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