Erik M; Russell, Kristoffer; Remme, Espen W.; Gjesdal, Ola; Smiseth, Otto A. & Skulstad, Helge (2012). Pacing improves left ventricular filling in narrow QRS and pulmonary hypertension. European Heart Journal. ISSN 0195-668X. 33, s. 533–533. Fulltekst i vitenarkiv
• Dahlslett, Thomas; Grenne, Bjørnar Leangen; Eek, Christian; Sjøli, Benthe; Skulstad, Helge & Smiseth, Otto A. [Vis alle 8 forfattere av denne artikkelen] (2012). Early strain echocardiography may exclude high-grade coronary artery stenosis in suspected non-ST-elevation acute coronary syndrome. European Heart Journal. ISSN 0195-668X. 33, s. 911–911. Fulltekst i vitenarkiv
• Russell, Kristoffer; Eriksen, Morten; Remme, Espen W.; Haugaa, Kristina; Skulstad, Helge & Edvardsen, I [Vis alle 7 forfattere av denne artikkelen] (2012). Wasted work fraction a novel method for assessing global and regional left ventricular function. European Heart Journal. ISSN 0195-668X. 33, s. 476–477. Fulltekst i vitenarkiv
• Dahlslett, Thomas; Grenne, Bjørnar; Eek, Christian; Sjøli, Benthe; Skulstad, Helge & Smiseth, Otto A. [Vis alle 8 forfattere av denne artikkelen] (2011). Early Strain Echocardiography May Exclude Significant Coronary Artery Stenosis in Suspected Non-ST-Elevation Acute Coronary Syndrome. Circulation. ISSN 0009-7322. 124(21). Fulltekst i vitenarkiv
• Grenne, Bjørnar Leangen; Eek, Christian; Sjøli, Benthe; Dahlslett, Thomas; Hol, Per Kristian & Skulstad, Helge [Vis alle 9 forfattere av denne artikkelen] (2010). A simplified 6 segments model of circumferential strain by echocardiography reflects LV infarct size in NSTEMI. European Heart Journal. ISSN 0195-668X. 31(Supp. 1), s. 1069–1069. Fulltekst i vitenarkiv
• Espinoza, Andreas Westenvik; Kerans, Viesturs; Halvorsen, Per Steinar; Opdahl, Anders; Bugge, Jan F & Skulstad, Helge [Vis alle 7 forfattere av denne artikkelen] (2010). Impaired diastolic filling reduces the frequency force reserve during therapeutic hypothermia in an experimental model. European Heart Journal. ISSN 0195-668X. 31, s. 724–724. Fulltekst i vitenarkiv
• Boe, E; Russell, Kristoffer; Remme, Espen W.; Gjesdal, Ola; Opdahl, Anders & Smiseth, Otto A. [Vis alle 7 forfattere av denne artikkelen] (2010). Dyssynchrony in regional and global acute ischemia: mechanical or electrical? European Heart Journal. ISSN 0195-668X. 31(Supp. 1), s. 407–407. Fulltekst i vitenarkiv
• Grenne, Bjørnar Leangen; Eek, Christian; Sjøli, Benthe; Dahlslett, Thomas; Uchto, Michael & Hoi, P K [Vis alle 10 forfattere av denne artikkelen] (2010). Circumferential strain by echocardiography identifies acute occlusions in non ST-elevation acute coronary syndromes. European Heart Journal. ISSN 0195-668X. 31(Supp. 1), s. 1061–1061. Fulltekst i vitenarkiv
• Halvorsen, Per Steinar; Espinoza, Andreas Westenvik; Skulstad, Helge; Bugge, Jan Frederik; Elle, Ole Jakob & Fosse, Erik (2010). EPICARDIAL DISPLACEMENTS BY A 3-AXIS ACCELEROMETER SENSOR DETECT LEFT VENTRICULAR DYSFUNCTION DURING CORONARY ARTERY OCCLUSION. Intensive Care Medicine. ISSN 0342-4642. 36, s. S351–S351. Fulltekst i vitenarkiv
• Gjesdal, Ola; Remme, Espen; Opdahl, Anders; Skulstad, Helge; Russell, Kristoffer & Kongsgård, Erik [Vis alle 8 forfattere av denne artikkelen] (2010). Preejection tug of war between early-activated septum and late-activated lateral wall in left bundle branch block. European Heart Journal. ISSN 0195-668X. 31, s. 407–407. Fulltekst i vitenarkiv
• Russell, Kristoffer; Remme, Espen; Gjesdal, Ola; Opdahl, Anders; Skulstad, Helge & Kongsgård, Erik [Vis alle 8 forfattere av denne artikkelen] (2010). Evaluation of left ventricular electrical dyssynchrony by onset of myocardial shortening: rate of LV pressure rise is an important confounder. European Heart Journal. ISSN 0195-668X. 31, s. 875–875. Fulltekst i vitenarkiv

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