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Flachskampf, Frank
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Publications (10 of 75) Show all publications
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
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
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
Steeds, R. P., Garbi, M., Cardim, N., Kasprzak, J. D., Sade, E., Nihoyannopoulos, P., . . . Lancellotti, P. (2017). EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: a report of literature and current practice review. European Heart Journal Cardiovascular Imaging, 18(11), 1191-1204
Open this publication in new window or tab >>EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: a report of literature and current practice review
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2017 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 18, no 11, p. 1191-1204Article, review/survey (Refereed) Published
Abstract [en]

The European Association for Cardiovascular Imaging (EACVI) has outlined the rationale for setting appropriate use criteria (AUC) in cardiovascular (CV) imaging. Transthoracic echocardiography (TTE) is the most common imaging modality in CV disease and is a central tool in diagnosis, follow-up, management planning and intervention. The purpose of AUC is to inform referrers, both to avoid under-use, which may result in incomplete or incorrect diagnosis and treatment, and also over-use, which may delay correct diagnosis, lead to 'treatment cascade', and wastes resources. The first step in defining AUC for TTE in the adult has been for a panel of experts in echocardiography to review the evidence, guidelines, recommendations, and position papers from the European Society of Cardiology, EACVI and other specialist societies, and current state-of-the-art clinical practice. The attached document summarizes this work, which will be used to under-pin the development of AUC.

Keywords
transthoracic echocardiography, appropriateness, indications
National Category
Cardiac and Cardiovascular Systems Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-346782 (URN)10.1093/ehjci/jew333 (DOI)000413460100001 ()28329307 (PubMedID)
Available from: 2018-03-22 Created: 2018-03-22 Last updated: 2018-03-22Bibliographically approved
Katus, H., Ziegler, A., Ekinci, O., Giannitsis, E., Stough, W. G., Achenbach, S., . . . Semjonow, V. (2017). Early diagnosis of acute coronary syndrome. European Heart Journal, 38(41), 3049-3055
Open this publication in new window or tab >>Early diagnosis of acute coronary syndrome
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2017 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, no 41, p. 3049-3055Article, review/survey (Refereed) Published
Abstract [en]

The diagnostic evaluation of acute chest pain has been augmented in recent years by advances in the sensitivity and precision of cardiac troponin assays, new biomarkers, improvements in imaging modalities, and release of new clinical decision algorithms. This progress has enabled physicians to diagnose or rule-out acute myocardial infarction earlier after the initial patient presentation, usually in emergency department settings, which may facilitate prompt initiation of evidence-based treatments, investigation of alternative diagnoses for chest pain, or discharge, and permit better utilization of healthcare resources. A non-trivial proportion of patients fall in an indeterminate category according to rule-out algorithms, and minimal evidence-based guidance exists for the optimal evaluation, monitoring, and treatment of these patients. The Cardiovascular Round Table of the ESC proposes approaches for the optimal application of early strategies in clinical practice to improve patient care following the review of recent advances in the early diagnosis of acute coronary syndrome. The following specific 'indeterminate' patient categories were considered: (i) patients with symptoms and high-sensitivity cardiac troponin <99th percentile; (ii) patients with symptoms and high-sensitivity troponin <99th percentile but above the limit of detection; (iii) patients with symptoms and high-sensitivity troponin >99th percentile but without dynamic change; and (iv) patients with symptoms and high-sensitivity troponin >99th percentile and dynamic change but without coronary plaque rupture/erosion/dissection. Definitive evidence is currently lacking to manage these patients whose early diagnosis is 'indeterminate' and these areas of uncertainty should be assigned a high priority for research.

Keywords
Acute coronary syndrome, Troponin
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-333083 (URN)10.1093/eurheartj/ehx492 (DOI)000414366100005 ()29029109 (PubMedID)
Available from: 2017-11-06 Created: 2017-11-06 Last updated: 2018-03-21Bibliographically approved
Flachskampf, F. & Baron, T. (2017). Echocardiographic Algorithms for Detecting Elevated Diastolic Pressures Reasonable, Not Perfect. Journal of the American College of Cardiology, 69(15), 1949-1951
Open this publication in new window or tab >>Echocardiographic Algorithms for Detecting Elevated Diastolic Pressures Reasonable, Not Perfect
2017 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 69, no 15, p. 1949-1951Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2017
Keywords
catheterization, diastole, Doppler, heart failure, net reclassification improvement
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-321547 (URN)10.1016/j.jacc.2017.02.022 (DOI)000398665500010 ()28408025 (PubMedID)
Available from: 2017-05-11 Created: 2017-05-11 Last updated: 2017-05-11Bibliographically 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
Flachskampf, F. A. (2016). How Exactly Do You Measure That Aorta?: Lessons From Multimodality Imaging. JACC Cardiovascular Imaging, 9(3), 227-229
Open this publication in new window or tab >>How Exactly Do You Measure That Aorta?: Lessons From Multimodality Imaging
2016 (English)In: JACC Cardiovascular Imaging, ISSN 1936-878X, E-ISSN 1876-7591, Vol. 9, no 3, p. 227-229Article in journal, Editorial material (Other academic) Published
Keywords
aorta, computed tomography, echocardiography, magnetic resonance
National Category
Radiology, Nuclear Medicine and Medical Imaging Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-299005 (URN)10.1016/j.jcmg.2015.07.017 (DOI)000372455400002 ()26897693 (PubMedID)
Note

Comment on: The Need for Standardized Methods for Measuring the Aorta: Multimodality Core Lab Experience From the GenTAC Registry. [JACC Cardiovasc Imaging. 2016]

Available from: 2016-07-13 Created: 2016-07-13 Last updated: 2017-11-28Bibliographically approved
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