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The Cardiac State Diagram: A new method for assessing cardiac mechanics
KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging.ORCID iD: 0000-0002-5156-2535
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2015. , p. 107
Series
TRITA-STH ; 2015:2
Keywords [en]
Cardiac State Diagram, Heart, Hydraulic, Mechanics, DAPP, DeltaV, Hydraulic forces, left ventricular, diastole
National Category
Engineering and Technology
Research subject
Applied Medical Technology
Identifiers
URN: urn:nbn:se:kth:diva-202743ISBN: 978-91-7595-477-6 (print)OAI: oai:DiVA.org:kth-202743DiVA, id: diva2:1078490
Public defence
2015-04-27, 3-221, Alfred Nobels Alle10, Huddinge, 15:57 (Swedish)
Opponent
Supervisors
Note

QC 20170306

Available from: 2017-03-06 Created: 2017-03-04 Last updated: 2017-03-06Bibliographically approved
List of papers
1. Impact of tachycardia and sympathetic stimulation by cold pressor test on cardiac diastology and arterial function in elderly females
Open this publication in new window or tab >>Impact of tachycardia and sympathetic stimulation by cold pressor test on cardiac diastology and arterial function in elderly females
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2013 (English)In: American Journal of Physiology. Heart and Circulatory Physiology, ISSN 0363-6135, E-ISSN 1522-1539, Vol. 304, no 7, p. H1002-H1009Article in journal (Refereed) Published
Abstract [en]

Johnson J, Hakansson F, Shahgaldi K, Manouras A, Norman M, Sahlen A. Impact of tachycardia and sympathetic stimulation by cold pressor test on cardiac diastology and arterial function in elderly females. Am J Physiol Heart Circ Physiol 304: H1002-H1009, 2013. First published January 25, 2013; doi:10.1152/ajpheart.00837.2012.-Abnormal vascular-ventricular coupling has been suggested to contribute to heart failure with preserved ejection fraction in elderly females. Failure to increase stroke volume (SV) during exercise occurs in parallel with dynamic changes in arterial physiology leading to increased afterload. Such adverse vascular reactivity during stress may reflect either sympathoexcitation or be due to tachycardia. We hypothesized that afterload elevation induces SV failure by transiently attenuating left ventricular relaxation, a phenomenon described in animal research. The respective roles of tachycardia and sympathoexcitation were investigated in n = 28 elderly females (70 +/- 4 yr) carrying permanent pacemakers. At rest, during atrial tachycardia pacing (ATP; 100 min(-1)) and during cold pressor test (hand immersed in ice water), we performed Doppler echocardiography (maximal untwist rate analyzed by speckle tracking imaging of rotational mechanics) and arterial tonometry (arterial stiffness estimated as augmentation index). Estimation of arterial compliance was based on an exponential relationship between arterial pressure and volume. We found that ATP produced central hypovolemia and a reduction in SV which was larger in patients with stiffer arteries (higher augmentation index). There was an associated adverse response of arterial compliance and vascular resistance during ATP and cold pressor test, causing an overall increase in afterload, but nonetheless enhanced maximal rate of untwist and no evidence of afterload-dependent failure of relaxation. In conclusion, tachycardia and cold provocation in elderly females produces greater vascular reactivity and SV failure in the presence of arterial stiffening, but SV failure does not arise secondary to afterload-dependent attenuation of relaxation.

Keywords
aging, augmentation index, diastolic function, hypertension
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-122100 (URN)10.1152/ajpheart.00837.2012 (DOI)000317002500010 ()2-s2.0-84878541611 (Scopus ID)
Note

QC 20130514

Available from: 2013-05-14 Created: 2013-05-13 Last updated: 2017-12-06Bibliographically approved
2. Mitral Annular Displacement by Doppler Tissue Imaging May Identify Coronary Occlusion and Predict Mortality in Patients with Non-ST-Elevation Myocardial Infarction
Open this publication in new window or tab >>Mitral Annular Displacement by Doppler Tissue Imaging May Identify Coronary Occlusion and Predict Mortality in Patients with Non-ST-Elevation Myocardial Infarction
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2013 (English)In: Journal of the American Society of Echocardiography, ISSN 0894-7317, E-ISSN 1097-6795, Vol. 26, no 8, p. 875-884Article in journal (Refereed) Published
Abstract [en]

Background: Mitral annular displacement (MAD) is a simple marker of left ventricular (LV) systolic function. The aim of this study was to test the hypothesis that MAD can distinguish patients with non-ST-segment elevation myocardial infarctions (NSTEMIs) from those with significant coronary artery disease without infarctions, identify coronary occlusion, and predict mortality in patients with NSTEMIs. MAD was compared with established indices of LV function. Methods: In this retrospective study, 167 patients with confirmed NSTEMIs were included at two Scandinavian centers. Forty patients with significant coronary artery disease but without myocardial infarctions were included as controls. Doppler tissue imaging was performed at the mitral level of the left ventricle in the three apical planes, and velocities were integrated over time to acquire MAD. LV ejection fraction, global longitudinal strain (GLS), and wall motion score index were assessed according to guidelines. Results: MAD and GLS could accurately distinguish patients with NSTEMIs from controls. During 48.6 +/- 12.1 months of follow-up, 22 of 167 died(13%). MAD, LV ejection fraction, and GLS were reduced and wall motion score index was increased among those who died compared with those who survived (P<.001, P<.001, P<.001, and P=.02, respectively). Multivariate Cox proportional-hazards analyses revealed that MAD was an independent predictor of death (hazard ratio, 1.36; 95% confidence interval, 1.07-1.73; P=.01). MAD and GLS were reduced and wall motion score index was increased in patients with coronary artery occlusion compared with those without occlusion (P=.006, P=.001, and P=.02), while LV ejection fraction did not differ (P=.20). Conclusions: MAD accurately identified patients with NSTEMIs, predicted mortality, and identified coronary occlusion in patients with NSTEMIs.

Keywords
Myocardial infarction, Mortality, Echocardiography
National Category
Medical Engineering
Identifiers
urn:nbn:se:kth:diva-127488 (URN)10.1016/j.echo.2013.05.011 (DOI)000322627500013 ()2-s2.0-84880953435 (Scopus ID)
Note

QC 20130902

Available from: 2013-09-02 Created: 2013-08-30 Last updated: 2017-12-06Bibliographically approved
3. The early diastolic myocardial velocity: A marker of increased risk in patients with coronary heart disease
Open this publication in new window or tab >>The early diastolic myocardial velocity: A marker of increased risk in patients with coronary heart disease
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2014 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 34, no 5, p. 389-396Article in journal (Refereed) Published
Abstract [en]

Objective: Tissue Doppler imaging (TDI) is a promising echocardiographic modality allowing quantification of myocardial performance. However, the prognostic potential of TDI in patients with acute myocardial infarction (AMI) is not yet investigated. We sought to explore the ability of TDI in identifying patients at risk for new cardiovascular events after AMI. Methods: One hundred and nineteen patients with AMI were recruited prospectively (mean age 61 years; range 32-81 years of age). Patients with diabetes mellitus (DM) were excluded. Echocardiography was performed 3-12 months after AMI. Two-dimensional (2-D) and TDI variables were recorded. The patients were followed during a mean period of 4·6 years (range 1-8 years). The primary end-point was defined as any of the following: death from any cause, non-fatal reinfarction or stroke, unstable angina pectoris, congestive heart failure requiring hospitalization and coronary revascularization procedure. Results: Thirty patients had some form of cardiovascular events during follow-up. Seven patients had cardiovascular death, 13 patients had reinfarction and four patients had a stroke. New angina or unstable angina was recorded in 21 patients. Of these patients, 13 underwent percutaneous coronary angioplasty (PCI) or coronary artery bypass grafting (CABG). The early diastolic myocardial velocity (Em) emerged as the only echocardiographic variable that offered a clear differentiation between patients that presented with new cardiovascular (CV) events as compared to the corresponding group without any CV events at follow-up (P&lt;0·05). In multivariate statistical analysis and after adjustment for age, sex, total cholesterol, body mass index (BMI) and other baseline characteristics, Em remained as independent predictors of CV events (HR, 1·18, 95% CI, 1·02-1·36; P&lt;0·05). However, none of the investigated variables evolved as an independent predictor of cardiovascular morbidity and mortality. Conclusion: Em appears to be a sensitive echocardiographic index in identifying non-diabetic patients with AMI at risk of new cardiovascular events.

Keywords
Early myocardial diastolic velocity, Myocardial infarction, Tissue velocity imaging
National Category
Medical Image Processing
Identifiers
urn:nbn:se:kth:diva-151043 (URN)10.1111/cpf.12110 (DOI)000341238500008 ()2-s2.0-84908356117 (Scopus ID)
Note

QC 20140915

Available from: 2014-09-15 Created: 2014-09-15 Last updated: 2017-12-05Bibliographically approved
4. Peak Systolic Velocity (PSV) using colour-coded Tissue Doppler Imaging (TDI) is a strong and independent predictor of outcome in acute coronary syndrome patients
Open this publication in new window or tab >>Peak Systolic Velocity (PSV) using colour-coded Tissue Doppler Imaging (TDI) is a strong and independent predictor of outcome in acute coronary syndrome patients
2012 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, p. 924-924Article in journal, Meeting abstract (Other academic) Published
National Category
Medical Engineering
Identifiers
urn:nbn:se:kth:diva-103387 (URN)000308012406489 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 25-29, 2012, Munchen, GERMANY
Note

QC 20121012

Available from: 2012-10-12 Created: 2012-10-11 Last updated: 2017-12-07Bibliographically approved
5. The Cardiac State Diagram as a novel approach for evaluation of phases of the cardiac cycle in asfyxiated fetal lambs
Open this publication in new window or tab >>The Cardiac State Diagram as a novel approach for evaluation of phases of the cardiac cycle in asfyxiated fetal lambs
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2012 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, p. 144-144Article in journal, Meeting abstract (Other academic) Published
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:kth:diva-98724 (URN)10.1111/j.1600-0412.2012.01435_2.x (DOI)000304987600250 ()
Conference
38TH NORDIC CONGRESS OF OBSTETRICS AND GYNECOLOGY 17–19 JUNE 2012, BERGEN, NORWAY
Note

QC 20120703

Available from: 2012-07-03 Created: 2012-07-02 Last updated: 2017-12-07Bibliographically approved
6. The Cardiac State Index (CSI), a new timing-based diagnostic tool foridentifying patients with acute coronary syndrome
Open this publication in new window or tab >>The Cardiac State Index (CSI), a new timing-based diagnostic tool foridentifying patients with acute coronary syndrome
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(English)Manuscript (preprint) (Other academic)
National Category
Medical Image Processing
Identifiers
urn:nbn:se:kth:diva-163517 (URN)
Note

QS 2015

Available from: 2015-04-07 Created: 2015-04-07 Last updated: 2017-03-04Bibliographically approved

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