Mai Tone Lønnebakken

University of Bergen | UiB · Department of Clinical Science

Background Acylcarnitines are essential for mitochondrial fatty acid oxidation. Earlier studies suggest that impaired energy metabolism may be implicated in the pathogenesis of microvascular angina. We explored metabolites from the carnitine pathway as predictors of cardiovascular disease (CVD) - and all-cause mortality among patients with non-obst...

Background Dobutamine stress echocardiography is an established diagnostic modality for assessing myocardial ischemia in patients with known or suspected coronary artery disease. Dobutamine infusion causes dose dependent increase in heart rate and contractility. However, in some cases it induces paradoxical sinus deceleration, whose underlying mech...

Funding Acknowledgements Type of funding sources: None. Background Previous studies have reported major sex differences in prevalence, demographics, and timing of intervention in left ventricular outflow tract (LVOT) obstruction. Whether the observed differences are related to LVOT anatomy is less explored. Purpose The aim of this study was to as...

Background The burden of non-obstructive coronary artery disease (CAD) in the society is high, and there is currently limited evidence-based recommendation for risk stratification and treatment. Previous studies have demonstrated an association between increasing extent of non-obstructive CAD and cardiovascular events. Whether hypertension, a modif...

Introduction: Myocardial ischemia is common among patients with chest pain and non-obstructive coronary artery disease (CAD). Epicardial adipose tissue (EAT) accumulation has been associated with inflammation, atherosclerosis and microvascular dysfunction. Accordingly, we hypothesised that EAT volume is associated with coronary plaque vulnerability...

Introduction Increased left ventricular mass index (LVMi) and left ventricular hypertrophy (LVH) by echocardiography are common in obesity and important cardiovascular risk predictors associated with myocardial ischemia in non-obstructive coronary artery disease (CAD). Accumulation of epicardial adipose tissue (EAT) suggest a possible direct impact...

Background Inadequate intake of polyunsaturated fatty acids (PUFAs) is recognized as a modifiable risk factor for atherosclerotic cardiovascular disease (CVD) (1,2). The n-6 PUFA linoleic acid (LA) constitutes the predominant portion of total dietary PUFAs (3). However, whereas cardiometabolic effects of PUFAs belonging to the n-3 series have been...

Background Although generally at lower risk than those with obstructive CAD, patients with non-obstructive CAD (NOCAD) are heterogeneous concerning long-term prognosis. Notably, reversible ischemia due to vascular dysfunction is a frequent finding in NOCAD patients (1). The endogenous, non-proteinogenic amino acid homoarginine (hArg) increases the...

Sex and gender are important modifiers of cardiovascular system physiology, pathophysiology, and disease development. The atherosclerosis process, together with the progressive loss of arterial elasticity with age, is a major factor influencing the development of overt cardiovascular, renal, and cerebrovascular disease. While differences between wo...

Aim Whether the total coronary atherosclerotic plaque burden is independently associated with myocardial ischemia in non-obstructive coronary artery disease (CAD) is not well established. We aimed to test the association of total plaque burden quantified by coronary computed tomography angiography (CCTA) with myocardial ischemia in patients with ch...

Background Ischemia with non-obstructive coronary arteries (INOCA) is incompletely understood. Depressed myocardial energetic efficiency index (MEEi), the ratio between external work and myocardial oxygen consumption, has been shown in heart failure. However, MEEi in INOCA has not been explored. Purpose To test whether MEEi is associated with INOC...

Background Reduced serum levels of high density lipoprotein cholesterol (HDL-C) is a hallmark of the metabolic syndrome. Epidemiologic studies have reported an inverse correlation between HDL- C and cardiovascular disease (CVD) risk. However, recent works suggest that the association is strongest in healthy individuals. Changes in particle number a...

Background In non-obstructive coronary artery disease (CAD), increasing extent of disease is associated with a worse prognosis. Statin therapy has been suggested to improve the prognosis. Whether hypertension, a modifiable CV risk factor, affects the extent of non-obstructive CAD in patients with stable angina is less explored. Purpose To assess t...

Objective Lower systemic arterial compliance (SAC) is associated with increased cardiovascular morbidity and mortality in hypertension, but this has not been assessed in a prospective study in aortic valve stenosis (AS). Methods Data from 1641 patients (38% women) with initially asymptomatic mild-moderate AS enrolled in the Simvastatin and Ezetimi...

Objective High aortic stiffness may reduce myocardial perfusion pressure and contribute to development of myocardial ischaemia. Whether high aortic stiffness is associated with myocardial ischaemia in patients with stable angina and non-obstructive coronary artery disease (CAD) is less explored. Methods Aortic stiffness was assessed as carotid-fem...

Background and aims: Obesity is associated with reduced left ventricular (LV) systolic myocardial function. We aimed to explore by means of a cross-sectional study whether this effect is offset in the presence of good fitness. Methods and results: We studied clinical and echocardiographic data from 469 overweight (body mass index [BMI] >27 kg/m2...

Background: The underlying mechanisms causing myocardial ischemia in non-obstructive coronary artery disease (CAD) are still unclear. We explored whether left ventricular hypertrophy (LVH) was associated with myocardial ischemia in patients with stable angina and non-obstructive CAD. Methods: 132 patients (mean age 63 ± 8 years, 56% women) with...

Background and aims Reduction of left ventricular mass index (LVMi) during antihypertensive treatment is less likely to occur in obese subjects. The aim of the study was to assess whether weight loss influences reduction of LVMi in treated, obese, hypertensive patients. Methods and results From the Campania Salute Network registry, we identified 1...

Background and aims: Subclinical cardiac disease, like abnormal left ventricular (LV) geometry or left atrial (LA) dilatation, is common in obesity. Less is known about sex differences in the prevalence and type of subclinical cardiac disease in obesity. Methods and results: Clinical and echocardiographic data from 581 women and men without esta...

Objectives: The association of transaortic flow rate (FR) with outcomes was tested in 1,661 patients with aortic valve stenosis (AS) in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. Background: Low transaortic flow may complicate grading of AS. However, the association of lower transaortic FR with adverse outcomes has not been r...

Strain rate imaging by tissue Doppler (TDI) is vulnerable to stationary reverberations and noise (clutter). Anatomic Doppler spectrum (ADS) presents retrospective spectral Doppler from ultra-high frame rate imaging (UFR-TDI) data for a region of interest, that is, ventricular wall or segment, at one time instance. This enables spectral assessment o...

Objective: In severe aortic valve stenosis (AS), low left ventricular (LV) stroke volume has been associated with increased cardiovascular (CV) mortality, but this association has not been explored during progression of AS in a large prospective study. Methods: In 1671 patients from the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study, the...

Background and aims: Good cardiorespiratory fitness has been suggested to reduce the risk of cardiovascular disease in obesity. We explored the association of fitness with the prevalences of major cardiovascular risk factor like hypertension (HT), diabetes and metabolic syndrome (MetS) in overweight and obese subjects. Methods and results: Clini...

Table S1. Clinical Characteristics of the Study Participants Without or With ≥5 g/m2.7 Regression of LVMi or Normalization of LVMi During Follow‐Up Table S2. Cardiac and Vascular Structural Characteristics of the Study Participants Without or With ≥5 g/m2.7 Regression of LVMi or Normalization of LVMi During Follow‐Up Table S3. Blood Pressure and...

Background Regression of left ventricular (LV) hypertrophy (LVH) has been a goal in clinical trials. This study tests the external validity of results of clinical trials on LVH regression using a large registry from a tertiary care center, to identify phenotypes less likely to achieve regression of LVH. Methods and Results Patients from the Campan...

At a given level of left ventricular (LV) systolic function, LV pump performance (assessed by stroke index [SVi]) may differ, depending on LV size. We evaluated whether low SVi may be considered a marker of risk for incident congestive heart failure (HF), independent of LV geometry and systolic function, assessed by ejection fraction (EF) or midwal...

There is little information on left ventricular (LV) hypertrophy (LVH) development during antihypertensive treatment. We evaluate incident LVH in a treated hypertensive cohort, the Campania Salute Network registry. We analyzed prospectively 4290 hypertensives (aged 50.3±11.1 years, 40% women) with at least 1-year follow-up, without LVH at baseline....

We tested the prognostic impact of a marker of arterial stiffness, pulse pressure/stroke volume index (PP/SVi) in patients with hypertension and left ventricular (LV) hypertrophy. We used data from 866 patients randomized to losartan or atenolol-based antihypertensive treatment, over a median of 4.8 years, in the Losartan Intervention For Endpoint...

Background Masked hypertension (MHT), defined as normal office blood pressure (BP) but high ambulatory BP, has been associated with increased cardiovascular risk. Although MHT has been associated with obesity, there is limited knowledge on the prevalence and covariates of MHT in obese cohorts. Methods Office and ambulatory BP recordings and other...

Aims In aortic valve stenosis (AS), having a small aortic root may influence both the assessment of AS severity and the treatment strategy. The aim was to test the prognostic implications of having a small aortic root in AS within a large prospective study. Methods and results We used data from 4.3-year follow-up of 1560 patients with asymptomatic...

Background: The association of hypertension with asymptomatic cardiovascular organ damage in patients with rheumatoid arthritis (RA) has been little studied by echocardiography. Methods: Echocardiography was done in 134 RA patients and 102 healthy controls. Left ventricular (LV) geometry was considered abnormal if LV mass index or relative wall...

Background In hereditary spherocytosis with severe anemia, splenectomy is a recommended treatment. However, the spleen carries an important role both in immune function and coagulation. The increased risk of bacterial infections associated with splenectomy is well known. Recently, hypercoagulation disorders have also been linked to splenectomy thro...

Objectives: The relation between aortic root dimension (ARD) and measures of arterial stiffness is uncertain. Accordingly, we studied the relation between ARD and an estimate of arterial stiffness in 12 392 hypertensive patients (age 53 ± 12 years, 43% women) free of prevalent cardiovascular disease and with ejection fraction at least 50%, from th...

Abnormal night-time blood pressure (BP) reduction is associated with increased cardiovascular risk in hypertension. Little is known about the prevalence and covariates of night-time BP reduction in ischemic stroke patients. Clinic and ambulatory BP measurements were recorded in 268 stroke survivors aged 15-60 years. The degree of night-time dipping...

Objective Chronic aortic regurgitation (AR) creates a volume load on the left ventricle, which induces adaptive responses. With time, excessive left ventricular (LV) dilatation may precipitate heart failure. β-adrenergic receptor antagonists (β-blockers) are beneficial in patients with heart failure, but their effect in AR is unclear. This trial wa...

Background— The prognostic importance of left ventricular (LV) mass in nonsevere asymptomatic aortic stenosis has not been documented in a large prospective study. Methods and Results— Cox regression analysis was used to assess the impact of echocardiographic LV mass on rate of major cardiovascular events in 1656 patients (mean age, 67 years; 39.6...

To study the relationship between obesity and heart rate (HR) in women and men. We studied 241 overweight and obese subjects without known heart disease. All subjects underwent ergospirometry during maximal exercise testing on treadmill and recording of body composition, electrocardiogram and clinic and ambulatory blood pressure. Women (n = 132) we...

Objective: The aim of this study was to determine the association of physical fitness with prevalence of cardiovascular risk factors in overweight and obese women and men without known cardiovascular disease. Design and method: Clinical data from 240 participants in the FAT associated target organ damage (FATCOR) study was analyzed. Physical fitnes...

Background: Women with non-ST elevation myocardial infarction (NSTEMI) have similar extent of myocardial ischemia but less obstructive coronary artery disease (CAD) than their male counterparts. We tested the impact of global coronary artery plaque area and artery tortuosity on myocardial perfusion in NSTEMI patients. Methods: Coronary artery pl...

Introduction: In clinical trials, women achieve less regression of hypertensive LV hypertrophy (LVH) than men. Whether this is evident also in less selective hypertensive patients is uncertain. Hypothesis: Find sex-differences in LV mass changes during hypertensive treatment. Methods: We evaluated 6969 hypertensive patients with follow-up>12 months...

Objective: Asymmetric septal hypertrophy (ASH) in patients with severe aortic stenosis (AS) has been associated with increased perioperative morbidity and mortality in smaller studies with severe aortic stenosis (AS). This association has not been tested in a large, longitudinal study. Methods: Clinical, echocardiographic and outcome data from 1730...

Objective Women with severe aortic valve stenosis (AS) have better LV systolic function and more concentric LV geometry than their male counterparts. However, sex differences in cardiovascular (CV) outcome during progression of AS have not been reported from a longitudinal prospective study. Methods Doppler echocardiography and CV events were recor...

Mini-Abstract Ultrasound is the preferred imaging modality in evaluation of iatrogenic pseudoaneurysms (PAs). This case illustrates that when a PA originating from the external pudendal artery, a side branch of the common femoral artery, is combined with a communicating arteriovenous fistula the diagnosis, having important therapeutic implications,...

Objective: We tested the impact of isolated systolic hypertension (ISH) on normalization of left ventricular (LV) structure during antihypertensive treatment. Methods: Baseline and annual echocardiograms were recorded in 873 hypertensive patients with electrocardiographic signs of LV hypertrophy during 4.8 years randomized losartan- or atenolol-...

We tested the hypothesis that the disproportionate increase of body surface area in obesity may lead to the overestimation of aortic stenosis (AS) severity when the aortic valve area (AVA) is indexed (AVAI) for body surface area in 1,524 patients enrolled in the Simvastatin and Ezetimibe in AS study. Obesity was defined as a body mass index of ≥30...

Aim: Higher systolic exercise blood pressure (BP) is associated with increased cardiovascular risk in hypertension. We aimed at identifying covariates of systolic exercise BP in overweight subjects. Methods: 77 subjects with body mass index (BMI) > 27 kg/m(2) and without known heart disease were tested. BP was measured by sphygmomanometry before...

Purpose: Women with non-ST elevation myocardial infarction (NSTEMI) have less obstructive coronary artery disease, but the same extent of myocardial ischemia. This may be explained by larger coronary artery plaque burden and tortuosity. The impact of these factors on myocardial ischemia is not entirely known in NSTEMI patients. Methods: In 108 pat...

Objective: Hypertension is associated with changes in left ventricular (LV) mass and geometry. We tested the impact of isolated systolic hypertension (ISH) on normalization of LV structure during antihypertensive treatment. Methods: Baseline and annual echocardiograms were recorded in 875 hypertensive patients with electrocardiographic signs of LV...

This study aims at absolute quantification in ultra-sound perfusion analysis in vivo. The main task of the study is to apply a perfusion model for intravascular tracers known mainly from other modalities to ultrasound perfusion analysis. Parametric formulation of the tissue residual function is proposed. Three perfusion parameters - blood flow, blo...

Objectives: This study investigated whether overweight and obesity impacted outcome in patients with aortic valve stenosis (AS). Background: Increased body mass index (BMI) is a strong predictor of higher cardiovascular (CV) morbidity and mortality in the general population but not among patients undergoing heart surgery. Methods: Cardiovascul...

Introduction Valvuloarterial impedance (Zva) is a measure of global (combined valvular and arterial) load opposing left ventricular (LV) ejection in aortic stenosis (AS). The present study identified covariates and tested the prognostic significance of global LV load in patients with asymptomatic AS. Methods 1418 patients with mild-moderate, asymp...

Background: Significant gender differences in angiographic severity of coronary artery disease (CAD) have been demonstrated among patients with non-ST-elevation myocardial infarction (NSTEMI). However, it is unknown if these gender differences are reflected in the extent of myocardial ischemia. Design and methods: We assessed segmental myocardia...

Pharmaceutical differences in central hemodynamics might influence cardiac response to antihypertensive treatment despite similar lowering of brachial blood pressure (BP). Data from all patients with at least two echocardiographic examinations in the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) echocardiographic substudy (n =...

The impact of hypertension on left ventricular structure and outcome during progression of aortic valve stenosis has not been reported from a large prospective study. Data from 1616 patients with asymptomatic aortic stenosis randomized to placebo-controlled treatment with combined simvastatin and ezetimibe in the Simvastatin Ezetimibe in Aortic Ste...

Contrast echocardiography at peak dobutamine-atropine stress demonstrating the globally delayed contrast enhancement in apical 4-chamber view.

Contrast echocardiography at baseline demonstrating the delayed contrast enhancement, in particularly in the distal part of intraventricular septum in an apical 4-chamber view.

Hypertension is associated with atherosclerosis and cardiac and vascular structural and functional changes. Myocardial ischemia may arise in hypertension independent of coronary artery disease through an interaction between several pathophysiological mechanisms, including left ventricular hypertrophy, increased arterial stiffness and reduced corona...

To evaluate whether lower stroke volume during antihypertensive treatment is a predictor of cardiovascular events independent of left ventricular geometric pattern. The association between left ventricular stroke volume and combined cardiovascular death, stroke and myocardial infarction, the prespecified primary study endpoint, was assessed in Cox...

Guidelines recommend coronary angiography in patients with non-ST-elevation myocardial infarction (NSTEMI) within 24 to 72 hours, a requirement that cannot always be met. The aim of this study was to evaluate the potential use of contrast echocardiography in prioritizing these patients by identifying those with NSTEMI and angiographically severe co...

Contrast echocardiography is a safe, accurate, and reproducible method to assess left ventricular volumes and function. Based on current guidelines, ultrasound contrast is indicated for left ventricular opacification at rest in patients with suboptimal echocardiographic images, and in stress echocardiography when >or= 2 adjacent segments are poorly...

Internal jugular vein thrombosis is a serious event with potentially fatal outcome, where the clinical symptoms may be vague or absent. This paper refers to a rare case where routine carotid Doppler ultrasound prior to coronary artery bypass grafting (CABG) and aortic valve replacement (AVR) in a 76-year-old man, incidentally revealed thrombosis of...

A 72-year-old woman was hospitalized with recurrent acute coronary syndrome after initial successful treatment of acute ST-elevation myocardial infarction with percutaneous coronary intervention. Echocardiography demonstrated unexpectedly a 9 x 8 mm pendulating structure attached to the anterior, proximal interventricular septum in the left ventric...

Quantitative contrast stress echocardiography (CSE) can assess regional myocardial perfusion. The aim of this study was to evaluate the performance of quantitative CSE in the detection of restenosis after percutaneous coronary intervention (PCI). Thirty-three patients with stable coronary artery disease, scheduled for PCI, underwent CSE and quantit...

Ultrasound is the preferred imaging modality in diagnosis of vascular complications following cardiac catheterization and intervention. In some cases, however, bleeding surrounding the femoral vessels, may severely distort the color Doppler images, making detection of venous complications especially difficult. This report refers to such a case wher...