ORCID Profile
0000-0001-6579-8250
Current Organisation
Karolinska Institutet
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Psychology | Social and Community Psychology
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.JELECTROCARD.2015.07.018
Abstract: The Selvester QRS score consists of a set of electrocardiographic criteria designed to identify, quantify and localize scar in the left ventricle using the morphology of the QRS complex. These criteria were updated in 2009 to expand their use to patients with underlying conduction abnormalities, but these versions have thus far only been validated in small and carefully selected populations. To determine the specificity for each of the criteria of the left bundle branch block (LBBB) modified Selvester QRS Score (LB-SS) in a population with strict LBBB and no myocardial scar as verified by cardiovascular magnetic resonance imaging with late gadolinium enhancement (CMR-LGE). We identified ninety-nine patients with LBBB without scar on CMR-LGE, who underwent a clinically indicated CMR scan at three different centers. The ECG recording date was any time prior to or <30days after the CMR scan. The LB-SS was applied and specificity for detection of scar in each of the 46 separate criteria was determined. The specificity ranged between 41% and 100% for the 46 criteria of LB-SS and 27/46 (59%) met ≥95% specificity. The mean±SD specificity was 90%±14%. Several of the criteria in the LB-SS lack adequate specificity. Elimination or modification of these nonspecific QRS morphology criteria may improve the specificity of the overall LB-SS.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.JELECTROCARD.2018.09.009
Abstract: The relationship between left ventricular (LV) ejection fraction (EF) and LV myocardial scar can identify potentially reversible causes of LV dysfunction. Left bundle branch block (LBBB) alters the electrical and mechanical activation of the LV. We hypothesized that the relationship between LVEF and scar extent is different in LBBB compared to controls. We compared the relationship between LVEF and scar burden between patients with LBBB and scar (n = 83), and patients with chronic ischemic heart disease and scar but no electrocardiographic conduction abnormality (controls, n = 90), who had undergone cardiovascular magnetic resonance (CMR) imaging at one of three centers. LVEF (%) was measured in CMR cine images. Scar burden was quantified by CMR late gadolinium enhancement (LGE) and expressed as % of LV mass (%LVM). Maximum possible LVEF (LVEFmax) was defined as the function describing the hypotenuse in the LVEF versus myocardial scar extent scatter plot. Dysfunction index was defined as LVEFmax derived from the control cohort minus the measured LVEF. Compared to controls with scar, LBBB with scar had a lower LVEF (median [interquartile range] 27 [19-38] vs 36 [25-50] %, p < 0.001), smaller scar (4 [1-9] vs 11 [6-20] %LVM, p < 0.001), and greater dysfunction index (39 [30-52] vs 21 [12-35] % points, p < 0.001). Among LBBB patients referred for CMR, LVEF is disproportionately reduced in relation to the amount of scar. Dyssynchrony in LBBB may thus impair compensation for loss of contractile myocardium.
Publisher: Springer Science and Business Media LLC
Date: 12-12-2022
DOI: 10.1038/S41560-022-01164-W
Abstract: Reaching net-zero targets requires massive increases in wind energy production, but efforts to build wind farms can meet stern local opposition. Here, inspired by related work on vaccinations, we examine whether opposition to wind farms is associated with a world view that conspiracies are common (‘conspiracy mentality’). In eight pre-registered studies (collective N = 4,170), we found moderate-to-large relationships between various indices of conspiracy beliefs and wind farm opposition. Indeed, the relationship between wind farm opposition and conspiracy beliefs was many times greater than its relationship with age, gender, education and political orientation. Information provision increased support, even among those high in conspiracy mentality. However, information provision was less effective when it was presented as a debate (that is, including negative arguments) and among participants who endorsed specific conspiracy theories about wind farms. Thus, the data suggest preventive measures are more realistic than informational interventions to curb the potentially negative impact of conspiracy beliefs.
Publisher: Wiley
Date: 19-01-2017
DOI: 10.1002/JOB.2171
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.JELECTROCARD.2018.05.019
Abstract: We aimed to improve the electrocardiographic 2009 left bundle branch block (LBBB) Selvester QRS score (2009 LBSS) for scar assessment. We retrospectively identified 325 LBBB patients with available ECG and cardiovascular magnetic resonance imaging (CMR) with late gadolinium enhancement from four centers (142 [44%] with CMR scar). Forty-four semi-automatically measured ECG variables pre-selected based on the 2009 LBSS yielded one multivariable model for scar detection and another for scar quantification. The 2009 LBSS achieved an area under the curve (AUC) of 0.60 (95% confidence interval 0.54-0.66) for scar detection, and R The 2009 LBSS detects and quantifies myocardial scar with poor accuracy. Improved models with extensive comparison of ECG and CMR had modest performance, indicating limited room for improvement of the 2009 LBSS.
Publisher: Elsevier BV
Date: 2012
Publisher: Springer Science and Business Media LLC
Date: 06-03-2020
DOI: 10.1186/S12880-020-00428-9
Abstract: Pulmonary hypertension is definitively diagnosed by the measurement of mean pulmonary artery (PA) pressure (mPAP) using right heart catheterization. Cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow analysis can estimate mPAP from blood flow vortex duration in the PA, with excellent results. Moreover, the peak systolic tricuspid regurgitation (TR) pressure gradient (TRPG) measured by Doppler echocardiography is commonly used in clinical routine to estimate systolic PA pressure. This study aimed to compare CMR and echocardiography with regards to quantitative and categorical agreement, and diagnostic yield for detecting increased PA pressure. Consecutive clinically referred patients ( n = 60, median [interquartile range] age 60 [48–68] years, 33% female) underwent echocardiography and CMR at 1.5 T ( n = 43) or 3 T ( n = 17). PA vortex duration was used to estimate mPAP using a commercially available time-resolved multiple 2D slice phase contrast three-directional velocity encoded sequence covering the main PA. Transthoracic Doppler echocardiography was performed to measure TR and derive TRPG. Diagnostic yield was defined as the fraction of cases in which CMR or echocardiography detected an increased PA pressure, defined as vortex duration ≥15% of the cardiac cycle (mPAP ≥25 mmHg) or TR velocity 2.8 m/s (TRPG 31 mmHg). Both CMR and echocardiography showed normal PA pressure in 39/60 (65%) patients and increased PA pressure in 9/60 (15%) patients, overall agreement in 48/60 (80%) patients, kappa 0.49 (95% confidence interval 0.27–0.71). CMR had a higher diagnostic yield for detecting increased PA pressure compared to echocardiography (21/60 (35%) vs 9/60 (15%), p 0.001). In cases with both an observable PA vortex and measurable TR velocity (34/60, 56%), TRPG was correlated with mPAP (R 2 = 0.65, p 0.001). There is good quantitative and fair categorical agreement between estimated mPAP from CMR and TRPG from echocardiography. CMR has higher diagnostic yield for detecting increased PA pressure compared to echocardiography, potentially due to a lower sensitivity of echocardiography in detecting increased PA pressure compared to CMR, related to limitations in the ability to adequately visualize and measure the TR jet by echocardiography. Future comparison between echocardiography, CMR and invasive measurements are justified to definitively confirm these findings.
Publisher: Wiley
Date: 18-07-2021
DOI: 10.1111/BJHP.12550
Abstract: Increasing vaccination hesitancy threatens societies’ capacity to contain pandemics and other diseases. One factor that is positively associated with vaccination intentions is a supportive subjective norm (i.e., the perception that close others approve of vaccination). On the downside, there is evidence that negative attitudes toward vaccinations are partly rooted in conspiracy mentality (i.e., the tendency to believe in conspiracies). The objective of this study is to examine the role of subjective norms in moderating the association between conspiracy mentality and vaccine hesitancy. We examined two competing predictions: Are those high in conspiracy mentality immune to subjective norms, or do subjective norms moderate the relationship between conspiracy mentality and vaccination intentions? We conducted five studies (total N = 1,280) to test these hypotheses across several vaccination contexts (some real, some fictitious). We measured conspiracy mentality, vaccination intentions, subjective norms, attitudes toward vaccination, and perceived behavioural control. A merged analysis across the studies revealed an interaction effect of conspiracy mentality and subjective norm on vaccination intentions. When subjective norm was high (i.e., when participants perceived that close others approved of vaccines) conspiracy mentality no longer predicted vaccination intentions. This was consistent with the moderating hypothesis of subjective norms and inconsistent with the immunity hypothesis. The typical negative relationship between conspiracy mentality and vaccination intentions is eliminated among those who perceive pro‐vaccination subjective norms. Although correlational, these data raise the possibility that pro‐vaccination views of friends and family can be leveraged to reduce vaccine hesitancy.
Publisher: Wiley
Date: 03-2017
DOI: 10.1111/ANEC.12440
Publisher: Elsevier BV
Date: 09-2015
Publisher: Wiley
Date: 05-2020
DOI: 10.1111/PACE.13916
Publisher: Springer Science and Business Media LLC
Date: 11-11-2019
DOI: 10.1186/S12968-019-0577-9
Abstract: Body position can be optimized for pulmonary ventilation erfusion matching during surgery and intensive care. However, positional effects upon distribution of pulmonary blood flow and vascular distensibility measured as the pulmonary blood volume variation have not been quantitatively characterized. In order to explore the potential clinical utility of body position as a modulator of pulmonary hemodynamics, we aimed to characterize gravitational effects upon distribution of pulmonary blood flow, pulmonary vascular distension, and pulmonary vascular distensibility. Healthy subjects ( n = 10) underwent phase contrast cardiovascular magnetic resonance (CMR) pulmonary artery and vein flow measurements in the supine, prone, and right/left lateral decubitus positions. For each lung, blood volume variation was calculated by subtracting venous from arterial flow per time frame. Body position did not change cardiac output ( p = 0.84). There was no difference in blood flow between the superior and inferior pulmonary veins in the supine ( p = 0.92) or prone body positions ( p = 0.43). Compared to supine, pulmonary blood flow increased to the dependent lung in the lateral positions (16–33%, p = 0.002 for both). Venous but not arterial cross-sectional vessel area increased in both lungs when dependent compared to when non-dependent in the lateral positions (22–27%, p ≤ 0.01 for both). In contrast, compared to supine, distensibility increased in the non-dependent lung in the lateral positions (68–113%, p = 0.002 for both). CMR demonstrates that in the lateral position, there is a shift in blood flow distribution, and venous but not arterial blood volume, from the non-dependent to the dependent lung. The non-dependent lung has a sizable pulmonary vascular distensibility reserve, possibly related to left atrial pressure. These results support the physiological basis for positioning patients with unilateral pulmonary pathology with the “good lung down” in the context of intensive care. Future studies are warranted to evaluate the diagnostic potential of these physiological insights into pulmonary hemodynamics, particularly in the context of non-invasively characterizing pulmonary hypertension.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.AHJ.2015.05.005
Abstract: The Selvester QRS score is an electrocardiographic tool designed to quantify myocardial scar. It was updated in 2009 to expand its usefulness in patients with conduction abnormalities such as bundle-branch and fascicular blocks. There is need to further validate the updated score in a broader group of patients with cardiovascular disease and conduction abnormalities. We primarily hypothesized that the updated score could distinguish between presence and absence of scar by cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement in 4 groups of patients with distinct conduction abnormalitites. A total of 193 patients were retrospectively identified that had received an electrocardiogram (ECG) and a CMR scan at Duke University Medical Center between January 2011 and August 2013: 62 with left bundle-branch block, 51 with right bundle-branch block (RBBB), 43 with left anterior fascicular block (LAFB), and 37 with RBBB + LAFB. Scar sizes estimated by ECG and by CMR were compared using scatterplots, modified Bland-Altman plots, and receiver operating characteristics curves. Of 193 patients, 96 (50%) had no scar by CMR. The QRS score generally overestimated CMR scar. The area under the curve ranged between 0.62 and 0.65 for the different conduction types, and 95% confidence intervals included 0.5 for all conduction types. Performance was slightly improved in LAFB and RBBB + LAFB by excluding all points derived from leads V4-V6. The Selvester QRS score for use in conduction abnormalities needs to be improved, primarily its specificity, to enable effective clinical use in a population with a wide range of left ventricular ejection fraction and low pretest probability of myocardial scar.
Publisher: Elsevier BV
Date: 05-2013
Publisher: Wiley
Date: 18-10-2022
DOI: 10.1002/EJSP.2888
Abstract: While a great deal is known about the in idual difference factors associated with conspiracy beliefs, much less is known about the country‐level factors that shape people's willingness to believe conspiracy theories. In the current article we discuss the possibility that willingness to believe conspiracy theories might be shaped by the perception (and reality) of poor economic performance at the national level. To test this notion, we surveyed 6723 participants from 36 countries. In line with predictions, propensity to believe conspiracy theories was negatively associated with perceptions of current and future national economic vitality. Furthermore, countries with higher GDP per capita tended to have lower belief in conspiracy theories. The data suggest that conspiracy beliefs are not just caused by intrapsychic factors but are also shaped by difficult economic circumstances for which distrust might have a rational basis.
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.JELECTROCARD.2015.06.003
Abstract: Estimation of the infarct size from body-surface ECGs in post-myocardial infarction patients has become possible using the Selvester scoring method. Automation of this scoring has been proposed in order to speed-up the measurement of the score and improving the inter-observer variability in computing a score that requires strong expertise in electrocardiography. In this work, we evaluated the quality of the QuAReSS software for delivering correct Selvester scoring in a set of standard 12-lead ECGs. Standard 12-lead ECGs were recorded in 105 post-MI patients prescribed implantation of an implantable cardiodefibrillator (ICD). Amongst the 105 patients with standard clinical left bundle branch block (LBBB) patterns, 67 had a LBBB pattern meeting the strict criteria. The QuAReSS software was applied to these 67 tracings by two independent groups of cardiologists (from a clinical group and an ECG core laboratory) to measure the Selvester score semi-automatically. Using various level of agreement metrics, we compared the scores between groups and when automatically measured by the software. The average of the absolute difference in Selvester scores measured by the two independent groups was 1.4±1.5 score points, whereas the difference between automatic method and the two manual adjudications were 1.2±1.2 and 1.3±1.2 points. Eighty-two percent score agreement was observed between the two independent measurements when the difference of score was within two point ranges, while 90% and 84% score agreements were reached using the automatic method compared to the two manual adjudications. The study confirms that the QuAReSS software provides valid measurements of the Selvester score in patients with strict LBBB with minimal correction from cardiologists.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 05-2020
Publisher: Wiley
Date: 19-02-2019
DOI: 10.1111/JCE.13875
Publisher: Cold Spring Harbor Laboratory
Date: 11-11-2022
DOI: 10.1101/2022.11.11.22282225
Abstract: Cardiac imaging-based indices of left ventricular (LV) mechanical dyssynchrony have limited accuracy for predicting the response to cardiac resynchronization therapy (CRT). The aim of the study was to evaluate the diagnostic performance of mechanical dyssynchrony indices in a study population of patients with severely reduced ejection fraction and no LV myocardial scar assessed by cardiovascular magnetic resonance (CMR), and either left bundle branch block (LBBB) or normal QRS duration. We retrospectively identified 80 patients from three centers, with LV ejection fraction ≤35%, no scar by CMR late gadolinium enhancement, and either normal electrocardiographic QRS duration ( ms) and normal frontal plane electrical axis (-30 to +90 degrees) (control, n=36), or LBBB by Strauss’ criteria (LBBB, n=44). The CMR image data from these subjects is made publicly available as part of this publication. CMR feature tracking was used to derive circumferential strain in a midventricular short-axis cine image. Using circumferential strain, mechanical dyssynchrony was quantified as the circumferential uniformity ratio estimate (CURE) and the systolic stretch index (SSI), respectively. Both CURE and SSI resulted in measures of mechanical dyssynchrony that were more severe (lower CURE, higher SSI) in LBBB compared to controls (CURE, median [interquartile range], 0.63 [0.54-0.75] vs 0.79 [0.69-0.86], p .001 SSI 9.4 [7.4-12.7] vs 2.2 [1.2-3.6], p .001). SSI outperformed CURE in the ability to discriminate between LBBB and controls (area under the receiver operating characteristics curve [95% confidence interval] 0.98 [0.95-1.00] vs 0.77 [0.66-0.86], p .001 sensitivity 93 [84-100] vs 75 [61-86] %, p=0.02 specificity 97 [92-100] vs 67 [50-81] %, p=0.003). The ability to discriminate between LBBB and normal QRS duration among patients with severely reduced ejection fraction and no scar was fair for CURE and excellent for SSI.
Publisher: Elsevier BV
Date: 03-2019
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.JELECTROCARD.2019.09.024
Abstract: Left ventricular hypertrophy (LVH), defined as an increased left ventricular mass (LVM), can manifest as increased wall thickness, ventricular dilatation, or both. Existing LVH criteria from the electrocardiogram (ECG) have poor sensitivity. However, it is unknown whether changes in wall thickness and mass, respectively, can be separately detected by the ECG. Patients undergoing cardiovascular magnetic resonance and resting 12-lead ECG were included. Exclusion criteria were clinical confounders that might influence the ECG, including myocardial scar. Advanced ECG (A-ECG) analysis included conventional ECG measures and litudes, derived vectorcardiographic and polarcardiographic measures, and singular value decomposition of waveform complexity. A-ECG scores for 1) increased LVM index (LVMI), and 2) increased global wall thickness index (GTI) beyond the upper limit of normal in healthy volunteers, respectively, were derived using multivariable logistic regression. The area under the curve (AUC) and its bootstrapped confidence interval (CI) for each score were compared to those of conventional ECG-LVH criteria including Cornell voltage, Cornell product, and Sokolow-Lyon voltage criteria. Out of 485 patients (median [interquartile range] age 51 [38-61] years, 54% female), 51 (11%) had increased LVMI and 65 (13%) had increased GTI. The A-ECG scores for increased LVMI (AUC [95% CI] 0.84 [0.78-0.90]), and increased GTI (0.80 [0.74-0.85]) differed, and had a higher AUC than the conventional ECG-LVH criteria (p < 0.001 for all). Increased LVMI differed from increased GTI in its electrocardiographic manifestation by A-ECG. New A-ECG scores outperform conventional ECG criteria for LVH in determining increased LVMI and GTI, respectively.
Publisher: Springer Science and Business Media LLC
Date: 22-11-2022
Publisher: Elsevier BV
Date: 06-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-01-2017
Abstract: Myocardial fibrosis quantified by myocardial extracellular volume fraction ( ECV ) and left ventricular mass (LVM) index ( LVMI ) measured by cardiovascular magnetic resonance might represent independent and opposing contributors to ECG voltage measures of left ventricular hypertrophy ( LVH ). Diffuse myocardial fibrosis can occur in LVH and interfere with ECG voltage measures. This phenomenon could explain the decreased sensitivity of LVH detectable by ECG , a fundamental diagnostic tool in cardiology. We identified 77 patients (median age, 53 [interquartile range, 26–60] years 49% female) referred for contrast‐enhanced cardiovascular magnetic resonance with ECV measures and 12‐lead ECG . Exclusion criteria included clinical confounders that might influence ECG measures of LVH . We evaluated ECG voltage‐based LVH measures, including Sokolow‐Lyon index, Cornell voltage, 12‐lead voltage, and the vectorcardiogram spatial QRS voltage, with respect to LVMI and ECV . ECV and LVMI were not correlated ( R 2 =0.02 P =0.25). For all voltage‐related parameters, higher LVMI resulted in greater voltage ( r =0.33–0.49 P .05 for all), whereas increased ECV resulted in lower voltage ( r =−0.32 to −0.57 P .05 for all). When accounting for body fat, LV end‐diastolic volume, and mass‐to‐volume ratio, both LVMI (β=0.58, P =0.03) and ECV (β=−0.46, P .001) were independent predictors of QRS voltage (multivariate adjusted R 2 =0.39 P .001). Myocardial mass and diffuse myocardial fibrosis have independent and opposing effects upon ECG voltage measures of LVH . Diffuse myocardial fibrosis quantified by ECV can obscure the ECG manifestations of increased LVM . This provides mechanistic insight, which can explain the limited sensitivity of the ECG for detecting increased LVM .
Start Date: 05-2021
End Date: 05-2024
Amount: $282,000.00
Funder: Australian Research Council
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