Nina Eide Hasselberg

Nina Eide Hasselberg, MD, PhD, Department of Cardiology, Oslo University Hospital, Rikshospitalet

Dr. Hasselberg got her Medical Degree at University of Oslo.
After her medical internship, she worked 4 years clinically in the Dept. of Internal Medicine at Stavanger University Hospital. She started her PhD with clinical research at Oslo University Hospital in June 2011. Her PhD work focused on myocardial function and prediction of arrhythmias in different cardiomyopathies, with emphasis on imaging modalities, especially echocardiography. She has worked as a postdoctoral fellow at University of Pittsburgh Medical Center, USA focusing on the project "Peak Strain Dispersion and Clinical Outcomes in the EchoCRT trial".

Hasselberg sucessfully defended her PhD thesis "Echocardiographic Assessment of Left Ventricular Function and Clinical Outcome in Heart Failure" in April 2016.

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Photo: Kristin Ellefsen, UiO

Doctor and researcher Nina Hasselberg studied the ability of strain echocardiographic techniques to assess myocardial function and functional capacity and to predict outcome in patients with cardiomyopathy and heart failure. Heart failure affects 1-2% of the adult population in developed countries. Effective treatment, including lifesaving implantable device therapy, has improved prognosis, but risk stratification for the individual heart failure patient remains difficult. Left ventricular function is a predictor of outcome in patients with heart failure. Over many years, ejection fraction (EF) has shown prognostic importance. EF is the left ventricular (LV) function parameter most often implemented in heart failure guidelines to determine eligibility to treatment and interventions such as device implantation. However, increasing evidence has been provided in recent years suggesting more sensitive methods for LV function assessment. Echocardiographic strain, i.e. myocardial deformation, is a sensitive method to assess both myocardial deformation and dyssynchrony. LV function by global longitudinal strain (GLS) has been shown to be a better marker than EF for predicting life-threatening ventricular arrhythmias and mortality in different patient populations. Myocardial dyssynchrony assessed by the mechanical dispersion from strain is a predictor of ventricular arrhythmias in several cardiomyopathies.

The general aim of the thesis has been to quantify regional and global myocardial function by the use of speckle tracking strain echocardiography and relate this myocardial function to exercise capacity and clinical outcomes in heart failure patients of different etiologies and different levels of myocardial dysfunction. Concluding that strain echocardiography was closely related to exercise capacity and could predict clinical outcome in addition to providing insights into regional and global myocardial function and mechanics in patients with heart failure.

Dr. Hasselberg has focused mainly on lamin A/C mutation positive patients and family members and patients diagnosed with heart failure with preserved/redused ejection fracture (HFpEF/HFrEF). Her third study focused on myocardial function and dyssynchrony in heart failure patients with CRT (cardiac resynchronization therapy).

In the published journal articles related to this thesis Dr. Hasselberg & co have explored the relationship between myocardial electrical, mechanical, and structural properties in lamin A/C mutation positive subjects and looked for risk markers of ventricular arrhythmias in lamin A/C positive family members (Risk prediction of ventricular arrhythmias and myocardial function in Lamin A/C mutation positive subjects. Europace 2014;16(4):563-71). The study concluded that there was a coupling between electrical, mechanical and structural properties in lamin A/C mutation positive subjects providing mechanic insight into myocardial dysfunction and the pathogenesis of conduction disorders and arrhythmias in these subjects. PR-interval on resting ECG was the strongest predictor of ventricular arrhythmias in this cohort. Dr. Hasselberg won two poster awards for her understudy on presence of lamin A/C mutation in Norway for her abstract Prevalence and cardiac penetrance of Lamin A/C mutation in Norway presented at the ESC Congress and the Center for Heart Failure Research (CHFR) Symposium during 2015.

The study in the second article "Left ventricular global longitudinal strain is associated with exercise capacity in failing hearts with preserved and redused ejection fraction" (Eur Heart J Cardiovascular Imaging 2015 Feb;16(2):217-24) showed that LV function by GLS was a strong, independent predictor of exercise capacity in heart failure patients, including in the HFpEF population separately. RV function was also related to exercise capacity (as shown previously). HFpEF patients showed slightly reduced systolic function by GLS. Preserved EF in these patients should therefore not be equalled to preserved systolic function. This study is also featured on unikard.org

The third study "Left ventricular markers of mortality and ventricular arrhythmias in heart failure patients with cardiac resynchronization therapy" (Eur Heart J Cardiovasc Imaging 2016 Mar;17(3):343-50) concluded that lack of resynchronization by CRT at 6 months, assessed by mechanical dispersion, was a predictor on ventricular arrhythmias in heart failure patients with CRT. Longitudinal LV function by GLS before CRT was a strong predictor of death and the need for heart transplantation and LVAD implantation during the 2-year follow-up, independently of CRT response. Circumferential function improved slightly compared to longitudinal function by biventricular pacing. Nevertheless, volymetric CRT response by reverse remodeling was more likely achieved if there was improvement of longitudinal function in addition to improved circumferential function by biventrivular pacing. This study was also featured on unikard.org.

Heart SFI