Otto Armin Smiseth

• Argulian, Edgar; Nagueh, Sherif F.; Grapsa, Julia & Smiseth, Otto Armin (2026). A simplified, tier-based method for clinical evaluation of diastolic function. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 27(8), s. 1539–1549. doi: 10.1093/ehjci/jeag123. Fulltekst i vitenarkiv
• Fernandes, Joao F.; Smiseth, Otto Armin; Lamata, Pablo; Bernstein, Brett S.; Kalos, Theodoros & Nio, Amanda [Vis alle 10 forfattere av denne artikkelen] (2026). Left Ventricular Myocardial Work Index: The Impact of Including Ventricular Diastolic Pressure. Journal of the American Society of Echocardiography. ISSN 0894-7317. 39(5), s. 520–522. doi: 10.1016/j.echo.2026.01.005. Fulltekst i vitenarkiv
• Smiseth, Otto Armin; Fernandes, Joao F.; Ohte, Nobuyuki; Wakami, Kazuaki; Donal, Erwan & Remme, Espen [Vis alle 7 forfattere av denne artikkelen] (2025). Imaging-based method to quantify left ventricular diastolic pressures. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 26(7), s. 1184–1194. doi: 10.1093/ehjci/jeaf017. Fulltekst i vitenarkiv Vis sammendrag

  Aims To establish an imaging-based method to quantify left ventricular (LV) diastolic pressures. Methods and results In 115 patients suspected of coronary artery disease, LV pressure was measured by micromanometers and images by echocardiography. LV filling pressure was measured as LV pre-atrial contraction pressure (pre-A PLV). Based on previous observations, we hypothesized that pre-A PLV approximates the sum of minimum PLV and maximum transmitral pressure difference. Parameters used for pressure estimates included LV volumes and strain, left atrial strain, mitral flow velocities, systolic arterial cuff pressure, and body mass index. Minimum PLV was estimated by predictors identified in a derivative cohort (n = 81). Mitral pressure difference was calculated by a simplified Navier–Stokes equation. Accuracy of estimates of minimum PLV, pre-A PLV, and end-diastolic PLV was investigated in a testing cohort (n = 19). Patient-specific LV diastolic pressure curves were constructed by adjusting a reference curve according to pressure estimates at key diastolic events. There was good agreement between estimated and measured pre-A PLV: bias 0.0, limits of agreement < 3.1 mmHg (±1.96 SD). Estimated minimum PLV and end-diastolic PLV also showed good agreement with measured pressures. Furthermore, there was good agreement between measured and estimated LV diastolic pressure curves, quantified as mean LV diastolic pressure: bias 0.2, limits of agreement < 3.2 mmHg. Conclusion The proposed non-invasive method provided estimates of minimum PLV, pre-A PLV, and end-diastolic PLV, each reflecting different features of diastolic function. Additionally, it provided an estimate of the LV diastolic pressure curve. Validation in larger populations with different phenotypes is necessary to determine the validity of the method in clinical practice.

• Lababidi, Hossam; Rahi, Wissam; Smiseth, Otto Armin; Billick, Kristen; Inoue, Katsuji & Khan, Faraz Hameed [Vis alle 15 forfattere av denne artikkelen] (2025). New Algorithm for Estimating Left Ventricular Filling Pressure by Echocardiography. Circulation. ISSN 0009-7322. 152(7), s. 424–435. doi: 10.1161/CIRCULATIONAHA.125.074974. Fulltekst i vitenarkiv
• 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.

• Qamruddin, Salima; Fang, Chen; Kachur, Sergey; Bharwani, Sahil; Elagizi, Andrew & Stewart, Merrill [Vis alle 9 forfattere av denne artikkelen] (2025). Peak myocardial work assessment to detect coronary ischemia during dobutamine stress echocardiography. Frontiers in Cardiovascular Medicine. 12. doi: 10.3389/fcvm.2025.1556991. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Peak global myocardial work efficiency (GWE), a measure of peak global myocardial constructive to wasted work ratio, has been shown to discriminate coronary ischemia during treadmill stress echocardiography (SE). We wanted to assess additive utility of peak global longitudinal strain (GLS), global work index (GWI), and GWE in improving positive predictive value (PPV) of an abnormal dobutamine stress echocardiography (DSE) and calculate cost-savings by avoiding secondary tests. Methods: We prospectively enrolled patients with abnormal DSE who underwent secondary confirmatory tests to confirm significant CAD as our primary cohort, and measured baseline and peak GLS, GWI, and GWE. We also included a control group with normal DSE results and similar measurements. The cost of secondary testing was used to calculate potential savings. Results: Among the 45 patients (71% females, mean age 60 ± 12 yrs.), 9 had significant CAD, 11 had non-significant CAD, and 25 were controls (N). Patients with significant CAD had significantly lower peak GLS [−15 (−17, −12.5) vs. −20 (−22, −19.5)%, p < 0.001], peak GWI [1,057 (810.5, 1,057) vs. 2,245 (1,928.5, 2,961) mmHg%, p = 0.02], peak GWE [82 (74.5, 86.5) vs. 89 [(86, 93.5)%, p = 0.001], and peak GCW [1,618 (1,153.5, 2,003) vs. 2,585 (2,262.5, 3,262) mmHg%, p = 0.02] compared to control. ROC analysis demonstrated peak GWE [AUC 0.76 (0.55, 0.97) p = 0.01] to discriminate coronary ischemia. Incorporating peak GWE of <87% into abnormal DSE interpretation improved PPV from 45% to 81%, resulting in an estimated cost savings of $8,274.00 per screened patient. Conclusions: Incorporating peak GWE into standard DSE interpretation enhanced diagnostic accuracy and reduced the cost of downstream testing.

• Nagueh, Sherif F.; Sanborn, Danita Y.; Oh, Jae K.; Anderson, Bonita; Billick, Kristen & Derumeaux, Genevieve [Vis alle 13 forfattere av denne artikkelen] (2025). Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography and for Heart Failure With Preserved Ejection Fraction Diagnosis: An Update From the American Society of Echocardiography. Journal of the American Society of Echocardiography. ISSN 0894-7317. 38(7), s. 537–569. doi: 10.1016/j.echo.2025.03.011. Fulltekst i vitenarkiv Vis sammendrag

  Echocardiographic assessment of left ventricular (LV) diastolic function is an integral part of the routine evaluation of patients presenting with symptoms of dyspnea or clinical concerns for heart failure. Given the presence of diastolic dysfunction in many cardiovascular diseases, clinical reports should include comments on diastolic function and/or left atrial (LA) pressure whenever possible. Since the publication of the 2016 ASE/EACVI guidelines for assessment of LV diastolic function, new data on additional echocardiographic variables as left atrial strain and their association with LV filling pressures have emerged. Moreover, prognostic data from epidemiologic studies have demonstrated the association of echocardiographic measures with the subsequent development of heart failure. This update provides a contemporary approach for the assessment of LV diastolic function and the estimation of LA pressure in the general population of patients in sinus rhythm referred for echocardiographic evaluation, and in special populations that require deviation from the general approach. The update also discusses the application of echocardiography in the diagnosis of patients with heart failure with preserved LV ejection fraction.

• Duchenne, Jürgen; Calle, Simon; Stankovic, Ivan; Puvrez, Alexis; Voros, Gabor & Aalen, John [Vis alle 17 forfattere av denne artikkelen] (2025). Strain-based staging as a unifying concept in cardiac resynchronization therapy. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 26(8), s. 1389–1399. doi: 10.1093/ehjci/jeaf162. Fulltekst i vitenarkiv
• Smiseth, Otto Armin & Maurer, Gerald (2024). Focus issue on heart failure with preserved left ventricular ejection fraction. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 25(11), s. 1473–1474. doi: 10.1093/ehjci/jeae211. Fulltekst i vitenarkiv
• Ribic, Darijan; Remme, Espen; Smiseth, Otto Armin; Massey, Richard; Eek, Christian & Kvitting, John-Peder [Vis alle 9 forfattere av denne artikkelen] (2024). Non-invasive myocardial work in aortic stenosis: Validation and improvement in left ventricular pressure estimation. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 25(2), s. 201–212. doi: 10.1093/ehjci/jead227. Fulltekst i vitenarkiv Vis sammendrag

  Aims The non-invasive myocardial work index (MWI) has been validated in patients without aortic stenosis (AS). A thorough assessment of methodological limitations is warranted before this index can be applied to patients with AS. Methods and results We simultaneously measured left ventricular pressure (LVP) by using a micromanometer-tipped catheter and obtained echocardiograms in 20 patients with severe AS. We estimated LVP curves and calculated pressure–strain loops using three different models: (i) the model validated in patients without AS; (ii) the same model, but with pressure at the aortic valve opening (AVO) adjusted to diastolic cuff pressure; and (iii) a new model based on the invasive measurements from patients with AS. Valvular events were determined by echocardiography. Peak LVP was estimated as the sum of the mean aortic transvalvular gradient and systolic cuff pressure. In same-beat comparisons between invasive and estimated LVP curves, Model 1 significantly overestimated early systolic pressure by 61 ± 5 mmHg at AVO compared with Models 2 and 3. However, the average correlation coefficients between estimated and invasive LVP traces were excellent for all models, and the overestimation had limited influence on MWI, with excellent correlation (r = 0.98, P < 0.001) and good agreement between the MWI calculated with estimated (all models) and invasive LVP. Conclusion This study confirms the validity of the non-invasive MWI in patients with AS. The accuracy of estimated LVP curves improved when matching AVO to the diastolic pressure in the original model, mirroring that of the AS-specific model. This may sequentially enhance the accuracy of regional MWI assessment.

• Inoue, Katsuji & Smiseth, Otto Armin (2024). Left atrium as key player and essential biomarker in heart failure. Journal of Cardiology. ISSN 0914-5087. doi: 10.1016/j.jjcc.2024.07.006. Fulltekst i vitenarkiv Vis sammendrag

  This article reviews roles of the left atrium as regulator of left ventricular filling, as compensatory reserve in left ventricular dysfunction and as diagnostic marker in patients with cardiovascular disorders. Application of novel imaging tools to assess left atrial function and their integration with conventional clinical methods are discussed. This includes a review of clinical applications of left atrial strain as a method to quantify the reservoir and booster pump components of left atrial function. Emerging methods for assessing left atrial wall stiffness and active work by pressure-strain loop analysis are discussed. Recommendations for how to apply left atrial strain in clinical routine to diagnose elevated left ventricular filling pressure are provided. Furthermore, a role for left atrial strain in the diagnostic work-up in patients suspected of pre-capillary pulmonary hypertension is proposed. The article also reviews how to implement parameters of atrial structure and function in clinical routine as recommended by recent international guidelines for imaging of heart failure.

• Puvrez, Alexis; Duchenne, Jürgen; Donal, Erwan; Gorcsan, John; Patel, Hitesh C. & Marwick, Thomas H. [Vis alle 12 forfattere av denne artikkelen] (2024). Mechanical dyssynchrony as a selection criterion for cardiac resynchronization therapy: Design of the AMEND-CRT trial. ESC Heart Failure. 11(6), s. 4390–4399. doi: 10.1002/ehf2.14932. Fulltekst i vitenarkiv Vis sammendrag

  Aims One third of patients do not improve after cardiac resynchronization therapy (CRT). Septal flash (SF) and apical rocking (ApRock) are deformation patterns observed on echocardiography in most patients eligible for CRT. These markers of mechanical dyssynchrony have been associated to improved outcome after CRT in observational studies and may be useful to better select patients. The aim of this trial is to investigate whether the current guideline criteria for selecting patients for CRT should be modified and include SF and ApRock to improve therapy success rate, reduce excessive costs and prevent exposure to device-related complications in patients who would not benefit from CRT. Methods The AMEND-CRT trial is a multicentre, randomized, parallel-group, double-blind, sham-controlled trial with a non-inferiority design. The trial will include 578 patients scheduled for CRT according to the 2021 ESC guidelines who satisfy all inclusion criteria. The randomization is performed 1:1 to an active control arm (‘guideline arm’) or an experimental arm (‘echo arm’). All participants receive a device, but in the echo arm, CRT is activated only when SF or ApRock or both are present. The outcome of both arms will be compared after 1 year. The primary outcome measures are the average change in left ventricular end-systolic volume and patient outcome assessed using a modified Packer Clinical Composite Score. Conclusions The findings of this trial will redefine the role of echocardiography in CRT and potentially determine which patients with heart failure and a prolonged QRS duration should receive CRT, especially in patients who currently have a class IIa or class IIb recommendation.

• Hammersbøen, Lars Egil Reine; Stugaard, Marie; Puvrez, Alexis; Larsen, Camilla Kjellstad; Remme, Espen & Kongsgård, Erik [Vis alle 15 forfattere av denne artikkelen] (2024). Mechanism and Impact of Left Atrial Dyssynchrony on Long-Term Clinical Outcome During Cardiac Resynchronization Therapy. JACC Cardiovascular Imaging. ISSN 1936-878X. doi: 10.1016/j.jcmg.2024.09.008. Fulltekst i vitenarkiv Vis sammendrag

  Background Left bundle branch block (LBBB) causes left atrial (LA) dyssynchrony. It is unknown if LA dyssynchrony impacts long-term prognosis. Objectives The purpose of this study was to determine mechanisms of LA dyssynchrony in LBBB and if LA dyssynchrony impacts long-term prognosis. Methods In a prospective multicenter study of 168 heart failure patients with LBBB, echocardiographic strain imaging was done before and after 6 months with cardiac resynchronization therapy (CRT). Outcome was assessed after 6 years. Dyssynchrony was measured relative to septum as delay in left ventricular (LV) lateral wall shortening and LA lateral wall stretch. Response to CRT was defined as at least 15% reduction in LV end-systolic volume. Results Before CRT, there was marked LA dyssynchrony of 105 ± 76 ms, which decreased to 37 ± 68 ms in CRT-responders (P < 0.001), whereas nonresponders showed only a modest reduction in LA dyssynchrony (P < 0.05). There was strong association between LA and LV dyssynchrony (r = 0.70), consistent with direct LV-LA mechanical interaction. CRT caused modest increase in LA reservoir strain (P < 0.01) and marked increase of LV filling time (P < 0.001) in responders. Mortality after 6 years was 21% (35 deaths). LA dyssynchrony did not independently predict mortality. However, the combination of preserved LA reservoir strain (≥18%) and resolved LA dyssynchrony (≤53 ms) after 6 months with CRT was associated with excellent long term-prognosis: HR: 0.11 (95% CI: 0.03-0.42) vs preserved reservoir strain and persistent LA dyssynchrony. Conclusions LA dyssynchrony in LBBB was attributed to direct LV-LA mechanical interactions. CRT improved diastolic function by increasing LV filling time. Patients with preserved LA reservoir strain and resolution of LA dyssynchrony by CRT had excellent long-term prognosis. (Contractile Reserve in Dyssynchrony: A Novel Principle to Identify Candidates for Cardiac Resynchronization Therapy [CRID-CRT]; NCT02525185)

• Sevre, Kaja Holter; Rist, Aurora; Wachtell, Kristian; Devereux, Richard B.; Aurigemma, Gerard P. & Smiseth, Otto Armin [Vis alle 14 forfattere av denne artikkelen] (2024). What Is the Current Best Drug Treatment for Hypertensive Heart Failure With Preserved Ejection Fraction? Review of the Totality of Evidence. American Journal of Hypertension. ISSN 0895-7061. 37(1), s. 1–14. doi: 10.1093/ajh/hpad073. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND More than 90% of patients developing heart failure (HF) have an epidemiological background of hypertension. The most frequent concomitant conditions are type 2 diabetes mellitus, obesity, atrial fibrillation, and coronary disease, all disorders/diseases closely related to hypertension. METHODS HF outcome research focuses on decreasing mortality and preventing hospitalization for worsening HF syndrome. All drugs that decrease these HF endpoints lower blood pressure. Current drug treatments for HF are (i) angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor neprilysin inhibitors, (ii) selected beta-blockers, (iii) steroidal and nonsteroidal mineralocorticoid receptor antagonists, and (iv) sodium-glucose cotransporter 2 inhibitors. RESULTS For various reasons, these drug treatments were first studied in HF patients with a reduced ejection fraction (HFrEF). However, subsequently, they have been investigated and, as we see it, documented as beneficial in HF patients with a preserved left ventricular ejection fraction (LVEF, HFpEF) and mostly hypertensive etiology, with effect estimates assessed partly on top of background treatment with the drugs already proven effective in HFrEF. Additionally, diuretics are given on symptomatic indications. CONCLUSIONS Considering the totality of evidence and the overall need for antihypertensive treatment and/or treatment of hypertensive complications in almost all HF patients, the principal drug treatment of HF appears to be the same regardless of LVEF. Rather than LVEF-guided treatment of HF, treatment of HF should be directed by symptoms (related to the level of fluid retention), signs (tachycardia), severity (NYHA functional class), and concomitant diseases and conditions. All HF patients should be given all the drug classes mentioned above if well tolerated.

• Robinson, Shaun; Ring, Liam; Oxborough, David; Harkness, Allan; Bennett, Sadie & Rana, Bushra [Vis alle 19 forfattere av denne artikkelen] (2024). The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Research & Practice. 11(1). doi: 10.1186/s44156-024-00051-2. Fulltekst i vitenarkiv Vis sammendrag

  Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/’preserved’ left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258–271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient’s bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59–G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a structured approach to the assessment of diastolic function and includes recommendations for the assessment of LV relaxation and filling pressures. Non-routine echocardiographic measures are described alongside guidance for application in specific circumstances. Provocative methods for revealing increased filling pressure on exertion are described and novel and emerging modalities considered. For rapid access to the core recommendations of the diastolic guideline, a quick-reference guide (additional file 1) accompanies the main guideline document. This describes in very brief detail the diastolic investigation in each patient group and includes all algorithms and core reference tables.

• Smiseth, Otto Armin; Wang, Tom Kai Ming; Klein, Allan L & Nagueh, Sherif F (2024). Left ventricular diastolic dysfunction in non-myocardial disorders. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 25(11), s. 1554–1565. doi: 10.1093/ehjci/jeae209. Fulltekst i vitenarkiv Vis sammendrag

  This article reviews and discusses non-myocardial disorders that represent diagnostic challenges when evaluating patients for suspected heart failure with preserved left ventricular ejection fraction. This includes pre-capillary pulmonary hypertension, which is important to differentiate from post-capillary hypertension caused by left-sided heart disease. The impact of electrical disorders on LV diastolic function is also reviewed, and includes a discussion of left bundle branch, which has both a direct effect on LV diastolic function, as well as a long-term effect due to remodelling. Furthermore, evaluation of diastolic function in patients with atrial fibrillation is discussed. Pericardial diseases are reviewed as well as effects of a normal pericardium on diastolic function in failing hearts. Finally, the article reviews how valvular diseases impact LV diastolic function.

• Rogstadkjernet, Magnus; Zha, Sigurd Zijun; Klæboe, Lars Gunnar; Larsen, Camilla Kjellstad; Aalen, John & Scheirlynck, Esther [Vis alle 14 forfattere av denne artikkelen] (2024). A deep learning based method for left ventricular strain measurements: repeatability and accuracy compared to experienced echocardiographers. BMC Medical Imaging. 24(1). doi: 10.1186/s12880-024-01470-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Speckle tracking echocardiography (STE) provides quantification of left ventricular (LV) deformation and is useful in the assessment of LV function. STE is increasingly being used clinically, and every effort to simplify and standardize STE is important. Manual outlining of regions of interest (ROIs) is labor intensive and may influence assessment of strain values. Purpose We hypothesized that a deep learning (DL) model, trained on clinical echocardiographic exams, can be combined with a readily available echocardiographic analysis software, to automate strain calculation with comparable fidelity to trained cardiologists. Methods Data consisted of still frame echocardiographic images with cardiologist-defined ROIs from 672 clinical echocardiographic exams from a university hospital outpatient clinic. Exams included patients with ischemic heart disease, heart failure, valvular disease, and conduction abnormalities, and some healthy subjects. An EfficientNetB1-based architecture was employed, and different techniques and properties including data set size, data quality, augmentations, and transfer learning were evaluated. DL predicted ROIs were reintroduced into commercially available echocardiographic analysis software to automatically calculate strain values. Results DL-automated strain calculations had an average absolute difference of 0.75 (95% CI 0.58–0.92) for global longitudinal strain (GLS), and 1.16 (95% CI 1.03–1.29) for single-projection longitudinal strain (LS), compared to operators. A Bland–Altman plot revealed no obvious bias, though there were fewer outliers in the lower average LS ranges. Techniques and data properties yielded no significant increase/decrease in performance. Conclusion The study demonstrates that DL-assisted, automated strain measurements are feasible, and provide results within interobserver variation. Employing DL in echocardiographic analyses could further facilitate adoption of STE parameters in clinical practice and research, and improve reproducibility.

• Smiseth, Otto Armin; Rider, Oliver; Cvijic, Marta; Valkovič, Ladislav; Remme, Espen & Voigt, Jens-Uwe (2024). Myocardial Strain Imaging: Theory, Current Practice, and the Future. JACC Cardiovascular Imaging. ISSN 1936-878X. doi: 10.1016/j.jcmg.2024.07.011. Fulltekst i vitenarkiv Vis sammendrag

  Myocardial strain imaging by echocardiography or cardiac magnetic resonance (CMR) is a powerful method to diagnose cardiac disease. Strain imaging provides measures of myocardial shortening, thickening, and lengthening and can be applied to any cardiac chamber. Left ventricular (LV) global longitudinal strain by speckle-tracking echocardiography is the most widely used clinical strain parameter. Several CMR-based modalities are available and are ready to be implemented clinically. Clinical applications of strain include global longitudinal strain as a more sensitive method than ejection fraction for diagnosing mild systolic dysfunction. This applies to patients suspected of having heart failure with normal LV ejection fraction, to early systolic dysfunction in valvular disease, and when monitoring myocardial function during cancer chemotherapy. Segmental LV strain maps provide diagnostic clues in specific cardiomyopathies, when evaluating LV dyssynchrony and ischemic dysfunction. Strain imaging is a promising modality to quantify right ventricular function. Left atrial strain may be used to evaluate LV diastolic function and filling pressure.

• 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.

• Rist, Aurora; Wachtell, Kristian; Sevre, Kaja Holter; Devereux, Richard B.; Aurigemma, Gerard P. & Smiseth, Otto Armin [Vis alle 14 forfattere av denne artikkelen] (2023). The current best drug treatment for hypertensive heart failure with preserved ejection fraction. European journal of internal medicine. ISSN 0953-6205. doi: 10.1016/j.ejim.2023.10.008. Fulltekst i vitenarkiv Vis sammendrag

  More than 90 % of patients developing heart failure (HF) have hypertension. The most frequent concomitant conditions are type-2 diabetes mellitus, obesity, atrial fibrillation, and coronary disease. HF outcome research focuses on decreasing mortality and preventing hospitalization for worsening HF syndrome. All drugs that decrease these HF endpoints lower blood pressure. Current drug treatments for HF are (i) angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor neprilysin inhibitors, (ii) selected beta-blockers, (iii) steroidal and non-steroidal mineralocorticoid receptor antagonists, and (iv) sodium-glucose cotransporter 2 inhibitors. For various reasons, these drug treatments were first studied in HF patients with a reduced ejection fraction (HFrEF). Subsequently, they have been investigated in HF patients with a preserved left ventricular ejection fraction (LVEF, HFpEF) of mostly hypertensive etiology, and with modest benefits largely assessed on top of background treatment with the drugs already proven effective in HFrEF. Additionally, diuretics are given on symptomatic indications. Patients with HFpEF may have diastolic dysfunction but also systolic dysfunction visualized by lack of longitudinal shortening. Considering the totality of evidence and the overall need for antihypertensive treatment and/or treatment of hypertensive complications in almost all HF patients, the principal drug treatment of HF appears to be the same regardless of LVEF. Rather than LVEF-guided treatment of HF, treatment of HF should be directed by symptoms (related to the level of fluid retention), signs (tachycardia), severity (NYHA functional class), and concomitant diseases and conditions. All HF patients should be given all the drug classes mentioned above if well tolerated.

• Duchenne, Jürgen; Larsen, Camilla Kjellstad; Cvijic, Marta; Galli, Elena; Aalen, John & Klop, Boudewijn [Vis alle 22 forfattere av denne artikkelen] (2023). Mechanical Dyssynchrony Combined with Septal Scarring Reliably Identifies Responders to Cardiac Resynchronization Therapy. Journal of Clinical Medicine. 12(18). doi: 10.3390/jcm12186108. Fulltekst i vitenarkiv
• Smiseth, Otto Armin; Donal, Erwan; Bøe, Espen Andreas Matthew; Ha, Jong-Won; Fernandes, Joao F. & Lamata, Pablo (2023). Phenotyping heart failure by echocardiography: imaging of ventricular function and haemodynamics at rest and exercise. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 24(10), s. 1329–1342. doi: 10.1093/ehjci/jead196. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Traditionally, congestive heart failure (HF) was phenotyped by echocardiography or other imaging techniques according to left ventricular (LV) ejection fraction (LVEF). The more recent echocardiographic modality speckle tracking strain is complementary to LVEF, as it is more sensitive to diagnose mild systolic dysfunction. Furthermore, when LV systolic dysfunction is associated with a small, hypertrophic ventricle, EF is often normal or supernormal, whereas LV global longitudinal strain can reveal reduced contractility. In addition, segmental strain patterns may be used to identify specific cardiomyopathies, which in some cases can be treated with patient-specific medicine. In HF with preserved EF (HFpEF), a diagnostic hallmark is elevated LV filling pressure, which can be diagnosed with good accuracy by applying a set of echocardiographic parameters. Patients with HFpEF often have normal filling pressure at rest, and a non-invasive or invasive diastolic stress test may be used to identify abnormal elevation of filling pressure during exercise. The novel parameter LV work index, which incorporates afterload, is a promising tool for quantification of LV contractile function and efficiency. Another novel modality is shear wave imaging for diagnosing stiff ventricles, but clinical utility remains to be determined. In conclusion, echocardiographic imaging of cardiac function should include LV strain as a supplementary method to LVEF. Echocardiographic parameters can identify elevated LV filling pressure with good accuracy and may be applied in the diagnostic workup of patients suspected of HFpEF.

• 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
• Larsen, Camilla Kjellstad; Smiseth, Otto Armin; Duchenne, Jürgen; Galli, Elena; Aalen, John & Lederlin, Mathieu [Vis alle 13 forfattere av denne artikkelen] (2023). Cardiac Magnetic Resonance Identifies Responders to Cardiac Resynchronization Therapy with an Assessment of Septal Scar and Left Ventricular Dyssynchrony. Journal of Clinical Medicine. 12(22). doi: 10.3390/jcm12227182. Fulltekst i vitenarkiv Vis sammendrag

  Background: The response to cardiac resynchronization therapy (CRT) depends on septal viability and correction of abnormal septal motion. This study investigates if cardiac magnetic resonance (CMR) as a single modality can identify CRT responders with combined imaging of pathological septal motion (septal flash) and septal scar. Methods: In a prospective, multicenter, observational study of 136 CRT recipients, septal scar was assessed using late gadolinium enhancement (LGE) (n = 127) and septal flash visually from cine CMR sequences. The primary endpoint was CRT response, defined as ≥15% reduction in LV end-systolic volume with echocardiography after 6 months. The secondary endpoint was heart transplantation or death of any cause assessed after 39 ± 13 months. Results: Septal scar and septal flash were independent predictors of CRT response in multivariable analysis (both p &lt; 0.001), while QRS duration and morphology were not. The combined approach of septal scar and septal flash predicted CRT response with an area under the curve of 0.86 (95% confidence interval (CI): 0.78–0.94) and was a strong predictor of long-term survival without heart transplantation (hazard ratio 0.27, 95% CI: 0.10–0.79). The accuracy of the approach was similar in the subgroup with intermediate (130–150 ms) QRS duration. The combined approach was superior to septal scar and septal flash alone (p &lt; 0.01). Conclusions: The combined assessment of septal scar and septal flash using CMR as a single-image modality identifies CRT responders with high accuracy and predicts long-term survival.

• Chan, Nicholas; Wang, Tom Kai Ming; Anthony, Chris; Hassan, Ossama Abou; Chetrit, Michael & Dillenbeck, Amy [Vis alle 9 forfattere av denne artikkelen] (2023). Echocardiographic Evaluation of Diastolic Function in Special Populations. American Journal of Cardiology. ISSN 0002-9149. 202, s. 131–143. doi: 10.1016/j.amjcard.2023.05.032. Fulltekst i vitenarkiv
• Olsen, Flemming Javier; Skaarup, Kristoffer Grundtvig; Lassen, Mats Christian Højbjerg; Johansen, Niklas Dyrby; Jensen, Gorm B. & Schnohr, Peter [Vis alle 15 forfattere av denne artikkelen] (2023). Association between myocardial work indices and cardiovascular events according to hypertension in the general population. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 25(3), s. 413–424. doi: 10.1093/ehjci/jead292. Fulltekst i vitenarkiv
• Stankovic, Ivan; Voigt, Jens-Uwe; Burri, Haran; Muraru, Denisa; Sade, Leyla Elif & Haugaa, Kristina Ingrid Helena Hermann [Vis alle 15 forfattere av denne artikkelen] (2023). Imaging in patients with cardiovascular implantable electronic devices: part 2-imaging after device implantation. A clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association (EHRA) of the ESC. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 25(1), s. e33–e54. doi: 10.1093/ehjci/jead273. Fulltekst i vitenarkiv
• Stankovic, Ivan; Voigt, Jens-Uwe; Burri, Haran; Muraru, Denisa; Sade, Leyla Elif & Haugaa, Kristina Ingrid Helena Hermann [Vis alle 15 forfattere av denne artikkelen] (2023). Imaging in patients with cardiovascular implantable electronic devices: part 1-imaging before and during device implantation. A clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association (EHRA) of the ESC. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 25(1), s. e1–e32. doi: 10.1093/ehjci/jead272. Fulltekst i vitenarkiv
• Larsen, Camilla Kjellstad; Galli, Elena; Duchenne, Jürgen; Aalen, John; Stokke, Caroline & Fjeld, Jan Gunnar [Vis alle 19 forfattere av denne artikkelen] (2022). Scar imaging in the dyssynchronous left ventricle: Accuracy of myocardial metabolism by positron emission tomography and function by echocardiographic strain. International Journal of Cardiology. ISSN 0167-5273. 372, s. 122–129. doi: 10.1016/j.ijcard.2022.11.042. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Response to cardiac resynchronization therapy (CRT) is reduced in patients with high left ventricular (LV) scar burden, in particular when scar is located in the LV lateral wall or septum. Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) can identity scar, but is not feasible in all patients. This study investigates if myocardial metabolism by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and contractile function by echocardiographic strain are alternatives to LGE-CMR. Methods In a prospective multicenter study, 132 CRT candidates (91% with left bundle branch block) were studied by speckle tracking strain echocardiography, and 53 of these by FDG-PET. Regional myocardial FDG metabolism and peak systolic strain were compared to LGE-CMR as reference method. Results Reduced FDG metabolism (<70% relative) precisely identified transmural scars (≥50% of myocardial volume) in the LV lateral wall, with area under the curve (AUC) 0.96 (95% confidence interval (CI) 0.90–1.00). Reduced contractile function by strain identified transmural scars in the LV lateral wall with only moderate accuracy (AUC = 0.77, CI 0.71–0.84). However, absolute peak systolic strain >10% could rule out transmural scar with high sensitivity (80%) and high negative predictive value (96%). Neither FDG-PET nor strain identified septal scars (for both, AUC < 0.80). Conclusions In CRT candidates, FDG-PET is an excellent alternative to LGE-CMR to identify scar in the LV lateral wall. Furthermore, preserved strain in the LV lateral wall has good accuracy to rule out transmural scar. None of the modalities can identify septal scar.

• Olsen, Flemming Javier; Skaarup, Kristoffer Grundtvig; Lassen, Mats Christian Højbjerg; Johansen, Niklas Dyrby; Sengeløv, Morten & Jensen, Gorm B [Vis alle 16 forfattere av denne artikkelen] (2022). Normal Values for Myocardial Work Indices Derived From Pressure-Strain Loop Analyses: From the CCHS. Circulation Cardiovascular Imaging. ISSN 1941-9651. 15(5), s. 316–327. doi: 10.1161/CIRCIMAGING.121.013712. Fulltekst i vitenarkiv
• Galli, Elena; Oger, Emmanuel; Aalen, John; Duchenne, Jürgen; Larsen, Camilla Kjellstad & Sade, Elif [Vis alle 16 forfattere av denne artikkelen] (2022). Left atrial strain is a predictor of left ventricular systolic and diastolic reverse remodelling in CRT candidates. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 23, s. 1373–1382. doi: 10.1093/ehjci/jeab163. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Aims This study aimed to explore the incidence of severe cardiac events in paediatric arrhythmogenic right ventricular cardiomyopathy (ARVC) patients and ARVC penetrance in paediatric relatives. Furthermore, the phenotype in childhood-onset ARVC was described. Methods Consecutive ARVC paediatric patients and genotype positive relatives ≤18 years of age were followed with electrocardiographic, structural, and arrhythmic characteristics according to the 2010 revised Task Force Criteria. Penetrance of ARVC disease was defined as fulfilling definite ARVC criteria and severe cardiac events were defined as cardiac death, heart transplantation (HTx) or severe ventricular arrhythmias. Childhood-onset disease was defined as meeting definite ARVC criteria ≤12 years of age. Results Among 62 individuals [age 9.8 (5.0–14.0) years, 11 probands], 20 (32%) fulfilled definite ARVC diagnosis, of which 8 (40%) had childhood-onset disease. The incidence of severe cardiac events was 23% (n = 14) by last follow-up and half of them occurred in patients ≤12 years of age. Among the eight patients with childhood-onset disease, five had biventricular involvement needing HTx and three had severe arrhythmic events. Among the 51 relatives, 6% (n = 3) met definite ARVC criteria at time of genetic diagnosis, increasing to 18% (n = 9) at end of follow-up. Conclusions In a paediatric ARVC cohort, there was a high incidence of severe cardiac events and half of them occurred in children ≤12 years of age. The ARVC penetrance in genotype positive paediatric relatives was 18%. These findings of a high-malignant phenotype in childhood-onset ARVC indicate a need for ARVC family screening at younger age than currently recommended.

• Olsen, Flemming Javier; Lassen, Mats Christian Højbjerg; Skaarup, Kristoffer Grundtvig; Christensen, Jacob; Davidovski, Filip Soeskov & Alhakak, Alia Saed [Vis alle 33 forfattere av denne artikkelen] (2022). Myocardial Work in Patients Hospitalized With COVID-19: Relation to Biomarkers, COVID-19 Severity, and All-Cause Mortality. Journal of the American Heart Association (JAHA). 11(19). doi: 10.1161/JAHA.122.026571. Fulltekst i vitenarkiv Vis sammendrag

  Background COVID‐19 infection has been hypothesized to affect left ventricular function; however, the underlying mechanisms and the association to clinical outcome are not understood. The global work index (GWI) is a novel echocardiographic measure of systolic function that may offer insights on cardiac dysfunction in COVID‐19. We hypothesized that GWI was associated with disease severity and all‐cause death in patients with COVID‐19. Methods and Results In a multicenter study of patients admitted with COVID‐19 (n=305), 249 underwent pressure‐strain loop analyses to quantify GWI at a median time of 4 days after admission. We examined the association of GWI to cardiac biomarkers (troponin and NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide]), disease severity (oxygen requirement and CRP [C‐reactive protein]), and all‐cause death. Patients with elevated troponin (n=71) exhibited significantly reduced GWI (1508 versus 1707 mm Hg%; P=0.018). A curvilinear association to NT‐proBNP was observed, with increasing NT‐proBNP once GWI decreased below 1446 mm Hg%. Moreover, GWI was significantly associated with a higher oxygen requirement (relative increase of 6% per 100–mm Hg% decrease). No association was observed with CRP. Of the 249 patients, 37 died during follow‐up (median, 58 days). In multivariable Cox regression, GWI was associated with all‐cause death (hazard ratio, 1.08 [95% CI, 1.01–1.15], per 100–mm Hg% decrease), but did not increase C‐statistics when added to clinical parameters. Conclusions In patients admitted with COVID‐19, our findings indicate that NT‐proBNP and troponin may be associated with lower GWI, whereas CRP is not. GWI was independently associated with all‐cause death, but did not provide prognostic information beyond readily available clinical parameters.

• Smiseth, Otto A.; Morris, Daniel A.; Cardim, Nuno; Cikes, Maja; Delgado, Victoria & Donal, Erwan [Vis alle 19 forfattere av denne artikkelen] (2022). Multimodality imaging in patients with heart failure and preserved ejection fraction: an expert consensus document of the European Association of Cardiovascular Imaging. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 23(2), s. e34–e61. doi: 10.1093/ehjci/jeab154. Fulltekst i vitenarkiv
• Karlsen, Sigve; Melichova, Daniela; Dahlslett, Thomas; Grenne, Bjørnar; Sjøli, Benthe & Smiseth, Otto A. [Vis alle 8 forfattere av denne artikkelen] (2022). Increased deformation of the left ventricle during exercise test measured by global longitudinal strain can rule out significant coronary artery disease in patients with suspected unstable angina pectoris. Echocardiography. ISSN 0742-2822. 39(2), s. 233–239. doi: 10.1111/echo.15295. Fulltekst i vitenarkiv Vis sammendrag

  Background Noninvasive identification of significant coronary artery disease (CAD) in patients with unstable angina pectoris (UAP) is challenging. Exercise stress testing has been used for years in patients with suspected CAD but has low diagnostic accuracy. The use of Global longitudinal strain (GLS) by speckle tracking echocardiography is a highly sensitive and reproducible parameter for detection of myocardial ischemia. Our aim was to study if identification of normal or ischemic myocardium by measurement of GLS immediately after an ordinary bicycle exercise stress testing in patients with suspected UAP could identify or rule out significant CAD. Methods Seventy-eight patients referred for coronary angiography from outpatient clinics and the emergency department with chest pain, inconclusive ECG and normal values of Troponin-T was included. All patients underwent echocardiographic examination at rest and immediately after maximum stress by exercise on a stationary bicycle. Significant CAD was defined by diameter stenosis > 90% by coronary angiography. In patients with coronary stenosis between 50–90%, fractional flow reserve (FFR) was measured and defined abnormal < .80. Analysis of echocardiographic data were performed blinded for angiographic data. Patients were discharged diagnosed with CAD (n = 34) or non-coronary chest pain (NCCP, n = 44). Results In patients with NCCP, GLS at rest was -21.1 ± 1.7% and -25.5 ± 2.6% at maximum stress (P < .01). In patients with CAD, GLS at rest was -16.8 ± 4.0% and remained unchanged at maximum stress (-16.6 ± 4.6%, P = .69). In patients with NCCP, LVEF was 56.1% ± 6.0 and increased to 61.8% 5.2, P < .01. In CAD patients, LVEF at rest was 54.7% ± 8.6 and increased to 58.2% ± 9.5 during stress, P = .16. In NCCP patients, Wall Motion Score index decreased .02 ± .07, P = .03 during stress and was without significant changes in patients with CAD. Area under the curve (AUC) for distinguishing CAD for was .97 (.95-1.00), .63 (.49-.76), and .71 (.59-.83) for GLS, LVEF, and WMSi, respectively. Conclusion In patients with suspected UAP, increased deformation of the left ventricle measured by GLS immediately after exercise stress testing identified normal myocardium without CAD. Reduced LV contractile function by GLS without increase after exercise identified significant CAD.

• Smiseth, Otto A.; Baron, Tomasz; Marino, Paolo; Marwick, Thomas & Flachskampf, Frank A. (2021). Imaging of the left atrium: pathophysiology insights and clinical utility. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 23(1), s. 2–13. doi: 10.1093/ehjci/jeab191. Fulltekst i vitenarkiv
• Gallard, Alban; Galli, Elena; Hubert, Arnaud; Bidaut, Auriane; Rolle, Virginie Le & Smiseth, Otto A. [Vis alle 9 forfattere av denne artikkelen] (2021). Echocardiographic view and feature selection for the estimation of the response to CRT. PLOS ONE. 16(6). doi: 10.1371/journal.pone.0252857. Fulltekst i vitenarkiv
• Smiseth, Otto A.; Donal, Erwan; Penicka, Martin & Sletten, Ole Jakob (2021). How to measure left ventricular myocardial work by pressure-strain loops. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 22(3), s. 259–261. doi: 10.1093/ehjci/jeaa301. Fulltekst i vitenarkiv
• Galli, Elena; Rolle, Virginie Le; Smiseth, Otto A.; Duchenne, Jürgen; Aalen, John & Larsen, Camilla Kjellstad [Vis alle 15 forfattere av denne artikkelen] (2021). Importance of Systematic Right Ventricular Assessment in Cardiac Resynchronization Therapy Candidates: A Machine Learning Approach. Journal of the American Society of Echocardiography. ISSN 0894-7317. s. 1–9. doi: 10.1016/j.echo.2020.12.025. Fulltekst i vitenarkiv
• Degtiarova, Ganna; Claus, Piet; Duchenne, Jürgen; Bogaert, Jan; Nuyts, Johan & Vöros, Gabor [Vis alle 15 forfattere av denne artikkelen] (2021). Left ventricular regional glucose metabolism in combination with septal scar extent identifies CRT responders. European Journal of Nuclear Medicine and Molecular Imaging. ISSN 1619-7070. s. 1–10. doi: 10.1007/s00259-020-05161-7. Fulltekst i vitenarkiv
• 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.

• Inoue, Katsuji; Khan, Faraz Hameed; Remme, Espen W.; Ohte, Nobuyuki; García-Izquierdo, Eusebio & Chetrit, Michael [Vis alle 18 forfattere av denne artikkelen] (2021). Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 23(1), s. 61–70. doi: 10.1093/ehjci/jeaa415. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Aims The aim of this study is to investigate determinants of left atrial (LA) reservoir and pump strain and if these parameters may serve as non-invasive markers of left ventricular (LV) filling pressure. Methods and results In a multicentre study of 322 patients with cardiovascular disease of different aetiologies, LA strain and other echocardiographic parameters were compared with invasively measured LV filling pressure. The strongest determinants of LA reservoir and pump strain were LV global longitudinal strain (GLS) (r-values 0.64 and 0.51, respectively) and LV filling pressure (r-values −0.52 and −0.57, respectively). Left atrial volume was another independent, but weaker determinant of both LA strains. For both LA strains, association with LV filling pressure was strongest in patients with reduced LV ejection fraction. Left atrial reservoir strain &amp;lt;18% and LA pump strain &amp;lt;8% predicted elevated LV filling pressure better (P &amp;lt; 0.05) than LA volume and conventional Doppler parameters. Accuracy to identify elevated LV filling pressure was 75% for LA reservoir strain alone and 72% for pump strain alone. When combined with conventional parameters, accuracy was 82% for both LA strains. In patients with normal LV systolic function by GLS, LA pump strain &amp;gt;14% identified normal LV filling pressure with 92% accuracy. Conclusion Left atrial reservoir and pump strain are determined predominantly by LV GLS and filling pressure. Accuracy of LA strains to identify elevated LV filling pressure was best in patients with reduced LV systolic function. High values of LA pump strain, however, identified normal LV filling pressure with good accuracy in patients with normal systolic function.

• Kasiakogias, Alexandros; Rosei, Enrico Agabiti; Camafort, Miguel; Ehret, Georg; Faconti, Luca & Ferreira, João Pedro [Vis alle 19 forfattere av denne artikkelen] (2021). Hypertension and heart failure with preserved ejection fraction: position paper by the European Society of Hypertension. Journal of Hypertension. ISSN 0263-6352. 39(8), s. 1522–1545. doi: 10.1097/HJH.0000000000002910. Fulltekst i vitenarkiv Vis sammendrag

  Hypertension constitutes a major risk factor for heart failure with preserved ejection fraction (HFpEF). HFpEF is a prevalent clinical syndrome with increased cardiovascular morbidity and mortality. Specific guideline-directed medical therapy (GDMT) for HFpEF is not established due to lack of positive outcome data from randomized controlled trials (RCTs) and limitations of available studies. Although available evidence is limited, control of blood pressure (BP) is widely regarded as central to the prevention and clinical care in HFpEF. Thus, in current guidelines including the 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Guidelines, blockade of the renin-angiotensin system (RAS) with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers provides the backbone of BP-lowering therapy in hypertensive patients. Although superiority of RAS blockers has not been clearly shown in dedicated RCTs designed for HFpEF, we propose that this core drug treatment strategy is also applicable for hypertensive patients with HFpEF with the addition of some modifications. The latter apply to the use of spironolactone apart from the treatment of resistant hypertension and the use of the angiotensin receptor neprilysin inhibitor. In addition, novel agents such as sodium-glucose co-transporter-2 inhibitors, currently already indicated for high-risk patients with diabetes to reduce heart failure hospitalizations, and finerenone represent promising therapies and results from ongoing RCTs are eagerly awaited. The development of an effective and practical classification of HFpEF phenotypes and GDMT through dedicated high-quality RCTs are major unmet needs in hypertension research and calls for action.

• Hubert, Arnaud; Gallard, Alban; Rolle, Virginie Le; Smiseth, Otto Armin; Leclercq, Christophe & Voigt, Jean-Uwe [Vis alle 10 forfattere av denne artikkelen] (2021). Left ventricular strain for predicting the response to cardiac resynchronization therapy: two methods for one question. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 22(12), s. 1482–1489. doi: 10.1093/ehjci/jeaa422. Fulltekst i vitenarkiv
• Galli, E.; Smiseth, Otto A.; Aalen, John; Larsen, Camilla Kjellstad; Sade, Leyla Elif & Hubert, A. [Vis alle 15 forfattere av denne artikkelen] (2021). Prognostic utility of the assessment of diastolic function in patients undergoing cardiac resynchronization therapy. International Journal of Cardiology. ISSN 0167-5273. 331, s. 144–151. doi: 10.1016/j.ijcard.2021.01.046. Fulltekst i vitenarkiv
• 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.

• Aalen, John; Donal, Erwan; Larsen, Camilla Kjellstad; Duchenne, Jürgen; Lederlin, Mathieu & Cvijic, Marta [Vis alle 19 forfattere av denne artikkelen] (2020). Imaging predictors of response to cardiac resynchronization therapy: left ventricular work asymmetry by echocardiography and septal viability by cardiac magnetic resonance. European Heart Journal. ISSN 0195-668X. 41(39), s. 3813–3823. doi: 10.1093/eurheartj/ehaa603. Fulltekst i vitenarkiv Vis sammendrag

  Aims: Left ventricular (LV) failure in left bundle branch block is caused by loss of septal function and compensatory hyperfunction of the LV lateral wall (LW) which stimulates adverse remodelling. This study investigates if septal and LW function measured as myocardial work, alone and combined with assessment of septal viability, identifies responders to cardiac resynchronization therapy (CRT). Methods and results: In a prospective multicentre study of 200 CRT recipients, myocardial work was measured by pressure-strain analysis and viability by cardiac magnetic resonance (CMR) imaging (n = 125). CRT response was defined as ≥15% reduction in LV end-systolic volume after 6 months. Before CRT, septal work was markedly lower than LW work (P < 0.0001), and the difference was largest in CRT responders (P < 0.001). Work difference between septum and LW predicted CRT response with area under the curve (AUC) 0.77 (95% CI: 0.70–0.84) and was feasible in 98% of patients. In patients undergoing CMR, combining work difference and septal viability significantly increased AUC to 0.88 (95% CI: 0.81–0.95). This was superior to the predictive power of QRS morphology, QRS duration and the echocardiographic parameters septal flash, apical rocking, and systolic stretch index. Accuracy was similar for the subgroup of patients with QRS 120–150 ms as for the entire study group. Both work difference alone and work difference combined with septal viability predicted long-term survival without heart transplantation with hazard ratio 0.36 (95% CI: 0.18–0.74) and 0.21 (95% CI: 0.072–0.61), respectively. Conclusion: Assessment of myocardial work and septal viability identified CRT responders with high accuracy.

• Gallard, Alban; Hubert, Arnaud; Smiseth, Otto A.; Voigt, Jens-Uwe; Rolle, Virginie Le & Leclercq, Christophe [Vis alle 10 forfattere av denne artikkelen] (2020). Prediction of response to cardiac resynchronization therapy using a multi-feature learning method. The International Journal of Cardiovascular Imaging. ISSN 1569-5794. doi: 10.1007/s10554-020-02083-1. Fulltekst i vitenarkiv
• Duchenne, Jürgen; Aalen, John; Cvijic, Marta; Larsen, Camilla Kjellstad; Galli, Elana & Bézy, Stéphanie [Vis alle 16 forfattere av denne artikkelen] (2020). Acute redistribution of regional left ventricular work by cardiac resynchronization therapy determines long-term remodelling. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 21, s. 619–628. doi: 10.1093/ehjci/jeaa003. 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)

• Larsen, Camilla Kjellstad; Aalen, John; Stokke, Caroline; Fjeld, Jan Gunnar; Kongsgård, Erik & Duchenne, Jürgen [Vis alle 11 forfattere av denne artikkelen] (2020). Regional myocardial work by cardiac magnetic resonance and non-invasive left ventricular pressure: A feasibility study in left bundle branch block. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 21(2), s. 143–153. doi: 10.1093/ehjci/jez231. Fulltekst i vitenarkiv
• Sörensen, Jens; Harms, Hendrik Johannes; Aalen, John; Baron, Tomasz; Smiseth, Otto A. & Flachskampf, Frank A. (2020). Myocardial efficiency: A fundamental physiological concept on the verge of clinical impact. JACC Cardiovascular Imaging. ISSN 1936-878X. s. 1–13. doi: 10.1016/j.jcmg.2019.08.030. Fulltekst i vitenarkiv
• Karlsen, Sigve; Dahlslett, Thomas; Grenne, Bjørnar; Sjøli, Benthe; Smiseth, Otto A. & Edvardsen, Thor [Vis alle 7 forfattere av denne artikkelen] (2019). Global longitudinal strain is a more reproducible measure of left ventricular function than ejection fraction regardless of echocardiographic training. Cardiovascular Ultrasound. 17(18). doi: 10.1186/s12947-019-0168-9. Fulltekst i vitenarkiv Vis sammendrag

  Background: Left ventricular ejection fraction (LVEF) is an established method for evaluation of left ventricular (LV)systolic function. Global longitudinal strain (GLS) by speckle tracking echocardiography seems to be an important additive method for evaluation of LV function with improved reproducibility compared with LVEF. Our aim was to compare reproducibility of GLS and LVEF between an expert and trainee both as echocardiographic examiner and analyst. Methods: Forty-seven patients with recent Acute Coronary Syndrome (ACS) underwent echocardiographic examination by both an expert echocardiographer and a trainee. Both echocardiographers, blinded for clinical data and each other’s findings, performed image analysis for evaluation of intra- and inter- observer variability. GLS was measured using speckle tracking echocardiography. LVEF was calculated by Simpson’s biplane method. Results: The trainee measured a GLS of−19.4% (±3.5%) and expert−18.7% (±3.2%) with an Intra class correlation coefficient (ICC) of 0.89 (0.74–0.95). LVEF by trainee was 50.3% (±8.2%) and by expert 53.6% (±8.6%), ICC coefficient was 0.63 (0.32–0.80). For GLS the systematic difference was 0.21% (−4.58–2.64) vs. 4.08% (−20.78–12.62) for LVEF. Conclusion: GLS is a more reproducible method for evaluation of LV function than LVEF regardless of echocardiographic training.

• Ha, Jong-Won; Andersen, Øyvind Senstad & Smiseth, Otto A. (2019). Diastolic stress test: Invasive and noninvasive testing. JACC Cardiovascular Imaging. ISSN 1936-878X. 13(1), s. 272–282. doi: 10.1016/j.jcmg.2019.01.037. Fulltekst i vitenarkiv
• 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
• Kjeldsen, Sverre; Lueder, Thomas Gero von; Smiseth, Otto A.; Wachtell, Kristian; Mistry, Nisha & Westheim, Arne [Vis alle 12 forfattere av denne artikkelen] (2019). Medical Therapies for Heart Failure With Preserved Ejection Fraction. Hypertension. ISSN 0194-911X. doi: 10.1161/HYPERTENSIONAHA.119.14057. Fulltekst i vitenarkiv Vis sammendrag

  Current cardiovascular pharmacotherapy targets maladaptive overactivation of the renin-angiotensin-aldosterone system (RAAS), which occurs throughout the continuum of cardiovascular disease spanning from hypertension to heart failure with reduced ejection fraction. Over the past 16 years, 4 prospective, randomized, placebo-controlled clinical trials using candesartan, perindopril, irbesartan, and spironolactone in patients with heart failure with preserved ejection fraction (HFpEF) failed to demonstrate increased efficacy of RAAS blockade added to guideline-directed medical therapy. We reappraise these trials and their weaknesses, which precluded statistically significant findings. Recently, dual-acting RAAS blockade with sacubitril-valsartan relative to stand-alone valsartan failed to improve outcome in the PARAGON-HF trial (Efficacy and Safety of LCZ696 Compared with Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction). The majority of patients with HFpEF experience hypertension, frequently with subclinical left ventricular dysfunction, contributed to by comorbidities such as coronary disease, diabetes mellitus, overweight, and atrial fibrillation. Contrasting the findings in HFpEF, trials evaluating RAAS blockade on either side of HFpEF on the cardiovascular continuum in patients with high-risk hypertension and heart failure with reduced ejection fraction, respectively, showed positive outcomes. We do not have a biologically plausible explanation for such divergent efficacy of RAAS blockade. Based on considerations of well-established clinical efficacy in hypertension and heart failure with reduced ejection fraction and the shortcomings of aforementioned clinical trials in HFpEF, we argue that RAAS blockers including MRAs (mineralocorticoid receptor antagonists; aldosterone antagonists) should be used in the treatment of patients with HFpEF.

• 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.

• Galli, Elena; Hubert, Arnaud; Rolle, Virginie Le; Hernandez, Alfredo; Smiseth, Otto A. & Mabo, Philippe [Vis alle 8 forfattere av denne artikkelen] (2019). Myocardial constructive work and cardiac mortality in resynchronization therapy candidates. American Heart Journal. ISSN 0002-8703. 212, s. 53–63. doi: 10.1016/j.ahj.2019.02.008. Fulltekst i vitenarkiv
• Galli, Elena; Leclercq, Christophe; Fournet, Maxime; Hubert, Arnaud; Bernard, Anne & Smiseth, Otto A. [Vis alle 10 forfattere av denne artikkelen] (2018). Value of myocardial work estimation in the prediction of response to cardiac resynchronization therapy. Journal of the American Society of Echocardiography. ISSN 0894-7317. 31(2), s. 220–230. doi: 10.1016/j.echo.2017.10.009. 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.

• Smiseth, Otto A. & Aalen, John (2018). Mechanism of harm from left bundle branch block. Trends in cardiovascular medicine. ISSN 1050-1738. s. 1–8. doi: 10.1016/j.tcm.2018.10.012. Fulltekst i vitenarkiv Vis sammendrag

  The impact of left bundle branch block (LBBB) on cardiac mechanical function ranges from minimal effect in some patients to marked reduction in left ventricular (LV) systolic function in others. It appears that this variability in part reflects differences in anatomical location of the bundle block. In most patients with LBBB and congestive heart failure, however, there is associated cardiac disease such as cardiomyopathies or coronary artery disease which contributes to LV dysfunction. The mechanism of harmful effect of LBBB on cardiac function is in-coordinated ventricular contractions which result in LV contractile inefficiency. Septal contribution to LV systolic function is lost or attenuated and an excessive workload is placed on the LV free wall which responds with remodeling and in some cases it decompensates. The magnitude of the contractile inefficiency depends on the extent of electrical conduction delay and degree of associated heart disease. Another mechanism, which in many patients contributes to cardiac dysfunction in LBBB, is mitral regurgitation due to in-coordinated contractions of the papillary muscles and altered mitral valve function due to LV remodeling. Potentially, reduced LV filling time due to prolonged LV systole may contribute to cardiac dysfunction, but there is limited knowledge about the clinical importance of this mechanism. In LBBB there is typically reduced septal perfusion, probably not as a sign of ischemia, but reflecting physiologic autoregulation of coronary flow in response to reduced septal work that reduces metabolic demand. Future studies should explore how current insights into mechanisms of cardiac mechanical effects of LBBB can be incorporated into decision algorithms for selection of patients for cardiac resynchronization therapy, as well as how to manage patients with LBBB and preserved LV function.

• Galli, Elena; Leclercq, Christophe; Hubert, Arnaud; Bernard, Anne; Smiseth, Otto A. & Mabo, Philippe [Vis alle 9 forfattere av denne artikkelen] (2018). Role ofmyocardial constructive work in the identification of responders to CRT. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 19(9), s. 1010–1018. doi: 10.1093/ehjci/jex191. Fulltekst i vitenarkiv
• Nagueh, Sherif F.; Smiseth, Otto A.; Dokainish, Hisham; Andersen, Øyvind Senstad; Abudiab, Muaz M. & Schutt, Robert C. [Vis alle 11 forfattere av denne artikkelen] (2018). Mean Right Atrial Pressure for Estimation of Left Ventricular Filling Pressure in Patients with Normal Left Ventricular Ejection Fraction: Invasive and Noninvasive Validation. Journal of the American Society of Echocardiography. ISSN 0894-7317. doi: 10.1016/j.echo.2018.01.025. Fulltekst i vitenarkiv
• Smiseth, Otto A. (2017). Evaluation of left ventricular diastolic function: state of the art after 35 years with Doppler assessment. Journal of Echocardiography. ISSN 1349-0222. s. 1–10. doi: 10.1007/s12574-017-0364-2. Fulltekst i vitenarkiv Vis sammendrag

  Left ventricular (LV) diastolic function can be evaluated by echocardiographic indices of LV relaxation/restoring forces, diastolic compliance, and filling pressure. By using a combination of indices, diastolic function can be graded and LV filling pressure estimated with high feasibility and good accuracy. Evaluation of diastolic function is of particular importance in patients with unexplained exertional dyspnea or other symptoms or signs of heart failure which cannot be attributed to impaired LV systolic function and to assess filling pressure in patients with heart failure and reduced LV ejection fraction. Furthermore, grading of diastolic dysfunction can be used for risk assessment in asymptomatic subjects and in patients with heart disease.

• Stokke, Thomas Muri; Hasselberg, Nina Eide; Smedsrud, Marit Kristine; Sarvari, Sebastian Imre; Haugaa, Kristina & Smiseth, Otto A. [Vis alle 8 forfattere av denne artikkelen] (2017). Geometry as a Confounder When Assessing Ventricular Systolic Function: Comparison Between Ejection Fraction and Strain. Journal of the American College of Cardiology. ISSN 0735-1097. 70(8), s. 942–954. doi: 10.1016/j.jacc.2017.06.046. Fulltekst i vitenarkiv
• Andersen, Øyvind Senstad; Smiseth, Otto A.; Dokainish, Hisham; Abudiab, Muaz M.; Schutt, Robert C. & Kumar, Arnav [Vis alle 15 forfattere av denne artikkelen] (2017). Estimating left ventricular filling pressure by echocardiography. Journal of the American College of Cardiology. ISSN 0735-1097. 69(15), s. 1937–1948. doi: 10.1016/j.jacc.2017.01.058. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Smiseth, Otto Armin; Hammersbøen, Lars Egil Reine & Inoue, Katsuji (2025). Bi-atrial strain beats left atrial strain as risk marker: shown in TAVI patients. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 26(8), s. 1490–1491. doi: 10.1093/ehjci/jeaf146. Fulltekst i vitenarkiv
• Muraru, Denisa; Pontone, Gianluca; Jurcut, Ruxandra; Magne, Julien; Donal, Erwan & Stankovic, Ivan [Vis alle 28 forfattere av denne artikkelen] (2024). How to conduct clinical research in cardiovascular imaging: a primer for clinical cardiologists and researchers-a statement of the European Association of Cardiovascular Imaging (EACVI) of the ESC. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 26(1), s. 4–21. doi: 10.1093/ehjci/jeae238. Fulltekst i vitenarkiv
• Olsen, Flemming Javier; Smiseth, Otto Armin & Biering-Sørensen, Tor (2024). Improving post-MI risk stratification with pressure-strain loops: Work in progress. International Journal of Cardiology. ISSN 0167-5273. 402. doi: 10.1016/j.ijcard.2024.131866. Fulltekst i vitenarkiv
• Smiseth, Otto Armin & Popescu, Bogdan A (2024). Estimating left atrial pressure in atrial fibrillation: An ongoing struggle. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 25(11), s. 1599–1600. doi: 10.1093/ehjci/jeae195. Fulltekst i vitenarkiv
• Smiseth, Otto Armin; Larsen, Camilla Kjellstad & Hopp, Einar (2024). Left atrial volume as risk marker: is minimum volume superior to maximum volume? European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 25(11), s. 1575–1576. doi: 10.1093/ehjci/jeae136. Fulltekst i vitenarkiv
• Gillebert, Thierry C. & Smiseth, Otto Armin (2024). Left atrial reservoir strain in prognosis of heart failure and time for getting terminology straight. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 25(3), s. 325–327. doi: 10.1093/ehjci/jead311. Fulltekst i vitenarkiv
• Smiseth, Otto Armin (2023). Trouble with estimating filling pressure in acute heart failure: lessons from Takotsubo syndrome. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 24(6), s. 708–709. doi: 10.1093/ehjci/jead082. Fulltekst i vitenarkiv
• Smiseth, Otto Armin & Gillebert, Thierry C. (2023). Personality traits and cardiovascular diseases: is it about 'don't worry, be happy', or is this a deeper underlying problem? European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 24(11), s. 1468–1469. doi: 10.1093/ehjci/jead185. Fulltekst i vitenarkiv
• Smiseth, Otto Armin; Fernandes, Joao F. & Lamata, Pablo (2023). The challenge of understanding heart failure with supernormal left ventricular ejection fraction: time for building the patient’s ‘digital twin’. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 24(3), s. 301–303. doi: 10.1093/ehjci/jeac268. Fulltekst i vitenarkiv
• Remme, Espen; Inoue, Katsuji & Smiseth, Otto Armin (2023). Machine learning in diastolic dysfunction: Left atrial strain trace superior to single points for estimation of filling pressure†. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 25(1), s. 27–28. doi: 10.1093/ehjci/jead257. Fulltekst i vitenarkiv
• Smiseth, Otto Armin; Belenkie, Israel; Keurs, Henk E.D.J. ter & Smith, Eldon R. (2023). In Memoriam: John Victor Tyberg, MD, PhD. Canadian Journal of Cardiology. ISSN 0828-282X. doi: 10.1016/j.cjca.2023.01.010. Fulltekst i vitenarkiv
• Smiseth, Otto Armin & Maurer, Gerald (2023). Cardiovascular imaging in personalized medicine: focus issue on phenotyping heart failure. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 24(10), s. 1281–1282. doi: 10.1093/ehjci/jead183. Fulltekst i vitenarkiv
• Popescu, Bogdan A.; Beladan, Carmen C.; Nagueh, Sherif F. & Smiseth, Otto A. (2022). How to assess left ventricular filling pressures by echocardiography in clinical practice. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 23(9), s. 1127–1129. doi: 10.1093/ehjci/jeac123. Fulltekst i vitenarkiv
• Duchenne, Jürgen; Larsen, Camilla Kjellstad; Cvijic, Marta; Galli, Elena; Klop, Boudewijn & Aalen, John [Vis alle 21 forfattere av denne artikkelen] (2022). Visual Presence of Mechanical Dyssynchrony Combined With Septal Scarring Identifies Responders to Cardiac Resynchronization Therapy. JACC Cardiovascular Imaging. ISSN 1936-878X. 15(12), s. 2151–2153. doi: 10.1016/j.jcmg.2022.06.020. Fulltekst i vitenarkiv
• Remme, Espen W. & Smiseth, Otto A. (2022). Order of tricuspid and mitral valve opening as an index of left ventricular filling pressure and prognosis. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 23(5), s. 627–628. doi: 10.1093/ehjci/jeab239. Fulltekst i vitenarkiv
• Boe, Espen & Smiseth, Otto A. (2022). Left atrial strain imaging: ready for clinical implementation in heart failure with preserved ejection fraction. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 23(9), s. 1169–1170. doi: 10.1093/ehjci/jeac059. Fulltekst i vitenarkiv
• Henein, Michael Y.; Tyberg, John V. & Smiseth, Otto A. (2022). Derek G. Gibson-a unique scientist and cardiologist, 1936-2021. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 23(5), s. 600–600. doi: 10.1093/ehjci/jeac024. Fulltekst i vitenarkiv
• Smiseth, Otto A. (2022). Left ventricular performance by work and wasted energy: is strain not sufficient? European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 23(2), s. 198–199. doi: 10.1093/ehjci/jeab233. Fulltekst i vitenarkiv
• Aalen, John & Smiseth, Otto A. (2021). Strain identifies pseudo-normalized right ventricular function in tricuspid regurgitation. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 22(8), s. 876–877. doi: 10.1093/ehjci/jeab089. Fulltekst i vitenarkiv
• Puvrez, Alexis; Duchenne, Jürgen; Gorcsan, John; Marwick, Thomas; Smiseth, Otto A. & Voigt, Jens-Uwe (2021). Why mechanical dyssynchrony remains relevant to cardiac resynchronization therapy. Letter regarding the article ‘Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care: a joint position statement from the Heart Failure Association (HFA), European Heart Rhythm Association (EHRA), and European Association of Cardiovascular Imaging (EACVI) of the European Society of Cardiology’. European Journal of Heart Failure. ISSN 1388-9842. 23(5), s. 843–844. doi: 10.1002/ejhf.2150. Fulltekst i vitenarkiv
• Smiseth, Otto A. & Aalen, John (2021). Right ventricular work: A step forward for non-invasive assessment of right ventricular function. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 22(2), s. 153–154. doi: 10.1093/ehjci/jeaa296. Fulltekst i vitenarkiv
• 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
• Smiseth, Otto A. & Maurer, Gerald (2021). Focus on the left atrium in cardiac disease. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 23(1), s. 1–1. doi: 10.1093/ehjci/jeab259. Fulltekst i vitenarkiv
• Smiseth, Otto A. & Inoue, Katsuji (2020). The left atrium: A mirror of ventricular systolic and diastolic function. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 21(3), s. 270–272. doi: 10.1093/ehjci/jez305. Fulltekst i vitenarkiv
• Smiseth, Otto A. & Larsen, Camilla Kjellstad (2020). Finding the “Golden Moment” for TAVR: Look Below the Valve. JACC Cardiovascular Imaging. ISSN 1936-878X. 13(12), s. 2573–2575. doi: 10.1016/j.jcmg.2020.08.018. Fulltekst i vitenarkiv
• Aalen, John & Smiseth, Otto A. (2020). Editorial commentary: Septal flash – what is behind the flashy name? Trends in cardiovascular medicine. ISSN 1050-1738. 30(2), s. 123–124. doi: 10.1016/j.tcm.2019.04.003. Fulltekst i vitenarkiv
• Edvardsen, Thor & Smiseth, Otto A. (2018). Evaluation of diastolic function by echocardiography: important progression, but issues to be resolved. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 19, s. 387–388. doi: 10.1093/ehjci/jex319. Fulltekst i vitenarkiv
• Smiseth, Otto A. (2018). Need for better diastolic stress test: Twistin' time is here? European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 19(1), s. 20–22. doi: 10.1093/ehjci/jex307. Fulltekst i vitenarkiv
• Finsberg, Henrik; Aalen, John; Larsen, Camilla; Remme, Espen; Sundnes, Joakim & Smiseth, Otto [Vis alle 7 forfattere av denne artikkelen] (2017). Assessment of regional myocardial work through adjoint-based data assimilation. Fulltekst i vitenarkiv Vis sammendrag

  Assessment of regional myocardial work through adjoint-based data assimilationIntroductionTo achieve efficient pumping of blood to the body, the healthy heart contracts in a synchronous manner. However, heart disease can alter how the heart is activated during a beat, and dyssynchronous contraction can occur, reducing the overall pumping efficiency. Advanced treatments exist for such cases, but selecting patients likely to respond can be challenging. The existing selection criteria, based on organ level measures of activation and contraction, have relatively low specificity. It is therefore of interest to extract new biomarkers to help better identify potential responders. Here we explore one example of a potential biomarker, the regional myocardial work [1], a measure of cardiac efficiency, using a computational model of cardiac mechanics optimized to patient specific data using a high level adjoint based data assimilation method. MethodsLeft ventricular (LV) geometry was obtained from 4D echocardiography, and the segmented chamber was modelled as an incompressible, continuous hyperelastic body described via an transversely isotropic material law[2]. Active force development was modeled through additively decomposing stress into passive and active stresses, the latter added along the cardiac fiber direction, defined by a rule based architecture. The model was fit to 4D imaging of the LV through the cardiac cycle using an adjoint-based data assimilation technique, which automatically solves for the gradient of the solution with respect to local active stress, for highly efficient minimization of model misfit against collected data. Simulations were optimized both globally and regionally in 17 delineated segments[3]. With these simulations, the amount of mechanical work performed between time point tm and tn could be regionally calculated through -W(tm, tn) = ∫ S: ∂tE dt = ∑i S(ti-½): dE(ti-½) where S(ti-½) = 0.5*(S(ti)+S(ti-1)) and dE(ti-½) = E(ti)-E(ti-1) Here subscript t indicates the time point, S is the Second Piola-Kirchhoff stress tensor and E is the Green-Lagrange strain tensor. ResultsWe tested the method on healthy control subjects and patients suffering from left bundle branch block (LBBB). The results show an excellent fit between measured and simulated strain (R^2 = 0.8) and volume (R^2 = 1.0). The estimated regional myocardial work, assessed in these segments, shows clear differences between the healthy and diseased patients (e.g Mid Septal longitudinal wasted work ratio[1]: 1.45 (LBBB), 0.24(Healthy)) and can potentially be used as a biomarker to map regional cardiac dysfunction. References[1] doi:10.1152/ajpheart.00191.2013 [2] doi:10.1098/rsta.2009.0091 [3] doi:10.1002/cnm.2863

• Smiseth, Otto A. & Nagueh, Sherif F. (2017). Letter by Smiseth and Nagueh et al regarding article, "Role of diastolic stress testing in the evaluation for heart failure with preserved ejection fraction: A simultaneous invasive-echocardiographic study". Circulation. ISSN 0009-7322. 136(4), s. 428–429. doi: 10.1161/CIRCULATIONAHA.117.027881. Fulltekst i vitenarkiv
• Haugaa, Kristina; Edvardsen, Thor & Smiseth, Otto A. (2017). Mechanical dyssynchrony - Resurrected as a flashing and rocking parameter to predict prognosis after cardiac resynchronization therapy. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 18(10), s. 1118–1119. doi: 10.1093/ehjci/jex198. Fulltekst i vitenarkiv

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