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Aagaard-Nilsen S, Dejgaard LA, Anfinsen OG, Lyseggen E, Holm T, Fink TS, Odland HH, Sevre K, Kongsgård E, Hegbom F, Stokke MK. Utility of the Inferior Axis and Left Bundle Branch Block Pattern for Categorization of Patients With Premature Ventricular Complexes Before Catheter Ablation. Am J Cardiol 2023; 201:148-149. [PMID: 37385167 DOI: 10.1016/j.amjcard.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Stine Aagaard-Nilsen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo; KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lars Andreas Dejgaard
- KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Ole-Gunnar Anfinsen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Erik Lyseggen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Torbjørn Holm
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Trine Synnøve Fink
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Hans Henrik Odland
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Knut Sevre
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Erik Kongsgård
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Finn Hegbom
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Mathis Korseberg Stokke
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo; KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
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Villegas-Martinez M, Odland HH, Hammersbøen LE, Sletten OJ, Stugaard M, Witsø M, Khan F, Wajdan A, Elle OJ, Remme EW. Pulse arrival time variation as a non-invasive marker of acute response to cardiac resynchronization therapy. Europace 2023; 25:1183-1192. [PMID: 36734281 PMCID: PMC10062362 DOI: 10.1093/europace/euad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/29/2022] [Indexed: 02/04/2023] Open
Abstract
AIMS Successful cardiac resynchronization therapy (CRT) shortens the pre-ejection period (PEP) which is prolonged in the left bundle branch block (LBBB). In a combined animal and patient study, we investigated if changes in the pulse arrival time (PAT) could be used to measure acute changes in PEP during CRT implantation and hence be used to evaluate acute CRT response non-invasively and in real time. METHODS AND RESULTS In six canines, a pulse transducer was attached to a lower limb and PAT was measured together with left ventricular (LV) pressure by micromanometer at baseline, after induction of LBBB and during biventricular pacing. Time-to-peak LV dP/dt (Td) was used as a surrogate for PEP. In twelve LBBB patients during implantation of CRT, LV and femoral pressures were measured at baseline and during five different pacing configurations. PAT increased from baseline (277 ± 9 ms) to LBBB (313 ± 16 ms, P < 0.05) and shortened with biventricular pacing (290 ± 16 ms, P < 0.05) in animals. There was a strong relationship between changes in PAT and Td in patients (r2 = 0.91). Two patients were classified as non-responders at 6 months follow-up. CRT decreased PAT from 320 ± 41 to 298 ± 39 ms (P < 0.05) in the responders, while PAT increased by 5 and 8 ms in the two non-responders. CONCLUSION This proof-of-concept study indicates that PAT can be used as a simple, non-invasive method to assess the acute effects of CRT in real time with the potential to identify long-term response in patients.
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Affiliation(s)
- Manuel Villegas-Martinez
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hans Henrik Odland
- Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Pacertool AS, Oslo, Norway
| | - Lars-Egil Hammersbøen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ole Jakob Sletten
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Marie Stugaard
- Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Marit Witsø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Faraz Khan
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ali Wajdan
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway.,Department of Informatics, University of Oslo, Oslo, Norway
| | - Ole Jakob Elle
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway.,Department of Informatics, University of Oslo, Oslo, Norway
| | - Espen W Remme
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway.,Pacertool AS, Oslo, Norway
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3
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Albatat M, Finsberg HN, Arevalo H, Sundnes J, Bergsland J, Balasingham I, Odland HH. Regional Left Ventricular Fiber Stress Analysis for Cardiac Resynchronization Therapy Response. Ann Biomed Eng 2023; 51:343-351. [PMID: 35900706 PMCID: PMC9867665 DOI: 10.1007/s10439-022-03030-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/18/2022] [Indexed: 01/26/2023]
Abstract
Cardiac resynchronization therapy (CRT) is an effective treatment for a subgroup of heart failure (HF) patients, but more than 30% of those selected do not improve after CRT implantation. Imperfect pre-procedural criteria for patient selection and optimization are the main causes of the high non-response rate. In this study, we evaluated a novel measure for assessing CRT response. We used a computational modeling framework to calculate the regional stress of the left ventricular wall of seven CRT patients and seven healthy controls. The standard deviation of regional wall stress at the time of mitral valve closure (SD_MVC) was used to quantify dyssynchrony and compared between patients and controls and among the patients. The results show that SD_MVC is significantly lower in controls than patients and correlates with long-term response in patients, based on end-diastolic volume reduction. In contrast to our initial hypothesis, patients with lower SD_MVC respond better to therapy. The patient with the highest SD_MVC was the only non-responder in the patient cohort. The distribution of fiber stress at the beginning of the isovolumetric phase seems to correlate with the degree of response and the use of this measurement could potentially improve selection criteria for CRT implantation. Further studies with a larger cohort of patients are needed to validate these results.
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Affiliation(s)
- Mohammad Albatat
- grid.55325.340000 0004 0389 8485Intervention Centre, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Henrik Nicolay Finsberg
- grid.419255.e0000 0004 4649 0885Department of Computational Physiology, Simula Research Laboratory, Fornebu, Norway
| | - Hermenegild Arevalo
- grid.419255.e0000 0004 4649 0885Department of Computational Physiology, Simula Research Laboratory, Fornebu, Norway
| | - Joakim Sundnes
- grid.419255.e0000 0004 4649 0885Department of Computational Physiology, Simula Research Laboratory, Fornebu, Norway
| | - Jacob Bergsland
- grid.55325.340000 0004 0389 8485Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Ilangko Balasingham
- grid.55325.340000 0004 0389 8485Intervention Centre, Oslo University Hospital, Oslo, Norway ,grid.5947.f0000 0001 1516 2393Department of Electronic Systems, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hans Henrik Odland
- grid.55325.340000 0004 0389 8485Department of Cardiology and Department of Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
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4
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Odland HH, Holm T, Cornelussen R, Kongsgård E. Determinants of the time-to-peak left ventricular dP/dt (Td) and QRS duration with different fusion strategies in cardiac resynchronization therapy. Front Cardiovasc Med 2022; 9:979581. [PMID: 36186985 PMCID: PMC9520326 DOI: 10.3389/fcvm.2022.979581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) is helpful in selected patients; however, responder rates rarely exceed 70%. Optimization of CRT may therefore benefit a large number of patients. Time-to-peak dP/dt (Td) is a novel marker of myocardial synergy that reflects the degree of myocardial dyssynchrony with the potential to guide and optimize treatment with CRT. Optimal electrical activation is a prerequisite for CRT to be effective. Electrical activation can be altered by changing the electrical wave-front fusion resulting from pacing to optimize resynchronization. We designed this study to understand the acute effects of different electrical wave-front fusion strategies and LV pre-/postexcitation on Td and QRS duration (QRSd). A better understanding of measuring and optimizing resynchronization can help improve the benefits of CRT. Methods Td and QRSd were measured in 19 patients undergoing a CRT implantation. Two biventricular pacing groups were compared: pacing the left ventricle (LV) with fusion with intrinsic right ventricular activation (FUSION group) and pacing the LV and right ventricle (RV) at short atrioventricular delay (STANDARD group) to avoid fusion with intrinsic RV activation. A quadripolar LV lead enabled pacing from widely separated electrodes; distal (DIST), proximal (PROX) and both electrodes combined (multipoint pacing, MPP). The LV was stimulated relative in time to RV activation (either RV pace-onset or QRS-onset), with the LV stimulated prior to (PRE), simultaneous with (SIM) or after (POST) RV activation. In addition, we analyzed the interactions of the two groups (FUSION/STANDARD) with three different electrode configurations (DIST, PROX, MPP), each paced with three different degrees of LV pre-/postexcitation (PRE, SIM, POST) in a statistical model. Results We found that FUSION provided shorter Td and QRSd than STANDARD, MPP provided shorter Td and QRSd than DIST and PROX, and SIM provided both the shortest QRSd and Td compared to PRE and POST. The interaction analysis revealed that pacing MPP with fusion with intrinsic RV activation simultaneous with the onset of the QRS complex (MPP*FUSION*SIM) shortened QRSd and Td the most compared to all other modes and configurations. The difference in QRSd and Td from their respective references were significantly correlated (β = 1, R = 0.9, p < 0.01). Conclusion Pacing modes and electrode configurations designed to optimize electrical wave-front fusion (intrinsic RV activation, LV multipoint pacing and simultaneous RV and LV activation) shorten QRSd and Td the most. As demonstrated in this study, electrical and mechanical measures of resynchronization are highly correlated. Therefore, Td can potentially serve as a marker for CRT optimization.
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Affiliation(s)
- Hans Henrik Odland
- Department of Cardiology and Pediatric Cardiology, Section for Arrhythmias, Oslo University Hospital, Oslo, Norway
- *Correspondence: Hans Henrik Odland
| | - Torbjørn Holm
- Department of Cardiology, Section for Arrhythmias, Oslo University Hospital, Oslo, Norway
| | | | - Erik Kongsgård
- Department of Cardiology, Section for Arrhythmias, Oslo University Hospital, Oslo, Norway
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5
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Wajdan A, Jahren TS, Villegas-Martinez M, Khan FH, Halvorsen PS, Odland HH, Elle OJ, Solberg AHS, Remme EW. Automatic Detection of Aortic Valve Events Using Deep Neural Networks on Cardiac Signals From Epicardially Placed Accelerometer. IEEE J Biomed Health Inform 2022; 26:4450-4461. [PMID: 35679388 DOI: 10.1109/jbhi.2022.3181148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Miniaturized accelerometers incorporated in pacing leads attached to the myocardium, are used to monitor cardiac function. For this purpose functional indices must be extracted from the acceleration signal. A method that automatically detects time of aortic valve opening (AVO) and aortic valve closure (AVC) will be helpful for such extraction. We tested if deep learning can be used to detect these valve events from epicardially attached accelerometers, using high fidelity pressure measurements to establish ground truth for these valve events. METHOD A deep neural network consisting of a CNN, an RNN, and a multi-head attention module was trained and tested on 130 recordings from 19 canines and 159 recordings from 27 porcines covering different interventions. Due to limited data, nested cross-validation was used to assess the accuracy of the method. RESULT The correct detection rates were 98.9% and 97.1% for AVO and AVC in canines and 98.2% and 96.7% in porcines when defining a correct detection as a prediction closer than 40 ms to the ground truth. The incorrect detection rates were 0.7% and 2.3% for AVO and AVC in canines and 1.1% and 2.3% in porcines. The mean absolute error between correct detections and their ground truth was 8.4 ms and 7.2 ms for AVO and AVC in canines, and 8.9 ms and 10.1 ms in porcines. CONCLUSION Deep neural networks can be used on signals from epicardially attached accelerometers for robust and accurate detection of the opening and closing of the aortic valve.
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6
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Villegas-Martinez M, Krogh MR, Andersen ØS, Sletten OJ, Wajdan A, Odland HH, Elle OJ, Remme EW. Tracking Early Systolic Motion for Assessing Acute Response to Cardiac Resynchronization Therapy in Real Time. Front Physiol 2022; 13:903784. [PMID: 35721553 PMCID: PMC9201723 DOI: 10.3389/fphys.2022.903784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
An abnormal systolic motion is frequently observed in patients with left bundle branch block (LBBB), and it has been proposed as a predictor of response to cardiac resynchronization therapy (CRT). Our goal was to investigate if this motion can be monitored with miniaturized sensors feasible for clinical use to identify response to CRT in real time. Motion sensors were attached to the septum and the left ventricular (LV) lateral wall of eighteen anesthetized dogs. Recordings were performed during baseline, after induction of LBBB, and during biventricular pacing. The abnormal contraction pattern in LBBB was quantified by the septal flash index (SFI) equal to the early systolic shortening of the LV septal-to-lateral wall diameter divided by the maximum shortening achieved during ejection. In baseline, with normal electrical activation, there was limited early-systolic shortening and SFI was low (9 ± 8%). After induction of LBBB, this shortening and the SFI significantly increased (88 ± 34%, p < 0.001). Subsequently, CRT reduced it approximately back to baseline values (13 ± 13%, p < 0.001 vs. LBBB). The study showed the feasibility of using miniaturized sensors for continuous monitoring of the abnormal systolic motion of the LV in LBBB and how such sensors can be used to assess response to pacing in real time to guide CRT implantation.
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Affiliation(s)
- Manuel Villegas-Martinez
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus Reinsfelt Krogh
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | | | - Ole Jakob Sletten
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Ali Wajdan
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Hans Henrik Odland
- Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Ole Jakob Elle
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Espen W. Remme
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- *Correspondence: Espen W. Remme,
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7
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Odland HH, Villegas-Martinez M, Ross S, Holm T, Cornelussen R, Remme EW, Kongsgard E. Shortening of time-to-peak left ventricular pressure rise (Td) in cardiac resynchronization therapy. ESC Heart Fail 2021; 8:5222-5236. [PMID: 34514746 PMCID: PMC8712829 DOI: 10.1002/ehf2.13601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/29/2021] [Accepted: 08/19/2021] [Indexed: 11/05/2022] Open
Abstract
Aims We tested the hypothesis that shortening of time‐to‐peak left ventricular pressure rise (Td) reflect resynchronization in an animal model and that Td measured in patients will be helpful to identify long‐term volumetric responders [end‐systolic volume (ESV) decrease >15%] in cardiac resynchronization therapy (CRT). Methods Td was analysed in an animal study (n = 12) of left bundle‐branch block (LBBB) with extensive instrumentation to detect left ventricular myocardial deformation, electrical activation, and pressures during pacing. The sum of electrical delays from the onset of pacing to four intracardiac electrodes formed a synchronicity index (SI). Pacing was performed at baseline, with LBBB, right and left ventricular pacing and finally with biventricular pacing (BIVP). We then studied Td at baseline and with BIVP in a clinical observational study in 45 patients during the implantation of CRT and followed up for up to 88 months. Results We found a strong relationship between Td and SI in the animals (R = 0.84, P < 0.01). Td and SI increased from narrow QRS at baseline (Td = 95 ± 2 ms, SI = 141 ± 8 ms) to LBBB (Td = 125 ± 2 ms, SI = 247 ± 9 ms, P < 0.01), and shortened with biventricular pacing (BIVP) (Td = 113 ± 2 ms and SI = 192 ± 7 ms, P < 0.01). Prolongation of Td was associated with more wasted deformation during the preejection period (R = 0.77, P < 0.01). Six patients increased ESV by 2.5 ± 18%, while 37 responders (85%) had a mean ESV decrease of 40 ± 15% after more than 6 months of follow‐up. Responders presented with a higher Td at baseline than non‐responders (163 ± 26 ms vs. 121 ± 19 ms, P < 0.01). Td decreased to 156 ± 16 ms (P = 0.02) with CRT in responders, while in non‐responders, Td increased to 148 ± 21 ms (P < 0.01). A decrease in Td with BIVP to values similar or below what was found at baseline accurately identified responders to therapy (AUC 0.98, P < 0.01). Td at baseline and change in Td from baseline was linear related to the decrease in ESV at follow‐up. All‐cause mortality was high among six non‐responders (n = 4), while no patients died in the responder group during follow‐up. Conclusions Prolongation of Td is associated with cardiac dyssynchrony and more wasted deformation during the preejection period. Shortening of a prolonged Td with CRT in patients accurately identifies volumetric responders to CRT with incremental value on top of current guidelines and practices. Thus, Td carries the potential to become a biomarker to predict long‐term volumetric response in CRT candidates.
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Affiliation(s)
- Hans Henrik Odland
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, 0027, Norway.,Department of Pediatric Cardiology, Oslo University Hospital, Oslo, 0027, Norway
| | | | - Stian Ross
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, 0027, Norway
| | - Torbjørn Holm
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, 0027, Norway
| | | | - Espen W Remme
- Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, 0027, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, 0027, Norway
| | - Erik Kongsgard
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, 0027, Norway
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Odland HH, Ross S, Cornelussen RN, Kongsgard E. B-PO03-193 THE MISSING LINK- TIME TO MAXIMAL RATE OF LEFT VENTRICULAR PRESSURE RISE REFLECTS RESYNCHRONIZATION WITH BIVENTRICULAR PACING IN PATIENTS WITH HEART FAILURE AND LEFT BUNDLE BRANCH BLOCK. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Odland HH, Ross S, Cornelussen RN, Kongsgard E. B-PO05-184 IMPACT OF HOMEOMETRIC AUTOREGULATION ON CONTRACTILITY AND TIME-TO-PEAK LV PRESSURE DERIVATIVE USING A STEPWISE CHANGE IN HEART RATE WITH RESYNCHRONIZATION THERAPY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Odland HH, Cornelussen RN, Kongsgard E. B-PO03-190 COMPARISON OF ADAPTIVE AND NON-ADAPTIVE PACING MODES WITH BIVENTRICULAR STIMULATION ON TIME-TO-PEAK DERIVATIVE OF LEFT VENTRICULAR PRESSURE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Villegas-Martinez M, Odland HH, Sletten OJ, Khan F, Wajdan A, Elle OJ, Fosse E, Krogh MR, Remme EW. Duration of the preejection phase is less preload dependent and therefore a better marker of acute response to cardiac resynchronization therapy than maximum pressure rise. Europace 2021. [DOI: 10.1093/europace/euab116.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EU’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie
Background
There is no consensus on which haemodynamic marker should be used to quantify acute response to cardiac resynchronization therapy (CRT) during implantation of the device. CRT has been shown to acutely reduce left ventricular (LV) end systolic as well as end-diastolic volume (EDV), precluding the use of preload dependent markers such as LV maximum pressure rise (dP/dtmax).
Purpose
As resynchronization will abolish the uncoordinated regional early systolic contractions of the LV, it will shorten the time to maximal pressure rise and aortic valve opening. For this reason, the purpose of this study was to investigate if duration from the time-point of ventricular pacing to dP/dtmax is less preload dependent and a better marker of acute response to CRT than dP/dtmax by comparing how the 2 markers reflected LV function during different CRT configurations.
Methods
LV pressure by micromanometer and volume by sonomicrometry were measured in 6 anaesthetized canines with left bundle branch block. Transient caval constrictions were performed to vary preload. Preload dependency of the 2 markers was compared by normalizing their values and calculating their relations to EDV. In 4 of the animals, biventricular pacing was performed at 3 different pacing sites with variations in atrioventricular delays that provided a range of response to CRT. To correct for acute
changes in preload by CRT, stroke volume (SV) at identical EDV found from transient caval constrictions, were assessed and used as reference to grade improved LV function. Linear regression analysis was used to assess the correlation of both the duration of the preejection phase and dP/dtmax with SV.
Results
The duration of the preejection phase varied less with changes in preload compared to dP/dtmax: the slopes of their relation to EDV were -0.6 ± 0.7 %/ml and 4.8 ± 2.1 %/ml (p = 0.004), respectively. Turning CRT on, acutely reduced EDV from 74 ± 16 to 69 ± 17 ml (p < 0.001) at the best pacing configuration. For the different pacing sites and settings, there was a consistent relation in all animals where the preejection phase shortened as SV increased (average r2 = 0.75) (Figure A). dP/dtmax showed no clear relation to SV (average r2 = 0.22) and included cases with both negative and positive slopes (Figure B).
Conclusions
The duration of the preejection phase correlated with changes in LV function induced by CRT while dP/dtmax performed poorly as preload was changed. Hence, the novel timing parameter was less preload dependent and may be a better marker for assessing acute response to CRT. Abstract Figure.
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Affiliation(s)
- M Villegas-Martinez
- Oslo University Hospital Rikshospitalet, The Intervention Centre, Oslo, Norway
| | - HH Odland
- Oslo University Hospital Rikshospitalet, Cardiology, Oslo, Norway
| | - OJ Sletten
- Oslo University Hospital Rikshospitalet, Institute for Surgical Research, Oslo, Norway
| | - F Khan
- Oslo University Hospital Rikshospitalet, Institute for Surgical Research, Oslo, Norway
| | - A Wajdan
- Oslo University Hospital Rikshospitalet, The Intervention Centre, Oslo, Norway
| | - OJ Elle
- Oslo University Hospital Rikshospitalet, The Intervention Centre, Oslo, Norway
| | - E Fosse
- Oslo University Hospital Rikshospitalet, The Intervention Centre, Oslo, Norway
| | - MR Krogh
- Oslo University Hospital Rikshospitalet, The Intervention Centre, Oslo, Norway
| | - EW Remme
- Oslo University Hospital Rikshospitalet, Institute for Surgical Research, Oslo, Norway
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12
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Odland HH, Holm T, Cornelussen R, Gammelsrud LO, Kongsgard E. Comparison of adaptive and non-adaptive pacing modes on time-to-peak dP/dt in multipoint pacing or standard biventricular pacing with different degrees of intraventricular fusion. Europace 2021. [DOI: 10.1093/europace/euab116.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Norwegian South-East Health Authorities
Background
We have investigated the timing of the peak left ventricular pressure rise, time to peak dP/dt (Td) as marker of resynchronization to be measured during implantation for detection of effective resynchronization. Td links the time domain (dyssynchrony) to the mechanical domain (pressure) as the dyssynergic muscular contractions resulting from electrical dyssynchrony delays pressure development and hence the timing of peak dP/dt, Td. Td shortens with resynchronization.
Purpose
In this study we investigated the acute changes in Td by comparing pacing the left ventricle (LV) with fusion of intrinsic right ventricular (RV) conduction (Adaptive, A) with pacing RV and LV (Non-Adaptive, NA), with and without multipoint pacing (MPP) and with different degrees of intraventricular pacing delays (RV-LV).
Methods
19 patients with sinus rhythm and LBBB undergoing CRT implantation were studied. We measured pressures with an indwelling LV pressure catheter. Td was calculated as the time from onset of pacing to peak dP/dt, and averaged in 10 subsequent beats at each stage of pacing. We used quadripolar LV pacing leads positioned in what was considered an optimal mid/basal posterolateral/ lateral branch of the coronary sinus and sequential pacing (DDD) was performed; Adaptive and Non-Adaptive pacing was performed at LV distal [LVdist], proximal electrode [LVprox] and at both electrodes as multipoint pacing [MPP]. VV-timing: LV pacing was performed relative to QRS onset (either as a result of intrinsic activation or RV pace, mean ± SD): 1. LV only -76 ± 21ms before QRS activation with minimal fusion with RV activation (LVonly); 2. -28 ± 14ms before QRS activation (Pre); 3. 12 ± 15ms after (Post) QRS activation. Linear mixed models were used for statistics of the pooled data. Results are estimated marginal means ±SEM, and only significant P < 0.05 changes are reported.
Results
Average Td (data pooled) with RVP was 173 ± 2ms, MPP 144 ± 0.4ms and BIVP 150 ± 0.4ms. When analyzing the interaction between pacingmode (A,NA), VV-timing (LVonly,Pre,Post) and electrode(LVdist,LVprox,MPP) in all interventions we found that Td was shorter (p < 0.01) with A(Post) for all electrode combinations [LVdist] 143 ± 4ms, [LVprox] 140 ± 4ms and [MPP] 134 ± 4ms, while Td with A(Pre) was shorter with [MPP] 139 ± 4ms only. A(post)[MPP] provided shorter Td than the other adaptive modes (p < 0.01). NA(Post)[MPP] at 145 ± 4ms and NA(Post)[LVdist] at 146 ± 4ms provided the shortest Td (p < 0.01) of the NA pacing modes, and Td with NA(Post)[MPP] was shorter (p < 0.01) than all NA pacing modes.
Conclusion
Td shortens the most with LV MPP timed to near simultaneous intrinsic RV activation, indicating a beneficial mechanical effect from Adaptive MPP compared to standard biventricular pacing.
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Affiliation(s)
- HH Odland
- Oslo University Hospital Rikshospitalet, Department of Pediatric Cardiology and Cardiology, Oslo, Norway
| | - T Holm
- Oslo University Hospital, Department of Cardiology, Oslo, Norway
| | - R Cornelussen
- Bakken Research Center, Maastricht, Netherlands (The)
| | | | - E Kongsgard
- Oslo University Hospital, Department of Cardiology, Oslo, Norway
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13
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Odland HH, Holm T, Gammelsrud LO, Cornelussen R, Kongsgaard E. Determinants of LV dP/dt max and QRS duration with different fusion strategies in cardiac resynchronisation therapy. Open Heart 2021; 8:e001615. [PMID: 33963078 PMCID: PMC8108692 DOI: 10.1136/openhrt-2021-001615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/13/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We designed this study to assess the acute effects of different fusion strategies and left ventricular (LV) pre-excitation/post-excitation on LV dP/dtmax and QRS duration (QRSd). METHODS We measured LV dP/dtmax and QRSd in 19 patients having cardiac resynchronisation therapy (CRT). Two groups of biventricular pacing were compared: pacing the left ventricle (LV) with FUSION with intrinsic right ventricle (RV) activation (FUSION), and pacing the LV and RV with NO FUSION with intrinsic RV activation. In the NO FUSION group, the RV was paced before the expected QRS onset. A quadripolar LV lead enabled distal, proximal and multipoint pacing (MPP). The LV was stimulated relative in time to either RV pace or QRS-onset in four pre-excitation/post-excitation classes (PCs). We analysed the interactions of two groups (FUSION/NO FUSION) with three different electrode configurations, each paced with four different degrees of LV pre-excitation (PC1-4) in a statistical model. RESULTS LV dP/dtmax was higher with NO FUSION than with FUSION (769±46 mm Hg/s vs 746±46 mm Hg/s, p<0.01), while there was no difference in QRSd (NO FUSION 156±2 ms and FUSION 155±2 ms). LV dP/dtmax and QRSd increased with LV pre-excitation compared with pacing timed to QRS/RV pace-onset regardless of electrode configuration. Overall, pacing LV close to QRS-onset (FUSION) with MPP shortened QRSd the most, while LV dP/dtmax increased the most with LV pre-excitation. CONCLUSION We show how a beneficial change in QRSd dissociates from the haemodynamic change in LV dP/dtmax with different biventricular pacing strategies. In this study, LV pre-excitation was the main determinant of LV dP/dtmax, while QRSd shortens with optimal resynchronisation.
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Affiliation(s)
- Hans Henrik Odland
- Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Holm
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | | | | | - Erik Kongsgaard
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
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14
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Albatat M, Arevalo H, Bergsland J, Strøm V, Balasingham I, Odland HH. Optimal pacing sites in cardiac resynchronization by left ventricular activation front analysis. Comput Biol Med 2020; 128:104159. [PMID: 33301952 DOI: 10.1016/j.compbiomed.2020.104159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/14/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
Cardiac resynchronization therapy (CRT) can substantially improve dyssynchronous heart failure and reduce mortality. However, about one-third of patients who are implanted, derive no measurable benefit from CRT. Non-response may partly be due to suboptimal activation of the left ventricle (LV) caused by electrophysiological heterogeneities. The goal of this study is to investigate the performance of a newly developed method used to analyze electrical wavefront propagation in a heart model including myocardial scar and compare this to clinical benchmark studies. We used computational models to measure the maximum activation front (MAF) in the LV during different pacing scenarios. Different heart geometries and scars were created based on cardiac MR images of three patients. The right ventricle (RV) was paced from the apex and the LV was paced from 12 different sites, single site, dual-site and triple site. Our results showed that for single LV site pacing, the pacing site with the largest MAF corresponded with the latest activated regions of the LV demonstrated during RV pacing, which also agrees with previous markers used for predicting optimal single-site pacing location. We then demonstrated the utility of MAF in predicting optimal electrode placements in more complex scenarios including scar and multi-site LV pacing. This study demonstrates the potential value of computational simulations in understanding and planning CRT.
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Affiliation(s)
- Mohammad Albatat
- Intervention Centre, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Hermenegild Arevalo
- Department of Computational Physiology, Simula Research Laboratory, Fornebu, Norway
| | | | - Vilde Strøm
- Department of Computational Physiology, Simula Research Laboratory, Fornebu, Norway
| | - Ilangko Balasingham
- Intervention Centre, Oslo University Hospital, Oslo, Norway; Department of Electronic Systems, Norwegian University of Science and Technology, Trondheim, Norway
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15
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Albatat M, Bergsland J, Arevalo H, Odland HH, Wall S, Sundnes J, Balasingham I. Multisite pacing and myocardial scars: a computational study. Comput Methods Biomech Biomed Engin 2020; 23:248-260. [PMID: 31958019 DOI: 10.1080/10255842.2020.1711885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cardiac resynchronization therapy (CRT) is a frequently effective treatment modality for dyssynchronous heart failure, however, 30% of patients do not respond, usually due to suboptimal activation of the left ventricle (LV). Multisite pacing (MSP) may increase the response rate, but its effect in the presence of myocardial scars is not fully understood. We use a computational model to study the outcome of MSP in an LV with scars in two different locations and of two different sizes. The LV was stimulated from anterior, posterior and lateral locations individually and in pairs, while a septal stimulation site represented right ventricular (RV) pacing. Intraventricular pressures were measured, and outcomes evaluated in terms of maximum LV pressure gradient (dP/dtmax)- change compared to isolated RV pacing. The best result obtained using various LV pacing locations included a combination of sites remote from scars and the septum. The highest dP/dtmax increase was achieved, regardless of scar size, using MSP with one pacing site located on the LV free wall opposite to the scar and one site opposite to the septum. These in silico modelling results suggest that making placement of pacing electrodes dependent on location of scarring, may alter acute haemodynamics and that such modelling may contribute to future CRT optimization.
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Affiliation(s)
| | | | - Hermenegild Arevalo
- Department of Computational Physiology, Simula Research Laboratory, Fornebu, Norway
| | | | - Samuel Wall
- Department of Computational Physiology, Simula Research Laboratory, Fornebu, Norway
| | - Joakim Sundnes
- Department of Computational Physiology, Simula Research Laboratory, Fornebu, Norway
| | - Ilangko Balasingham
- Intervention Centre, Oslo University Hospital, Oslo, Norway.,Department of Electronic Systems, Norwegian University of Science and Technology, Trondheim, Norway
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16
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Babić A, Odland HH, Lyseggen E, Holm T, Ross S, Hopp E, Haugaa KH, Kongsgård E, Edvardsen T, Gérard O, Samset E. An image fusion tool for echo-guided left ventricular lead placement in cardiac resynchronization therapy: Performance and workflow integration analysis. Echocardiography 2019; 36:1834-1845. [PMID: 31628770 DOI: 10.1111/echo.14483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/11/2019] [Accepted: 08/29/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The response rate to cardiac resynchronization therapy (CRT) may be improved if echocardiographic-derived parameters are used to guide the left ventricular (LV) lead deployment. Tools to visually integrate deformation imaging and fluoroscopy to take advantage of the combined information are lacking. METHODS An image fusion tool for echo-guided LV lead placement in CRT was developed. A personalized average 3D cardiac model aided visualization of patient-specific LV function in fluoroscopy. A set of coronary venography-derived landmarks facilitated registration of the 3D model with fluoroscopy into a single multimodality image. The fusion was both performed and analyzed retrospectively in 30 cases. Baseline time-to-peak values from echocardiography speckle-tracking radial strain traces were color-coded onto the fused LV. LV segments with suspected scar tissue were excluded by cardiac magnetic resonance imaging. The postoperative augmented image was used to investigate: (a) registration accuracy and (b) agreement between LV pacing lead location, echo-defined target segments, and CRT response. RESULTS Registration time (264 ± 25 seconds) and accuracy (4.3 ± 2.3 mm) were found clinically acceptable. A good agreement between pacing location and echo-suggested segments was found in 20 (out of 21) CRT responders. Perioperative integration of the proposed workflow was successfully tested in 2 patients. No additional radiation, compared with the existing workflow, was required. CONCLUSIONS The fusion tool facilitates understanding of the spatial relationship between the coronary veins and the LV function and may help targeted LV lead delivery.
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Affiliation(s)
- Aleksandar Babić
- Center for Cardiological Innovation, Oslo, Norway.,GE Vingmed Ultrasound, Horten, Norway.,University of Oslo, Oslo, Norway
| | - Hans Henrik Odland
- Center for Cardiological Innovation, Oslo, Norway.,University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Erik Lyseggen
- Center for Cardiological Innovation, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Holm
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Stian Ross
- Center for Cardiological Innovation, Oslo, Norway.,University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Einar Hopp
- Center for Cardiological Innovation, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Kristina H Haugaa
- Center for Cardiological Innovation, Oslo, Norway.,University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Erik Kongsgård
- Center for Cardiological Innovation, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Thor Edvardsen
- Center for Cardiological Innovation, Oslo, Norway.,University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Olivier Gérard
- Center for Cardiological Innovation, Oslo, Norway.,GE Vingmed Ultrasound, Horten, Norway
| | - Eigil Samset
- Center for Cardiological Innovation, Oslo, Norway.,GE Vingmed Ultrasound, Horten, Norway.,University of Oslo, Oslo, Norway
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17
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Aria S, Elfarri Y, Elvegård M, Gottfridsson A, Grønaas HS, Harang S, Jansen A, Madland TER, Martins IB, Olstad MW, Ryan TL, Shaban AN, Svenningsen ØL, Sørensen AD, Ulvestad EH, Vister OM, Øvergaard MB, Kalvøy H, Pettersen FJ, Odland HH, Joten VM, Martinsen ØG, Tronstad C, Elvebakk O, Martinsen ØG. Measuring Blood Pulse Wave Velocity with Bioimpedance in Different Age Groups. Sensors (Basel) 2019; 19:s19040850. [PMID: 30791368 PMCID: PMC6412959 DOI: 10.3390/s19040850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/05/2019] [Accepted: 02/14/2019] [Indexed: 11/16/2022]
Abstract
In this project, we have studied the use of electrical impedance cardiography as a possible method for measuring blood pulse wave velocity, and hence be an aid in the assessment of the degree of arteriosclerosis. Using two different four-electrode setups, we measured the timing of the systolic pulse at two locations, the upper arm and the thorax, and found that the pulse wave velocity was in general higher in older volunteers and furthermore that it was also more heart rate dependent for older subjects. We attribute this to the fact that the degree of arteriosclerosis typically increases with age and that stiffening of the arterial wall will make the arteries less able to comply with increased heart rate (and corresponding blood pressure), without leading to increased pulse wave velocity. In view of these findings, we conclude that impedance cardiography seems to be well suited and practical for pulse wave velocity measurements and possibly for the assessment of the degree of arteriosclerosis. However, further studies are needed for comparison between this approach and reference methods for pulse wave velocity and assessment of arteriosclerosis before any firm conclusions can be drawn.
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Affiliation(s)
- Shafa Aria
- Department of Physics, University of Oslo, 0372 Oslo, Norway.
| | - Yassine Elfarri
- Department of Physics, University of Oslo, 0372 Oslo, Norway.
| | - Marius Elvegård
- Department of Physics, University of Oslo, 0372 Oslo, Norway.
| | | | | | - Sigve Harang
- Department of Physics, University of Oslo, 0372 Oslo, Norway.
| | - Anders Jansen
- Department of Physics, University of Oslo, 0372 Oslo, Norway.
| | | | | | | | - Tommy Lee Ryan
- Department of Physics, University of Oslo, 0372 Oslo, Norway.
| | | | | | | | | | | | | | - Håvard Kalvøy
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, 0372 Oslo, Norway.
| | - Fred Johan Pettersen
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, 0372 Oslo, Norway.
- Department of Physics, University of Oslo, 0316 Oslo, Norway.
| | | | | | | | - Christian Tronstad
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, 0372 Oslo, Norway.
| | - Ole Elvebakk
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, 0372 Oslo, Norway.
| | - Ørjan Grøttem Martinsen
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, 0372 Oslo, Norway.
- Department of Physics, University of Oslo, 0316 Oslo, Norway.
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18
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Ross S, Odland HH, Fischer T, Edvardsen T, Gammelsrud LO, Haland TF, Cornelussen R, Hopp E, Kongsgaard E. Contractility surrogates derived from three-dimensional lead motion analysis and prediction of acute haemodynamic response to CRT. Open Heart 2019; 5:e000874. [PMID: 30613408 PMCID: PMC6307559 DOI: 10.1136/openhrt-2018-000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/05/2018] [Accepted: 11/12/2018] [Indexed: 12/02/2022] Open
Abstract
Background Patient-specific left ventricular (LV) lead optimisation strategies with immediate feedback on cardiac resynchronisation therapy (CRT) effectiveness are needed. The purpose of this study was to compare contractility surrogates derived from biventricular lead motion analysis to the peak positive time derivative of LV pressure (dP/dtmax) in patients undergoing CRT implantation. Methods Twenty-seven patients underwent CRT implantation with continuous haemodynamic monitoring. The right ventricular (RV) lead was placed in apex and a quadripolar LV lead was placed laterally. Biplane fluoroscopy cine films facilitated construction of three-dimensional RV–LV interlead distance waveforms at baseline and under biventricular pacing (BIVP) from which the following contractility surrogates were derived; fractional shortening (FS), time to peak systolic contraction and peak shortening of the interlead distance (negative slope). Acute haemodynamic CRT response was defined as LV ∆dP/dtmax ≥ 10 %. Results We observed a mean increase in dP/dtmax under BIVP (899±205 mm Hg/s vs 777±180 mm Hg/s, p<0.001). Based on ΔdP/dtmax, 18 patients were classified as acute CRT responders and nine as non-responders (23.3%±10.6% vs 1.9±5.3%, p<0.001). The baseline RV–LV interlead distance was associated with echocardiographic LV dimensions (end diastole: R=0.61, p=0.001 and end systole: R=0.54, p=0.004). However, none of the contractility surrogates could discriminate between the acute CRT responders and non-responders (ΔFS: −2.5±2.6% vs − 2.0±3.1%, p=0.50; Δtime to peak systolic contraction: −9.7±18.1% vs −10.8±15.1%, p=0.43 and Δpeak negative slope: −8.7±45.9% vs 12.5±54.8 %, p=0.09). Conclusion The baseline RV–LV interlead distance was associated with echocardiographic LV dimensions. In CRT recipients, contractility surrogates derived from the RV–LV interlead distance waveform could not discriminate between acute haemodynamic responders and non-responders.
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Affiliation(s)
- Stian Ross
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hans Henrik Odland
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Thor Edvardsen
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Ove Gammelsrud
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Medtronic Norge AS, Akershus, Norway
| | - Trine Fink Haland
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Richard Cornelussen
- Medtronic Plc, Bakken research Center, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Einar Hopp
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Erik Kongsgaard
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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19
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Aalen J, Remme EW, Krogh MR, Andersen OS, Masuda K, Odland HH, Opdahl A, Smiseth OA. P3739Septal rebound stretch is a tug of war between septum and left ventricular lateral wall. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Aalen
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - E W Remme
- Oslo University Hospital, Inst. for Surgical Research, Oslo, Norway
| | - M R Krogh
- Oslo University Hospital, Inst. for Surgical Research, Oslo, Norway
| | - O S Andersen
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - K Masuda
- Osaka University Hospital, Osaka, Japan
| | - H H Odland
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - A Opdahl
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - O A Smiseth
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
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20
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Aalen J, Remme EW, Larsen CK, Hopp E, Andersen OS, Krogh M, Ross S, Odland HH, Kongsgaard E, Skulstad H, Smiseth OA. P5660Reduced left ventricular lateral wall contractility leads to recovery of septal function in left bundle branch block. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Aalen
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - E W Remme
- Oslo University Hospital, Inst. for Surgical Research, Oslo, Norway
| | - C K Larsen
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - E Hopp
- Oslo University Hospital, Dep. of Radiology, Oslo, Norway
| | - O S Andersen
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - M Krogh
- Oslo University Hospital, Inst. for Surgical Research, Oslo, Norway
| | - S Ross
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - H H Odland
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - E Kongsgaard
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - H Skulstad
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - O A Smiseth
- Dep. of Cardiology and Inst. for Surgical Research, Oslo University Hospital, Oslo, Norway
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21
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Masuda K, Aalen J, Andersen OS, Krogh M, Odland HH, Stugaard M, Remme EW, Nakatani S, Smiseth OA. P2743Estimation of filling pressure by E/e' in left bundle branch block: why is it so difficult? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Masuda
- Osaka University Graduate School of Medicine Division of Functional Diagnostics, Suita, Osaka, Japan
| | - J Aalen
- Oslo University Hospital, Oslo, Norway
| | | | - M Krogh
- Oslo University Hospital, Oslo, Norway
| | | | - M Stugaard
- Osaka University Graduate School of Medicine Division of Functional Diagnostics, Suita, Osaka, Japan
| | - E W Remme
- Oslo University Hospital, Oslo, Norway
| | - S Nakatani
- Osaka University Graduate School of Medicine Division of Functional Diagnostics, Suita, Osaka, Japan
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22
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Olberg HK, Odland HH, Kask A, Engelsen BA. A woman in her thirties with seizure relapse after a previous diagnosis of epilepsy. Tidsskr Nor Laegeforen 2018; 138:16-1044. [PMID: 29737768 DOI: 10.4045/tidsskr.16.1044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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23
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Balaban G, Finsberg H, Odland HH, Rognes ME, Ross S, Sundnes J, Wall S. High-resolution data assimilation of cardiac mechanics applied to a dyssynchronous ventricle. Int J Numer Method Biomed Eng 2017; 33:e2863. [PMID: 28039961 DOI: 10.1002/cnm.2863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/31/2016] [Accepted: 12/28/2016] [Indexed: 06/06/2023]
Abstract
Computational models of cardiac mechanics, personalized to a patient, offer access to mechanical information above and beyond direct medical imaging. Additionally, such models can be used to optimize and plan therapies in-silico, thereby reducing risks and improving patient outcome. Model personalization has traditionally been achieved by data assimilation, which is the tuning or optimization of model parameters to match patient observations. Current data assimilation procedures for cardiac mechanics are limited in their ability to efficiently handle high-dimensional parameters. This restricts parameter spatial resolution, and thereby the ability of a personalized model to account for heterogeneities that are often present in a diseased or injured heart. In this paper, we address this limitation by proposing an adjoint gradient-based data assimilation method that can efficiently handle high-dimensional parameters. We test this procedure on a synthetic data set and provide a clinical example with a dyssynchronous left ventricle with highly irregular motion. Our results show that the method efficiently handles a high-dimensional optimization parameter and produces an excellent agreement for personalized models to both synthetic and clinical data.
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Affiliation(s)
- Gabriel Balaban
- Simula Research Laboratory, P.O. Box 134 1325 Lysaker, Norway
- Department of Informatics, University of Oslo, P.O. Box 1080, Blindern 0316 Oslo, Norway
- Center for Cardiological Innovation, Songsvannsveien 9, 0372 Oslo, Norway
| | - Henrik Finsberg
- Simula Research Laboratory, P.O. Box 134 1325 Lysaker, Norway
- Department of Informatics, University of Oslo, P.O. Box 1080, Blindern 0316 Oslo, Norway
- Center for Cardiological Innovation, Songsvannsveien 9, 0372 Oslo, Norway
| | - Hans Henrik Odland
- Faculty of Medicine, University of Oslo, P.O. Box 1078 Blindern, 0316 Oslo, Norway
- Department of Pediatrics, Oslo University Hospital, PO Nydalen, Oslo, Norway
| | - Marie E Rognes
- Simula Research Laboratory, P.O. Box 134 1325 Lysaker, Norway
- Department of Mathematics, University of Oslo, P.O Box 1053, Blindern 0316 Oslo, Norway
| | - Stian Ross
- Faculty of Medicine, University of Oslo, P.O. Box 1078 Blindern, 0316 Oslo, Norway
- Center for Cardiological Innovation, Songsvannsveien 9, 0372 Oslo, Norway
| | - Joakim Sundnes
- Simula Research Laboratory, P.O. Box 134 1325 Lysaker, Norway
- Department of Informatics, University of Oslo, P.O. Box 1080, Blindern 0316 Oslo, Norway
- Center for Cardiological Innovation, Songsvannsveien 9, 0372 Oslo, Norway
| | - Samuel Wall
- Simula Research Laboratory, P.O. Box 134 1325 Lysaker, Norway
- Center for Cardiological Innovation, Songsvannsveien 9, 0372 Oslo, Norway
- Department of Mathematical Science and Technology, Norwegian University of Life Sciences, Universitetstunet 3 1430 Ås, Norway
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Behdadfar S, Navarro L, Sundnes J, Maleckar M, Ross S, Odland HH, Avril S. A Centerline-Based Model Morphing Algorithm for Patient-Specific Finite Element Modeling of the Left Ventricle. IEEE Trans Biomed Eng 2017; 65:1391-1398. [PMID: 28945587 DOI: 10.1109/tbme.2017.2754980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
GOAL Hexahedral automatic model generation is a recurrent problem in computer vision and computational biomechanics. It may even become a challenging problem when one wants to develop a patient-specific finite element (FE) model of the left ventricle (LV), particularly when only low resolution images are available. In the present study, a fast and efficient algorithm is presented and tested to address such a situation. METHODS A template FE hexahedral model was created for an LV geometry using a general electric ultrasound (US) system. A system of centerline was considered for this LV mesh. Then, the nodes located over the endocardial and epicardial surfaces are, respectively, projected from this centerline onto the actual endocardial and epicardial surfaces reconstructed from a patient's US data. Finally, the position of the internal nodes is derived by finding the deformations with minimal elastic energy. This approach was applied to eight patients suffering from congestive heart disease. An FE analysis was performed to derive the stress induced in the LV tissue by diastolic blood pressure on each of them. RESULTS Our model morphing algorithm was applied successfully and the obtained meshes showed only marginal mismatches when compared to the corresponding US geometries. The diastolic FE analyses were successfully performed in seven patients to derive the distribution of principal stresses. CONCLUSION The original model morphing algorithm is fast and robust with low computational cost. SIGNIFICANCE This low-cost model morphing algorithm may be highly beneficial for future patient-specific reduced-order modeling of the LV with potential application to other crucial organs.
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Ross S, Odland HH, Aranda A, Edvardsen T, Gammelsrud LO, Haland TF, Cornelussen R, Hopp E, Kongsgaard E. Cardiac resynchronization therapy when no lateral pacing option exists: vectorcardiographic guided non-lateral left ventricular lead placement predicts acute hemodynamic response. Europace 2017; 20:1294-1302. [DOI: 10.1093/europace/eux249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/04/2017] [Indexed: 01/29/2023] Open
Affiliation(s)
- Stian Ross
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Hans Henrik Odland
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Alfonso Aranda
- Medtronic Plc, Bakken research Center, Maastricht, The Netherlands
| | - Thor Edvardsen
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Lars Ove Gammelsrud
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, Oslo, Norway
- Medtronic Norge AS, Lysaker, Norway
| | - Trine Fink Haland
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Richard Cornelussen
- Medtronic Plc, Bakken research Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, PO Box 616, Maastricht, The Netherlands
| | - Einar Hopp
- Clinic of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Erik Kongsgaard
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, Oslo, Norway
- University of Oslo, Oslo, Norway
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Ross S, Odland HH, Edvardsen T, Cornelussen R, Gammelsrud LO, Kongsgaard E. MYOCARDIAL CONTRACTILE RESERVE VERIFIED WITH DUAL CHAMBER RIGHT VENTRICULAR PACING PREDICTS RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pettersen FJ, Martinsen ØG, Høgetveit JO, Kalvøy H, Odland HH. Bioimpedance measurements of temporal changes in beating hearts. Biomed Phys Eng Express 2016. [DOI: 10.1088/2057-1976/2/6/065015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Babic A, Odland HH, Gérard O, Samset E. Parametric ultrasound and fluoroscopy image fusion for guidance of left ventricle lead placement in cardiac resynchronization therapy. J Med Imaging (Bellingham) 2015; 2:025001. [PMID: 26158110 DOI: 10.1117/1.jmi.2.2.025001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/13/2015] [Indexed: 11/14/2022] Open
Abstract
Recent studies show that the response rate to cardiac resynchronization therapy (CRT) could be improved if the left ventricle (LV) is paced at the site of the latest mechanical activation, but away from the myocardial scar. A prototype system for CRT lead placement guidance that combines LV functional information from ultrasound with live x-ray fluoroscopy was developed. Two mean anatomical models, each containing LV epi-, LV endo- and right ventricle endocardial surfaces, were computed from a database of 33 heart failure patients as a substitute for a patient-specific model. The sphericity index was used to divide the observed population into two groups. The distance between the mean and the patient-specific models was determined using a signed distance field metric (reported in mm). The average error values for LV epicardium were [Formula: see text] and for LV endocardium were [Formula: see text]. The validity of using average LV models for a CRT procedure was tested by simulating coronary vein selection in a group of 15 CRT candidates. The probability of selecting the same coronary branch, when basing the selection on the average model compared to a patient-specific model, was estimated to be [Formula: see text]. This was found to be clinically acceptable.
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Affiliation(s)
- Aleksandar Babic
- Center for Cardiological Innovation , Songsvannsveien 9, Oslo 0372, Norway ; GE Vingmed Ultrasound AS , Strandpromenaden 45, Horten 3183, Norway ; University of Oslo , Department of Informatics, Gaustadalléen 23 B, Oslo 0373, Norway
| | - Hans Henrik Odland
- Center for Cardiological Innovation , Songsvannsveien 9, Oslo 0372, Norway ; Oslo University Hospital , Department of Cardiology and Pediatrics, P.O. Box 1072, Blindern, Oslo 0316, Norway
| | - Olivier Gérard
- GE Vingmed Ultrasound AS , Strandpromenaden 45, Horten 3183, Norway
| | - Eigil Samset
- Center for Cardiological Innovation , Songsvannsveien 9, Oslo 0372, Norway ; GE Vingmed Ultrasound AS , Strandpromenaden 45, Horten 3183, Norway ; University of Oslo , Department of Informatics, Gaustadalléen 23 B, Oslo 0373, Norway
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Ross S, Kongsgaard E, Edvardsen T, Haland T, Skaardal R, Ove GL, Fischer T, Cornelussen R, Odland HH. THE ACUTE RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY IS NOT RELATED TO LEFT VENTRICULAR LEAD POSITION OR ELECTRICAL SEPARATION TIME. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bjerre A, Erlandsen M, Odland HH, Dorenberg E, Hafsahl G. Fourteen-year-old boy with severe hypertension and monosymptomatic nocturnal enuresis (case presentation). Acta Paediatr 2014; 103:466-7. [PMID: 24689817 DOI: 10.1111/apa.12542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/02/2013] [Accepted: 12/13/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Bjerre
- Department of Pediatrics, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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Bjerre A, Erlandsen M, Odland HH, Dorenberg E, Hafsahl G. Fourteen-year-old boy with severe hypertension and monosymptomatic nocturnal enuresis (discussion and diagnosis). Acta Paediatr 2014; 103:564-5. [PMID: 24689818 DOI: 10.1111/apa.12548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/02/2013] [Accepted: 12/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Anna Bjerre
- Department of Pediatrics, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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Berg A, Bråtane E, Odland HH, Brudvik C, Rosland B, Hirth A. [Cardiovascular risk assessment for the use of ADHD drugs in children]. Tidsskr Nor Laegeforen 2014; 134:710-4. [PMID: 24721858 DOI: 10.4045/tidsskr.13.0565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Drug therapy for ADHD (Attention Deficit Hyperactivity Disorder) has generally been regarded as safe. ECG screening of healthy children and adolescents before initiating this type of treatment appears to be usual in Norway, despite recommendations that ECGs should only be undertaken in individuals who are at risk. The purpose of this article is to clarify relevant guidelines for cardiovascular risk assessment for the use of ADHD drugs in children and adolescents, as well as to propose practical recommendations. METHOD The article is based on a literature search in PubMed completed on 1 October 2013, and on the author's own clinical experience and discretionary assessments. RESULTS The use of CNS stimulants and atomoxetine is associated with a slight rise in blood pressure and pulse rate, as well as small changes in QT interval. A small percentage of patients (5-10%) experience a clinically significant rise in blood pressure and pulse rate. Sudden death does not appear to occur more frequently in children and adolescents taking ADHD drugs in therapeutic doses than in children and adolescents who do not use such drugs. There is little knowledge available on the long-term effects of ADHD drugs on the cardiovascular system of otherwise healthy individuals, or on the risk related to the use of ADHD drugs in children and adolescents with cardiac disease. The drugs are thought to increase the risk of sudden cardiac death in some arrhythmia syndromes. INTERPRETATION Our assessment is that caution should be exercised in the use of ADHD drugs in children with potentially dangerous cardiac arrhythmias. We recommend clinical examination and a thorough medical history review in order to identify individuals at risk before initiating drug therapy, and also suggest that it is not necessary for healthy children to be given an ECG examination before introducing ADHD drugs. In children with known cardiac disease, arrhythmia or risk factors for cardiac disease, ADHD treatment should be undertaken in consultation with a medical specialist with competence in pediatric cardiology.
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Affiliation(s)
- Ansgar Berg
- Barneklinikken Haukeland universitetssykehus og Klinisk institutt 2 Universitetet i Bergen
| | | | | | | | | | - Asle Hirth
- Barneklinikken Haukeland universitetssykehus
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Odland HH, Brun H, Sejersted Y, Dalen M, Edvardsen T, Saugstad OD, Thaulow E. Myocardial Longitudinal Peak Systolic Acceleration (pSac): Relationship to Ejection Phase, Pressure, and Contractility. Echocardiography 2012; 29:541-53. [DOI: 10.1111/j.1540-8175.2011.01628.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Alsharnoubi JM, Odland HH, Saugstad OD. Nicotine does not influence NF-κB activity in neonatal mice reoxygenated with room-air or 100% oxygen. J Matern Fetal Neonatal Med 2012; 25:2102-5. [DOI: 10.3109/14767058.2012.678434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Odland HH, Kro GAB, Edvardsen T, Thaulow E, Saugstad OD. Impaired diastolic function and disruption of the force-frequency relationship in the right ventricle of newborn pigs resuscitated with 100% oxygen. Neonatology 2012; 101:147-53. [PMID: 21952615 DOI: 10.1159/000330804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 07/08/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Resuscitation with 100% oxygen increases oxidative stress and is detrimental for organ function. OBJECTIVE To study the effects of resuscitation with 100% oxygen compared to room-air on myocardial function. METHODS Twenty-eight newborn pigs underwent global hypoxia (8% oxygen/N2) until base excess reached -20 mmol/l. The animals were randomized into two groups and resuscitated with either 100% or room air for 30 min. Myocardial tissue Doppler velocities and acceleration of the mitral and tricuspid valve annuli during systole and diastole were assessed before global hypoxia and after resuscitation together with troponin I. RESULTS Peak early diastolic velocity (E') and acceleration (pEac) in the septum and pEac in the lateral tricuspid valve annulus were lower after resuscitation with 100% oxygen, suggesting impaired diastolic relaxation in the right ventricle. Lower systolic velocities and acceleration in the right ventricle relative to heart rate indicate disruption of the right ventricular force-frequency relationship after resuscitation with 100% oxygen. Troponins were higher in the 100% oxygen group, suggesting increased myocardial damage in this group. CONCLUSION Resuscitation with 100% oxygen compared to room air induces diastolic dysfunction, disrupts the systolic force-frequency relationship and increases myocardial damage in the newborn pig.
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Affiliation(s)
- Hans Henrik Odland
- Department of Pediatric Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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Odland HH, Kro GAB, Edvardsen T, Thaulow E, Saugstad OD. Atrioventricular valve annulus velocity and acceleration during global hypoxia in newborn pigs - assessment of myocardial function. Neonatology 2010; 97:100-7. [PMID: 19713716 DOI: 10.1159/000235806] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Accepted: 01/27/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Global hypoxia may affect regions of the neonatal heart during systole and diastole differently. OBJECTIVE In the first study, the aim was to assess longitudinal myocardial function in newborn pigs during global hypoxia and recovery. In the second study, invasive hemodynamic data were evaluated and compared with tissue velocities and acceleration. METHODS Myocardial Doppler measurements of velocity and acceleration in the atrioventricular valve annuli during global hypoxia were made. RESULTS In the first experiment, systolic velocity (S), early diastolic velocity (E') and peak systolic acceleration (pSac) decreased during hypoxia. S, pSac and E'(mva) (mitral valve annulus) recovered after reoxygenation, while E'(septal) and E'(tva) (tricuspid valve annulus) did not. Isovolumic acceleration (IVA) did not reflect systolic dysfunction. In the second experiment, S(mva) and pSac(mva) declined during hypoxia similarly to maximum dP/dT. E'(mva) and E'(tva) were correlated with tau and both changed parallel to minimum dP/dT. In the TVA maximum dP/dT and pSac(tva) did not change, while S(tva) declined. By correcting for heart rate the pattern of alteration in S and pSac became comparable to the changes in E'. CONCLUSION Tissue Doppler velocity in systole, diastole and acceleration during rapid ejection reflect hemodynamic changes in the neonatal myocardium during global hypoxia and recovery. S and pSac reflect systolic function, while E' correlates with tau and mirrors diastolic function.
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Affiliation(s)
- Hans Henrik Odland
- Department of Pediatric Research, Rikshospitalet University Hospital, Oslo, Norway.
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Dohlen G, Odland HH, Carlsen H, Blomhoff R, Thaulow E, Saugstad OD. Antioxidant activity in the newborn brain: a luciferase mouse model. Neonatology 2008; 93:125-31. [PMID: 17785990 DOI: 10.1159/000107777] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 06/20/2007] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Oxidative stress in the newborn period may cause cell injury and inflammation if the antioxidant capacity is insufficient. To monitor antioxidant and inflammatory activity we examined by in vivo imaging various strains of luciferase reporter mice whose light-emitting properties were regulated by response elements or complete promoters related to oxidative stress and/or inflammation. The aim of this study is to present a model that can monitor genetic activity in vivo during pregnancy and the first 10 days of life. METHODS One mouse strain reports the activity of nuclear factor-kappaB (NF-kappaB) activity, a transcription factor essential for modulating inflammation, apoptosis, differentiation and cell growth. A second mouse strain reports on superoxide dismutase 1-promoter activity. A third strain reports the promoter activity of gamma-glutamylcysteine synthetase, the rate limiting enzyme in glutathione production, and the last strain reports on antioxidant responsive element (ARE)/electrophil responsive element. Wild-type female mice mated with NF-kappaB mice were imaged through pregnancy to monitor intrauterine NF-kappaB activation. RESULTS Intrauterine NF-kappaB activity increased dramatically from day 17 towards labor. During the first 4 days of life luminescence measured was intense in all mice with distinct strain differences. All strains had high luminescence levels at day 1 and a considerably lower level at day 10. CONCLUSION This model allows investigation of the transcriptional regulation of key proteins related to oxidative stress and inflammation in pregnancy and the first days of life. With very little stress to the newborn animals genetic activity can be monitored day by day.
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Affiliation(s)
- Gaute Dohlen
- Department of Pediatric Research, Rikshospitalet Medical Center, Oslo, Norway.
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Abstract
The most common reason for heart failure in children is volume overload secondary to a left-to-right shunt. Therefore, an accurate diagnosis with identification of possible surgical or interventional reactions should be the first priority. Medical therapy is mainly based on diuretics, angiotensin-converting enzyme inhibitors, cardiac glycosides and beta-blockers. There are few prospective trials in pediatric cardiology, but the available data reach a similar conclusion to that of adults with heart failure. Diuretics are an important tool in patients with fluid retention, and angiotensin-converting enzyme inhibitors are helpful in patients with volume overload of the ventricles. Cardiac glycosides are still in use, but there is a trend toward primary use of diuretics. Angiotensin-converting enzyme inhibitors and beta-blockers have been used successfully in the treatment of heart failure in children, but there are limited data on its efficacy.
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Odland HH, Zeller B, Fjaerli HO, Zimmer O. [Acute pyelonephritis in children with minimal or normal urine findings]. Tidsskr Nor Laegeforen 2001; 121:3166-9. [PMID: 11876137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Over the past years we have seen several children with serious bacterial infections in whom the focus of the infection was found in the kidneys despite of normal or minimal urine findings. MATERIAL AND METHODS We review the cases of all children hospitalised at our paediatric department from 1995-2000 with normal or minimal urine findings, and in whom acute pyelonephritis was diagnosed by means of computerized tomographic imaging of the kidneys. RESULTS All 10 children (aged 9 months to 9 years) had focal areas of decreased enhancement in the kidney parenchyma. All received intravenous antibiotic treatment. Vesicouretheral reflux was detected in four patients and required surgical intervention in one. One patient had considerable renal scarring and decreased renal function on dimercaptosuccinic acid (DMSA) scintigraphy. INTERPRETATION In children with suspected serious bacterial infection, it is important to have the possibility of renal infection in mind in spite of normal urine findings. The importance of establishing the right diagnosis lies in the fact that patients with pyelonephritis need further investigation and follow-up.
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Affiliation(s)
- H H Odland
- Barneavdelingen, Sentralsykehuset i Akershus 1474 Nordbyhagen.
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