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Flachskampf, Frank
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Publications (10 of 82) Show all publications
Flachskampf, F. (2018). Aortic Stenosis in Cancer Survivors After Chest Radiation. JACC Cardiovascular Imaging, 11(8), 1081-1083
Open this publication in new window or tab >>Aortic Stenosis in Cancer Survivors After Chest Radiation
2018 (English)In: JACC Cardiovascular Imaging, ISSN 1936-878X, E-ISSN 1876-7591, Vol. 11, no 8, p. 1081-1083Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
aortic stenosis, outcomes, progression, radiation heart disease
National Category
Radiology, Nuclear Medicine and Medical Imaging Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-366310 (URN)10.1016/j.jcmg.2018.04.020 (DOI)000440865100006 ()29909099 (PubMedID)
Available from: 2018-11-20 Created: 2018-11-20 Last updated: 2018-11-20Bibliographically approved
Harms, H. J., Hansson, N. H., Kero, T., Baron, T., Tolbod, L. P., Kim, W. Y., . . . Sörensen, J. (2018). Automatic calculation of myocardial external efficiency using a single 11C-acetate PET scan.. Journal of Nuclear Cardiology, 1-8
Open this publication in new window or tab >>Automatic calculation of myocardial external efficiency using a single 11C-acetate PET scan.
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2018 (English)In: Journal of Nuclear Cardiology, ISSN 1071-3581, E-ISSN 1532-6551, p. 1-8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Myocardial external efficiency (MEE) is defined as the ratio of kinetic energy associated with cardiac work [forward cardiac output (FCO)*mean systemic pressure] and the chemical energy from oxygen consumed (MVO2) by the left ventricular mass (LVM). We developed a fully automated method for estimating MEE based on a single 11C-acetate PET scan without ECG-gating.

METHODS AND RESULTS: Ten healthy controls, 34 patients with aortic valve stenosis (AVS), and 20 patients with mitral valve regurgitation (MVR) were recruited in a dual-center study. MVO2 was calculated using washout of 11C -acetate activity. FCO and LVM were calculated automatically using dynamic PET and parametric image formation. FCO and LVM were also obtained using cardiac magnetic resonance (CMR) in all subjects. The correlation between MEEPET-CMR and MEEPET was high (r = 0.85, P < 0.001) without significant bias. MEEPET was 23.6 ± 4.2% for controls and was lowered in AVS (17.2 ± 4.3%, P < 0.001) and in MVR (18.0 ± 5.2%, P = 0.004). MEEPET was strongly associated with both NYHA class (P < 0.001) and the magnitude of valvular dysfunction (mean aortic gradient: P < 0.001, regurgitant fraction: P = 0.009).

CONCLUSION: A single 11C-acetate PET yields accurate and automated MEE results on different scanners. MEE might provide an unbiased measurement of the phenotypic response to valvular disease.

Keywords
11C-acetate, Myocardial efficiency, myocardial energetics, positron emission tomography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-356783 (URN)10.1007/s12350-018-1338-0 (DOI)29946824 (PubMedID)
Available from: 2018-08-07 Created: 2018-08-07 Last updated: 2018-11-08Bibliographically approved
Kavianipour, M., Farkhooy, A. & Flachskampf, F. (2018). Clinical outcome and functional characteristics of patients with asymptomatic low-flow low-gradient severe aortic stenosis with preserved ejection fraction are closer to high-gradient severe than to moderate aortic stenosis. The International Journal of Cardiovascular Imaging, 34(4), 545-552
Open this publication in new window or tab >>Clinical outcome and functional characteristics of patients with asymptomatic low-flow low-gradient severe aortic stenosis with preserved ejection fraction are closer to high-gradient severe than to moderate aortic stenosis
2018 (English)In: The International Journal of Cardiovascular Imaging, ISSN 1569-5794, E-ISSN 1875-8312, Vol. 34, no 4, p. 545-552Article in journal (Refereed) Published
Abstract [en]

Asymptomatic "paradoxic" severe low-flow low-gradient aortic stenosis with preserved ejection fraction (PAS) constitutes a challenging condition where the optimal management and follow-up remain elusive. We evaluated the clinical outcome in patients with PAS as compared to asymptomatic patients with moderate (MAS) or classical severe aortic stenosis (CAS). Consecutive asymptomatic moderate or severe aortic stenosis patients without concomitant other heart or lung disease (n = 121) were invited. Participants (n = 74) were assigned to three subgroups with regard to degree of aortic stenosis: MAS (n = 25), CAS (n = 22) and PAS (n = 27). Echocardiographic parameters at baseline and clinical outcome data after > 3 years of follow-up time were obtained. Patients with PAS had the smallest stroke volumes and the highest relative wall thickness (p < 0.05). Left ventricular mass index was highest in subjects with CAS, followed closely by PAS and eventually MAS subjects. Whereas ejection fraction was similar amongst the subgroups, a stepwise decrease in global longitudinal left ventricular strain with increasing degree of aortic stenosis was observed, with CAS patients displaying the lowest mean global longitudinal strain, followed by PAS and MAS. A trend towards increasing mortality rate by increasing degree of stenosis was observed. Patients with CAS underwent aortic valve replacement surgery more frequently than both PAS and MAS (p < 0.001). These data suggest that echocardiographic parameters and clinical outcome in patients with PAS bear closer resemblance to CAS than to MAS, but management of PAS is more conservative than in CAS.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-333365 (URN)10.1007/s10554-017-1264-2 (DOI)000427902300007 ()29124471 (PubMedID)
Available from: 2017-11-11 Created: 2017-11-11 Last updated: 2018-05-30Bibliographically approved
Delgado, V., Cardim, N., Cosyns, B., Donal, E., Flachskampf, F., Galderisi, M., . . . Popescu, B. A. (2018). Criteria for recommendation, expert consensus, and appropriateness criteria papers: update from the European Association of Cardiovascular Imaging Scientific Documents Committee. European Heart Journal Cardiovascular Imaging, 19(8), 835-837
Open this publication in new window or tab >>Criteria for recommendation, expert consensus, and appropriateness criteria papers: update from the European Association of Cardiovascular Imaging Scientific Documents Committee
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2018 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 19, no 8, p. 835-837Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2018
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-365170 (URN)10.1093/ehjci/jey079 (DOI)000441154400001 ()29905776 (PubMedID)
Available from: 2018-11-09 Created: 2018-11-09 Last updated: 2018-11-09Bibliographically approved
Carlsson, M., Heiberg, E., Ostenfeld, E., Steding-Ehrenborg, K., Kovács, S. J., Flachskampf, F. & Arheden, H. (2018). Functional Contribution of Circumferential Versus Longitudinal Strain: Different Concepts Suggest Conflicting Results.. Journal of the American College of Cardiology, 71(2), 254-255, Article ID S0735-1097(17)41601-9.
Open this publication in new window or tab >>Functional Contribution of Circumferential Versus Longitudinal Strain: Different Concepts Suggest Conflicting Results.
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2018 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 71, no 2, p. 254-255, article id S0735-1097(17)41601-9Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-368896 (URN)10.1016/j.jacc.2017.09.1156 (DOI)29325646 (PubMedID)
Available from: 2018-12-10 Created: 2018-12-10 Last updated: 2018-12-10
Almeida, J. G., Fontes-Carvalho, R., Sampaio, F., Ribeiro, J., Bettencourt, P., Flachskampf, F., . . . Azevedo, A. (2018). Impact of the 2016 ASE/EACVI recommendations on the prevalence of diastolic dysfunction in the general population. European Heart Journal Cardiovascular Imaging, 19(4), 380-386
Open this publication in new window or tab >>Impact of the 2016 ASE/EACVI recommendations on the prevalence of diastolic dysfunction in the general population
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2018 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 19, no 4, p. 380-386Article in journal (Refereed) Published
Abstract [en]

Aims: Diastolic dysfunction (DD) is frequent in the general population; however, the assessment of diastolic function remains challenging. We aimed to evaluate the impact of the recent 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) recommendations in the prevalence and grades of DD compared with the 2009 guidelines and the Canberra Study Criteria (CSC).

Methods and results: Within a population-based cohort, a total of 1000 individuals, aged ≥45 years, were evaluated retrospectively. Patients with previously known cardiac disease or ejection fraction <50% were excluded. Diastolic function was assessed by transthoracic echocardiography. DD prevalence and grades were determined according to the three classifications. The mean age was 62.0 ± 10.5 years and 37% were men. The prevalence of DD was 1.4% (n = 14) with the 2016 recommendations, 38.1% (n = 381) with the 2009 recommendations, and 30.4% (n = 304) using the CSC. The concordance between the updated recommendations and the other two was poor (from k = 0.13 to k = 0.18, P < 0.001). Regarding the categorization in DD grades, none of the 14 individuals with DD by the 2016 guidelines were assigned to Grade 1 DD, 64% were classified as Grade 2, 7% had Grade 3, and 29% had indeterminate grade.

Conclusion: The application of the new 2016 ASE/EACVI recommendations resulted in a much lower prevalence of DD. The concordance between the classifications was poor. The updated algorithm seems to be able to diagnose only the most advanced cases.

Keywords
diastole, echocardiography, diastolic dysfunction, heart failure
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-355691 (URN)10.1093/ehjci/jex252 (DOI)000431296600004 ()29236978 (PubMedID)
Available from: 2018-07-04 Created: 2018-07-04 Last updated: 2018-07-04Bibliographically approved
Čelutkienė, J., Plymen, C. M., Flachskampf, F., de Boer, R. A., Grapsa, J., Manka, R., . . . Nihoyannopoulos, P. (2018). Innovative imaging methods in heart failure: a shifting paradigm in cardiac assessment. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology.. European Journal of Heart Failure
Open this publication in new window or tab >>Innovative imaging methods in heart failure: a shifting paradigm in cardiac assessment. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology.
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2018 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844Article in journal (Refereed) Epub ahead of print
Abstract [en]

Myriad advances in all fields of cardiac imaging have stimulated and reflected new understanding of cardiac performance, myocardial damage and the mechanisms of heart failure. In this paper, the Heart Failure Association assesses the potential usefulness of innovative imaging modalities in enabling more precise diagnostic and prognostic evaluation, as well as in guiding treatment strategies. Many new methods have gradually penetrated clinical practice and are on their way to becoming a part of routine evaluation. This paper focuses on myocardial deformation and three-dimensional ultrasound imaging; stress tests for the evaluation of contractile and filling function; the progress of magnetic resonance techniques; molecular imaging and other sound innovations. The Heart Failure Association aims to highlight the ways in which paradigms have shifted in several areas of cardiac assessment. These include reassessing of the simplified concept of ejection fraction and implementation of the new parameters of cardiac performance applicable to all heart failure phenotypes; switching from two-dimensional to more accurate and reproducible three-dimensional ultrasound volumetric evaluation; greater tissue characterization via recently developed magnetic resonance modalities; moving from assessing cardiac function and congestion at rest to assessing it during stress; from invasive to novel non-invasive hybrid techniques depicting coronary anatomy and myocardial perfusion; as well as from morphometry to the imaging of pathophysiologic processes such as inflammation and apoptosis. This position paper examines the specific benefits of imaging innovations for practitioners dealing with heart failure aetiology, risk stratification and monitoring, and, in addition, for scientists involved in the development of future research.

Keywords
Cardiac magnetic resonance, Computed tomography, Echocardiography, Global longitudinal strain, Heart failure, Hybrid imaging, Imaging, Molecular imaging, Nuclear imaging, Speckle tracking, Stress echocardiography
National Category
Medical and Health Sciences
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-368886 (URN)10.1002/ejhf.1330 (DOI)30411833 (PubMedID)
Available from: 2018-12-10 Created: 2018-12-10 Last updated: 2018-12-10
Flachskampf, F. A. & Nihoyannopoulos, P. (2018). Our obsession with normal values. ECHO RESEARCH AND PRACTICE, 5(2), R17-R21
Open this publication in new window or tab >>Our obsession with normal values
2018 (English)In: ECHO RESEARCH AND PRACTICE, ISSN 2055-0464, Vol. 5, no 2, p. R17-R21Article, review/survey (Refereed) Published
Abstract [en]

Normal values provide the background for interpretation of quantitative imaging data and thus are essential information for daily routine. Nevertheless, the ways how normal values are obtained, presented and interpreted, often do not receive the attention they deserve. We review the concepts of normalcy, the implications of typical normal ranges including the types of distribution of normal data, the possibilities to index for confounding biological factors like body surface area and the limitations of the very concept of normal values, demonstrating that there are no easy statistical solutions for difficult clinical problems.

Keywords
normal values, multimodality, guidelines, statistics
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-366831 (URN)10.1530/ERP-17-0082 (DOI)000435732700006 ()29563145 (PubMedID)
Available from: 2018-11-28 Created: 2018-11-28 Last updated: 2018-11-28Bibliographically approved
Baron, T., Berglund, L., Hedin, E.-M. & Flachskampf, F. (2018). Test-retest reliability of new and conventional echocardiographic parameters of left ventricular systolic function.. Clinical Research in Cardiology
Open this publication in new window or tab >>Test-retest reliability of new and conventional echocardiographic parameters of left ventricular systolic function.
2018 (English)In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Reliability of left ventricular function measurements depends on actual biological conditions, repeated registrations and their analyses.

OBJECTIVE: To investigate test-retest reliability of speckle-tracking-derived strain measurements and its determinants compared to the conventional parameters, such as ejection fraction (EF), LV volumes and mitral annular plane systolic excursion (MAPSE).

METHODS: In 30 patients with a wide range of left ventricular function (mean EF 46.4 ± 16.4%, range 14-73%), standard echo views were acquired independently in a blinded fashion by two different echocardiographers in immediate sequence and analyzed off-line by two independent readers, creating 4 data sets per patient. Test-retest reliability of studied parameters was calculated using the smallest detectable change (SDC) and a total, inter-acquisition and inter-reader intra-class correlation coefficient (ICC).

RESULTS: The smallest detectable change normalized to the mean absolute value of the measured parameter (SDCrel) was lowest for MAPSE (10.7%). SDCrel for EF was similar to GLS (14.2 and 14.7%, respectively), while SDCrel for CS was much higher (35.6%). The intra-class correlation coefficient was excellent (> 0.9) for all measures of the left ventricular function. Intra-patient inter-acquisition reliability (ICCacq) was significantly better than inter-reader reliability (ICCread) (0.984 vs. 0.950, p = 0.03) only for EF, while no significant difference was observed for any other LV function parameter. Mean intra-subject standard deviations were significantly correlated to the mean values for CS and LV volumes, but not for the other studied parameters.

CONCLUSIONS: In a test-retest setting, both with normal and impaired left ventricular function, the smallest relative detectable change of EF, GLS and MAPSE was similar (11-15%), but was much higher for CS (35%). Surprisingly, reliability of GLS was not superior to that of EF. Acquisition and reader to a similar extent influenced the reliability of measurements of all left ventricular function measures except for ejection fraction, where the reliability was more dependent on the reader than on the acquisition.

Keywords
Ejection fraction, Global longitudinal strain, Left ventricular function, Mitral annulus plane systolic excursion, Test–retest reliability
National Category
Medical and Health Sciences
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-368888 (URN)10.1007/s00392-018-1363-7 (DOI)30368567 (PubMedID)
Available from: 2018-12-10 Created: 2018-12-10 Last updated: 2018-12-10
Nordström, J., Kero, T., Harms, H. J., Widström, C., Flachskampf, F., Sörensen, J. & Lubberink, M. (2017). Calculation of left ventricular volumes and ejection fraction from dynamic cardiac-gated 15O-water PET/CT: 5D-PET. EJNMMI Physics, 4(1), Article ID 26.
Open this publication in new window or tab >>Calculation of left ventricular volumes and ejection fraction from dynamic cardiac-gated 15O-water PET/CT: 5D-PET
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2017 (English)In: EJNMMI Physics, ISSN 2197-7364, E-ISSN 2191-219X, Vol. 4, no 1, article id 26Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Quantitative measurement of myocardial blood flow (MBF) is of increasing interest in the clinical assessment of patients with suspected coronary artery disease (CAD). (15)O-water positron emission tomography (PET) is considered the gold standard for non-invasive MBF measurements. However, calculation of left ventricular (LV) volumes and ejection fraction (EF) is not possible from standard (15)O-water uptake images. The purpose of the present work was to investigate the possibility of calculating LV volumes and LVEF from cardiac-gated parametric blood volume (V B) (15)O-water images and from first pass (FP) images. Sixteen patients with mitral or aortic regurgitation underwent an eight-gate dynamic cardiac-gated (15)O-water PET/CT scan and cardiac MRI. V B and FP images were generated for each gate. Calculations of end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV) and LVEF were performed with automatic segmentation of V B and FP images, using commercially available software. LV volumes and LVEF were calculated with surface-, count-, and volume-based methods, and the results were compared with gold standard MRI.

RESULTS: Using V B images, high correlations between PET and MRI ESV (r = 0.89, p < 0.001), EDV (r = 0.85, p < 0.001), SV (r = 0.74, p = 0.006) and LVEF (r = 0.72, p = 0.008) were found for the volume-based method. Correlations for FP images were slightly, but not significantly, lower than those for V B images when compared to MRI. Surface- and count-based methods showed no significant difference compared with the volume-based correlations with MRI. The volume-based method showed the best agreement with MRI with no significant difference on average for EDV and LVEF but with an overestimation of values for ESV (14%, p = 0.005) and SV (18%, p = 0.004) when using V B images. Using FP images, none of the parameters showed a significant difference from MRI. Inter-operator repeatability was excellent for all parameters (ICC > 0.86, p < 0.001).

CONCLUSION: Calculation of LV volumes and LVEF from dynamic (15)O-water PET is feasible and shows good correlation with MRI. However, the analysis method is laborious, and future work is needed for more automation to make the method more easily applicable in a clinical setting.

National Category
Cardiac and Cardiovascular Systems Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-333781 (URN)10.1186/s40658-017-0195-2 (DOI)000415372700001 ()29138942 (PubMedID)
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2018-02-22Bibliographically approved
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