Publications by authors named "Håvard Dalen"

100 Publications

Ten-Year Cardiovascular Disease Risk Trajectories by Obstetric History: A Longitudinal Study in the Norwegian HUNT Study.

J Am Heart Assoc 2022 Jan 11:e021733. Epub 2022 Jan 11.

K.G. Jebsen Center for Genetic Epidemiology Department of Public Health and Nursing NTNUNorwegian University of Science and Technology Trondheim Norway.

Background Women with a history of obstetric complications are at increased risk of cardiovascular disease, but whether they should be specifically targeted for cardiovascular disease (CVD) risk screening is unknown. Methods and Results We used linked data from the Norwegian HUNT (Trøndelag Health) Study and the Medical Birth Registry of Norway to create a population-based, prospective cohort of parous women. Using an established CVD risk prediction model (A Norwegian risk model for cardiovascular disease), we predicted 10-year risk of CVD (nonfatal myocardial infarction, fatal coronary heart disease, and nonfatal or fatal stroke) based on established risk factors (age, systolic blood pressure, total and high-density lipoprotein cholesterol, smoking, antihypertensive use, and family history of myocardial infarction). Predicted 10-year CVD risk scores in women aged between 40 and 60 years were consistently higher in those with a history of obstetric complications. For example, when aged 40 years, women with a history of preeclampsia had a 0.06 percentage point higher mean risk score than women with all normotensive deliveries, and when aged 60 years this difference was 0.86. However, the differences in the proportion of women crossing established clinical thresholds for counseling and treatment in women with and without a complication were modest. Conclusions Findings do not support targeting parous women with a history of pregnancy complications for CVD screening. However, pregnancy complications identify women who would benefit from primordial and primary prevention efforts such as encouraging and supporting behavioral changes to reduce CVD risk in later life.
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http://dx.doi.org/10.1161/JAHA.121.021733DOI Listing
January 2022

The role of cardiovascular risk factors in maternal cardiovascular disease according to offspring birth characteristics in the HUNT study.

Sci Rep 2021 Nov 26;11(1):22981. Epub 2021 Nov 26.

Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.

A history of preterm or small (SGA) or large (LGA) for gestational age offspring is associated with smoking and unfavorable levels of BMI, blood pressure, glucose and lipids. Whether and to what extent the excess cardiovascular risk observed in women with these pregnancy complications is explained by conventional cardiovascular risk factors (CVRFs) is not known. We examined the association between a history of SGA, LGA or preterm birth and cardiovascular disease among 23,284 parous women and quantified the contribution of individual CVRFs to the excess cardiovascular risk using an inverse odds weighting approach. The hazard ratios (HR) between SGA and LGA offspring and CVD were 1.30 (95% confidence interval (CI) 1.15, 1.48) and 0.89 (95% CI 0.76, 1.03), respectively. Smoking explained 49% and blood pressure may have explained ≈12% of the excess cardiovascular risk in women with SGA offspring. Women with preterm birth had a 24% increased risk of CVD (HR 1.24, 95% CI 1.06, 1.45), but we found no evidence for CVRFs explaining any of this excess cardiovascular risk. While smoking explains a substantial proportion of excess cardiovascular risk in women with SGA offspring and blood pressure may explain a small proportion in these women, we found no evidence that conventional CVRFs explain any of the excess cardiovascular risk in women with preterm birth.
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http://dx.doi.org/10.1038/s41598-021-99478-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8626478PMC
November 2021

as a cause of early prosthetic valve endocarditis.

BMJ Case Rep 2021 Nov 11;14(11). Epub 2021 Nov 11.

Clinic of Cardiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.

Infective endocarditis (IE) is associated with severe complications and a high mortality rate. Identification of the causative pathogen is crucial to optimise treatment. We present a case of prosthetic valve endocarditis caused by , a very rare cause of human infection and not previously reported as a cause of IE. Despite proper antibiotic therapy, the patient eventually needed surgery after progression of the infection. After surgery, he quickly recovered without evidence of relapse during an 8-month follow-up period. This report highlights critical decision making in a complex and potentially life-threatening situation, where neither guidelines nor previous clinical or microbiological experience were able to give clear treatment recommendations.
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http://dx.doi.org/10.1136/bcr-2021-245152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8586894PMC
November 2021

Effect of 5 years of exercise training on the cardiovascular risk profile of older adults: the Generation 100 randomized trial.

Eur Heart J 2021 Nov 8. Epub 2021 Nov 8.

Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Post Box 8905, Trondheim 7491, Norway.

Aims: The aim of this study was to compare the effects of 5 years of supervised exercise training (ExComb), and the differential effects of subgroups of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), with control on the cardiovascular risk profile in older adults.

Methods And Results: Older adults aged 70-77 years from Trondheim, Norway (n = 1567, 50% women), able to safely perform exercise training were randomized to 5 years of two weekly sessions of HIIT [∼90% of peak heart rate (HR), n = 400] or MICT (∼70% of peak HR, n = 387), together forming ExComb (n = 787), or control (instructed to follow physical activity recommendations, n = 780). The main outcome was a continuous cardiovascular risk score (CCR), individual cardiovascular risk factors, and peak oxygen uptake (VO2peak). CCR was not significantly lower [-0.19, 99% confidence interval (CI) -0.46 to 0.07] and VO2peak was not significantly higher (0.39 mL/kg/min, 99% CI -0.22 to 1.00) for ExComb vs. control. HIIT showed higher VO2peak (0.76 mL/kg/min, 99% CI 0.02-1.51), but not lower CCR (-0.32, 99% CI -0.64 to 0.01) vs. control. MICT did not show significant differences compared to control or HIIT. Individual risk factors mostly did not show significant between-group differences, with some exceptions for HIIT being better than control. There was no significant effect modification by sex. The number of cardiovascular events was similar across groups. The healthy and fit study sample, and contamination and cross-over between intervention groups, challenged the possibility of detecting between-group differences.

Conclusions: Five years of supervised exercise training in older adults had little effect on cardiovascular risk profile and did not reduce cardiovascular events.

Registration: ClinicalTrials.gov: NCT01666340.
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http://dx.doi.org/10.1093/eurheartj/ehab721DOI Listing
November 2021

Feasibility and Clinical Impact of Point-of-Care Carotid Artery Examinations by Experts using Hand-Held Ultrasound Devices in Patients with Ischemic Stroke or Transitory Ischemic Attack.

J Stroke Cerebrovasc Dis 2021 Dec 16;30(12):106086. Epub 2021 Sep 16.

Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, 7491 Trondheim, Norway; Clinic of Cardiology, St. Olavs Hospital, Norway. Electronic address:

Background And Purpose: To evaluate the feasibility and clinical influence of carotid artery examinations in patients admitted with stroke or TIA with hand-held ultrasound by experts, to identify individuals not in need of further carotid artery diagnostics.

Materials And Methods: Cardiologists experienced in carotid ultrasound examined 80 patients admitted to a stroke unit with suspected stroke or TIA with hand-held ultrasound devices (HUD). Grey scale and color Doppler images were stored using a GE Vscan with dual probe (phased array and linear transducer). High-end triplex ultrasound performed by a cardiologist, blinded to the details of the HUD study, was performed in all patients and used as reference. Computer tomography angiography was performed when clinically indicated.

Results: Stroke or TIA was diagnosed in 62 (78%) patients. Age was median (range) 72 (23-93) years. A significant stenosis (> 50% diameter reduction) was ruled out in 61 (76%) of patients by the HUD examinations. Sensitivity and specificity for diagnosing a significant stenosis was 92% and 93%, respectively. One of 12 significant stenoses was missed by HUD. All four patients in need of surgery were identified by the HUD examination. Sensitivity and specificity to identify a significant stenosis by HUD was 87% and 83%, respectively, compared to CT angiography.

Conclusion: HUD examinations of the carotid arteries by experts, using hand-held ultrasound devices, were feasible and may reduce the need for high-end diagnostic imaging of the carotid vessels in patients with stroke and TIA. Thus, HUD may improve diagnostic workflow in stroke units in the future.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.106086DOI Listing
December 2021

Bone mineral density and risk of cardiovascular disease in men and women: the HUNT study.

Eur J Epidemiol 2021 Nov 13;36(11):1169-1177. Epub 2021 Sep 13.

K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.

The association between bone mineral density (BMD) and cardiovascular disease (CVD) is not fully understood. We evaluated BMD as a risk factor for cardiovascular disease and specifically atrial fibrillation (AF), acute myocardial infarction (AMI), ischemic (IS) and hemorrhagic stroke (HS) and heart failure (HF) in men and women. This prospective population cohort utilized data on 22 857 adults from the second and third surveys of the HUNT Study in Norway free from CVD at baseline. BMD was measured using single and dual-energy X-ray absorptiometry in the non-dominant distal forearm and T-score was calculated. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated from adjusted cox proportional hazards models. The analyses were sex-stratified, and models were adjusted for age, age-squared, BMI, physical activity, smoking status, alcohol use, and education level. Additionally, in women, we adjusted for estrogen use and postmenopause. During a mean follow-up of 13.6 ± 5.7 years, 2 928 individuals (12.8%) developed fatal or non-fatal CVD, 1 020 AF (4.5%), 1 172 AMI (5.1%), 1 389 IS (6.1%), 264 HS (1.1%), and 464 HF (2.0%). For every 1 unit decrease in BMD T-score the HR for any CVD was 1.01 (95% CI 0.98 to 1.04) in women and 0.99 (95% CI 0.94 to 1.03) in men. Point estimates for the four cardiovascular outcomes ranged from slightly protective (HR 0.95 for AF in men) to slightly deleterious (HR 1.12 for HS in men). We found no evidence of association of lower distal forearm BMD with CVD, AF, AMI, IS, HS, and HF.
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http://dx.doi.org/10.1007/s10654-021-00803-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629874PMC
November 2021

Measurement of high-sensitivity troponin-I in suspected coronary-related chest pain in Emergency Departments.

Tidsskr Nor Laegeforen 2021 09 25;141(2021-12). Epub 2021 Aug 25.

Background: The study aimed to evaluate a new algorithm based on analyses of high-sensitivity troponin I for rapid diagnostic clarification in cases of suspected cardiac chest pain.

Material And Method: Two time periods - before (01.10.2016-31.12.2016) and after (01.03.2017-28.02.2018) the introduction of a diagnostic algorithm - were studied by reviewing the medical records of patients who arrived at the emergency department with chest pain. The diagnostic algorithm included a high-sensitivity troponin I test on admission (0 hours) and one hour later (the 0 h/1 h algorithm). The primary endpoint was the proportion of patients that were discharged directly from the emergency department. Secondary endpoints were acute cardiac arrest and death within 30 days and within one year.

Results: A larger proportion of patients with chest pain were discharged directly from the emergency department when the 0 h/1 h algorithm was used (10/91 (11 %) before versus 118/306 (39 %) after, p <0.001). Deaths and the incidence of acute myocardial infarction one year after the introduction of the 0 h/1 h algorithm were low (≤ 3 %) and not statistically different from the period before the introduction (p≥ 0.20).

Interpretation: The implementation of a diagnostic algorithm based on measurements of high-sensitivity troponin I resulted in fewer patients being hospitalised, and we did not register more deaths or deaths from myocardial infarction. The algorithm was suitable for identifying patients with chest pain who could safely be discharged without the need for hospitalisation, which we believe may optimise patient flow in hospitals.
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http://dx.doi.org/10.4045/tidsskr.21.0037DOI Listing
September 2021

Short-term outcome after open-heart surgery for severe chronic rheumatic heart disease in a low-income country, with comparison with an historical control group: an observational study.

Open Heart 2021 08;8(2)

Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

Objectives: Rheumatic heart disease (RHD) is a major burden in low-income and middle-income countries (LMICs). Cardiac surgery is the only curative treatment. Little is known about patients with severe chronic RHD operated in LMICs, and challenges regarding postoperative follow-up are an important issue. At Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia, we aimed to evaluate the course and 12-month outcome of patients with severe chronic RHD who received open-heart surgery, as compared with the natural course of controls waiting for surgery and undergoing only medical treatment.

Methods: Clinical data and outcome measures were registered in 46 patients operated during five missions from March 2016 to November 2019, and compared with the first-year course in a cohort of 49 controls from the same hospital's waiting list for surgery. Adverse events were death or complications such as stroke, other thromboembolic events, bleeding, hospitalisation for heart failure and infectious endocarditis.

Results: Survival at 12 months was 89% and survival free from complications was 80% in the surgical group. Despite undergoing open-heart surgery, with its inherent risks, outcome measures of the surgical group were non-inferior to the natural course of the control group in the first year after inclusion on the waiting list (p≥0.45). All except six surgical patients were in New York Heart Association class I after 12 months and 84% had resumed working.

Conclusions: Cardiac surgery for severe chronic RHD is feasible in LMICs if the service is structured and planned. Rates of survival and survival free from complications were similar to those of controls at 12 months. Functional level and resumption of work were high in the surgical group. Whether the patients who underwent cardiac surgery will have better long-term prognosis, in line with what is known in high-income countries, needs to be evaluated in future studies.
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http://dx.doi.org/10.1136/openhrt-2021-001706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8356187PMC
August 2021

Friends in Sports: Social Networks in Leisure, School and Social Media.

Int J Environ Res Public Health 2021 06 8;18(12). Epub 2021 Jun 8.

Department of Sport and Social Sciences, Norwegian School of Sport Sciences, 0863 Oslo, Norway.

Young athletes value their social relations in sports, and these social relations can have consequences when it comes to joining, continuing, and quitting sports. Yet the important question of how social relations in sports develop has not yet been adequately answered. Hence, we investigated how athletes' social relations in sports depend on social relations outside of sports: in leisure, school, and social media. A total of 387 athletes (aged 16-19) from 30 Norwegian sports groups completed a survey on electronic tablets. We asked how social relations in leisure, school, and social media-through the social mechanisms of contact, homophily, and contagion-influenced social relations in sports. We also controlled for the effect of exercise frequency and duration (years) of contact in sports. Exponential random graph modelling (ERGM) analyses showed that first and foremost, relations from social media and leisure, but also school networks and exercise frequency, influence sports networks. This study shows that social relations in sports are diverse and depend on social relations outside sports. We discuss how this has 'counterintuitive' consequences for sports participation, particularly the importance of supporting athletes' social relations outside of sports for the strengthening of social relations within sports when addressing challenges concerning recruitment, continuation, and dropout from sports.
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http://dx.doi.org/10.3390/ijerph18126197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8229858PMC
June 2021

Variability of echocardiographic measures of left ventricular diastolic function. The HUNT study.

Echocardiography 2021 06 6;38(6):901-908. Epub 2021 May 6.

Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.

Objective: Investigate variability related to image acquisition and reading process for echocardiographic measures of left ventricular (LV) diastolic function, and its influence on classification of LV diastolic dysfunction (LVDD).

Methods: Forty participants (19 women) mean age 62 (28-88) years underwent echocardiographic examinations twice by different echocardiographers and blinded analyses by four readers in a cross-sectional design. Measurements included quantification of two- (2D) and three-dimensional (3D) recordings of the left atrium (LA) (maximal) volume (LAV ) and spectral Doppler blood flow and tissue velocities for assessment of LV diastolic function. Variability and reproducibility measures were calculated using variance component analyses and Kappa statistics.

Results: Image acquisition influenced variability more than image reading (mean 24% and 4% of variance, respectively), but variability from image reading was especially important for 2D LAV (16% of variance) compared to 4% for 3D LAV , which was reflected in better agreement for 3D measures. The variability of measures used in classification of LVDD had clinical significance, and agreement across the four raters in classification using current recommendations was only fair (Kappa 0.42), but the agreement improved when using 3D LAV (Kappa 0.58). Agreement and reliability measures were reported for all measures.

Conclusion: Performing a new image acquisition influenced variability more than a introducing a new image reader, but there were differences across the different measures. LAV by 3D is superior to 2D with respect to lower variability. The variability of diastolic measures influences the reliability of LVDD classification, and this should be taken into account in the everyday clinic.
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http://dx.doi.org/10.1111/echo.15073DOI Listing
June 2021

Exercise training and high-sensitivity cardiac troponin T in patients with heart failure with reduced ejection fraction.

ESC Heart Fail 2021 06 23;8(3):2183-2192. Epub 2021 Mar 23.

Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.

Aims: Whether an exercise training intervention is associated with reduction in long-term high-sensitivity cardiac troponin T (hs-cTnT) concentration (a biomarker of subclinical myocardial injury) in patients with heart failure with reduced ejection fraction (HFrEF) is unknown. The aims were to determine (i) the effect of a 12 week endurance exercise training intervention with different training intensities on hs-cTnT in stable patients with HFrEF (left ventricular ejection fraction ≤ 35%) and (ii) associations between hs-cTnT and peak oxygen uptake (VO ).

Methods And Results: In this sub-study of the SMARTEX-HF trial originally including 261 patients from nine European centres, 213 eligible patients were included after withdrawals and appropriate exclusions [19% women, mean age 61.2 years (standard deviation: 11.9)], randomized to high-intensity interval training (HIIT; n = 77), moderate continuous training (MCT; n = 63), or a recommendation of regular exercise (RRE; n = 73). Hs-cTnT measurements and clinical data acquired before (BL) and after a 12 week exercise training intervention (12 weeks) and at 1 year follow-up (1 year) were analysed using multivariable mixed models. Baseline hs-cTnT was above the 99th percentile upper reference limit of 14 ng/L in 35 (48%), 35 (56%), and 49 (64%) patients in the RRE, MCT, and HIIT groups, respectively. Median hs-cTnT was 16 ng/L at BL, 14 ng/L at 12 weeks, and 14 ng/L at 1 year. Hs-cTnT was statistically significantly reduced at 12 weeks in a model adjusted for randomization group, centre and VO , and after further adjustment in the final model that also included age, sex, creatinine concentrations, N-terminal pro-brain natriuretic peptide, smoking, and heart failure treatment. The mean reduction from BL to 12 weeks in the final model was 1.1 ng/L (95% confidence interval: 1.0-1.2 ng/L, P < 0.001), and the reduction was maintained at 1 year with a mean reduction from BL to 1 year of 1.1 ng/L (95% confidence interval: 1.0-1.1 ng/L, P = 0.025). Randomization group was not associated with hs-cTnT at any time point (overall test: P = 0.20, MCT vs. RRE: P = 0.81, HIIT vs. RRE: P = 0.095, interaction time × randomization group: P = 0.88). Independent of time point, higher VO correlated with lower hs-cTnT (mean reduction over all time points: 0.2 ng/L per increasing mL·kg ·min , P = 0.002), without between-group differences (P = 0.19).

Conclusions: In patients with stable HFrEF, a 12 week exercise intervention was associated with reduced hs-cTnT in all groups when adjusted for clinical variables. Higher VO correlated with lower hs-cTnT, suggesting a positive long-term effect of increasing VO on subclinical myocardial injury in HFrEF, independent of training programme.
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http://dx.doi.org/10.1002/ehf2.13310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120390PMC
June 2021

Circulating microRNAs May Serve as Biomarkers for Hypertensive Emergency End-Organ Injuries and Address Underlying Pathways in an Animal Model.

Front Cardiovasc Med 2020 12;7:626699. Epub 2021 Feb 12.

Department of Nephrology, Clinic of Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.

There is an incomplete understanding of the underlying pathophysiology in hypertensive emergencies, where severely elevated blood pressure causes acute end-organ injuries, as opposed to the long-term manifestations of chronic hypertension. Furthermore, current biomarkers are unable to detect early end-organ injuries like hypertensive encephalopathy and renal thrombotic microangiopathy. We hypothesized that circulating microRNAs (c-miRs) could identify acute and chronic complications of severe hypertension, and that combinations of c-miRs could elucidate important pathways involved. We studied the diagnostic accuracy of 145 c-miRs in Dahl salt-sensitive rats fed either a low-salt ( = 20: 0.3% NaCl) or a high-salt ( = 60: 8% NaCl) diet. Subclinical hypertensive encephalopathy and thrombotic microangiopathy were diagnosed by histopathology. In addition, heart failure with preserved ejection fraction was evaluated with echocardiography and N-terminal pro-brain natriuretic peptide; and endothelial dysfunction was studied using acetylcholine-induced aorta ring relaxation. Systolic blood pressure increased severely in animals on a high-salt diet (high-salt 205 ± 20 mm Hg vs. low-salt 152 ± 18 mm Hg, < 0.001). Partial least squares discriminant analysis revealed 68 c-miRs discriminating between animals with and without hypertensive emergency complications. Twenty-nine c-miRs were strongly associated with hypertensive encephalopathy, 24 c-miRs with thrombotic microangiopathy, 30 c-miRs with heart failure with preserved ejection fraction, and 28 c-miRs with endothelial dysfunction. Hypertensive encephalopathy, thrombotic microangiopathy and heart failure with preserved ejection fraction were associated with deviations in many of the same c-miRs, whereas endothelial dysfunction was associated with a different set of c-miRs. Several of these c-miRs demonstrated fair to good diagnostic accuracy for a composite outcome of hypertensive encephalopathy, thrombotic microangiopathy and heart failure with preserved ejection fraction in receiver-operating-curve analyses (area-under-curve 0.75-0.88). Target prediction revealed an enrichment of genes related to several pathways relevant for cardiovascular disease (e.g., mucin type O-glycan biosynthesis, MAPK, Wnt, Hippo, and TGF-beta signaling). C-miRs could potentially serve as biomarkers of severe hypertensive end-organ injuries and elucidate important pathways involved.
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http://dx.doi.org/10.3389/fcvm.2020.626699DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906971PMC
February 2021

How reproducible is the diagnosis of borderline rheumatic heart disease?

Int J Cardiol 2021 04 24;328:163-164. Epub 2020 Dec 24.

Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway; Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.

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http://dx.doi.org/10.1016/j.ijcard.2020.12.031DOI Listing
April 2021

Effect of exercise training for five years on all cause mortality in older adults-the Generation 100 study: randomised controlled trial.

BMJ 2020 10 7;371:m3485. Epub 2020 Oct 7.

Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Post Box 8905, 7491 Trondheim, Norway

Objective: To evaluate the effect of five years of supervised exercise training compared with recommendations for physical activity on mortality in older adults (70-77 years).

Design: Randomised controlled trial.

Setting: General population of older adults in Trondheim, Norway.

Participants: 1567 of 6966 individuals born between 1936 and 1942.

Intervention: Participants were randomised to two sessions weekly of high intensity interval training at about 90% of peak heart rate (HIIT, n=400), moderate intensity continuous training at about 70% of peak heart rate (MICT, n=387), or to follow the national guidelines for physical activity (n=780; control group); all for five years.

Main Outcome Measure: All cause mortality. An exploratory hypothesis was that HIIT lowers mortality more than MICT.

Results: Mean age of the 1567 participants (790 women) was 72.8 (SD 2.1) years. Overall, 87.5% of participants reported to have overall good health, with 80% reporting medium or high physical activity levels at baseline. All cause mortality did not differ between the control group and combined MICT and HIIT group. When MICT and HIIT were analysed separately, with the control group as reference (observed mortality of 4.7%), an absolute risk reduction of 1.7 percentage points was observed after HIIT (hazard ratio 0.63, 95% confidence interval 0.33 to 1.20) and an absolute increased risk of 1.2 percentage points after MICT (1.24, 0.73 to 2.10). When HIIT was compared with MICT as reference group an absolute risk reduction of 2.9 percentage points was observed (0.51, 0.25 to 1.02) for all cause mortality. Control participants chose to perform more of their physical activity as HIIT than the physical activity undertaken by participants in the MICT group. This meant that the controls achieved an exercise dose at an intensity between the MICT and HIIT groups.

Conclusion: This study suggests that combined MICT and HIIT has no effect on all cause mortality compared with recommended physical activity levels. However, we observed a lower all cause mortality trend after HIIT compared with controls and MICT.

Trial Registration: ClinicalTrials.gov NCT01666340.
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http://dx.doi.org/10.1136/bmj.m3485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539760PMC
October 2020

Left ventricular longitudinal shortening: relation to stroke volume and ejection fraction in ageing, blood pressure, body size and gender in the HUNT3 study.

Open Heart 2020 09;7(2)

Asgardstrand General Practice, Horten, Norway.

Background: Aims of this cross-sectional study were to assess: the relative contribution of left ventricular (LV) systolic long-axis shortening (mean mitral annular plane systolic excursion, MAPSE) to stroke volume (SV), the mechanisms for preserved ejection fraction (EF) despite reduced MAPSE, the age dependency of myocardial volume and myocardial systolic compression.

Methods: Linear dimensions and longitudinal and cross-sectional M-modes were acquired in 1266 individuals without history of heart disease, diabetes or known hypertension from the third wave of the Nord-Trøndelag Health Study. Measurements were entered into a half-ellipsoid LV model for volume calculations, and volumes were related to age, body size (body surface area, BSA), sex and blood pressure (BP).

Results: Mean BP and proportion with hypertensive values increased with increasing age. MAPSE contributed to 75% of SV, with no relation to age or BSA as both MAPSE and SV decreased with increasing age. LV end-diastolic volume (LVEDV) and SV increased with BSA and decreased with higher age; EF was not related to age or BSA. Myocardial volume increased with higher age and BSA, with an additional gender dependency. The association of age with myocardial volume was not significant when corrected for BP, while both systolic and diastolic BP were significant associated with myocardial volume. Myocardial compression was less than 3%.

Conclusions: MAPSE contributes approximately 75% and short axis shortening 25% to SV. Both decline with age, but their percentage contributions to SV are unchanged. EF is preserved by the simultaneous decrease in LVEDV and SV. Myocardial volume is positively associated with age, but this is only related to higher BP, which may have implications for BP treatment in ageing. The myocardium is near incompressible.
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http://dx.doi.org/10.1136/openhrt-2020-001243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520903PMC
September 2020

Age-related change in peak oxygen uptake and change of cardiovascular risk factors. The HUNT Study.

Prog Cardiovasc Dis 2020 Nov - Dec;63(6):730-737. Epub 2020 Sep 21.

Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway. Electronic address:

Background: Large longitudinal studies on change in directly measured peak oxygen uptake (VO) is lacking, and its significance for change of cardiovascular risk factors is uncertain. We aimed to assess ten-year change in VO and the influence of leisure-time physical activity (LTPA), and the association between change in VO and change in cardiovascular risk factors.

Methods And Results: A healthy general population sample had their VO directly measured in two (n = 1431) surveys of the Nord-Trøndelag Health Study (HUNT3; 2006-2008 and HUNT4; 2017-19). Average ten-year decline in VO was non-linear and progressed from 3% in the third to about 20% in the eight decade in life and was more pronounced in men. The fit linear mixed models including an additional 2,933 observations from subjects participating only in HUNT3 showed similar age-related decline. Self-reported adherence to LTPA recommendations was associated with better maintenance of VO, with intensity seemingly more important than minutes of LTPA with higher age. Adjusted linear regression analyses showed that one mL/kg/min better maintenance of VO was associated with favorable changes of individual cardiovascular risk factors (all p ≤ 0.002). Using logistic regression one mL/kg/min better maintenance of VO was associated with lower adjusted odds ratio of hypertension (0.95 95% CI 0.92 to 0.98), dyslipidemia (0.92 95% CI 0.89 to 0.94), and metabolic syndrome (0.86 95% CI 0.83 to 0.90) at follow-up.

Conclusions: Although VO declines progressively with age, performing LTPA and especially high-intensity LTPA is associated with less decline. Maintaining VO is associated with an improved cardiovascular risk profile.
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http://dx.doi.org/10.1016/j.pcad.2020.09.002DOI Listing
February 2021

Acute perimyocarditis with cardiac tamponade in COVID-19 infection without respiratory disease.

BMJ Case Rep 2020 Aug 19;13(8). Epub 2020 Aug 19.

Clinic of Cardiology, Saint Olavs Hospital University Hospital in Trondheim, Trondheim, Norway.

The COVID-19 pandemic with its severe respiratory disease has caused overflow to hospitals and intensive care units. Elevated troponins and natriuretic peptides are related to cardiac injury and poor prognosis. We present a young woman with COVID-19 infection with haemodynamic instability caused by acute perimyocarditis and cardiac tamponade. Troponin T was modestly elevated. Focused cardiac ultrasound made the diagnosis. Echocardiography revealed transient thickening of the myocardial walls. After pericardial drainage and supportive care, she improved significantly within 1 week without targeted therapy. The case illustrates the importance of cardiac diagnostic imaging in patients with COVID-19 and elevated cardiac biomarkers.
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http://dx.doi.org/10.1136/bcr-2020-236218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440216PMC
August 2020

Translation of Simultaneous Vessel Wall Motion and Vectorial Blood Flow Imaging in Healthy and Diseased Carotids to the Clinic: A Pilot Study.

IEEE Trans Ultrason Ferroelectr Freq Control 2021 03 25;68(3):558-569. Epub 2021 Feb 25.

This study aims to investigate the clinical feasibility of simultaneous extraction of vessel wall motion and vectorial blood flow at high frame rates for both extraction of clinical markers and visual inspection. If available in the clinic, such a technique would allow a better estimation of plaque vulnerability and improved evaluation of the overall arterial health of patients. In this study, both healthy volunteers and patients were recruited and scanned using a planewave acquisition scheme that provided a data set of 43 carotid recordings in total. The vessel wall motion was extracted based on the complex autocorrelation of the signals received, while the vector flow was extracted using the transverse oscillation technique. Wall motion and vector flow were extracted at high frame rates, which allowed for a visual appreciation of tissue movement and blood flow simultaneously. Several clinical markers were extracted, and visual inspections of the wall motion and flow were conducted. From all the potential markers, young healthy volunteers had smaller artery diameter (7.72 mm) compared with diseased patients (9.56 mm) ( p -value ≤ 0.001), 66% of diseased patients had backflow compared with less than 10% for the other patients ( p -value ≤ 0.05), a carotid with a pulse wave velocity extracted from the wall velocity greater than 7 m/s was always a diseased vessel, and the peak wall shear rate decreased as the risk increases. Based on both the pathological markers and the visual inspection of tissue motion and vector flow, we conclude that the clinical feasibility of this approach is demonstrated. Larger and more disease-specific studies using such an approach will lead to better understanding and evaluation of vessels, which can translate to future use in the clinic.
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http://dx.doi.org/10.1109/TUFFC.2020.3015340DOI Listing
March 2021

Psychometric Properties of the Norwegian Version of the Electronic Health Literacy Scale (eHEALS) Among Patients After Percutaneous Coronary Intervention: Cross-Sectional Validation Study.

J Med Internet Res 2020 07 28;22(7):e17312. Epub 2020 Jul 28.

Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

Background: Web-based technology has recently become an important source for sharing health information with patients after an acute cardiac event. Therefore, consideration of patients' perceived electronic health (eHealth) literacy skills is crucial for improving the delivery of patient-centered health information.

Objective: The aim of this study was to translate and adapt the eHealth Literacy Scale (eHEALS) to conditions in Norway, and to determine its psychometric properties. More specifically, we set out to determine the reliability (internal consistency, test-retest) and construct validity (structural validity, hypotheses testing, and cross-cultural validity) of the eHEALS in self-report format administered to patients after percutaneous coronary intervention.

Methods: The original English version of the eHEALS was translated into Norwegian following a widely used cross-cultural adaptation process. Internal consistency was calculated using Cronbach α. The intraclass correlation coefficient (ICC) was used to assess the test-retest reliability. Confirmatory factor analysis (CFA) was performed for a priori-specified 1-, 2-, and 3-factor models. Demographic, health-related internet use, health literacy, and health status information was collected to examine correlations with eHEALS scores.

Results: A total of 1695 patients after percutaneous coronary intervention were included in the validation analysis. The mean age was 66 years, and the majority of patients were men (1313, 77.46%). Cronbach α for the eHEALS was >.99. The corresponding Cronbach α for the 2-week retest was .94. The test-retest ICC for eHEALS was 0.605 (95% CI 0.419-0.743, P<.001). The CFA showed a modest model fit for the 1- and 2-factor models (root mean square error of approximation>0.06). After modifications in the 3-factor model, all of the goodness-of-fit indices indicated a good fit. There was a weak correlation with age (r=-0.206). Between-groups analysis of variance showed a difference according to educational groups and the eHEALS score, with a mean difference ranging from 2.24 (P=.002) to 4.61 (P<.001), and a higher eHEALS score was found for patients who were employed compared to those who were retired (mean difference 2.31, P<.001). The eHEALS score was also higher among patients who reported using the internet to find health information (95% CI -21.40 to -17.21, P<.001), and there was a moderate correlation with the patients' perceived usefulness (r=0.587) and importance (r=0.574) of using the internet for health information. There were also moderate correlations identified between the eHEALS score and the health literacy domains appraisal of health information (r=0.380) and ability to find good health information (r=0.561). Weak correlations with the mental health composite score (r=0.116) and physical health composite score (r=0.116) were identified.

Conclusions: This study provides new information on the psychometric properties of the eHEALS for patients after percutaneous coronary intervention, suggesting a multidimensional rather than unidimensional construct. However, the study also indicated a redundancy of items, indicating the need for further validation studies.

Trial Registration: ClinicalTrials.gov NCT03810612; https://clinicaltrials.gov/ct2/show/NCT03810612.
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http://dx.doi.org/10.2196/17312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7420812PMC
July 2020

Feasibility and Reliability of Automatic Quantitative Analyses of Mitral Annular Plane Systolic Excursion by Handheld Ultrasound Devices: A Pilot Study.

J Ultrasound Med 2021 Feb 25;40(2):341-350. Epub 2020 Jul 25.

Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.

Objectives: Handheld ultrasound devices (HUDs) have previously been limited to grayscale imaging without options for left ventricle (LV) quantification. We aimed to study the feasibility and reliability of automatic measurements of mitral annular plane systolic excursion (MAPSE) by HUDs.

Methods: An algorithm that automatically measured MAPSE from live grayscale recordings was implemented in a HUD. Twenty patients at a university hospital were examined by either a cardiologist or a sonographer. Standard echocardiography using a high-end scanner was performed. The apical 4-chamber view was recorded 4 times by both echocardiography and the HUD. MAPSE was measured by M-mode and color tissue Doppler (cTD) during echocardiography and automatically by the HUD.

Results: The automatic method underestimated mean MAPSE ± SD versus M-mode (9.6 ± 2.2 versus 10.9 ± 2.6 mm; difference, 1.2 ± 1.4 mm, P < .005). The difference between the automatic and cTD measurements was not significant (0.8 ± 1.8 mm; P = .073). The intraclass correlation coefficients (ICCs) between automatic and M-mode measurements was 0.85, and 0.81 for cTD measurements. There was good agreement between the methods, and the intra- and inter-rater ICCs were excellent for all methods (≥0.86).

Conclusions: In this novel study evaluating automatic quantification of LV longitudinal function by HUD, we showed the high feasibility and reliability of the method. Compared to M-mode imaging, the automatic method underestimated MAPSE by 8% to 10%, but the difference with cTD imaging was nonsignificant. We conclude that this study's method for automatic quantitative assessment of LV function can be integrated in HUDs.
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http://dx.doi.org/10.1002/jum.15408DOI Listing
February 2021

Left ventricular diastolic function: Effects of high-intensity exercise after acute myocardial infarction.

Echocardiography 2020 06 4;37(6):858-866. Epub 2020 Jun 4.

MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.

Objectives: Reduced left ventricular (LV) diastolic function indicates poor prognosis after acute myocardial infarction (AMI). Our aim was to study whether a twelve-week high-intensity interval training program could improve diastolic function in patients with a relatively recent AMI.

Design: Twenty-eight patients (mean age 56 (SD 8) years) with a recent AMI performed high-intensity interval training twice a week for 12 weeks. Each training session consisted of four 4-minute bouts at 85%-95% of peak heart rate, separated by 4-minute active breaks. A cardiopulmonary exercise test was performed to determine peak oxygen uptake (VO ). Echocardiography was performed at rest and during an upright bicycle exercise test.

Results: There was a significant increase in mitral annulus early diastolic velocity (e') at peak exercise (75 W) from baseline to follow-up (7.9 (1.5) vs. 8.4 (1.7) cm/s, P = .012), but no change in e' at rest (7.1 (1.9) vs. 7.3 (1.7) cm/s, P = .42). There was a significant increase in VO (mean (SD), 35.2 (7.3) vs. 38.9 (7.4) ml/kg/min, P < .001). e' at peak exercise correlated with VO both at baseline and follow-up (r = 0.50, P = .007, and r = 0.41, P = .032).

Conclusion: The present study shows that LV diastolic function during exercise is related to VO . We also found an improvement of diastolic function after exercise training, even in a population with a relatively well preserved systolic and diastolic function. The results demonstrate the importance of obtaining measurements during exercise when evaluating the effects of exercise interventions.
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http://dx.doi.org/10.1111/echo.14750DOI Listing
June 2020

Feasibility and Accuracy of Tele-Echocardiography, With Examinations by Nurses and Interpretation by an Expert via Telemedicine, in an Outpatient Heart Failure Clinic.

J Ultrasound Med 2020 Dec 21;39(12):2313-2323. Epub 2020 May 21.

Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.

Objectives: To study the feasibility and accuracy of focused echocardiography by nurses supported by near-real-time interpretation via telemedicine by an experienced cardiologist.

Methods: Fifty consecutive patients were included from an outpatient heart failure (HF) clinic. Limited echocardiography was performed by 1 of 3 specialized nurses. The echocardiograms were transferred by a secure transfer model for near-real-time interpretation to 1 out-of-hospital cardiologist, assessing, among others, the left ventricular (LV) internal diameter, end-diastolic volume, ejection fraction, left atrial (LA) indexed end-systolic volume, mitral early inflow velocity (E), the ratio of E to mitral late inflow, and the ratio of E to the mitral annular early diastolic velocity. The reference method was echocardiography by 1 of 4 experienced cardiologists.

Results: The median age of the population (46% women) was 79 (range, 33-95) years. The assessment and quantification of LA and LV dimensions, volumes, and functional indices were feasible in 94% or more via the telemedical approach. The agreement with reference measurements was very high by the telemedical approach. The mean duration ± SD of the complete telemedical approach from the start of echocardiography until the cardiologist's report was received by the caregiving nurse was 1.32 ± 0.36 (range, 1.58) hours. The correlations with reference to the above-specified indices were r = 0.75 to 0.94.

Conclusions: Limited echocardiography by nurses in an outpatient heart failure clinic, supported by interpretation by an out-of-hospital cardiologist, was feasible and reliable. This may reduce geographic disparities and allow more patients to benefit from the advantages of implementing focused echocardiography by noncardiologists in diagnostics and follow-up.
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http://dx.doi.org/10.1002/jum.15341DOI Listing
December 2020

Automatic quantification of left ventricular function by medical students using ultrasound.

BMC Med Imaging 2020 03 16;20(1):29. Epub 2020 Mar 16.

Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Prinsesse Kristinas gate 3, 7030, Trondheim, Norway.

Background: Automatic analyses of echocardiograms may support inexperienced users in quantifying left ventricular (LV) function. We have developed an algorithm for fully automatic measurements of mitral annular plane systolic excursion (MAPSE) and mitral annular systolic (S') and early diastolic (e') peak velocities. We aimed to study the influence of user experience of automatic measurements of these indices in echocardiographic recordings acquired by medical students and clinicians.

Methods: We included 75 consecutive patients referred for echocardiography at a university hospital. The patients underwent echocardiography by clinicians (cardiologists, cardiology residents and sonographers), who obtained manual reference measurements of MAPSE by M-mode and of S' and e' by colour tissue Doppler imaging (cTDI). Immediately after, each patient was examined by 1 of 39 medical students who were instructed in image acquisition on the day of participation. Each student acquired cTDI recordings from 1 to 4 patients. All cTDI recordings by students and clinicians were analysed for MAPSE, S' and e' using a fully automatic algorithm. The automatic measurements were compared to the manual reference measurements.

Results: Correct tracking of the mitral annulus was feasible in 50 (67%) and 63 (84%) of the students' and clinicians' recordings, respectively (p = 0.007). Image quality was highest in the clinicians' recordings. Mean difference ± standard deviation of the automatic measurements of the students' recordings compared to the manual reference was - 0.0 ± 2.0 mm for MAPSE, 0.3 ± 1.1 cm/s for S' and 0.6 ± 1.4 cm/s for e'. The corresponding intraclass correlation coefficients for MAPSE, S' and e' were 0.85 (good), 0.89 (good) and 0.92 (excellent), respectively. Automatic measurements from the students' and clinicians' recordings were in similar agreement with the reference when mitral annular tracking was correct.

Conclusions: In case of correct tracking of the mitral annulus, the agreement with reference for the automatic measurements was overall good. Low image quality reduced feasibility. Adequate image acquisition is essential for automatic analyses of LV function indices, and thus, appropriate education of the operators is mandatory. Automatic measurements may help inexperienced users of ultrasound, but do not remove the need for dedicated education and training.
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http://dx.doi.org/10.1186/s12880-020-00430-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7077164PMC
March 2020

Over all variability of mitral annular plane peak systolic velocity and peak global longitudinal strain rate in relation to age, body size, and sex: The HUNT Study.

Echocardiography 2020 04 10;37(4):578-585. Epub 2020 Mar 10.

Department of Medical Imaging and Circulation, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

Background: Left ventricular (LV) systolic global function can be assessed by peak annular systolic velocity S'. Global longitudinal strain rate (GLSR) is relative LV shortening rate, equivalent to normalizing S' for LV length (S' ). It has previously been shown that mitral annular plane systolic excursion (MAPSE) and global longitudinal strain (GLS) have similar biological variability, but GLS normalizes for one dimension only, inducing a systematic error, increasing body size dependence. The objective of this study was to compare S' with GLSR in the same way, comparing biological variability and body size dependence.

Methods And Results: A total of 1266 subjects from the third wave of Nord-Trøndelag Health Study (HUNT), without evidence of heart disease, were examined. Strain rate, S' and wall lengths were measured in the four walls of the two- and four-chamber views. Mean S' was 8.4 (1.4) cm/s, (S' ) was 0.7 (0.14)s and GLSR 1.02 (0.14)s . All measures declined with age. Normalization of mitral annular velocities for LV length, or the use of GLSR, did not reduce overall biological variability compared with S'. S' did show a weak, positive correlation to BSA, while S' and GLSR a slightly stronger, negative correlation to BSA.

Conclusions: S', S' , and GLSR have similar biological variability, which is mainly due to age, not body size variation. Normalizing S' for LV length (as in S or GLSR) reverses correlation with BSA inducing a systematic error, due to the one-dimensional normalization for one dimension only.
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http://dx.doi.org/10.1111/echo.14630DOI Listing
April 2020

Left Atrial Volume, Cardiorespiratory Fitness, and Diastolic Function in Healthy Individuals: The HUNT Study, Norway.

J Am Heart Assoc 2020 02 28;9(3):e014682. Epub 2020 Jan 28.

Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway.

Background Left atrial (LA) size and cardiorespiratory fitness (CRF) are predictors of future cardiovascular events in high-risk populations. LA dilatation is a diagnostic criterion for left ventricular diastolic dysfunction. However, LA is dilated in endurance athletes with high CRF, but little is known about the association between CRF and LA size in healthy, free-living individuals. We hypothesized that in a healthy population, LA size was associated with CRF and leisure-time physical activity, but not with echocardiographic indexes of left ventricular diastolic dysfunction. Methods and Results In this cross-sectional study from HUNT (Nord-Trøndelag Health Study), 107 men and 138 women, aged 20 to 82 years, without hypertension, cardiovascular, pulmonary, or malignant disease participated. LA volume was assessed by echocardiography and indexed to body surface area LAVI (left atrial volume index). CRF was measured as peak oxygen uptake (VO) using ergospirometry, and percent of age- and-sex-predicted VO was calculated. Indexes of left ventricular diastolic dysfunction were assessed in accordance with latest recommendations. LAVI was >34 mL/m in 39% of participants, and LAVI was positively associated with VO and percentage of age- and-sex-predicted VO (β [95% CI], 0.11 [0.06-0.16] and 0.18 [0.09-0.28], respectively) and weighted minutes of physical activity per week (β [95% CI], 0.01 [0.003-0.015]). LAVI was not associated with other indexes of left ventricular diastolic dysfunction. There was an effect modification between age and VO/percentage of age- and-sex-predicted VO showing higher LAVI with advanced age and higher VO/percentage of age- and-sex-predicted VO as presented in prediction diagrams. Conclusions Interpretation of LAVI as a marker of diastolic dysfunction should be done in relation to age-relative CRF. Studies on the prognostic value of LAVI in fit subpopulations are needed.
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http://dx.doi.org/10.1161/JAHA.119.014682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7033857PMC
February 2020

Systolic Dysfunction in Systemic Sclerosis: Prevalence and Prognostic Implications.

ACR Open Rheumatol 2019 Jun 31;1(4):258-266. Epub 2019 May 31.

Oslo University Hospital, Oslo, Norway and University of Oslo Oslo Norway.

Objective: Primary cardiac involvement is presumed to account for a substantial part of disease-related mortality in systemic sclerosis (SSc). Still, there are knowledge gaps on the evolution and total burden of systolic dysfunction in SSc. Here we evaluated prospective left ventricular (LV) and right ventricular (RV) systolic function in an unselected SSc cohort and assessed the burden of systolic dysfunction on mortality.

Methods: From the Oslo University Hospital cohort, 277 SSc patients were included from 2003-2016 and compared with healthy controls. Serial echocardiographies were reevaluated in order to detect change in systolic function. Right heart catheterization was performed on patients suspected of pulmonary hypertension. Descriptive and regression analyses were conducted.

Results: At baseline, LV systolic dysfunction by ejection fraction less than 50%, or a global longitudinal strain greater than -17.0%, was found in 12% and 24%, respectively. RV systolic dysfunction measured by tricuspid annular plane systolic excursion (TAPSE) less than 17 mm was evident in 10%. Follow-up echocardiography was performed after a median of 3.3 years (interquartile range [IQR] 1.5-5.6). At follow-up, LV systolic function remained stable, whereas RV function evaluated by TAPSE deteriorated (mean 23.1 to 21.7 mm, = 0.005) equaling a 15% prevalence of RV systolic dysfunction. RV systolic function predicted mortality in multivariable models (hazard ratio 0.41, 95% confidence interval [CI] 0.19-0.90, value 0.027), whereas LV systolic function lost predictive significance when adjusted for TAPSE.

Conclusion: In this unselected and prospective study, systolic dysfunction of the LV and RV was a frequent complication of SSc. LV systolic function remained stable across the observation period, whereas RV function deteriorated and predicted mortality.
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http://dx.doi.org/10.1002/acr2.1037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857986PMC
June 2019

Baseline and Exercise Predictors of V˙O2peak in Systolic Heart Failure Patients: Results from SMARTEX-HF.

Med Sci Sports Exerc 2020 04;52(4):810-819

Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, DENMARK.

Purpose: This study aimed to investigate baseline, exercise testing, and exercise training-mediated predictors of change in peak oxygen uptake (V˙O2peak) from baseline to 12-wk follow-up (ΔV˙O2peak) in a post hoc analysis from the SMARTEX Heart Failure trial.

Methods: We studied 215 patients with heart failure with left ventricular ejection fraction (LVEF) ≤35%, and New York Heart Association (NYHA) classes II-III who were randomized to either supervised high-intensity interval training with exercise target intensity of 90%-95% of peak heart rate (HRpeak) or supervised moderate continuous training (MCT) with target intensity of 60%-70% of HRpeak, or who received a recommendation of regular exercise on their own. Predictors of ΔV˙O2peak were assessed in two models: a logistic regression model comparing highest and lowest tertiles (baseline parameters) and a multivariate linear regression model (test/training/clinical parameters).

Results: The change in V˙O2peak in response to the interventions (ΔV˙O2peak) varied substantially, from -8.50 to +11.30 mL·kg·min. Baseline NYHA (class II gave higher odds vs III; odds ratio (OR), 7.1 (2.0-24.9); P = 0.002), LVEF (OR per percent, 1.1 (1.0-1.2); P = 0.005), and age (OR per 10 yr, 0.5 (0.3-0.8); P = 0.003) were associated with ΔV˙O2peak.In the multivariate linear regression, 34% of the variability in ΔV˙O2peak was explained by the increase in exercise training workload, ΔHRpeak between baseline and 12-wk posttesting, age, and ever having smoked.

Conclusion: Exercise training response (ΔV˙O2peak) correlated negatively with age, LVEF, and NYHA class. The ability to increase workload during the training period and increased ΔHRpeak between baseline and the 12-wk test were associated with a positive outcome.
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http://dx.doi.org/10.1249/MSS.0000000000002193DOI Listing
April 2020

Left ventricular global strains by linear measurements in three dimensions: interrelations and relations to age, gender and body size in the HUNT Study.

Open Heart 2019;6(2):e001050. Epub 2019 Sep 26.

MI Lab and Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway.

Background: Strain is a relative deformation and has three dimensions, in the left ventricle (LV) usually longitudinal (ε), transmural (ε) and circumferential (ε) strain. All three components can be measured generically by the basic systolic and diastolic dimension measures of LV wall length, wall thickness and diameter. In this observational study we aimed to study the relations of normal generic strains to age, body size and gender, as well as the interrelations between the three strain components.

Methods: Generic strains derived from dimension measures by longitudinal and cross-sectional M-mode in all three dimensions were measured in 1266 individuals without heart disease from the Nord-Trøndelag Health Study.

Results: The mean ε was -16.3%, ε was -22.7% and ε was 56.5%. Normal values by age and gender are provided. There was a gradient of ε from the endocardial, via the midwall to the external level, lowest at the external. All strains decreased in absolute values by increasing body surface area (BSA) and age, relations were strongest for ε. Gender differences were mainly a function of BSA differences. The three strain components were strongly interrelated through myocardial incompressibility.

Conclusions: Global systolic strain is the total deformation of the myocardium; the three strain components are the spatial coordinates of this deformation, irrespective of the technology used for measurement. Normal values are method-dependent and not normative across methods. Interrelation of strains indicates a high degree of myocardial incompressibility and that longitudinal strain carries most of the total information.
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http://dx.doi.org/10.1136/openhrt-2019-001050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802996PMC
February 2021

Normal ranges for automatic measurements of tissue Doppler indices of mitral annular motion by echocardiography. Data from the HUNT3 Study.

Echocardiography 2019 09 23;36(9):1646-1655. Epub 2019 Sep 23.

Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

Background: Automatic quantification of left ventricular (LV) function could enhance workflow for cardiologists and assist inexperienced clinicians who perform focused cardiac ultrasound. We have developed an algorithm for automatic measurements of the mitral annular plane systolic excursion (MAPSE) and peak velocities in systole (S') and early (e') and late (a') diastole. We aimed to establish normal reference values for the automatic measurements and to compare them with manual measurements.

Methods And Results: Healthy participants (n = 1157, 52.5% women) from the HUNT3 cross-sectional population study in Norway were included. The mean age ± standard deviation (SD) was 49 ± 14 (range: 19-89) years. The algorithm measured MAPSE, S', e', and a' from apical 4-chamber color tissue Doppler imaging (cTDI) recordings. The manual measurements were obtained by two echocardiographers, who measured MAPSE by M-mode and the velocities by cTDI. For men and women, age-specific reference values were created for groups (mean ± 1.96SD) and by linear regression (mean, 95% prediction interval). Age was negatively correlated with MAPSE, S', and e' and positively correlated with a'. There were small differences between genders. Normal reference ranges were created. The coefficients of variation between automatic and manual measurements ranged from 5.5% (S') to 11.7% (MAPSE).

Conclusion: Normal reference values for automatic measurements of LV function indices are provided. The automatic measurements were in line with the manual measurements. Implementing automatic measurements and comparison with normal ranges in ultrasound scanners can allow for quick and precise interpretation of LV function.
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http://dx.doi.org/10.1111/echo.14476DOI Listing
September 2019

Asthma, asthma control and risk of acute myocardial infarction: HUNT study.

Eur J Epidemiol 2019 Oct 11;34(10):967-977. Epub 2019 Sep 11.

Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.

Asthma, a chronic inflammatory airway disease, shares several common pathophysiological mechanisms with acute myocardial infarction (AMI). Our aim was to assess the prospective associations between asthma, levels of asthma control and risk of AMI. We followed 57,104 adults without previous history of AMI at baseline from Nord-Trøndelag health study (HUNT) in Norway. Self-reported asthma was categorised as active asthma (i.e., using asthma medication) and non-active asthma (i.e., not using asthma medication). Levels of asthma control were defined as controlled, partly controlled, and uncontrolled based on the Global Initiative for Asthma guidelines. AMI was ascertained by linking HUNT data with hospital records. A total of 2868 AMI events (5.0%) occurred during a mean (SD) follow-up of 17.2 (5.4) years. Adults with active asthma had an estimated 29% higher risk of developing AMI [adjusted hazard ratio (HR) 1.29, 95% CI 1.08-1.54] compared with adults without asthma. There was a significant dose-response association between asthma control and AMI risk, with highest risk in adults with uncontrolled asthma (adjusted HR 1.73, 95% CI 1.13-2.66) compared to adults with controlled asthma (p for trend < 0.05). The associations were not explained by smoking status, physical activity and C-reactive protein levels. Our study suggests that active asthma and poor asthma control are associated with moderately increased risk of AMI. Further studies are needed to evaluate causal relationship and the underlying mechanisms and to clarify the role of asthma medications in the risk of AMI.
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http://dx.doi.org/10.1007/s10654-019-00562-xDOI Listing
October 2019
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