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Bjerner, Tomas
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Publications (10 of 40) Show all publications
Themudo, R., Johansson, L. E., Ebeling Barbier, C., Lind, L., Ahlström, H. & Bjerner, T. (2017). The number of unrecognized myocardial infarction scars detected at DE-MRI increase during a 5-year follow-up. European Radiology, 27(2), 715-722
Open this publication in new window or tab >>The number of unrecognized myocardial infarction scars detected at DE-MRI increase during a 5-year follow-up
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2017 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 27, no 2, p. 715-722Article in journal (Refereed) Published
Abstract [en]

Objectives

In an elderly population, the prevalence of unrecognized myocardial infarction (UMI) scars found via late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging was more frequent than expected. This study investigated whether UMI scars detected with LGE-CMR at age 70 would be detectable at age 75 and whether the scar size changed over time.

Methods

From 248 participants that underwent LGE-CMR at age 70, 185 subjects underwent a follow-up scan at age 75. A myocardial infarction (MI) scar was defined as late enhancement involving the subendocardium.

Results

In the 185 subjects that underwent follow-up, 42 subjects had a UMI scar at age 70 and 61 subjects had a UMI scar at age 75. Thirty-seven (88 %) of the 42 UMI scars seen at age 70 were seen in the same myocardial segment at age 75. The size of UMI scars did not differ between age 70 and 75.

Conclusions

The prevalence of UMI scars detected at LGE-CMR increases with age. During a 5-year follow-up, 88 % (37/42) of the UMI scars were visible in the same myocardial segment, reassuring that UMI scars are a consistent finding. The size of UMI scars detected during LGE-CMR did not change over time.

Keywords
Unrecognized myocardial infarction, delayed-enhancement magnetic resonance imaging, follow-up study, epidemiology
National Category
Radiology, Nuclear Medicine and Medical Imaging Cardiac and Cardiovascular Systems
Research subject
Radiology; Cardiology; Epidemiology
Identifiers
urn:nbn:se:uu:diva-172069 (URN)10.1007/s00330-016-4439-7 (DOI)000392142000032 ()27255402 (PubMedID)
Funder
Swedish Research Council, k2013-64x-08268-3
Available from: 2012-04-02 Created: 2012-04-02 Last updated: 2017-12-07Bibliographically approved
Baron, T., Orndahl, L. H., Kero, T., Sörensen, J., Bjerner, T., Hedin, E.-M., . . . Flachskampf, F. (2017). Volumetric quantification of regurgitant volume in asymptomatic severe degenerative mitral regurgitation by echocardiography and cardiac mri with independent validation of forward stroke volume by positron emission tomography. Paper presented at 66th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), MAR 17-19, 2017, Washington, DC. Journal of the American College of Cardiology, 69(11 Suppl), 1973-1973
Open this publication in new window or tab >>Volumetric quantification of regurgitant volume in asymptomatic severe degenerative mitral regurgitation by echocardiography and cardiac mri with independent validation of forward stroke volume by positron emission tomography
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2017 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 69, no 11 Suppl, p. 1973-1973Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2017
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-321054 (URN)10.1016/S0735-1097(17)35362-7 (DOI)000397342302695 ()
Conference
66th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), MAR 17-19, 2017, Washington, DC
Available from: 2017-05-05 Created: 2017-05-05 Last updated: 2017-05-05Bibliographically approved
Baron, T., Örndahl, L. H., Kero, T., Sörensen, J., Bjerner, T., Hedin, E.-M., . . . Flachskampf, F. A. (2016). Comparison of left ventricular volumes and regurgitant volumes by echocardiography and magnetic resonance in patients with severe degenerative mitral regurgitation. Paper presented at Congress of the European-Society-of-Cardiology (ESC), AUG 27-31, 2016, Rome, ITALY. European Heart Journal, 37, 1239-1239
Open this publication in new window or tab >>Comparison of left ventricular volumes and regurgitant volumes by echocardiography and magnetic resonance in patients with severe degenerative mitral regurgitation
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2016 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, p. 1239-1239Article in journal, Meeting abstract (Refereed) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-313883 (URN)000383869506148 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 27-31, 2016, Rome, ITALY
Available from: 2017-01-25 Created: 2017-01-25 Last updated: 2017-11-29Bibliographically approved
Flachskampf, F. A., Biering-Sorensen, T., Solomon, S. D., Duvernoy, O., Bjerner, T. & Smiseth, O. A. (2016). Heart Rate Is an Important Consideration for Cardiac Imaging of Diastolic Function Reply [Letter to the editor]. JACC Cardiovascular Imaging, 9(6), 758-759
Open this publication in new window or tab >>Heart Rate Is an Important Consideration for Cardiac Imaging of Diastolic Function Reply
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2016 (English)In: JACC Cardiovascular Imaging, ISSN 1936-878X, E-ISSN 1876-7591, Vol. 9, no 6, p. 758-759Article in journal, Letter (Refereed) Published
National Category
Cardiac and Cardiovascular Systems Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-299974 (URN)10.1016/j.jcmg.2015.11.015 (DOI)000377418700022 ()26897672 (PubMedID)
Available from: 2016-08-01 Created: 2016-08-01 Last updated: 2017-11-28Bibliographically approved
Ebeling Barbier, C., Themudo, R., Bjerner, T., Johansson, L., Lind, L. & Ahlström, H. (2016). Long-term prognosis of unrecognized myocardial infarction detected with cardiovascular magnetic resonance in an elderly population. Journal of Cardiovascular Magnetic Resonance, 18(1), 43
Open this publication in new window or tab >>Long-term prognosis of unrecognized myocardial infarction detected with cardiovascular magnetic resonance in an elderly population
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2016 (English)In: Journal of Cardiovascular Magnetic Resonance, ISSN 1097-6647, E-ISSN 1532-429X, Vol. 18, no 1, p. 43-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Individuals with unrecognized myocardial infarctions (UMIs) detected with cardiovascular magnetic resonance (CMR) constitute a recently defined group whose prognosis has not been fully evaluated. However, increasing evidence indicate that these individuals may be at considerable cardiovascular risk. The aim of the present study was to investigate the prognostic impact of CMR detected UMIs for major adverse cardiac events (MACE) in community living elderly individuals.

METHODS: Late gadolinium enhancement CMR was performed in 248 randomly chosen 70-year-olds. Individuals with myocardial infarction (MI) scars, with or without a hospital diagnosis of MI were classified as recognized MI (RMI) or UMI, respectively. Medical records and death certificates were scrutinized. MACE was defined as cardiac death, non-fatal MI, a new diagnosis of angina pectoris, or symptom-driven coronary artery revascularization.

RESULTS: During follow-up (mean 11 years) MACE occurred in 10 % (n = 18/182) of the individuals without MI scars, in 20 % (n = 11/55) of the individuals with UMI, and in 45 % (n = 5/11) of the individuals with RMI, with a significant difference between the UMI group and the group without MI scars (p = 0.045), and between the RMI group and the group without MI scars (p = 0.0004). Cardiac death and/or non-fatal MI occurred in 15, 5, and 3 of the individuals in the NoMI, UMI, and RMI group respectively. Hazards ratios for MACE adjusted for risk factors and sex were 2.55 (95 % CI 1.20-5.42; p = 0.015) for UMI and 3.28 (95 % CI1.16-9.22; p = 0.025) for RMI.

CONCLUSIONS: The presence of a CMR detected UMI entailed a more than double risk for MACE in community living 70-year-old individuals.

Keywords
Unrecognized myocardial infarction; Cardiovascular magnetic resonance; Epidemiology; Prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-300406 (URN)10.1186/s12968-016-0264-z (DOI)000381378600001 ()27430315 (PubMedID)
Funder
Swedish Research Council, K2013-64X-08268-23-3
Available from: 2016-08-08 Created: 2016-08-08 Last updated: 2018-02-28Bibliographically approved
Nordenskjöld, A. M., Hammar, P., Ahlström, H., Bjerner, T., Duvernoy, O., Eggers, K. M., . . . Lindahl, B. (2016). Unrecognized Myocardial Infarction Assessed by Cardiac Magnetic Resonance Imaging - Prognostic Implications. PLoS ONE, 11(2), Article ID e0148803.
Open this publication in new window or tab >>Unrecognized Myocardial Infarction Assessed by Cardiac Magnetic Resonance Imaging - Prognostic Implications
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 2, article id e0148803Article in journal (Refereed) Published
Abstract [en]

Background Clinically unrecognized myocardial infarctions (UMI) are not uncommon and may be associated with adverse outcome. The aims of this study were to determine the prognostic implication of UMI in patients with stable suspected coronary artery disease (CAD) and to investigate the associations of UMI with the presence of CAD. Methods and Findings In total 235 patients late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) imaging and coronary angiography were performed. For each patient with UMI, the stenosis grade of the coronary branch supplying the infarcted area was determined. UMIs were present in 25% of the patients and 67% of the UMIs were located in an area supplied by a coronary artery with a stenosis grade >= 70%. In an age-and gender-adjusted model, UMI independently predicted the primary endpoint (composite of death, myocardial infarction, resuscitated cardiac arrest, hospitalization for unstable angina pectoris or heart failure within 2 years of follow-up) with an odds ratio of 2.9; 95% confidence interval 1.1-7.9. However, this association was abrogated after adjustment for age and presence of significant coronary disease. There was no difference in the primary endpoint rates between UMI patients with or without a significant stenosis in the corresponding coronary artery. Conclusions The presence of UMI was associated with a threefold increased risk of adverse events during follow up. However, the difference was no longer statistically significant after adjustments for age and severity of CAD. Thus, the results do not support that patients with suspicion of CAD should be routinely investigated by LGE-CMR for UMI. However, coronary angiography should be considered in patients with UMI detected by LGE-CMR.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-282490 (URN)10.1371/journal.pone.0148803 (DOI)000371218400049 ()26885831 (PubMedID)
Funder
Swedish Research CouncilSwedish Heart Lung Foundation, 20140486
Note

Författare 3-8 delar på tredje författarskapet.

Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2017-11-30Bibliographically approved
Nordenskjold, A. M., Hammar, P., Ahlström, H., Bjerner, T., Duvernoy, O., Eggers, K. M., . . . Lindahl, B. (2016). Unrecognized myocardial infarctions detected by cardiac magnetic resonance imaging are associated with cardiac troponin I levels. Clinica Chimica Acta, 455, 189-194
Open this publication in new window or tab >>Unrecognized myocardial infarctions detected by cardiac magnetic resonance imaging are associated with cardiac troponin I levels
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2016 (English)In: Clinica Chimica Acta, ISSN 0009-8981, E-ISSN 1873-3492, Vol. 455, p. 189-194Article in journal (Refereed) Published
Abstract [en]

Background: Both unrecognized myocardial infarction (UMI) and elevated levels of biomarkers are common in patients with stable coronary artery disease (CAD). The objective of this study was to determine the association between levels of cardiac biomarkers, UMI and extent of CAD in patients with stable CAD.

Methods: A total of 235 patients (median age: 65 years; 34% women) with stable CAD without previously known myocardial infarction were examined with late gadolinium enhancement cardiovascular magnetic resonance imaging and coronary angiography. Blood samples were drawn at enrolment and high sensitivity cardiac troponin I (cTnI), NT-proBNP and Galectin-3 were analyzed.

Results: UMI was detected in 58 patients (25%). The median levels of cTnI, NT-proBNP and Galectin-3 were significantly higher in patients with UMI compared to those without, (p < 0.001, p = 0.006 and p = 0.033, respectively). After adjustment for cardiovascular risk factors, left ventricular ejection fraction and renal function, cTnI remained independently associated with the presence of UMI (p = 0.031) and the extent of CAD (p = 0.047). Neither NT-proBNP, nor Galectin-3, was independently associated with UMI or extent of CAD.

Conclusions: The independent association between levels of cTnI and UMI indicates a common pathophysiological pathway for the cTnI elevation and development of UMI.

Keywords
Cardiac troponin, NT-proBNP, Unrecognized myocardial infarction, Coronary artery disease, Cardiac magnetic resonance imaging
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-294683 (URN)10.1016/j.cca.2016.01.029 (DOI)000373655100030 ()26828531 (PubMedID)
Available from: 2016-06-01 Created: 2016-05-26 Last updated: 2017-11-30Bibliographically approved
Harms, H. J., Tolbod, L. P., Hansson, N. H., Kero, T., Örndahl, L. H., Kim, W. Y., . . . Sörensen, J. (2015). Automatic extraction of forward stroke volume using dynamic PET/CT: a dual-tracer and dual-scanner validation in patients with heart valve disease.. EJNMMI physics, 2(1), Article ID 25.
Open this publication in new window or tab >>Automatic extraction of forward stroke volume using dynamic PET/CT: a dual-tracer and dual-scanner validation in patients with heart valve disease.
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2015 (English)In: EJNMMI physics, ISSN 2197-7364, Vol. 2, no 1, article id 25Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of this study was to develop and validate an automated method for extracting forward stroke volume (FSV) using indicator dilution theory directly from dynamic positron emission tomography (PET) studies for two different tracers and scanners.

METHODS: 35 subjects underwent a dynamic (11)C-acetate PET scan on a Siemens Biograph TruePoint-64 PET/CT (scanner I). In addition, 10 subjects underwent both dynamic (15)O-water PET and (11)C-acetate PET scans on a GE Discovery-ST PET/CT (scanner II). The left ventricular (LV)-aortic time-activity curve (TAC) was extracted automatically from PET data using cluster analysis. The first-pass peak was isolated by automatic extrapolation of the downslope of the TAC. FSV was calculated as the injected dose divided by the product of heart rate and the area under the curve of the first-pass peak. Gold standard FSV was measured using phase-contrast cardiovascular magnetic resonance (CMR).

RESULTS: FSVPET correlated highly with FSVCMR (r = 0.87, slope = 0.90 for scanner I, r = 0.87, slope = 1.65, and r = 0.85, slope = 1.69 for scanner II for (15)O-water and (11)C-acetate, respectively) although a systematic bias was observed for both scanners (p < 0.001 for all). FSV based on (11)C-acetate and (15)O-water correlated highly (r = 0.99, slope = 1.03) with no significant difference between FSV estimates (p = 0.14).

CONCLUSIONS: FSV can be obtained automatically using dynamic PET/CT and cluster analysis. Results are almost identical for (11)C-acetate and (15)O-water. A scanner-dependent bias was observed, and a scanner calibration factor is required for multi-scanner studies. Generalization of the method to other tracers and scanners requires further validation.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-268064 (URN)10.1186/s40658-015-0133-0 (DOI)000379208500025 ()26501826 (PubMedID)
Available from: 2015-12-02 Created: 2015-12-02 Last updated: 2016-08-10Bibliographically approved
Flachskampf, F. A., Biering-Sörensen, T., Solomon, S. D., Duvernoy, O., Bjerner, T. & Smiseth, O. A. (2015). Cardiac Imaging to Evaluate Left Ventricular Diastolic Function. JACC Cardiovascular Imaging, 8(9), 1071-1093
Open this publication in new window or tab >>Cardiac Imaging to Evaluate Left Ventricular Diastolic Function
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2015 (English)In: JACC Cardiovascular Imaging, ISSN 1936-878X, E-ISSN 1876-7591, Vol. 8, no 9, p. 1071-1093Article in journal (Refereed) Published
Abstract [en]

Left ventricular diastolic dysfunction in clinical practice is generally diagnosed by imaging. Recognition of heart failure with preserved ejection fraction has increased interest in the detection and evaluation of this condition and prompted an improved understanding of the strengths and weaknesses of different imaging modalities for evaluating diastolic dysfunction. This review briefly provides the pathophysiological background for current clinical and experimental imaging parameters of diastolic dysfunction, discusses the merits of echocardiography relative to other imaging modalities in diagnosing and grading diastolic dysfunction, summarizes Lessons from clinical trials that used parameters of diastolic function as an inclusion criterion or endpoint, and indicates current areas of research.

Place, publisher, year, edition, pages
Uppsala Univ, Inst Med Vetenskaper, Akad Sjukhuset, S-75185 Uppsala, Sweden.: , 2015
Keywords
cardiac magnetic resonance, computed tomography, diastolic dysfunction, echocardiography, heart failure with preserved ejection fraction (HFpEF), left ventricular function
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-265925 (URN)10.1016/j.jcmg.2015.07.004 (DOI)000361933100013 ()26381769 (PubMedID)
Available from: 2015-11-04 Created: 2015-11-04 Last updated: 2017-12-01Bibliographically approved
Hammar, P., Nordenskjöld, A. M., Lindahl, B., Duvernoy, O., Ahlström, H., Johansson, L., . . . Bjerner, T. (2015). Unrecognized myocardial infarctions assessed by cardiovascular magnetic resonance are associated with the severity of the stenosis in the supplying coronary artery. Journal of Cardiovascular Magnetic Resonance, 17, Article ID 98.
Open this publication in new window or tab >>Unrecognized myocardial infarctions assessed by cardiovascular magnetic resonance are associated with the severity of the stenosis in the supplying coronary artery
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2015 (English)In: Journal of Cardiovascular Magnetic Resonance, ISSN 1097-6647, E-ISSN 1532-429X, Vol. 17, article id 98Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A previous study has shown an increased prevalence of late gadolinium enhancement cardiovascular magnetic resonance (LGE CMR) detected unrecognized myocardial infarction (UMI) with increasing extent and severity of coronary artery disease. However, the coronary artery disease was evaluated on a patient level assuming normal coronary anatomy. Therefore, the aims of the present study were to investigate the prevalence of UMI identified by LGE CMR imaging in patients with stable angina pectoris and no known previous myocardial infarction; and to investigate whether presence of UMI is associated with stenotic lesions in the coronary artery supplying the segment of the myocardium in which the UMI is located, using coronary angiography to determine the individual coronary anatomy in each patient.

METHODS: In this prospective multicenter study, we included patients with stable angina pectoris and without prior myocardial infarction, scheduled for coronary angiography. A LGE CMR examination was performed prior to the coronary angiography. The study cohort consisted of 235 patients (80 women, 155 men) with a mean age of 64.8 years.

RESULTS: UMIs were found in 25 % of patients. There was a strong association between stenotic lesions (≥70 % stenosis) in a coronary artery and the presence of an UMI in the myocardial segments supplied by the stenotic artery; it was significantly more likely to have an UMI downstream a stenosis ≥ 70 % as compared to < 70 % (OR 5.1, CI 3.1-8.3, p < 0.0001). 56 % of the UMIs were located in the inferior and infero-lateral myocardial segments, despite predominance for stenotic lesions in the left anterior descending artery.

CONCLUSION: UMI is common in patients with stable angina and the results indicate that the majority of the UMIs are of ischemic origin due to severe coronary atherosclerosis. In contrast to what is seen in recognized myocardial infarctions, UMIs are predominately located in the inferior and infero-lateral myocardial segments.

TRIAL REGISTRATION: The PUMI study is registered at ClinicalTrials.gov ( NCT01257282 ).

Keywords
Angiography; Coronary disease; Imaging; Infarction; Cardiovascular magnetic resonance
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-267878 (URN)10.1186/s12968-015-0202-5 (DOI)000365177100001 ()26585508 (PubMedID)
Funder
Swedish Research Council
Available from: 2015-11-27 Created: 2015-11-27 Last updated: 2017-12-01Bibliographically approved
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