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Blomstrand, Peter
Publications (6 of 6) Show all publications
Kylhammar, D., Hult, L., Blomstrand, P., Engstrom, G., Johnson, J., Ostgren, C. J. & Engvall, J. (2019). Global longitudinal strain and mechanical dispersion in the general population aged 50-64 years - results from the echocardiography study of the Swedish CArdioPulmonary bioImage Study (SCAPIS). Paper presented at Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology, Paris, France, Aug 31-Sep 04, 2019. European Heart Journal, 40(1), 1859-1859, Article ID 3075.
Open this publication in new window or tab >>Global longitudinal strain and mechanical dispersion in the general population aged 50-64 years - results from the echocardiography study of the Swedish CArdioPulmonary bioImage Study (SCAPIS)
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2019 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, no 1, p. 1859-1859, article id 3075Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background

The Swedish CArdioPulmonary bioImage Study (SCAPIS) was initiated to improve understanding of underlying mechanisms in order to prevent cardiovascular and pulmonary disease. 30 000 individuals aged 50–64 years, randomly selected from the general population, were included in the study. Six-thousand-eight-hundred of the individuals underwent transthoracic echocardiography.

Global longitudinal strain (GLS) and mechanical dispersion (MD) are novel echocardiographic measures of left ventricular (LV) systolic function and electrical instability reflecting risk for malignant arrhythmia, respectively. Previous studies suggest that the limit of normal for GLS is −16% and that MD >70 ms may be associated with increased risk for malignant arrhythmias. GLS and MD have, however, not before been investigated in a large population-based study.

Purpose

The purpose of this first project within the SCAPIS echocardiography study is to determine the prevalence of impaired GLS and MD in the general population aged 50–64 years.

Methods

GLS and MD, defined as mean peak longitudinal strain of the 18 LV segments and standard deviation of time-to-peak strain for the 18 LV segments, respectively, were analysed using a commercially available software. For group comparisons, the independent-samples t-test, the Mann-Whitney U-test or One Way Analysis of Variance with the Bonferroni post hoc test were performed. Values are mean±standard deviation.

Results

1850 examinations have so far been reviewed, whereof image quality was considered adequate for strain analysis in 1480 individuals (80%). Image quality, assessed as the number of visually assessable LV segments, was better for the second half of the examinations, as compared to the first half (p<0.001). Of the 1480 individuals where GLS and MD were assessed, 51% were women and mean age was 57±4.4 years with no difference in age between the sexes (p=ns). Mean GLS was −20±2% and men had significantly more negative (p<0.001) GLS values than women (−21±2% vs. −19±2%). There was no significant difference (p=ns) in GLS when comparing individuals aged 50–54, 55–59 or 60–64 years, respectively. GLS values were less negative than −16% in 1.9% of the study population. Mean MD was 41±12 ms with no significant difference (p=ns) between the sexes. MD was significantly lower (p<0.001) among individuals aged 50–54 years, as compared to those aged 55–59 or 60–64 years, respectively. MD was >70 ms in 1.6% of the study population.

Conclusions

These preliminary data from the SCAPIS echocardiography study suggest that, in the general population aged 50–64 years, 1.9% have impaired GLS and 1.6% have increased MD, which is possibly associated with a higher risk for malignant arrhythmias. Men had more negative GLS values than women and MD was lower in the lowest age tertile. Further analyses are ongoing.

Acknowledgement/Funding

The Swedish Heart and Lung Foundation. Grants from Linkoping University. ALF-grants from the Swedish government (LIO-700841).

Place, publisher, year, edition, pages
Oxford University Press, 2019
Keywords
Tissue Doppler, Speckle Tracking and Strain Imaging
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-47821 (URN)10.1093/eurheartj/ehz745.0031 (DOI)000507313000343 ()
Conference
Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology, Paris, France, Aug 31-Sep 04, 2019
Available from: 2020-02-18 Created: 2020-02-18 Last updated: 2020-02-18Bibliographically approved
Rundqvist, L., Engvall, J., Blomstrand, P., Carlsson, E. & Faresjö, M. (2019). Resting level of insulin-like growth factor 1 is not at play in cardiac enlargement in endurance-trained adolescents. BioMed Research International, 1-7, Article ID 9647964.
Open this publication in new window or tab >>Resting level of insulin-like growth factor 1 is not at play in cardiac enlargement in endurance-trained adolescents
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2019 (English)In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, p. 1-7, article id 9647964Article in journal (Refereed) Published
Abstract [en]

Purpose. The study aimed to investigate resting levels of several selected growth and metabolic hormones in a group of 24 endurance-trained adolescents (aged 13-19 years) compared with 24 untrained age- and sex-matched controls, and to investigate if increased cardiac dimensions were related to these hormones at rest with emphasis on insulin-like growth factor-1 (IGF-1).

Methods. The hormones (cortisol, IGF-1, IGF-2, follicle-stimulating hormone, growth hormone, luteinizing hormone, prolactin, and thyroid-stimulating hormone) were analysed with chemiluminescence microparticle immunoassay (CMIA) or multiplex fluorochrome (Luminex) technique. Cardiac dimensions were assessed by echocardiographic examination at rest. Peak oxygen uptake was obtained by a maximal cardiopulmonary exercise test on a treadmill.

Results. Circulating levels of analysed hormones at rest did not differ between the groups. A correlation was found between increased cardiac dimensions and IGF-1 in the controls, but not in the active group. This correlation declined also among the controls when the cardiac parameters were indexed for body surface area.

Conclusion. Increased cardiac dimensions in endurance-trained adolescents could not be related to resting levels of hormones associated with growth and metabolism, including IGF-1 and GH. In addition, the resting levels of these hormones seem not to be affected by intense regular endurance exercise in adolescents. These findings may contribute to the knowledge about cellular signaling that trigger growth as well as cardiac adaptation to endurance training in young athletes. 

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-43514 (URN)10.1155/2019/9647964 (DOI)000491982600002 ()31663002 (PubMedID)2-s2.0-85073601637 (Scopus ID)GOA HHJ 2019 (Local ID)GOA HHJ 2019 (Archive number)GOA HHJ 2019 (OAI)
Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-11-14Bibliographically approved
Rundqvist, L., Engvall, J., Faresjö, M. & Blomstrand, P. (2018). Left ventricular diastolic function is enhanced after peak exercise in endurance-trained adolescents as well as in their non-trained controls. Clinical Physiology and Functional Imaging, 38(6), 1054-1061
Open this publication in new window or tab >>Left ventricular diastolic function is enhanced after peak exercise in endurance-trained adolescents as well as in their non-trained controls
2018 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 38, no 6, p. 1054-1061Article in journal (Refereed) Published
Abstract [en]

The aims of the study were to explore the temporal change of cardiac function after peak exercise in adolescents, and to investigate how these functional changes relate to maximal oxygen uptake (VO2max ). The cohort consisted of 27 endurance-trained adolescents aged 13-19 years, and 27 controls individually matched by age and gender. Standard echocardiography and colour tissue Doppler were performed at rest, and immediately after as well as 15 min after a maximal cardio pulmonary exercise test (CPET) on a treadmill. The changes in systolic and diastolic parameters after exercise compared to baseline were similar in both groups. The septal E/e'-ratio increased immediately after exercise in both the active and the control groups (from 9·2 to 11·0; P<0·001, and from 8·7 to 10·2; P = 0·008, respectively). In a comparison between the two groups after CPET, the septal E/e'-ratio was higher in the active group both immediately after exercise and 15 min later compared to the control group (P = 0·007 and P = 0·006, respectively). We demonstrated a positive correlation between VO2max and cardiac function including LVEF and E/e' immediately after CPET, but the strongest correlation was found between VO2max and LVEDV (r = 0·67, P<0·001) as well as septal E/e' (r = 0·34, P = 0·013). Enhanced diastolic function was found in both groups, but this was more pronounced in active adolescents. The cardiac functional response to exercise, in terms of LVEF and E/e', correlates with the increase in VO2 uptake. These findings in trained as well as un-trained teenagers have practical implications when assessing cardiac function.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
E/e′, diastolic function, echocardiography, heart, systolic function, training, youngster
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-41801 (URN)10.1111/cpf.12534 (DOI)000446073500019 ()29947056 (PubMedID)2-s2.0-85054186924 (Scopus ID)PP HHJ 2019 embargo 12 (Local ID)PP HHJ 2019 embargo 12 (Archive number)PP HHJ 2019 embargo 12 (OAI)
Available from: 2018-10-10 Created: 2018-10-10 Last updated: 2019-06-26Bibliographically approved
Blomstrand, P., Sjöblom, P., Nilsson, M., Wijkman, M., Engvall, M., Länne, T., . . . Engvall, J. (2018). Overweight and obesity impair left ventricular systolic function as measured by left ventricular ejection fraction and global longitudinal strain. Cardiovascular Diabetology, 17(1), Article ID 113.
Open this publication in new window or tab >>Overweight and obesity impair left ventricular systolic function as measured by left ventricular ejection fraction and global longitudinal strain
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2018 (English)In: Cardiovascular Diabetology, ISSN 1475-2840, E-ISSN 1475-2840, Vol. 17, no 1, article id 113Article in journal (Refereed) Published
Abstract [en]

Aims

Obesity is associated with type 2 diabetes mellitus, left ventricular diastolic dysfunction and heart failure but it is unclear to which extent it is related to left ventricular systolic dysfunction. The aim of the study was to explore the effects of overweight and obesity on left ventricular systolic function in patients with type 2 diabetes mellitus and a control group of non-diabetic persons.

Methods

We prospectively investigated 384 patients with type 2 diabetes mellitus, and 184 controls who participated in the CARDIPP and CAREFUL studies. The participants were grouped according to body mass index (normal weight < 25 kg/m2, overweight 25–29 kg/m2, and obesity ≥ 30 kg/m2). Echocardiography was performed at the beginning of the study and after 4-years in the patient group.

Results

Univariable and multivariable regression analysis revealed that variations in left ventricular ejection fraction, global longitudinal strain, left ventricular mass and diastolic function expressed as E/é (the ratio between early diastolic mitral flow and annular motion velocities) all are related to body mass index. The mean and standard deviation of left ventricular ejection fraction and global longitudinal strain values were 57% (8%) vs. − 18.6% (2.3%) for normal weight patients, 53% (8%) vs. − 17.5% (2.3%) for overweight, and 49% (9%) vs. − 16.2% (3.0%) for obese (p < 0.05 vs. p < 0.05). Corresponding results in the control group were 58% (6%) vs. − 22.3% (3.0%), 55% (7%) vs. − 20.8% (3.1%) and 54% (8%) − 19.6% (4.0%) (p < 0.05 vs. p < 0.05). Patients who gained weight from baseline to follow-up changed left ventricular ejection fraction (median and interquartile range) by − 1.0 (9.0) % (n = 187) and patients who lost weight changed left ventricular ejection fraction by 1.0 (10.0) % (n = 179) (p < 0.05).

Conclusion

Overweight and obesity impair left ventricular ejection fraction and global longitudinal strain in both patients with type 2 diabetes mellitus and non-diabetic persons.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Diabetes mellitus, Echocardiography, Obesity, Overweight
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-41244 (URN)10.1186/s12933-018-0756-2 (DOI)000442121700001 ()30107798 (PubMedID)2-s2.0-85051543997 (Scopus ID)
Available from: 2018-08-27 Created: 2018-08-27 Last updated: 2019-02-01Bibliographically approved
Blomstrand, P., Engvall, M., Festin, K., Lindstrom, T., Länne, T., Maret, E., . . . Engvall, J. (2015). Left ventricular diastolic function, assessed by echocardiography and tissue Doppler imaging, is a strong predictor of cardiovascular events, superior to global left ventricular longitudinal strain, in patients with type 2 diabetes. European Heart Journal Cardiovascular Imaging, 16(9), 1000-1007
Open this publication in new window or tab >>Left ventricular diastolic function, assessed by echocardiography and tissue Doppler imaging, is a strong predictor of cardiovascular events, superior to global left ventricular longitudinal strain, in patients with type 2 diabetes
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2015 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 16, no 9, p. 1000-1007Article in journal (Refereed) Published
Abstract [en]

Aims: The aim of the study was to determine whether left ventricular systolic function, in terms of global left ventricular longitudinal strain (GLS), and diastolic function, expressed as the ratio between early diastolic transmitral flow and mitral annular motion velocities (E/e'), can predict cardiovascular events in patients with diabetes mellitus type 2.

Methods and results: We prospectively investigated 406 consecutive patients, aged 55-65 years, with diabetes mellitus, who participated in the CARDIPP study. Echocardiography, pulse pressure (pp), and glycosylated haemoglobin (HbA1c) were analysed. Twelve cases of myocardial infarction and seven cases of stroke were identified during the follow-up period of 67 +/- 17 months. Univariate Cox regression analysis showed that E/e' was a strong predictor of cardiovascular events (hazards ratio 1.12; 95% confidence interval 1.06-1.18, P < 0.001). E/e' was prospectively associated with cardiovascular events independent of age, sex, GLS, left ventricular ejection fraction (LVEF), pp, and HbA1c in multivariate analysis. Receiver operating characteristic curves showed that E/e' and HbA1c were the strongest predictors for cardiovascular events, both having an area under the curve (AUC) of 0.71 followed by LVEF with an AUC of 0.65 and GLS of 0.61. In a Kaplan-Meyer analysis, the cumulative probability of an event during the follow-up period was 8.6% for patients with an E/e' ratio >15 compared with 2.6% for patients with E/e' <= 15, P = 0.011.

Conclusion: In middle-aged patients with type 2 diabetes, E/e' is a strong predictor of myocardial infarction and stroke, comparable with HbA1c and superior to GLS and LVEF.

Keywords
echocardiography, global left ventricular longitudinal strain, diastolic dysfunction, diabetes mellitus, myocardial infarction, stroke
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-28549 (URN)10.1093/ehjci/jev027 (DOI)000364539700011 ()25750201 (PubMedID)2-s2.0-84989196033 (Scopus ID)
Available from: 2015-12-10 Created: 2015-12-10 Last updated: 2017-12-01Bibliographically approved
Carlsson, E., Rundqvist, L., Blomstrand, P. & Faresjö, M.Enhanced immune response to a potent type 1 diabetes-related autoantigen is observed in endurance-trained boys.
Open this publication in new window or tab >>Enhanced immune response to a potent type 1 diabetes-related autoantigen is observed in endurance-trained boys
(English)Manuscript (preprint) (Other academic)
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-43515 (URN)
Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-04-23
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