Clinical Physiology

A woman is looking at two computer screens from a MRI scan.

Physiological measurement methods for improved diagnosis and characterization of cardiovascular and pulmonary diseases.

Description of our research

Our research focuses on the development, validation, and application of advanced physiological examinations to improve diagnosis, phenotyping, risk stratification, and follow-up of heart, vascular, and lung diseases. By combining imaging, functional measurements, and biomarkers, we aim to enable earlier disease detection and, once a diagnosis is established, a more detailed characterization of disease impact. This in turn allows for earlier therapy, individualized treatment, and improved patient outcomes.

The group has specialized methodological expertise in clinical physiological diagnostics of cardiovascular and pulmonary diseases. We use a broad range of advanced techniques, including echocardiography, magnetic resonance imaging, and positron emission tomography of the heart, as well as cardiopulmonary exercise testing (ergospirometry). For pulmonary physiology, we employ methods such as forced oscillation technique to assess lung mechanics, nitrogen washout to measure ventilation heterogeneity, exhaled nitric oxide to evaluate airway inflammation, dynamic and static spirometry, and carbon monoxide diffusing capacity to assess gas exchange. In addition, we apply novel approaches to study the peripheral airways, including analysis of exhaled particles from the small airways (PExA) and nanoparticle-based Airspace Dimension Assessment (AiDA) to characterize distal airspace size.

Our research spans clinical, population-based, and translational studies, conducted in close collaboration with clinical departments at Uppsala University Hospital. We also collaborate with other research groups at Uppsala University, the Swedish University of Agricultural Sciences, and multiple national and international academic partners. The group is led by Professor Andrei Malinovschi.

Research Areas

Pulmonary Function Research (Andrei Malinovschi)

This research focuses on the clinical value of different lung function techniques in diseases such as asthma, COPD, and cystic fibrosis. Particular emphasis is placed on:

Early diagnosis of asthma and COPD
Detection of small airway involvement in various lung diseases
Combining functional tests and biomarkers to predict disease progression and guide treatment

Assessing small airway function remains methodologically challenging, and no consensus yet exists on which techniques provide the most clinically relevant information or how they best complement each other.

Oscillometry measures airway resistance and reactance at different frequencies during tidal breathing and has proven more sensitive than spirometry for detecting peripheral airway impairment.
Nitrogen washout evaluates ventilation heterogeneity and provides insights into small airway involvement.
Particle analysis in exhaled air (PExA) enables non-invasive assessment of local processes in the peripheral airways by measuring endogenous aerosol particles that reflect inflammation, barrier disruption, or tissue changes.
Airspace Dimension Assessment (AiDA), a nanoparticle-based technique, provides information on distal airspace dimensions and can detect early emphysema.
Fractional exhaled nitric oxide (FeNO) is used as a non-invasive biomarker of airway inflammation and is combined with other markers to identify patients at risk of disease progression.
Ergospirometry measures oxygen uptake and carbon dioxide production during exercise, enabling an integrated analysis of cardiac, pulmonary, and muscular function. It is applied in several clinical studies, including those evaluating prognosis in cystic fibrosis and congenital heart disease, as well as interventions in cystic fibrosis and COPD.

The group is engaged in major projects such as SCAPIS (Swedish CArdioPulmonary bioImage Study) and RHINESSA (Respiratory Health in Northern Europe, Spain and Australia), and leads multiple studies within these areas.

Cardiovascular Research

Our group also investigates structural and functional cardiovascular diagnostics, aiming to improve non-invasive characterization of heart and vascular disease.

Cardiac Imaging (Frank Flachskampf)

This research focuses on developing and validating imaging methods, specialized software, and physiological parameters using echocardiography, magnetic resonance imaging (MRI), and positron emission tomography (PET).

A central area of study is valvular heart disease, such as aortic and mitral regurgitation. Asymptomatic patients are examined with echocardiography at rest and during exercise, complemented by MRI and PET, to determine the optimal timing for surgical intervention.

Other research areas include cardiomyopathies and infiltrative conditions such as cardiac amyloidosis and carcinoid syndrome. Multimodality imaging is used to detect early signs of impaired function.

Epidemiological Clinical Physiology of Cardiovascular Disease (Pär Hedberg)

Pär Hedberg is Associate Professor of Clinical Physiology and Senior Consultant at Västmanland Hospital, Västerås, with more than 25 years of clinical experience. His research focuses on the epidemiology and diagnostics of cardiovascular diseases, with a particular emphasis on cardiac function.

He is one of the initiators and chairman of the SAVa study (Studies of Atherosclerosis in Västmanland), launched in 2005, which includes over 1,400 patients with cardiovascular disease and 850 controls. SAVa aims to identify novel risk markers and improve diagnostic tools for atherosclerotic disease in clinical practice.

Go to www.savastudy.se for more information.