1
|
Lord RN, Adams ZH, George K, Somauroo J, Jones H, Oxborough D. Exploratory assessment of right ventricular structure and function during prolonged endurance cycling exercise. Echo Res Pract 2023; 10:22. [PMID: 38115147 PMCID: PMC10731767 DOI: 10.1186/s44156-023-00035-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/17/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND A reduction in right ventricular (RV) function during recovery from prolonged endurance exercise has been documented alongside RV dilatation. A relative elevation in pulmonary artery pressure and therefore RV afterload during exercise has been implicated in this post-exercise dysfunction but has not yet been demonstrated. The current study aimed to assess RV structure and function and pulmonary artery pressure before, during and after a 6-h cycling exercise bout. METHODS Eight ultra-endurance athletes were recruited for this study. Participants were assessed prior to exercise supine and seated, during exercise at 2, 4 and 6 h whilst cycling seated at 75% maximum heart rate, and post-exercise in the supine position. Standard 2D, Doppler and speckle tracking echocardiography were used to determine indices of RV size, systolic and diastolic function. RESULTS Heart rate and RV functional parameters increased from baseline during exercise, however RV structural parameters and indices of RV systolic and diastolic function were unchanged between in-exercise assessment points. Neither pulmonary artery pressures (26 ± 9 mmHg vs 17 ± 10 mmHg, P > 0.05) nor RV wall stress (7.1 ± 3.0 vs 6.2 ± 2.4, P > 0.05) were significantly elevated during exercise. Despite this, post-exercise measurements revealed RV dilation (increased RVD1 and 3), and reduced RV global strain (- 21.2 ± 3.5 vs - 23.8 ± 2.3, P = 0.0168) and diastolic tissue velocity (13.8 ± 2.5 vs 17.1 ± 3.4, P = 0.019) vs pre-exercise values. CONCLUSION A 6 h cycling exercise bout at 75% maximum heart rate did not alter RV structure, systolic or diastolic function assessments during exercise. Pulmonary artery pressures are not elevated beyond normal limits and therefore RV afterload is unchanged throughout exercise. Despite this, there is some evidence of RV dilation and altered function in post-exercise measurements.
Collapse
Affiliation(s)
- Rachel N Lord
- Centre for Health Activity and Wellbeing Research, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK.
| | - Zoe H Adams
- Centre for Health Activity and Wellbeing Research, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool, UK
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool, UK
- Countess of Chester Hospital, NHS Trust, Chester, UK
| | - Helen Jones
- Research Institute for Sport and Exercise Sciences, Liverpool, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool, UK
| |
Collapse
|
2
|
Orlowska M, Bézy S, Ramalli A, Voigt JU, D'hooge J. High-Frame-Rate Speckle Tracking for Echocardiographic Stress Testing. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1644-1651. [PMID: 35637027 DOI: 10.1016/j.ultrasmedbio.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 01/21/2022] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
Stress echocardiography helps to diagnose cardiac diseases that cannot easily be detected or do not even manifest at rest. In clinical practice, assessment of the stress test is usually performed visually and, therefore, in a qualitative and subjective way. Although speckle tracking echocardiography (STE) has been proposed for the quantification of function during stress, its time resolution is inadequate at high heart rates. Recently, high-frame-rate (HFR) imaging approaches have been proposed together with dedicated STE algorithms capable of handling small interframe displacements. The aim of this study was to determine if HFR STE is effective in assessing strain and strain rate parameters during echocardiographic stress testing. Specifically, stress echocardiography, at four different workload intensities, was performed in 25 healthy volunteers. At each stress level, HFR images from the apical four-chamber view were recorded using the ULA-OP 256 experimental scanner. Then, the myocardium was tracked with HFR STE, and strain and strain rate biomarkers were extracted to further analyze systolic and diastolic (early and late) peaks, as well as a short-lived isovolumic relaxation peak during stress testing. The global systolic strain response was monophasic, revealing a significant (p < 0.001) increase at low stress but then reaching a plateau. In contrast, all strain rate indices linearly increased (p < 0.001) with increasing stress level. These findings are in line with those reported using tissue Doppler imaging and, thus, indicate that HFR STE can be a useful tool in assessing cardiac function during stress echocardiography.
Collapse
Affiliation(s)
- Marta Orlowska
- Laboratory of Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Stéphanie Bézy
- Laboratory of Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Alessandro Ramalli
- Department of Information Engineering, University of Florence, Florence, Italy
| | - Jens-Uwe Voigt
- Laboratory of Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jan D'hooge
- Laboratory of Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| |
Collapse
|
3
|
Long TM, Lee F, Lam K, Wallman KE, Walwyn TS, Choong CS, Naylor LH. Cardiovascular Testing Detects Underlying Dysfunction in Childhood Leukemia Survivors. Med Sci Sports Exerc 2019; 52:525-534. [PMID: 31652239 DOI: 10.1249/mss.0000000000002168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Childhood leukemia survivors commonly develop late-onset cardiovascular disease after treatment with anthracyclines. Resting echocardiogram is the standard procedure for monitoring cardiac health but this method may not be sensitive enough to detect subclinical injury. Exercise echocardiography may provide a viable alternative. METHODS Nineteen (9 males; age, 19 ± 3 yr) anthracycline-treated survivors of childhood leukemia and 17 (8 males) healthy individuals of similar age (22 ± 2 yr) were recruited. All survivors had normal resting echocardiography upon recruitment. Exercise echocardiography was performed using contemporary imaging techniques. Flow-mediated dilation (FMD), body composition, and cardiorespiratory fitness (V˙O2peak) were assessed to determine predisposition to additional disease. RESULTS Mitral valve peak flow velocity in late diastole (interaction, P = 0.007) increased from rest in survivors (P = 0.023) and controls (P = 0.020) immediately postexercise but did not recover again in the survivors (exercise-recovery, P = 0.784) after recuperation. Consequently, E/A ratio (interaction, P < 0.001) was lower in the survivors at recovery (P < 0.001). Survivors had reduced FMD (7.88 ± 1.70 vs 9.65 ± 2.83; P = 0.030), maximal and recovery HR (P = 0.001; P < 0.001), minute ventilation (P < 0.001), and V˙O2peak (absolute, 2.64 ± 0.62 vs 3.14 ± 0.74 L·min, P = 0.034; relative, 36.78 ± 11.49 vs 45.14 ± 6.80 mL·kg·min; P = 0.013) compared with controls. They also had higher total body fat (percentage, P = 0.034; mass, P = 0.024) and fat mass in the central (P = 0.050), peripheral (P = 0.039) and visceral (P < 0.001) regions. Survivors matched controls with regard to height (173.0 ± 7.8 cm vs 173.8 ± 9.1 cm; P = 0.796), body mass (76.16 ± 19.05 kg vs 70.07 ± 13.96 kg; P = 0.287) and body mass index (25.2 ± 5.1 vs 22.9 ± 2.7; P = 0.109). CONCLUSIONS Exercise echocardiography unmasked subclinical diastolic dysfunction that may indicate late anthracycline toxicity in apparently healthy survivors of childhood leukemia. Presence of secondary risk factors indicates increased predisposition to comorbidities and highlights the importance of assessing cardiovascular health during follow-up.
Collapse
Affiliation(s)
- Treya M Long
- School of Human Sciences: Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, AUSTRALIA
| | - Felicity Lee
- Advanced Heart Failure Unit and Cardiac Transplant Service of Western Australia, Fiona Stanley Hospital, Murdoch, Western Australia, AUSTRALIA
| | - Kaitlyn Lam
- Advanced Heart Failure Unit and Cardiac Transplant Service of Western Australia, Fiona Stanley Hospital, Murdoch, Western Australia, AUSTRALIA
| | - Karen E Wallman
- School of Human Sciences: Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, AUSTRALIA
| | | | | | - Louise H Naylor
- School of Human Sciences: Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, AUSTRALIA
| |
Collapse
|
4
|
Hasan BS, Lunze FI, Alvi N, Shafer KM, Rhodes J. Feasibility of exercise stress echocardiography and myocardial response in patients with repaired congenital heart disease. Am Heart J 2017; 188:1-10. [PMID: 28577664 DOI: 10.1016/j.ahj.2017.02.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/18/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Exercise stress echocardiography (ESE) can unmask ventricular dysfunction in asymptomatic patients with congenital heart disease (CHD), but its acquisition and interpretation is often challenging, and the method has not been validated in CHD. This study aimed to evaluate the feasibility of ESE using Doppler imaging and to assess myocardial response to exercise in patients with biventricular (BiV) and univentricular (UniV) circulation after CHD repair. METHODS In this single-center prospective study, we recruited 55 participants (17 females), median age 14 years (8-22 years). Our analysis categorized participants in these three groups: with structurally normal hearts as controls (n=21), with BiV circulation (n=20) and with UniV circulation (n=14). We acquired ESE images of the systemic ventricle including pulsed-wave flow and spectral tissue Doppler imaging (TDI) of lateral free wall before and immediately after standard, symptom-limited exercise tests on an electronically braked cycle ergometer. RESULTS During ESE we obtained inflow E-wave and TDI systolic (S') and early diastolic (E') velocities in 93% to 100% of participants at rest and in 90% to 100% of participants post exercise. Feasibility to obtain Doppler imaging parameter was the same across study groups. The myocardial response to exercise was increase in heart rate (HR), S' and inflow E-wave velocity in all participants. Patients with BiV circulation had preserved ventricular function at rest. While patients with UniV circulation had low S', E', and E-wave velocities at rest in comparison to controls and to BiV group (all P<.001), both patients with BiV and UniV circulation showed significant increases in HR, S' velocity and inflow E-wave velocity post exercise, with magnitudes of these increases higher in controls than in the BiV and UniV group. The S' and E' velocities were strongly associated with lower percent predicted peak oxygen consumption VO2 (rs=0.614 and rs=0.64, respectively, both P<.001). CONCLUSION ESE with Doppler imaging is a practical noninvasive diagnostic method and sufficiently robust for the assessment of morphologic LV/systemic ventricles under exercise in patients after biventricular and univentricular CHD repair. Although patients with BiV and UniV circulation had both preserved myocardial response to exercise, the magnitude of this response was the lowest in patients with UniV circulation.
Collapse
Affiliation(s)
- Babar S Hasan
- Department of Pediatrics and Child Health, Aga Khan Medical University, Pakistan.
| | - Fatima I Lunze
- Department of Cardiology Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Najveen Alvi
- Department of Pediatrics and Child Health, Aga Khan Medical University, Pakistan
| | - Keri M Shafer
- Department of Cardiology Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jonathan Rhodes
- Department of Cardiology Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
5
|
Cifra B, Mertens L, Mirkhani M, Slorach C, Hui W, Manlhiot C, Friedberg MK, Dragulescu A. Systolic and Diastolic Myocardial Response to Exercise in a Healthy Pediatric Cohort. J Am Soc Echocardiogr 2016; 29:648-54. [DOI: 10.1016/j.echo.2016.02.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Indexed: 10/22/2022]
|
6
|
Assessment of Speckle-Tracking Echocardiography-Derived Global Deformation Parameters During Supine Exercise in Children. Pediatr Cardiol 2016; 37:519-27. [PMID: 26671508 DOI: 10.1007/s00246-015-1309-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
Abstract
Exercise echocardiography is an underutilized tool in pediatrics with current applications including detecting segmental wall abnormalities, assessing the utility of global ventricular function, and measuring pulmonary hemodynamics. No prior study has applied speckle-tracking echocardiography (STE) during exercise echocardiography in children. The aim of this study was to determine the feasibility of measuring speckle-tracking-derived peak systolic velocities, global longitudinal and circumferential strain, and global strain rates at various phases of exercise. Ninety-seven healthy children underwent cardiopulmonary exercise testing using supine cycle ergometry. The exercise stress test consisted of baseline pulmonary function testing, monitoring of blood pressure and heart rate responses, electrocardiographic recordings, and oxygen saturations while subjects pedaled against a ramp protocol based on body weight. Echocardiographic measurements and specifically speckle-tracking analysis were performed during exercise at baseline, at a heart rate of 160 beats per minute and at 10 min after exercise. Peak systolic velocity, peak systolic strain, and peak systolic strain rate at these three phases were compared in the subjects in which all measurements were accurately obtained. We were able to complete peak velocity, strain, and strain rate measurements in all three exercise phases for 36 out of the 97 subjects tested. There was no significant difference between the feasibility of measuring circumferential versus longitudinal strain (p = 0.25, B-corrected = 0.75). In the 36 subjects studied, the magnitude of circumferential strain values decreased from -18.3 ± 4.8 to -13.7 ± 4.0 % from baseline to HR 160 (p < 0.0001, B-corrected < 0.0001), before returning to -19.6 ± 4.4 % at recovery (p = 0.19 when compared to baseline). Longitudinal strain did not vary significantly from baseline to HR 160 (from -17.7 ± 4.4 to -16.6 ± 4.4 %, p = 0.16); likewise the average recovery strain was no different from those values (-18.4 ± 3.6 %; p = 0.34). Peak circumferential and longitudinal strain rates increased from baseline to HR 160, but neither decreased to baseline levels after 10 min of recovery, which correlated with heart rate variations with exercise. We studied the effects of frame rate on deformation measurements and we observed no difference between measurements taken at lower (<60 frames per second, fps) and higher (≥60 fps) frame rates. This study shows that it is technically difficult to retrospectively measure peak velocities, strain, and strain rate in exercising pediatric subjects with STE. The majority of subjects that were excluded from the study had inadequate echocardiographic images when tachycardic from increased respiratory effort and body movements near peak exercise. Improvements in technique and higher image frame rates could make application of STE to pediatric cardiopulmonary testing more successful in the future.
Collapse
|
7
|
Sahin V, Uyar IS, Gul I, Akpinar MB, Abacilar AF, Uc H, Okur FF, Tavli T, Ates M, Alayunt EA. Evaluation of myocardial contractility determination with tissue tracking echocardiography after levosimendan infusion in patients with poor left ventricular function and hemodynamics. Heart Surg Forum 2015; 17:E313-8. [PMID: 25586282 DOI: 10.1532/hsf98.2014415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to assess the effect of conventional inotropic drugs compared to levosimendan using tissue tracking echocardiography in the early postoperative period for patients with low ejection fraction undergoing coronary artery bypass graft (CABG) surgery. METHODS We prospectively analyzed 115 patients (69 male, 46 female) who planned for elective coronary artery bypass surgery with low ejection fraction, ≤% 30, from September 2012 to December 2013. Patients were divided into two groups. Levosimendan was used at a loading dose of 15 μg/kg/min for the first twenty minutes, and continued at a maintenance dose of 0.2 μg/kg/min six hours before the anesthetic induction in group I (n = 47, 23 male, mean age 67.16 ± 4.72 years). Dopamine at 10 μg/kg/min and/or dobutamine at 10 μg/kg/min were used at the time of weaning from cardiopulmonary bypass in group II (n = 68, 47 male, mean age 65.43 ± 6.12 years). The patients were evaluated preoperatively and on the fifth postoperative day by transthoracic echocardiography. Patients were also evaluated just before the cardiopulmonary bypass and at the 12th and 24th hours on the first postoperative day by transesophageal echocardiography. Student t test and χ2 test were used for statistical analyses. RESULTS There were no significant differences in demographics and preoperative hemodynamic parameters between groups I and II. Hemodynamic and echocardiographic parameters were significantly better in group I receiving levosimendan, compared to group II. CONCLUSION Levosimendan enhances functional myocardial tissue mass and ensures positive hemodynamic effect in the early postoperative period in patients with low ejection fraction undergoing elective CABG.
Collapse
Affiliation(s)
- Veysel Sahin
- Division of Cardiac Surgery, Sifa University Medical Faculty, Izmir, Turkey
| | - Ihsan Sami Uyar
- Division of Cardiac Surgery, Sifa University Medical Faculty, Izmir, Turkey
| | - Ilker Gul
- Division of Cardiology, Sifa University Medical Faculty, Izmir, Turkey
| | | | | | - Halil Uc
- Division of Cardiac Surgery, Sifa University Medical Faculty, Izmir, Turkey
| | - Faik Fevzi Okur
- Division of Cardiac Surgery, Sifa University Medical Faculty, Izmir, Turkey
| | - Talat Tavli
- Division of Cardiology, Sifa University Medical Faculty, Izmir, Turkey
| | - Mehmet Ates
- Division of Cardiac Surgery, Sifa University Medical Faculty, Izmir, Turkey
| | - Emin Alp Alayunt
- Division of Cardiac Surgery, Sifa University Medical Faculty, Izmir, Turkey
| |
Collapse
|
8
|
Lord RN, George K, Jones H, Somauroo J, Oxborough D. Reproducibility and feasibility of right ventricular strain and strain rate (SR) as determined by myocardial speckle tracking during high-intensity upright exercise: a comparison with tissue Doppler-derived strain and SR in healthy human hearts. Echo Res Pract 2014; 1:31-41. [PMID: 26693290 PMCID: PMC4676466 DOI: 10.1530/erp-14-0011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/16/2014] [Accepted: 07/28/2014] [Indexed: 11/08/2022] Open
Abstract
This study aimed to establish feasibility for myocardial speckle tracking (MST) and intra-observer reliability of both MST and tissue velocity imaging (TVI)-derived right ventricular (RV) strain (ϵ) and strain rate (SR) at rest and during upright incremental exercise. RV ϵ and SR were derived using both techniques in 19 healthy male participants. MST-derived ϵ and SR were feasible at rest (85% of segments tracked appropriately). Feasibility reduced significantly with progressive exercise intensity (3% of segments tracking appropriately at 90% maximum heart rate (HRmax)). Coefficient of variations (CoVs) of global ϵ values at rest was acceptable for both TVI and MST (7-12%), with low bias and narrow limits of agreement. Global SR data were less reliable for MST compared with TVI as demonstrated with CoV data (systolic SR=15 and 61%, early diastolic SR=16 and 17% and late diastolic SR=26 and 31% respectively). CoVs of global RV ϵ and SR obtained at 50% HRmax were acceptable using both techniques. As exercise intensity increased to 70 and 90% HRmax, reliability of ϵ and SR values reduced with larger variability in MST. We conclude that RV global and regional ϵ and SR data are feasible, comparable and reliable at rest and at 50% HRmax using both MST and TVI. Reliability was reduced during higher exercise intensities with only TVI acceptable for clinical and scientific use.
Collapse
Affiliation(s)
- Rachel N Lord
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University , Tom Reilly Building, Byrom Street, Liverpool, L3 3AF , UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University , Tom Reilly Building, Byrom Street, Liverpool, L3 3AF , UK
| | - Helen Jones
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University , Tom Reilly Building, Byrom Street, Liverpool, L3 3AF , UK
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University , Tom Reilly Building, Byrom Street, Liverpool, L3 3AF , UK ; Countess of Chester Hospital, NHS Trust , Chester , UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University , Tom Reilly Building, Byrom Street, Liverpool, L3 3AF , UK
| |
Collapse
|
9
|
Lemmer Hunsinger CE, Engel ME, Stanfliet JC, Mayosi BM. Reference intervals for the echocardiographic measurements of the right heart in children and adolescents: a systematic review. Cardiovasc Ultrasound 2014; 12:3. [PMID: 24476413 PMCID: PMC3922696 DOI: 10.1186/1476-7120-12-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/14/2014] [Indexed: 01/12/2023] Open
Abstract
Background Transthoracic echocardiography is the primary imaging modality for the diagnosis of right ventricular (RV) involvement in congenital and acquired heart diseases. There is increasing recognition of the contribution of RV dysfunction in heart diseases affecting children and adolescents, but there is insufficient information on reference intervals for the echocardiographic measurements of the right heart in children and adolescents that represent all the continental populations of the world. Objective The aim of this systematic review was to collate, from published studies, normative data for echocardiographic evaluation of the right heart in children and adolescents, and to identify gaps in knowledge in this field especially with respect to sub-Saharan Africans. Methods We performed a systematic literature search to identify studies of reference intervals for right heart measurements as determined by transthoracic echocardiography in healthy children and adolescents of school-going age. Articles were retrieved from electronic databases with a combination of search terms from the earliest date available until May 2013. Results Reference data were available for a broad range of variables. Fifty one studies out of 3096 publications were included. The sample sizes of the reference populations ranged from 13 to 2036 with ages varying from 5 to 21 years. We identified areas lacking sufficient reference data. These included reference data for determining right atrial size, tricuspid valve area, RV dimensions and areas, the RV % fractional area change, pulmonary artery pressure gradients and the right-sided haemodynamics, including the inferior vena cava dimensions and collapsibility. There were no data for sub-Saharan African children and adolescents. Conclusion Reliable reference data are lacking for important echocardiographic measurements of the RV in children and adolescents, especially for sub-Saharan Africans.
Collapse
Affiliation(s)
- Carolina E Lemmer Hunsinger
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Observatory, Cape Town, South Africa.
| | | | | | | |
Collapse
|
10
|
Muller MD, Mast JL, Patel H, Sinoway LI. Cardiac mechanics are impaired during fatiguing exercise and cold pressor test in healthy older adults. J Appl Physiol (1985) 2013; 114:186-94. [PMID: 23154996 PMCID: PMC3544501 DOI: 10.1152/japplphysiol.01165.2012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 11/12/2012] [Indexed: 01/06/2023] Open
Abstract
We sought to determine how the aging left ventricle (LV) responds to sympathetic nervous system (SNS) activation. Three separate echocardiographic experiments were conducted in 11 healthy young (26 ± 1 yr) and 11 healthy older (64 ± 1 yr) adults. Tissue Doppler imaging was used to measure systolic myocardial velocity (S(m)), early diastolic myocardial velocity (E(m)), and late diastolic myocardial velocity (A(m)) during isometric fatiguing handgrip (IFHG), a 2-min cold pressor test (CPT), and 5 min of normobaric hypoxia. Heart rate (HR) and mean arterial pressure (MAP) were also monitored on a beat-by-beat basis; rate pressure product (RPP) was used as an index of myocardial oxygen demand. At peak IFHG, the groups had similar increases in RPP, but the ΔS(m) was significantly greater (i.e., larger impairment) in the older subjects (-0.82 ± 0.13 cm/s) compared with the young subjects (0.37 ± 0.30 cm/s). At peak IFHG, the ΔE(m) was similar between older (-1.59 ± 0.68 cm/s) and young subjects (-1.06 ± 0.76 cm/s). In response to the CPT, both S(m) and E(m) were reduced in the older adults but did not change relative to baseline in the young subjects. Normobaric hypoxia elevated HR and RPP in both groups but did not alter Tissue Doppler parameters. These data indicate that S(m) and E(m) are reduced in healthy older adults during IFHG and CPT. We speculate that suboptimal LV adaptations to SNS stress may partly explain why acute heavy exertion can trigger myocardial ischemia.
Collapse
Affiliation(s)
- Matthew D Muller
- Pennsylvania State University College of Medicine, Penn State Hershey, Heart and Vascular Institute, Hershey, Pennsylania 17033, USA
| | | | | | | |
Collapse
|
11
|
Supine Exercise Echocardiographic Measures of Systolic and Diastolic Function in Children. J Am Soc Echocardiogr 2012; 25:773-81. [DOI: 10.1016/j.echo.2012.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Indexed: 10/28/2022]
|
12
|
Blank AC, Hakim S, Strengers JL, Tanke RB, van Veen TA, Vos MA, Takken T. Exercise capacity in children with isolated congenital complete atrioventricular block: does pacing make a difference? Pediatr Cardiol 2012; 33:576-85. [PMID: 22331055 PMCID: PMC3311981 DOI: 10.1007/s00246-012-0176-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 11/09/2011] [Indexed: 12/17/2022]
Abstract
The management of patients with isolated congenital complete atrioventricular block (CCAVB) has changed during the last decades. The current policy is to pace the majority of patients based on a variety of criteria, among which is limited exercise capacity. Data regarding exercise capacity in this population stems from previous publications reporting small case series of unpaced patients. Therefore, we have investigated the exercise capacity of a group of contemporary children with CCAVB. Sixteen children (mean age 11.5 ± 4; seven boys, nine girls) with CCAVB were tested. In 13 patients, a median number of three pacemakers were implanted, whereas in three patients no pacemaker was given. All patients had an echocardiogram and completed a cardiopulmonary cycle exercise test. Exercise parameters were determined and compared with reference values obtained from healthy Dutch peers. The peak oxygen uptake/body mass was reduced to 34.4 ± 9.5 ml kg(-1) min(-1) (79 ± 24% of predicted) and the ventilatory threshold was reduced to 52 ± 17% of peak oxygen uptake (78 ± 21% of predicted), whereas the peak work load/body mass was 2.8 ± 0.6 W/kg (91 ± 24% of predicted), which was similar to controls. Importantly, 25% of the paced patients showed upper rate restriction by the pacemaker. In conclusion, children with CCAVB show a reduced peak oxygen uptake and ventilatory threshold, whereas they show normal peak work rates. This indicates that they generate more energy during exercise from anaerobic energy sources. Paced children with CCAVB do not perform better than unpaced children.
Collapse
Affiliation(s)
- A Christian Blank
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
13
|
Muller MD, Gao Z, Mast JL, Blaha CA, Drew RC, Leuenberger UA, Sinoway LI. Aging attenuates the coronary blood flow response to cold air breathing and isometric handgrip in healthy humans. Am J Physiol Heart Circ Physiol 2012; 302:H1737-46. [PMID: 22345567 DOI: 10.1152/ajpheart.01195.2011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The purpose of this echocardiography study was to measure peak coronary blood flow velocity (CBV(peak)) and left ventricular function (via tissue Doppler imaging) during separate and combined bouts of cold air inhalation (-14 ± 3°C) and isometric handgrip (30% maximum voluntary contraction). Thirteen young adults and thirteen older adults volunteered to participate in this study and underwent echocardiographic examination in the left lateral position. Cold air inhalation was 5 min in duration, and isometric handgrip (grip protocol) was 2 min in duration; a combined stimulus (cold + grip protocol) and a cold pressor test (hand in 1°C water) were also performed. Heart rate, blood pressure, O(2) saturation, and inspired air temperature were monitored on a beat-by-beat basis. The rate-pressure product (RPP) was used as an index of myocardial O(2) demand, and CBV(peak) was used as an index of myocardial O(2) supply. The RPP response to the grip protocol was significantly blunted in older subjects (Δ1,964 ± 396 beats·min(-1)·mmHg) compared with young subjects (Δ3,898 ± 452 beats·min(-1)·mmHg), and the change in CBV(peak) was also blunted (Δ6.3 ± 1.2 vs. 11.2 ± 2.0 cm/s). Paired t-tests showed that older subjects had a greater change in the RPP during the cold + grip protocol [Δ2,697 ± 391 beats·min(-1)·mmHg compared with the grip protocol alone (Δ2,115 ± 375 beats·min(-1)·mmHg)]. An accentuated RPP response to the cold + grip protocol (compared with the grip protocol alone) without a concomitant increase in CBV(peak) may suggest a dissociation between the O(2) supply and demand in the coronary circulation. In conclusion, older adults have blunted coronary blood flow responses to isometric exercise.
Collapse
Affiliation(s)
- Matthew D Muller
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | | | | | | | | | | |
Collapse
|
14
|
Normal Parameters of Right Ventricular Mechanics With Exertion in Healthy Individuals: A Tissue Doppler Imaging Study. Am J Med Sci 2011; 341:23-7. [DOI: 10.1097/maj.0b013e3181f1fde3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Enhanced systolic myocardial function in elite endurance athletes during combined arm-and-leg exercise. Eur J Appl Physiol 2010; 111:905-13. [DOI: 10.1007/s00421-010-1712-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2010] [Indexed: 11/25/2022]
|
16
|
Dalen H, Thorstensen A, Vatten LJ, Aase SA, Stoylen A. Reference Values and Distribution of Conventional Echocardiographic Doppler Measures and Longitudinal Tissue Doppler Velocities in a Population Free From Cardiovascular Disease. Circ Cardiovasc Imaging 2010; 3:614-22. [DOI: 10.1161/circimaging.109.926022] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Havard Dalen
- From the Department of Circulation and Medical Imaging (H.D., A.T., S.A.A., A.S.) and Department of Public Health (L.J.V.), Norwegian University of Science and Technology, Trondheim, Norway; Department of Medicine (H.D.), Levanger Hospital, Nord-Trøndelag Health Trust, Nord-Trøndelag, Norway; and Department of Cardiology (A.S.), St Olavs Hospital/Trondheim University Hospital, Trondheim, Norway
| | - Anders Thorstensen
- From the Department of Circulation and Medical Imaging (H.D., A.T., S.A.A., A.S.) and Department of Public Health (L.J.V.), Norwegian University of Science and Technology, Trondheim, Norway; Department of Medicine (H.D.), Levanger Hospital, Nord-Trøndelag Health Trust, Nord-Trøndelag, Norway; and Department of Cardiology (A.S.), St Olavs Hospital/Trondheim University Hospital, Trondheim, Norway
| | - Lars J. Vatten
- From the Department of Circulation and Medical Imaging (H.D., A.T., S.A.A., A.S.) and Department of Public Health (L.J.V.), Norwegian University of Science and Technology, Trondheim, Norway; Department of Medicine (H.D.), Levanger Hospital, Nord-Trøndelag Health Trust, Nord-Trøndelag, Norway; and Department of Cardiology (A.S.), St Olavs Hospital/Trondheim University Hospital, Trondheim, Norway
| | - Svein A. Aase
- From the Department of Circulation and Medical Imaging (H.D., A.T., S.A.A., A.S.) and Department of Public Health (L.J.V.), Norwegian University of Science and Technology, Trondheim, Norway; Department of Medicine (H.D.), Levanger Hospital, Nord-Trøndelag Health Trust, Nord-Trøndelag, Norway; and Department of Cardiology (A.S.), St Olavs Hospital/Trondheim University Hospital, Trondheim, Norway
| | - Asbjorn Stoylen
- From the Department of Circulation and Medical Imaging (H.D., A.T., S.A.A., A.S.) and Department of Public Health (L.J.V.), Norwegian University of Science and Technology, Trondheim, Norway; Department of Medicine (H.D.), Levanger Hospital, Nord-Trøndelag Health Trust, Nord-Trøndelag, Norway; and Department of Cardiology (A.S.), St Olavs Hospital/Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
17
|
Shizukuda Y, Plummer SL, Harrelson A. Customized exercise echocardiography: beyond detection of coronary artery disease. Echocardiography 2010; 27:186-94. [PMID: 20380677 DOI: 10.1111/j.1540-8175.2009.01086.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Exercise echocardiography has been established as a reliable diagnostic tool for assessment of myocardial ischemia. However, more recent advances in its technique have expanded its routine clinical use to include quantification of exercise-induced diastolic dysfunction, exercise-induced pulmonary hypertension, and dynamic assessment of mitral and aortic valve function. The indications for exercise echocardiography have increased to include cardiac symptoms such as exertional dyspnea, fatigue, and limited exercise capacity. In light of its expanded capability for evaluating cardiovascular function, we believe that exercise echocardiography should be utilized in a new paradigm of personalized cardiology, in which we regularly investigate individual patient symptoms for endpoints beyond critical myocardial ischemia, for example, exercise-induced pulmonary hypertension. We refer to this refocused use of exercise echocardiography as "customized exercise echocardiography." In this review article, we present current scientific evidence to support our proposed role and discuss the logistical requirements for proper test performance of customized exercise echocardiography.
Collapse
Affiliation(s)
- Yukitaka Shizukuda
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio 45267, USA.
| | | | | |
Collapse
|
18
|
Argyle R, Ray S. Stress and strain: double trouble or useful tool? EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:716-22. [DOI: 10.1093/ejechocard/jep066] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
19
|
Bjällmark A, Larsson M, Shahgaldi K, Lind B, Winter R, Brodin LÅ. Differences in myocardial velocities during supine and upright exercise stress echocardiography in healthy adults. Clin Physiol Funct Imaging 2009; 29:216-23. [DOI: 10.1111/j.1475-097x.2009.00860.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
20
|
Pavlopoulos H, Nihoyannopoulos P. Strain and strain rate deformation parameters: from tissue Doppler to 2D speckle tracking. Int J Cardiovasc Imaging 2007; 24:479-91. [PMID: 18074240 DOI: 10.1007/s10554-007-9286-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Accepted: 11/22/2007] [Indexed: 01/19/2023]
Abstract
Strain and strain rate deformation parameters based on Color Doppler Myocardial Imaging, and more recently on two-dimensional (2D) gray scale images, have evolved as important methods for the quantification of myocardial function. Although these parameters are already applicable in the research field, their acquisition and analysis involve a number of technical challenges and complexities. Accurate knowledge of the basic principles of those techniques, as presented in this article, will further enhance their applicability to clinical practice.
Collapse
Affiliation(s)
- Harry Pavlopoulos
- Imperial College of Medicine and Technology, Echocardiography Department, National Heart and Lung Institute, Hammersmith Hospital, Du Cane Rd, W12 0HS London, UK.
| | | |
Collapse
|