ACC Scientific Sessions in New Orleans

American College of Cardiology was founded in the late 1940’s and throughout the years its mission has been to transform cardiovascular care and improve heart health. The College, with its 52 000 members, is a place for cardiovascular professionals to learn, grow and share knowledge, and will remain so, as stated on the ACC webpage.

During the ACC 19th Scientific Sessions Meeting in New Orleans in March, our visiting researcher Associate Professor Katsuji Inoue from Japan, presented two abstracts titled “Left Atrial Strain as a Surrogate Marker of Atrial Chamber Stiffness” and “Reduced Left Atrial Reservoir Strain at Rest Predicts Elevated Left Ventricular Filling Pressure During Exercise”, where the latter was selected as a moderated poster under the non-invasive imaging session in addition to being introduced in the Echocardiography Highlights Session at the ACC 2019. 

Professor Otto Smiseth held an interesting and important talk on guidelines in diastology on March 17th. The talk was titled ”Diastology: Please Simplify the Guidelines for Me!”.

Photos courtesy of Katsuji Inoue

CHFR Workshop

Center for Heart Failure Research (CHFR) invites to a workshop on Diastolic Function in Heart Failure on Wednesday 7th of November at Ullevål Hospital, starting at 12'00 o'clock.

Holding the key note lecture will be Professor Frank A. Flachskampf, MD, PhD from University of Uppsala, Sweden.

Professor Flachskampf is part of a world-renowned clinical research team in ischaemic heart disease and his talk will address how imaging reflects pathophysiology in diastolic function assessment.

The final talk of the day will be by Associate professor Stig Urheim, MD, PhD from Haukeland University Hospital. His talk is titled "Exercise intolerance in heart failure patients with preserved EF (HFpEF) - not only diastolic impairment".

Sign up for the workshop     


Read the program

CHFR Workshop

CHFR Workshop on Dyssynchrony in Heart Failure took place at Rikshospitalet on Thursday October 11th. The workshop had focus on dyssynchrony and consequences for the failing heart, including the effects of cardiac resynchronization therapy. Methods to identify and quantify dyssynchrony by cardiac imaging were the main topic.


Opening the meeting was invited speaker Professor Theodore P. Abraham, MD, PhD from University of California, San Francisco with an excellent talk on the role of imaging in patients with left ventricular dyssynchrony. Professor Abraham directs the UCSF Echocardiography laboratory and is also a co-director of the UCSF HCM Center of Excellence. He is a well renowned expert in transthoracic, stress and transesophageal echocardiography.


Continuing the meeting was Professor Eigil Samset with his talk on myocardial work for dyssynchrony assessment followed by several PhD fellows and postdocs at Integrated CardioVascular Function who held talks on a variety of selected topics.


Visiting researcher, associate professor Katsuji Inoue MD, PhD from Department of Cardiology, Pulmonology, Hypertension & Nephrology at Ehime University Graduate School of Medicine in Japan, held an interesting talk on atrial mechanics during left bundle branch block. Finishing the meeting was Professor Helge Skulstad, who shed light on the future perspectives of research in the field of dyssynchrony.


The organizers would like to thank all speakers and participants.

From left; Faraz Kahn Hameed, MD, Camilla K. Larsen, MD, Associate professor Helge Skulstad, MD, PhD, Associate professor Katsuji Inoue, MD, PhD, Professor Theodore P. Abraham, MD, PhD, John Aalen, MD, Professor Eigil Samset, PhD, Ole Jakob Sletten, MD, Espen Remme, M.Sc.Eng, PhD, Petter Storsten, MD and Espen Bøe, MD, PhD.

Copyright OUH

From the left: Associate professor Kasumi Masuda, M.Sc, PhD, Professor Satoshi Nakatani, MD, PhD, Professor Otto Smiseth, MD, PhD, and Associate professor  Katsuji Inoue, MD, PhD.

Copyright: Kasumi Masuda

CHFR Symposium on Heart Failure 2018

The Annual CHFR Symposium on Heart Failure has now been arranged for the 16th time.

Among the invited speakers at the CHFR Symposium this year was the President of the Japanese Society of Echocardiography, Satoshi Nakatani from Osaka University Graduate School of Medicine. He held a very interesting talk on novel methods for quantification of left ventricular function.

Researchers at the Integrated CardioVascular Function are participating in several ongoing international studies. Visiting us this year has been Associate professor Kasumi Masuda, M.Sc, PhD and Associate professor Katsuji Inoue, MD, PhD. They are both working on projects focusing on work efficiency and diastolic function. Kasumi Masuda already presented one abstract at the ESC Congress earlier this year and is among the authors who have been collaborating on abstracts presented at the CHFR Symposium.

The symposium has grown to become an international event, housing researchers from all around the world. Several research areas within cardiology and cardiovascular diseases are covered during the symposium. This year young researchers presented data in the following sessions;

I:   Biomarkers and cardiac disease

II:  Cellular signaling: Myocardial hypertrophy and ischemia

III: Cardiac function during heart failure and exercise training

IV: Cellular signaling: Myocardial function and arrhythmias

V:  Diagnostic and therapeutical strategies for cardiac disease

VI: Inflammatory mediators and metabolism

The research group was well represented in the session for Cardiac function during heart failure and exercise training, with almost half of the abstracts. PhD fellow Ole Jakob Sletten was the 2nd runner up for the best poster prize in the same session. Presenting were PhD fellows John Aalen, MD, Petter Storsten, MD, Camilla Kjellstad Larsen MD, and Ole Jakob Sletten, MD.

New study published in Journal of Applied Physiology

Atrial switch operation in patients with transposition of the great arteries (TGA), leads to leftward shift and changes the geometry of the interventricular septum. This mechanistic study demonstrates that septal dysfunction contributes to failure of the systemic RV after atrial switch in TGA patients. Medical therapy that counteracts septal flattening may improve function of the systemic RV. First author of the study is PhD fellow Petter Storsten.

Storsten P, Eriksen M, Remme EW, Boe E, Erikssen G, Smiseth OA, Skulstad H

Dysfunction of the Systemic Right Ventricle After Atrial Switch: Physiological Implications of Altered Septal Geometry and Load.

J Appl Physiol. 2018 Sep 6.  [Epub ahead of print]

PMID: 30188795

Several studies were presented at the ESC Congress in Munich

The world’s largest conference in cardiovascular medicine took place late August in Munich, Germany. The annual Congress hosted by the European Society of Cardiology has earned a strong global reputation as a provider of the latest science in the field. New guidelines and their implementation are discussed. Clinically relevant information and advice is presented in numerous sessions, including over 4 500 abstract presentations. This year the spotlight was on “Valvular Heart Disease” focusing on innovative treatments and techniques.

Studies from the research group Integrated CardioVascular Function were strongly represented at the Congress. Among those were “Septal work is a more sensitive marker of myocardial dysfunction in dyssynchrony than strain” with first author John Aalen. Regional myocardial work by echocardiography was recently introduced as a clinical method. Since work incorporates load it may be superior to strain imaging to identify myocardial dysfunction. The hypothesis was that myocardial work identifies preclinical myocardial dysfunction in patients with left bundle branch block (LBBB). The study concluded that myocardial work was more sensitive than strain to identify myocardial dysfunction in patients with LBBB and normal LVEF.

Doctor Espen Bøe, who successfully defended his PhD thesis during the summer, was selected to present his study “Ventricular volume changes are more accurate markers of acute response to CRT than contraction indices” under the best poster session. The purpose of the study was to determine the effect of cardiac resynchronisation therapy (CRT) on contraction indices and ventricular volumes during LBBB by pressure-volume analysis. The findings of the study suggest that LV volume changes rather than conventional contraction indices should be used to evaluate acute CRT response. These observations may explain some of the apparent inconsistency between acute response and long-term response to CRT.

Read more about the presented studies on Saturday, Sunday, Monday and Tuesday.

                  Pictures by Margareth Ribe, John Aalen and Kristina Haugaa.

Espen Bøe, MD, will be defending his PhD thesis on Friday June 22nd

Espen Bøe will hold his trial lecture "Pacemaker therapy and heart failure with preserved ejection fraction" at 10.15 o'clock in the Green Auditorium at Rikshospitalet.

The defence of his thesis "Evaluation of left ventricular function by pressure-volume and pressure-dimension analyses: Studies in myocardial ischemia and ventricular dyssynchrony"

begins at 12.15 o'clock in the same auditorium.

About the thesis:

In this thesis, pressure-volume and pressure-dimension analyses, during ventricular pacing (experimentally) and myocardial ischemia (clinically), were used to investigate regional and global left ventricular (LV) function.

First, potential beneficial mechanisms of cardiac resynchronization therapy (CRT) and LV pacing in heart failure with narrow QRS were explored. LV pacing improved LV filling during baseline and heart failure with increased external constraint, however, systolic function was impaired by CRT and LV pacing due to pacing-induced dyssynchrony.

In a similar fashion, the acute effect of CRT on ventricular function during left bundle branch block was assessed using both load-dependent and load-independent parameters. CRT improved LV performance acutely by increasing ventricular efficiency demonstrated by unaltered or increased parameters of systolic function at a reduced preload. The reduction in preload attenuated CRT related improvements in conventional parameters of systolic function, which are used clinically.

Finally, in a clinical study, a non-invasive method of calculating regional myocardial work was compared to strain echocardiography at identifying acute coronary occlusion (ACO) in patients with non-ST-elevation acute coronary syndrome. The myocardial work index identified ACO with a higher sensitivity and specificity compared to strain. Further analysis showed that strain was sensitive to changes in load.

This research contributes to the understanding and assessment of CRT’s effect on cardiac function during normal and dyssynchronous electrical activation. Further, it shows that the myocardial work index was superior to current echocardiographic methods by accounting for the effect of load on myocardial shortening. The thesis demonstrates the ongoing need for experimental studies and pressure-volume analysis to understand current topics in cardiology.

Abstract results for ESC Congress 2018 in Munich

Abstract results were announced this week, and our research group will now present seven abstracts during the ESC Congress in August, which is the largest cardiovascular congress in the world. First authors Espen Boe, John Aalen, Camilla Kjellstad Larsen and Petter Storsten will present their work.

Prof. Smiseth is an invited speaker on the subject "Multi-modality imaging approach for heart failure management", and his talk is titled "Imaging the dyssynchrony. Where are we?"

Espen Remme is invited to speak at the session "Easy to measure, hard to understand: a review of left ventricular strain in echocardiography" and his talk is titled "Circumferential strain is the main contributor to left ventricular function".

Click here to visit the Scientific Program at the official ESC site.

Annual report 2017 from Center for Cardiological Innovation (CCI)

As a part of the CCI, please visit this page to view the annual report from 2017.

Previous reports are available here.

New article in JACC Cardiovascular Imaging: Afterload Hypersensitivity in Patients With Left Bundle Branch Block

The first author of the article is John Aalen, and the article is now in press. In a combined clinical and experimental study, the authors show how patients with left bundle branch block are hypersensitive to an acute increase in afterload. Compared to healthy controls there were a twice as large reduction in left ventricular ejetion fraction with similar increase in systolic blood pressure.

Authors and full title:

Aalen J, Storsten P, Remme EW, Sirnes PA, Gjesdal O,Larsen CK, Kongsgaard E, Boe E, Skulstad H, Hisdal J, Smiseth OA. Afterload Hypersensitivity in Patients With Left Bundle Branch Block, JACC: Cardiovascular Imaging, 2018


EuroEcho Congress 2017

The annual congress was this year in Lisbon, Portugal. We presented several abstracts, and John Aalen was awarded the Young Investigator Award- Basic Science Session. His presentation was entitled  “Negative crosstalk between the septum and left ventricular lateral wall in left bundle branch block: the lateral wall paradox”. This study shows how septal function in left bundle branch block is highly affected by contractility in the left ventricular lateral wall.  Øyvind S. Andersen presented his abstract on diastolgy in a Rapid Fire session, and Ass. Prof. Helge Skulstad spoke during the session "Assessment of diastolic function". His talk was entitled "LV strain and twist and LA strain"

The following abstracts were presented:

Aalen J, Hisdal J, Storsten P, Remme EW, Larsen CK, Sirnes PA, Gjesdal O, Skulstad H, Smiseth OA

Pressure-strain loops in the evaluation of left bundle branch block: septal function is aggravated by increased afterload

Aalen J, Larsen CK, Hopp E, Andersen OS, Krogh MR, Odland HH, Kongsgard E, Skulstad H, Remme EW, Smiseth OA

Negative crosstalk between left ventricular lateral wall and septum in left bundle branch block: "the lateral wall paradox"

Andersen OS, Remme EW, Broch K, Andreassen AK, Skulstad H, Gude E, Smiseth OA

Improved estimate of left ventricular filling pressure by left atrial and left ventricular strain imaging

Larsen CK, Aalen J, Kongsgård E, Fjeld JG, Smiseth OA, Hopp E

Increased diffuse interstitial fibrosis in the septum compared to the left ventricular lateral wall in patients with heart failure and left bundle branch block

Remme EW, Stokke TM, Haugaa KH, Smiseth OA, Edvardsen T

Subendocardial speckle tracking overestimates myocardial shortening and may falsely indicate preserved systolic function in hypertrophic cardiomyopathy patients

15th annual CHFR symposium 2017

Center for Heart Failure Research (CHFR) had the annual symposium at Holmenkollen from 20-22 september. We presented four abstracts, and John Aalen won the 1st prize in his poster session. He presented results from his study on increased afterload in patients with left bundle branch block. Øyvind S. Andersen got 2nd place in his session.

Prof. Smiseth was chairman in the session "Developments in cardiac imaging".

The following abstracts were presented:

"Relative downregulation of septal function and metabolism in TGA patients with atrial switch" Authors:Storsten P, Fjeld JG, Sherwani AG, Boe E, Remme EW, Gjesdal O, Erikssen G, Smiseth OA, Skulstad H.

"Regional myocardial work by magnetic resonance imaging and non-invasive left ventricular pressure: a feasibility study in left bundle branch block" Authors: Larsen CK, Aalen J, Stokke C, Fjeld JG, Kongsgård E, Smiseth OA, Hopp E

"Increased Heart Rate Aggravates Diastolic Dysfunction in Left Bundle Branch Block

Authors: Andersen OS, Krogh MR, Boe E, Storsten P, Aalen J, Larsen CK, Skulstad H, Odland HH, Smiseth OA, Remme EW

"Patients with left bundle branch block are hypersensitive to afterload: moderate elevation of systolic pressure caused marked depression of left ventricular function"

Authors: Aalen J, Storsten P, Hisdal J, Remme EW, Larsen CK, Sirnes PA, Gjesdal O, Skulstad H, Smiseth OA

ESC Congress 2017 in Barcelona

We presented two abstracts at the ESC Congress. John Aalen presented his work druring a rapid fire session. The abstracts are listed below:

Aalen J, Storsten P, Hisdal J, Remme EW, Larsen CK, Sirnes PA, Gjesdal O, Skulstad H, Smiseth OA. Patients with left bundle branch block are hypersensitive to afterload: moderate elevation of systolic pressure caused marked depression of left ventricular

Storsten P, Fjeld JG, Sherwani AG, Boe E, Remme EW, Gjesdal O, Erikssen G, Smiseth OA, Skulstad H. Relative downregulation of septal function and metabolism in TGA patients after atrial switch

New article describing the geometric relationship between ejection fraction and strain and the discrepancies between the two measures, published in Journal of the American College of Cardiology

Several studies have reported significant reduced shortening despite unaltered ejection fraction (EF) in various patient populations. In this study we derived the geometric relationship between EF and strain in order to better understand these inconsistencies between EF and strain. We derived an equation that showed the direct relationship between EF and the 4 variables global longitudinal strain(GLS), global circumferential strain (GCS), end diastolic wall thickness and short axis diameter which was validated and showed good accuracy in 100 patients. The mathematical model showed how EF can be unaltered despite reduced shortening if wall thickness was increased and/or diameter reduced. It also showed that GCS contributes more to EF than GLS.

Authors and full title: 

Stokke TM, Hasselberg NE, Smedsrud MK, Sarvari SI, Haugaa KH, Smiseth OA, Edvardsen T, Remme EW.

Geometry as a Confounder When Assessing Ventricular Systolic Function: Comparison Between Ejection Fraction and Strain.

Journal of the American College of Cardiology. 2017,70(8):942-54.

New article: Estimating Left Ventricular Filling Pressure by Echocardiography

This study, published in the Journal of the American College of Cardiology, investigated whether left ventricular (LV) filling pressure can be estimated non-invasively using echocardiography. In 450 patient, echocardiography was performed simultaneously with invasive measurements of filling pressure. Non-invasive estimation of LV filling pressure was based on the algorithm suggested for this purpose in the most recent guidelines for evaluation of LV diastolic function. Our study demonstrated that echocardiography significantly improves estimation of LV filling pressure, when compared to clinical evaluation alone.

Our study was a collaboration between Oslo University Hospital, Rikshospitalet, Norway; McMaster University, Hamilton, Canada; Yonsei University College of Medicine, Seoul, Korea; Cleveland Clinic, Cleveland, Ohio; and Methodist DeBakey Heart and Vascular Center, Houston, Texas.

Authors and full title: Oyvind S. Andersen , Otto A. Smiseth, Hisham Dokainish, Muaz M. Abudiab, Robert C. Schutt, Arnav Kumar, Kimi Sato, Serge Harb,  Einar Gude, Espen W. Remme, Arne K. Andreassen, Jong-Won Ha, Jiaqiong Xu, Allan L. Klein, Sherif F. Nagueh. Estimating Left Ventricular Filling Pressure by Echocardiography. J Am Coll Cardiol. 2017 Apr 18;69(15):1937-1948. doi: 10.1016/j.jacc.2017.01.058.

Read more here