Author
Helge Skulstad
Other affiliations: Akershus University Hospital, University of Oslo
Bio: Helge Skulstad is an academic researcher from Oslo University Hospital. The author has contributed to research in topics: Ejection fraction & Myocardial infarction. The author has an hindex of 28, co-authored 97 publications receiving 3154 citations. Previous affiliations of Helge Skulstad include Akershus University Hospital & University of Oslo.
Papers published on a yearly basis
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TL;DR: The novel non-invasive method for regional LV pressure–strain loop area corresponded well with invasive measurements and with directly measured myocardial work and it reflected myocardIAL metabolism.
Abstract: Aims Left ventricular (LV) pressure–strain loop area reflects regional myocardial work and metabolic demand, but the clinical use of this index is limited by the need for invasive pressure. In this study, we introduce a non-invasive method to measure LV pressure–strain loop area.
Methods and results Left ventricular pressure was estimated by utilizing the profile of an empiric, normalized reference curve which was adjusted according to the duration of LV isovolumic and ejection phases, as defined by timing of aortic and mitral valve events by echocardiography. Absolute LV systolic pressure was set equal to arterial pressure measured invasively in dogs ( n = 12) and non-invasively in patients ( n = 18). In six patients, myocardial glucose metabolism was measured by positron emission tomography (PET). First, we studied anaesthetized dogs and observed an excellent correlation ( r = 0.96) and a good agreement between estimated LV pressure–strain loop area and loop area by LV micromanometer and sonomicrometry. Secondly, we validated the method in patients with various cardiac disorders, including LV dyssynchrony, and confirmed an excellent correlation ( r = 0.99) and a good agreement between pressure–strain loop areas using non-invasive and invasive LV pressure. Non-invasive pressure–strain loop area reflected work when incorporating changes in local LV geometry ( r = 0.97) and showed a strong correlation with regional myocardial glucose metabolism by PET ( r = 0.81).
Conclusions The novel non-invasive method for regional LV pressure–strain loop area corresponded well with invasive measurements and with directly measured myocardial work and it reflected myocardial metabolism. This method for assessment of regional work may be of clinical interest for several patients groups, including LV dyssynchrony and ischaemia.
414 citations
TL;DR: The new SDE approach might be a more accurate marker than TDE for detecting systolic regional myocardial dysfunction induced by LAD occlusion and reduced velocities in all septal segments during angioplasty.
264 citations
TL;DR: Postsystolic shortening is a relatively nonspecific feature of ischemic myocardium and may occur in dyskinetic segments by an entirely passive mechanism, however, in segments with systolic hypokinesis or akinesis, postsyStolic shortens is a marker of actively contracting myocardia.
Abstract: Background— Postsystolic shortening in ischemic myocardium has been proposed as a marker of tissue viability. Our objectives were to determine if postsystolic shortening represents active fiber shortening or passive recoil and if postsystolic shortening may be quantified by strain Doppler echocardiography (SDE). Methods and Results— In 15 anesthetized dogs, we measured left ventricular (LV) pressure, myocardial long-axis strains by SDE, and segment lengths by sonomicrometry before and during LAD stenosis and occlusion. Active contraction was defined as elevated LVP and stress during postsystolic shortening when compared with the fully relaxed ventricle at similar segment lengths. LAD stenosis decreased systolic shortening from 10.4±1.2% to 5.9±0.9% (P<0.05), whereas postsystolic shortening increased from 1.1±0.3% to 4.2±0.7% (P<0.05). In hypokinetic and akinetic segments, LV pressure–segment length and LV stress–segment length loop analysis indicated that postsystolic shortening was active. LAD occlusion ...
245 citations
University of Oslo1, Oslo University Hospital2, University of Rennes3, St Bartholomew's Hospital4, Queen Mary University of London5, University of Milano-Bicocca6, Humboldt University of Berlin7, University of Edinburgh8, Université catholique de Louvain9, Semmelweis University10, University Hospital Southampton NHS Foundation Trust11, University of Siena12, French Institute of Health and Medical Research13, Medical University of Vienna14
TL;DR: This poster presents a poster presented at the European Society of Cardiology Congress on Wednesday, 5 February 2020 entitled “Cardiology and Cardiac Rhythm Management: Promoting Consistency in Patients with Challenging Stroke”.
Abstract: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020.
230 citations
TL;DR: It is indicated that peak ejection velocity is an inappropriate measure of function in severely ischemic myocardium, and therefore IVC and IVR velocities are better markers of function.
Abstract: Background— Tissue Doppler imaging (TDI) is a potentially powerful method for diagnosing myocardial ischemia. This study was designed to investigate how velocity patterns in ischemic myocardium relates to regional function, and to determine whether timing of velocity measurements relative to ejection and isovolumic phases may increase the diagnostic power of TDI. Methods and Results— In 17 open-chest anesthetized dogs we measured pressures by micromanometers, myocardial longitudinal segment lengths by sonomicrometry, and velocities by TDI. Myocardial longitudinal strain rate was calculated as velocity divided by distance to the left ventricle apex. Moderate ischemia (left anterior descending coronary artery stenosis) caused parallel reductions in regional systolic shortening by sonomicrometry (P<0.05) and in peak systolic velocities by TDI (P<0.05). Severe ischemia (left anterior descending coronary artery occlusion), however, induced systolic lengthening by sonomicrometry (P<0.001), whereas peak TDI velo...
215 citations
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TL;DR: The current guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation are based on the findings of the ESC Task Force on 12 March 2015.
Abstract: ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).
6,866 citations
Turku University Hospital1, National University of Ireland, Galway2, University of Catania3, University of Naples Federico II4, University of Paris5, Bispebjerg Hospital6, University of Sheffield7, University of Cambridge8, Stavanger University Hospital9, Oslo University Hospital10, Hospital Clínico San Carlos11, Mayo Clinic12, University of Western Brittany13, Rabin Medical Center14, Slovak Medical University15, Saarland University16, University of Barcelona17, University of Brescia18, University of Bern19, University of Erlangen-Nuremberg20, Leiden University Medical Center21
TL;DR: In this article, the authors present guidelines for the management of patients with coronary artery disease (CAD), which is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries.
Abstract: Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The disease can have long, stable periods but can also become unstable at any time, typically due to an acute atherothrombotic event caused by plaque rupture or erosion. However, the disease is chronic, most often progressive, and hence serious, even in clinically apparently silent periods. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). The Guidelines presented here refer to the management of patients with CCS. The natural history of CCS is illustrated in Figure 1.
3,448 citations
TL;DR: A correction has been published: European Heart Journal, ehaa895, https://doi.org/10.1093/eurheartj/ehaa-895.
Abstract: A correction has been published: European Heart Journal, ehaa895, https://doi.org/10.1093/eurheartj/ehaa895
2,361 citations
TL;DR: Speckle tracking echocardiography provides accurate and angle-independent measurements of LV dimensions and strains and has potential to become a clinical bedside tool for quantifying myocardial strain.
1,236 citations
TL;DR: In this paper, the authors assess the feasibility of 2D strain, a software for real-time quantitative echocardiographic assessment of myocardial function, which is based on the estimation that a discrete set of tissue velocities are present per each of many small elements on the ultrasound image.
Abstract: Objectives We sought to assess the feasibility of 2-dimensional strain, a novel software for real-time quantitative echocardiographic assessment of myocardial function Methods Conventional and a novel non-Doppler–based echocardiography technique for advanced wall-motion analysis were performed in 20 patients with myocardial infarction and 10 healthy volunteers from the apical views Two-dimensional strain is on the basis of the estimation that a discrete set of tissue velocities are present per each of many small elements on the ultrasound image This software permits real-time assessment of myocardial velocities, strain, and strain rate These parameters were also compared with Doppler tissue imaging measurements in 10 additional patients Results In all, 803% of infarct and 978% of normal segments could be adequately tracked by the software Peak systolic strain, strain rate, and peak systolic myocardial velocities, calculated from the software, were significantly higher in the normal than in the infarct segments In the 10 additional patients, velocities, strain, and strain rate obtained with the novel software were not significantly different from those obtained with Doppler tissue imaging Conclusion Two-dimensional strain can accomplish real-time wall-motion analysis, and has the potential to become a standard for real-time automatic echocardiographic assessment of cardiac function
1,136 citations