Kirsi Lauerma - Academia.edu (original) (raw)

Papers by Kirsi Lauerma

Nutrition Metabolism and Cardiovascular Diseases, Jul 1, 2018

Background and aims Obesity and metabolic syndrome (MetS) are risk factors of atrial fibrillation... more Background and aims Obesity and metabolic syndrome (MetS) are risk factors of atrial fibrillation (AF), but limited data exist on their effect on left atrial (LA) function. The aim of the study was to evaluate the effects of cardiac, hepatic and intra-abdominal ectopic fat depots and cardiometabolic risk factors on LA function in non-diabetic male subjects. Methods and results Myocardial and hepatic triglyceride contents were measured with 1.5T 1 H-magnetic resonance spectroscopy and LA and left ventricular function, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), epicardial and pericardial fat by magnetic resonance imaging (MRI) in 33 men with MetS and 40 men without MetS. LA volumes were assessed using a novel three-chamber orientation based MRI approach. LA ejection fraction (EF) was lower in MetS patients than in the control group (44 ± 7.7 % in MetS vs. 49 ± 8.6 % in controls, p=0.013) without LA enlargement, indicating LA dysfunction. LA EF correlated negatively with waist circumference, body mass index, SAT, VAT, fasting serum insulin, and homeostasis model assessment of insulin resistance index, and positively with fasting serum high-density lipoprotein cholesterol. VAT was the best predictor of reduced LA EF. Conclusions MetS associates with subclinical LA dysfunction. Multiple components of MetS are related to LA dysfunction, notably visceral obesity and insulin resistance. Further studies are needed to elucidate the role of mechanical atrial remodeling in the development of AF.

Journal of Ultrasound in Medicine, 2016

B-Lines on Pediatric Lung Sonography Comparison With Computed Tomography onographic artifacts fro... more B-Lines on Pediatric Lung Sonography Comparison With Computed Tomography onographic artifacts from the surface of the lungs can be used to estimate alterations of lung parenchyma. 1 A sonogram of normal air-filled lungs consists of horizontal artifacts from the pleural line, known as A-lines. 2 Vertical artifacts, known as B-lines, are nonspecific sonographic findings (Figure 1). Multiple Blines are seen in lung edema, interstitial lung disease, infections, lung contusion, and atelectasis. 3-8 Sporadic B-lines can also be seen in healthy individuals. 4,9,10 B-lines can be used to estimate lung water. 11 The number of B-lines correlates with lung edema scores from chest radiographs and with extravascular lung water measured invasively using the trans pulmonary thermodilution method. 12,13 The number of B-lines decreases during hemodialysis and in neonates during postnatal pulmonary adaptation. 14-16

Vascular Health and Risk Management, Oct 1, 2008

Arterial elasticity changes in familial hypercholesterolemia (FH) and diabetes mellitus (DM) with... more Arterial elasticity changes in familial hypercholesterolemia (FH) and diabetes mellitus (DM) with different but overlapping mechanisms. We compared aortic elasticity between 19 FH patients with the same mutation, 18 type 2 DM patients, and 30 controls, all aged 48 to 64. They underwent aortic magnetic resonance imaging, risk-factor assessment, and carotid and femoral ultrasound measurements. All patients were on adequate cardiovascular medication including statins and had established coronary heart disease (CHD). FH patients had longerduration CHD (13.3 ± 7.7 years) than did DM patients (5.0 ± 3.1). Aortic compliance in the descending thoracic (DM 0.38 ± 0.14 vs control 0.53 ± 0.19, P = 0.032) and abdominal aorta (DM 0.45 ± 0.20 vs control 0.66 ± 0.25, P = 0.011) was lower in DM patients than in controls, whereas no signifi cant difference existed between FH patients and controls. Carotid and femoral intima-media thickness was greater in FH and DM patients than in controls with no difference between patient groups. Carotid or femoral plaques appeared in 15 (79%) FH and in 10 (56%) DM patients. One control had a femoral plaque. Five FH patients showed stenosis, occlusion or both in carotid arteries. In our opinion, DM patients' lower compliance refl ect mainly arterial media affecting arteriosclerosis, while FH patients' plaque status and longer duration of CHD suggest more advanced atherosclerosis. The FH patients may therefore be at increased risk for atherothrombotic events. However, due to small patient material, larger confi rmatory studies are needed.

Background: Left ventricle rotation and torsion are fundamental components of myocardial function... more Background: Left ventricle rotation and torsion are fundamental components of myocardial function, and several software packages have been developed for analysis of these components. The purpose of this study was to compare the suitability of two software packages with different technical principles for analysis of rotation and torsion of the left ventricle during systole. Methods: A group of hypertrophic cardiomyopathy (HCM) patients (N = 14, age 43 ± 11 years), mutation carriers without hypertrophy (N = 10, age 34 ± 13 years), and healthy relatives (N = 12, age 43 ± 17 years) underwent a cardiovascular magnetic resonance examination, including spatial modulation of magnetization tagging sequences in basal and apical planes of the left ventricle. The tagging images were analyzed offline using a harmonic phase image analysis method with Gabor filtering and a non-rigid registration-based free-form deformation technique. Left-ventricle rotation and torsion scores were obtained from end-diastole to end-systole with both software. Results: Analysis was successful in all cases with both software applications. End-systolic torsion values between the study groups were not statistically different with either software. End-systolic apical rotation, end-systolic basal rotation, and end-systolic torsion were consistently higher when analyzed with non-rigid registration than with harmonic phase-based analysis (p < 0.0001). End-systolic rotation and torsion values had significant correlations between the two software (p < 0.0001), most significant in the apical plane. Conclusions: When comparing absolute values of rotation and torsion between different individuals, softwarespecific reference values are required. Harmonic phase flow with Gabor filtering and non-rigid registration-based methods can both be used reliably in the analysis of systolic rotation and torsion patterns of the left ventricle.

Scandinavian Cardiovascular Journal, 2003

Transmyocardial laser revascularization (TMLR) creates channels in the myocardium. The aim of the... more Transmyocardial laser revascularization (TMLR) creates channels in the myocardium. The aim of the treatment is to relieve angina in patients with end-stage coronary artery disease. We studied the effect of TMLR on myocardial function and perfusion with the combination of cine magnetic resonance imaging (MRI) and thallium scintigraphy. Eight patients with severe triple-vessel coronary artery disease were studied with MRI and thallium scintigraphy before and 6 months after laser treatment. TMLR did not improve global left ventricular (LV) function or myocardial perfusion. However, systolic wall thickening deprived in segments with fixed perfusion defects in 6 months and laser treatment prevented this deprivation (p = 0.03). In addition single photon emission computed tomography (SPECT) imaging indicated that TMLR prevented conversion of reversible into fixed defects. In severe, progressing coronary artery disease TMLR does not improve global LV function or myocardial perfusion, but it preserves systolic wall thickening in fixed defects (scar). It also prevents changes from ischemic myocardial regions to scar.

European Journal of Radiology, Aug 1, 2014

Objectives: The aim of this study was to introduce a single center "real life" experience of perf... more Objectives: The aim of this study was to introduce a single center "real life" experience of performing MRI examinations in clinical practice on patients with cardiac pacemaker systems. Additionally, we aimed to evaluate the safety of using a dedicated safety protocol for these patients. Materials and methods: We used a 1.5 Tesla MRI scanner to conduct 68 MRI scans of different body regions in patients with pacing systems. Of the cardiac devices, 32% were MR-conditional, whereas the remaining 68% were MR-unsafe. We recorded the functional parameters of the devices prior, immediately after, and approximately one month after the MRI scanning, and compared the device parameters to the baseline values. Results: All MRI examinations were completed safely, and each device could be interrogated normally following the MRI. We observed no changes in the programmed parameters of the devices. For most of the participants, the distributions of the immediate and one-month changes in the device parameters were within 20% of the baseline values, although some changes approached clinically important thresholds. Furthermore, we observed no differences in the variable changes between MR-conditional and MR-unsafe pacing systems, or between scans of the thorax area and other scanned areas. Conclusion: MRI in patients with MR-conditional pacing systems and selected MR-unsafe systems could be performed safely under strict conditions in this study.

Myokardiitti on harvinainen ja syiltaan moni nainen sydanlihaksen tulehdussairaus. Lasten myokar... more Myokardiitti on harvinainen ja syiltaan moni nainen sydanlihaksen tulehdussairaus. Lasten myokardiitin tavallisimpia aiheuttajia ovat virus infektiot, joissa virukset tai niiden aktivoimat immunologiset reaktiot tuhoavat sydanlihas soluja. Krooninen sydanlihasvaurio voi kehit tya infektion laukaiseman tai yllapitaman im muuni tai autoimmuunireaktion seurauksena tai olla osa systeemista autoimmuunisairautta. Suuri osa myokardiittiin sairastuneista lapsista on oireettomia. Ensioireita voivat kuitenkin olla sydamen vajaatoiminta, rytmihairiot ja akkikuo lema. Myokardiittidiagnoosi edellyttaa kliinista epailya ja sen perusteella valittuja varmistavia laboratorio ja kuvantamistutkimuksia. Suuri osa myokardiiteista on itsestaan rajoittuvia ja pa ranee spontaanisti, mutta osa johtaa kroonisen sydanlihasvaurion, laajentavan kardiomyopa tian (DCM) syntyyn. Myokardiitin patogeneesin vaiheittaisuuden ymmartaminen, uudet kuvan tamismenetelmat seka diagnostiikan ja hoidon kehittyminen mahdollistanevat tulevaisuudessa yksilollisesti raataloidyn, oikeaaikaisen hoidon.

Journal of Electrocardiology, Nov 1, 2018

Objectives: The sensitivity and specificity of the conventional 12-lead ECG to identify carriers ... more Objectives: The sensitivity and specificity of the conventional 12-lead ECG to identify carriers of hypertrophic cardiomyopathy (HCM)causing mutations without left ventricular hypertrophy (LVH) has been limited. We assessed the ability of novel electrocardiographic parameters to improve the detection of HCM mutation carriers. Methods: We studied 140 carriers (G+) of the TPM1-Asp175Asn or MYBPC3-Gln1061X pathogenic variants for HCM: The G+/LVH+ group (n = 98) consisted of mutation carriers with LVH and the G+/LVH− group (n = 42) without LVH. The control group consisted of 30 subjects. The standard 12-lead ECG was comprehensively analyzed and two novel ECG variables were introduced: RV1bRV2NRV3 and septal remodeling. A subset of 65 individuals underwent cardiac magnetic resonance imaging and 2D strain echocardiography. Results: Conventional major ECG criteria were sensitive (90%) and specific (97%) in identifying G+/LVH+ subjects. RV1bRV2NRV3 and septal remodeling were more prevalent in the G+/LVH− subjects compared to the control group (33% vs 3%, p = 0.005 and 45% vs 3%, p b 0.001, respectively). The combination of RV1bRV2NRV3 and Q waves and repolarization abnormalities (QR) differentiated between the G+/LVH− subjects and the control group with a sensitivity of 52% and specificity of 97%. The combination of septal remodeling and QR differentiated between G+/LVH− subjects and the control group with a sensitivity of 64% and specificity of 97%. Conclusions: The novel ECG-parameters RV1bRV2NRV3 and septal remodeling were effective in identifying G+/ LVH− subjects and could be useful in the diagnostics of new suspected HCM patients and in the screening and follow-up of HCM families.

Academic Radiology, Feb 1, 2006

We evaluated the diagnostic accuracy of an eight-row multidetector computed tomography coronary a... more We evaluated the diagnostic accuracy of an eight-row multidetector computed tomography coronary angiography (MDCT-CA) in detecting high-grade (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50%) stenoses in the three main coronary arteries in patients with coronary artery disease (CAD). Side branches were excluded. We correlated magnetic resonance imaging (MRI) findings of the myocardium with MDCT-CA of the coronary arteries. Fourteen CAD patients underwent conventional coronary angiography (CCA), MDCT-CA, and MRI. We determined the calcium burden with non-enhanced MDCT scan. Then MDCT-CA was performed after intravenous contrast injection during a single breathhold. The left ventricular (LV) MR cine imaging was assessed at rest and perfusion defects were observed during pharmacologic stress after contrast administration. Delayed contrast-enhanced MRI was performed to picture infarctions. MDCT-CA had sensitivity 82%, specificity 94%, positive predictive value 79%, and negative predictive value 95% of stenoses of more than 50% in the main coronary arteries when compared with CCA. LV wall dysfunction, perfusion defects, and infarctions were detected in 50%-78% of sectors assigned to calcifications or stenoses, but also in sectors supplied by normally perfused coronary arteries. CCA and MDCT-CA revealed comparable results in evaluating stenotic lesions above 50% in the main subepicardial coronary branches. There were no significant correlations between the degree of stenosis or calcification at MDCT-CA and the MR findings, but the combined information of MDCT-CA and MRI showed the variability of myocardial changes in regions perfused by significantly stenosed, calcified, and normal main coronary arteries.

Magnetic Resonance Materials in Physics Biology and Medicine, Oct 3, 2019

Objectives Postoperative patients with tetralogy of Fallot (TOF) are often compromised by chronic... more Objectives Postoperative patients with tetralogy of Fallot (TOF) are often compromised by chronic pulmonary regurgitation and chronic right ventricular volume load. We sought to determine whether pulmonary regurgitation (PR) would affect right and left ventricle (RV and LV) strain. Materials and methods This cross-sectional analysis included 40 patients who had TOF with surgical repair, with an average follow-up period of 11.8 ± 3.0 years. Altogether, 44 healthy volunteers with similar age and gender distribution were recruited. A cardiovascular magnetic resonance imaging study with feature tracking analysis was performed on all patients and controls. Results RV peak longitudinal strain was increased in TOF patients with PR > 30 ml/m 2 when compared to those with PR < 30 ml/m 2 (− 22.5% ± 2.7% vs − 19.7% ± 3.5%, p = 0.018) and controls (p = 0.007). PR volume correlated with peak RV longitudinal strain (R = − 0.37, p = 0.030) and peak RV longitudinal strain rate (systolic: R = 0.37, p = 0.03; diastolic: R = 0.39, p = 0.021). The peak RV circumferential strain, from base to apex, increased more than in healthy controls (apexbase difference 7.6% ± 4.2% vs 3.3% ± 2.4%, p < 0.0001). Conclusions Pediatric patients with TOF and a severe pulmonary regurgitation show an enhanced longitudinal strain when compared to patients with milder regurgitation or to control subjects. In addition, mean RV circumferential strain of the patients is significantly enhanced compared to healthy individuals.

European journal of echocardiography, Mar 15, 2011

To assess whether strain rate imaging (SRI) can serve to evaluate myocardial viability in patient... more To assess whether strain rate imaging (SRI) can serve to evaluate myocardial viability in patients with acute coronary syndrome (ACS). Methods and results In 23 patients with ACS, we measured longitudinal tissue Doppler strain and strain rate values from left ventricular basal, mid, and apical segments (n ¼ 414). These segments were grouped according to their acute end-systolic strain values (S ES) into those with normocontraction (S ES ≤213%), hypocontraction (S ES between 213 and 27%), and severe contraction abnormality (S ES .27%). At 8 months, we evaluated the recovery of contraction: Segments with acutely severe contraction abnormality that improved their strain values to ≤27% were defined as viable, and those that failed to do so as non-viable. In the acute phase, S ES , post-systolic strain, as well as systolic, early, and late diastolic strain rate values were significantly better in the viable than in the non-viable segments. Post-systolic strain had the best AUC 0.78, and a cutoff value of 23.8% predicted recovery from severe contraction abnormality with a sensitivity of 85% and specificity of 62%. The transmurality of the infarction, assessed by magnetic resonance imaging with delayed enhancement, was significantly larger in the non-viable than in the viable segments (P ¼ 0.006). Acute global S ES and systolic strain rate showed the best correlations with final global S ES and global infarction percentage after recovery. Conclusion SRI can serve to evaluate myocardial viability in patients with ACS, and to assess the recovery of segmental as well as global left ventricular function.

Academic Radiology, Oct 1, 2005

An image registration method was developed to automatically correct motion artifacts, mostly from... more An image registration method was developed to automatically correct motion artifacts, mostly from breathing, from cardiac cine magnetic resonance (MR) images. The location of each slice in an image stack was optimized by maximizing a similarity measure of the slice with another image slice stack. The optimization was performed iteratively and both image stacks were corrected simultaneously. Two procedures to optimize the similarity were tested: standard gradient optimization and stochastic optimization in which one slice is chosen randomly from the image stacks and its location is optimized. In this work, cine short- and long-axis images were used. In addition to visual inspection results from real data, the performance of the algorithm was evaluated quantitatively by simulating the movements in four real MR data sets. The mean error and standard deviation were defined for 50 simulated movements as each slice was randomly displaced. The error rate, defined as the percentage of non-satisfactory registration results, was evaluated. The paired t-test was used to evaluate the statistical difference between the tested optimization methods. The algorithm developed was successfully applied to correct motion artifacts from real and simulated data. The results, where typical motion artifacts were simulated, indicated an error rate of about 3%. Subvoxel registration accuracy was also achieved. When different optimization methods were compared, the registration accuracy of the stochastic approach proved to be superior to the standard gradient technique (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 10(-9)). The novel method was capable of robustly and accurately correcting motion artifacts from cardiac cine MR images.

Circulation, Sep 1, 1994

Background The current treatment of many cases of acute myocardial infarction involves the use of... more Background The current treatment of many cases of acute myocardial infarction involves the use of thrombolytic agents. Evaluation of this therapy requires determination of the success of reperfusion and assessment of the presence and extent of infarction in the reperfused territory. The present study was designed to simulate in rat models several possible outcomes of reperfusion therapy: (1) successful reperfusion and absence of myocardial infarction, (2) successful reperfusion and presence of myocardial infarction, and (3) unsuccessful reperfusion. The usefulness of contrast-enhanced fast magnetic resonance (MR) imaging in defining the success of reperfusion was investigated. The dynamic effects were examined of low and high doses of gadolinium-BOPTA/dimeglumine (Gd-BOPTA/dimeg) on myocardial signal using MR inversion recovery echo planar imaging (IR-EPI) and gradient recalled echo planar imaging (GR-EPI), respectively. Methods and Results Rats were subjected to one of the following regimens: reperfused reversible myocardial injury (n=9), reperfused irreversible myocardial injury (n=9), and occlusive infarction (n=9). MR echo planar images were acquired every 1 or 2 seconds before, during, and after administration of Gd-BOPTA/dimeg. In all groups, normal myocardial signal was sharply increased on IR-EPI and decreased on GR-EPI at the peak of the bolus, followed by a

European Journal of Echocardiography, May 1, 2013

Time after contrast injection is crucial to determine infarct transmurality and myocardial functi... more Time after contrast injection is crucial to determine infarct transmurality and myocardial functional recovery after an acute myocardial infarction

Scandinavian Journal of Surgery, Jun 1, 2007

Annals of Noninvasive Electrocardiology, Jul 4, 2018

Ahluwalia, & Rutten-Ramos, 2014). The disease is characterized by ventricular repolarization abno... more Ahluwalia, & Rutten-Ramos, 2014). The disease is characterized by ventricular repolarization abnormalities arising from structural changes of cellular hypertrophy, interstitial fibrosis, and myofiber disarray and on the other hand from disturbances in the ion currents and calcium handling on the molecular and cellular level. In combination, these changes constitute the arrhythmic substrate responsible for the risk of malignant ventricular arrhythmias (Coppini et al., 2013; Maron, 2010). The stratification of risk for malignant ventricular arrhythmias in HCM is based on multiple factors, but even with current clinical guidelines gaps remain (Elliott et al., 2014).

Vascular Health and Risk Management, Aug 1, 2008

In familial hypercholesterolemia (FH) the level of LDL cholesterol is 2-3 times that of the norma... more In familial hypercholesterolemia (FH) the level of LDL cholesterol is 2-3 times that of the normal population and leads to accelerated atherosclerosis. Improved care for risk factors has decreased cardiovascular mortality of these patients. We studied subclinical atherosclerotic changes with morphologic and functional aortic magnetic resonance imaging (MRI) in FH patients under the age of 50. 39 DNA test-verifi ed heterozygous FH-North Karelia patients, aged 6-48, 28 of them treated with statins, and 25 healthy controls, aged 12 to 50, underwent aortic MRI, carotid ultrasound (US), and risk-factor assessment. No differences in any of the morphologic or functional aortic parameters appeared between patients and controls. Age and gender were independent predictors of the majority of the morphologic and functional measures. Carotid intima-media thickness assessed by US was greater in patients (0.57 mm ± 0.13 vs 0.48 ± 0.13 mm, p = 0.005) as was cholesterol-years score (243 ± 122 vs 137 ± 74, p Ͻ 0.001). Patients had thicker intima-media of the common carotid artery and higher cholesterol burden as indicated by their cholesterol-years score. Despite this, no differences existed in morphologic or functional aortic parameters assessed with MRI. The improved care of cardiovascular risk factors, especially statin treatment, may protect the aorta of FH patients. However, larger confi rmatory studies are needed.

Acta Anaesthesiologica Scandinavica, Aug 24, 2015

European journal of echocardiography, May 7, 2008

The distribution of myocardial strain values can be visualized by colour-coded strain images. We ... more The distribution of myocardial strain values can be visualized by colour-coded strain images. We examined for the first time if this strain-mapping function can be used to study the extent of prior myocardial infarction. Methods and results Echocardiography and cardiac magnetic resonance imaging with delayed contrast enhancement were performed in 26 patients with chronic myocardial infarction. Two-dimensional strain images of the left ventricle were obtained in all standard apical views. Myocardial segments (n ¼ 416) were assigned a score ranging from one to four based on the strain-coded colour of the segment, with higher scores representing worse myocardial function. Strain-mapping scores and quantitative strain values averaged, respectively, 1.3 + 0.6 and 216.4 + 7.6% in segments without infarction, 1.7 + 1.0 and 215.0 + 8.6% in non-transmural infarctions, and 2.8 + 1.2 and 26.5 + 8.6% in transmural infarctions. Strain-mapping had a sensitivity of 60% and a specificity of 95% in detecting segments with transmural myocardial infarction. Corresponding values for echocardiographic wall motion analysis were 50 and 96%. Strain-mapping was possible in 80% of the segments and inter-observer agreement was substantial (k ¼ 0.63). Conclusion Strain-mapping is a clinically applicable method for the assessment of regional myocardial function in post-myocardial infarction patients. Strain-mapping has reasonable feasibility and is more sensitive in detecting infarction damage than routine wall motion analysis.