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Kerstens TP, Donker SC, Kleinnibbelink G, van Dijk AP, Oxborough D, Thijssen DHJ. Left and right ventricular strain-volume/area loops: a narrative review of current physiological understanding and potential clinical value. Echo Res Pract 2024; 11:12. [PMID: 38769555 PMCID: PMC11106969 DOI: 10.1186/s44156-024-00046-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
Traditionally, echocardiography is used for volumetric measurements to aid in assessment of cardiac function. Multiple echocardiographic-based assessment techniques have been developed, such as Doppler ultrasound and deformation imaging (e.g., peak global longitudinal strain (GLS)), which have shown to be clinically relevant. Volumetric changes across the cardiac cycle can be related to deformation, resulting in the Ventricular Strain-Volume/Area Loop. These Loops allow assessment of the dynamic relationship between longitudinal strain change and volumetric change across both systole and diastole. This integrated approach to both systolic and diastolic function assessment may offer additional information in conjunction with traditional, static, measures of cardiac function or structure. The aim of this review is to summarize our current understanding of the Ventricular Strain-Volume/Area Loop, describe how acute and chronic exposure to hemodynamic stimuli alter Loop characteristics, and, finally, to outline the potential clinical value of these Loops in patients with cardiovascular disease. In summary, several studies observed Loop changes in different hemodynamic loading conditions and various (patho)physiological conditions. The diagnostic and prognostic value, and physiological interpretation remain largely unclear and have been addressed only to a limited extent.
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Affiliation(s)
- Thijs P Kerstens
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Stijn Cm Donker
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Medicine, Liverpool John Moores University, L3 5UX, Liverpool, United Kingdom
| | - Geert Kleinnibbelink
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands
| | - Arie Pj van Dijk
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands
| | - David Oxborough
- Research Institute for Sport and Exercise Medicine, Liverpool John Moores University, L3 5UX, Liverpool, United Kingdom
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Research Institute for Sport and Exercise Medicine, Liverpool John Moores University, L3 5UX, Liverpool, United Kingdom.
- Department of Medical BioSciences (928), Radboud University Medical Center, 6500HB, Nijmegen, P.O. Box 9101, The Netherlands.
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2
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Flanagan H, Cooper R, George KP, Augustine DX, Malhotra A, Paton MF, Robinson S, Oxborough D. The athlete's heart: insights from echocardiography. Echo Res Pract 2023; 10:15. [PMID: 37848973 PMCID: PMC10583359 DOI: 10.1186/s44156-023-00027-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/07/2023] [Indexed: 10/19/2023] Open
Abstract
The manifestations of the athlete's heart can create diagnostic challenges during an echocardiographic assessment. The classifications of the morphological and functional changes induced by sport participation are often beyond 'normal limits' making it imperative to identify any overlap between pathology and normal physiology. The phenotype of the athlete's heart is not exclusive to one chamber or function. Therefore, in this narrative review, we consider the effects of sporting discipline and training volume on the holistic athlete's heart, as well as demographic factors including ethnicity, body size, sex, and age.
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Affiliation(s)
- Harry Flanagan
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Robert Cooper
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Daniel X Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - Aneil Malhotra
- Institute of Sport, Manchester Metropolitan University and University of Manchester, Manchester, UK
| | - Maria F Paton
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.
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Gillebert TC. Strain-volume loops and cardiac function. Eur Heart J Cardiovasc Imaging 2023; 24:1177-1179. [PMID: 37282734 DOI: 10.1093/ehjci/jead129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Thierry C Gillebert
- Department of Cardiology, Ghent University and Ghent University Hospital, Ghent, Belgium
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4
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Kerstens TP, Weerts J, van Dijk APJ, Weijers G, Knackstedt C, Eijsvogels TMH, Oxborough D, van Empel VPM, Thijssen DHJ. Association of left ventricular strain-volume loop characteristics with adverse events in patients with heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2023; 24:1168-1176. [PMID: 37259911 PMCID: PMC10445262 DOI: 10.1093/ehjci/jead117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/24/2023] [Accepted: 05/15/2023] [Indexed: 06/02/2023] Open
Abstract
AIMS Patients with heart failure with preserved ejection fraction (HFpEF) are characterized by impaired diastolic function. Left ventricular (LV) strain-volume loops (SVL) represent the relation between strain and volume during the cardiac cycle and provide insight into systolic and diastolic function characteristics. In this study, we examined the association of SVL parameters and adverse events in HFpEF. METHODS AND RESULTS In 235 patients diagnosed with HFpEF, LV-SVL were constructed based on echocardiography images. The endpoint was a composite of all-cause mortality and Heart Failure (HF)-related hospitalization, which was extracted from electronic medical records. Cox-regression analysis was used to assess the association of SVL parameters and the composite endpoint, while adjusting for age, sex, and NYHA class. HFpEF patients (72.3% female) were 75.8 ± 6.9 years old, had a BMI of 29.9 ± 5.4 kg/m2, and a left ventricular ejection fraction of 60.3 ± 7.0%. Across 2.9 years (1.8-4.1) of follow-up, 73 Patients (31%) experienced an event. Early diastolic slope was significantly associated with adverse events [second quartile vs. first quartile: adjusted hazards ratio (HR) 0.42 (95%CI 0.20-0.88)] after adjusting for age, sex, and NYHA class. The association between LV peak strain and adverse events disappeared upon correction for potential confounders [adjusted HR 1.02 (95% CI 0.96-1.08)]. CONCLUSION Early diastolic slope, representing the relationship between changes in LV volume and strain during early diastole, but not other SVL-parameters, was associated with adverse events in patients with HFpEF during 2.9 years of follow-up.
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Affiliation(s)
- Thijs P Kerstens
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Jerremy Weerts
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, The Netherlands
| | - Arie P J van Dijk
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Gert Weijers
- Medical UltraSound Imaging Center (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Christian Knackstedt
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, UK
| | - Vanessa P M van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, The Netherlands
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, UK
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Sun X, Li L, Sun M, Hou S, Li Z, Li P, Liu M, Hua S. Evaluation of Left Ventricular Systolic Function Using Layer-Specific Strain in Rats Performing Endurance Exercise: A Pilot Study. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1395-1400. [PMID: 36878830 DOI: 10.1016/j.ultrasmedbio.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/30/2022] [Accepted: 01/20/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The functional characteristics of exercise-induced myocardial hypertrophy were studied in a rat model in conjunction with ultrasound layered strain technique to investigate the hidden changes in the heart brought about by exercise. METHODS Forty specific pathogen free (SPF) adult Sprague-Dawley rats were selected and randomly divided into two groups of 20 exercise and 20 control rats. The longitudinal and circumferential strain parameters were measured using the ultrasonic stratified strain technique. The differences between the two groups and the predictive effect of stratified strain parameters on left ventricular systolic function were analyzed. RESULTS The exercise group had significantly higher global endocardial myocardial longitudinal strain (GLSendo), global mid-myocardial global longitudinal strain (GLSmid) and global endocardial myocardial global longitudinal strain (GCSendo) values than the control group (p < 0.05). Even though global mid-myocardial circumferential strain (GCSmid) and global epicardial myocardial circumferential strain (GCSepi) were higher in the exercise group than in the control group, statistical significance was not reached (p > 0.05). Conventional echocardiography parameters were well correlated with GLSendo, GLSmid, and GCSendo (p < 0.05). GLSendo was the best predictor of left ventricular myocardial contractile performance in athletes determined using the receiver operating characteristic curve, with an area under the curve of 0.97, sensitivity of 95% and specificity of 90%. CONCLUSION Rats performing endurance exercise exhibited subclinical changes in the heart after prolonged high-intensity exercise. A stratified strain parameter, GLSendo, played an important role in the evaluation of LV systolic performance in exercising rats.
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Affiliation(s)
- Xinxin Sun
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lijin Li
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Mengjiao Sun
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - SuYun Hou
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhen Li
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Pengge Li
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Mengmeng Liu
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shaohua Hua
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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6
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Kerstens TP, Weerts J, van Dijk APJ, Weijers G, Knackstedt C, Eijsvogels TMH, Oxborough D, van Empel VPM, Thijssen DHJ. Left ventricular strain-volume loops and diastolic dysfunction in suspected heart failure with preserved ejection fraction. Int J Cardiol 2023; 378:144-150. [PMID: 36796492 DOI: 10.1016/j.ijcard.2023.01.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Presence of left ventricular diastolic dysfunction (DD) is key in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). However, non-invasive assessment of diastolic function is complex, cumbersome, and largely based on consensus recommendations. Novel imaging techniques may help detecting DD. Therefore, we compared left ventricular strain-volume loop (SVL) characteristics and diastolic (dys-)function in suspected HFpEF patients. METHOD AND RESULTS 257 suspected HFpEF patients with sinus rhythm during echocardiography were prospectively included. 211 patients with quality-controlled images and strain and volume analysis were classified according to the 2016 ASE/EACVI recommendations. Patients with indeterminate diastolic function were excluded, resulting in two groups: normal diastolic function (control; n = 65) and DD (n = 91). Patients with DD were older (74.8 ± 6.9 vs. 68.5 ± 9.4 years, p < 0.001), more often female (88% vs 72%, p = 0.021), and more often had a history of atrial fibrillation (42% vs. 23%, p = 0.024) and hypertension (91% vs. 71%, p = 0.001) compared to normal diastolic function. SVL analysis showed a larger uncoupling i.e., a different longitudinal strain contribution to volume change, in DD compared to controls (0.556 ± 1.10% vs. -0.051 ± 1.14%, respectively, P < 0.001). This observation suggests different deformational properties during the cardiac cycle. After adjustment for age, sex, history of atrial fibrillation and hypertension, we found an adjusted odds ratio of 1.68 (95% confidence interval 1.19-2.47) for DD per unit increase in uncoupling (range: -2.95-3.20). CONCLUSION Uncoupling of the SVL is independently associated with DD. This might provide novel insights in cardiac mechanics and new opportunities to assess diastolic function non-invasively.
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Affiliation(s)
- Thijs P Kerstens
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands; Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Jerremy Weerts
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, the Netherlands
| | - Arie P J van Dijk
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Gert Weijers
- Medical UltraSound Imaging Center (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - C Knackstedt
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, the Netherlands
| | - Thijs M H Eijsvogels
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, United Kingdom
| | - Vanessa P M van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, the Netherlands
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, United Kingdom.
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7
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Keller M, Puhlmann AS, Heller T, Rosenberger P, Magunia H. Right ventricular volume-strain loops using 3D echocardiography-derived mesh models: proof-of-concept application on patients undergoing different types of open-heart surgery. Quant Imaging Med Surg 2022; 12:3679-3691. [PMID: 35782265 PMCID: PMC9246735 DOI: 10.21037/qims-21-1204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/28/2022] [Indexed: 09/18/2023]
Abstract
BACKGROUND Right ventricular (RV) function can be quantified by right heart catheterization-derived pressure-volume loops. While this technique is invasive, echocardiography-based volume-strain loops (VSLs) potentially reflect a non-invasive alternative. In this study, an approach to generate VSLs from volume and multidimensional strain data of 3D echocardiography-derived RV mesh models is evaluated with regard to feasibility and reproducibility. METHODS In a retrospective cohort study design, 3D intraoperative transesophageal echocardiograms of twenty-three patients undergoing aortic valve surgery (AVS) and eighteen patients undergoing off-pump coronary artery bypass (OPCAB) grafting were available prior to sternotomy and after sternal closure. RV meshes were generated using 3D speckle-tracking. Custom-made software quantified the meshes' volumes, global longitudinal (RV-GLS) and global circumferential strain (RV-GCS) for VSL generation. Linear regression of systolic VSLs yielded slopes, intercepts and systolic areas. Polynomial regression of two orders was used to analyze systolic-diastolic coupling at 10% increments of the RV end-diastolic volume (RVEDV). Reproducibility was analyzed by fourfold double-measurements of four datasets. RESULTS VSL calculation was feasible from all included 3D datasets. RV-GLS remained unaltered, but RV-GCS worsened in AVS [abs. diff. (∆) 3.9%, P<0.01] and OPCAB patients (∆4.5%, P<0.001). While RV-GCS systolic areas were markedly reduced at the end of AVS (∆268mL%, P<0.01) and OPCAB (∆185mL%, P<0.001), RV-GCS slopes did not change. Systolic-diastolic uncoupling was not observed, but in trend, decreased diastolic RV-GCS after AVS (P=0.06) and increased diastolic RV-GCS after OPCAB (P=0.06) were observed. Intraclass correlation coefficients (0.84-0.98) and coefficients of variation (6.4-11.8%) indicated good reproducibility. CONCLUSIONS RV VSL generation using 3D echocardiography-derived mesh models is feasible. Longitudinal and circumferential strain vectors yield intrinsically different VSL indices. In future investigations, VSLs of multidimensional strains could provide further insight into periprocedural changes of RV mechanics.
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Affiliation(s)
| | - Ann-Sophie Puhlmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University, Tuebingen, Germany
| | - Tim Heller
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University, Tuebingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University, Tuebingen, Germany
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Kleinnibbelink G, Panhuyzen-Goedkoop N, Hulshof H, van Dijk A, George K, Somauroo J, Oxborough D, Thijssen DHJ. Exercise Training Induces Left- but not Right-sided Cardiac Remodelling in Olympic Rowers. Int J Sports Med 2021; 43:151-160. [PMID: 34375989 DOI: 10.1055/a-1524-2611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Whilst the athlete's heart has been extensively described, less work has focused on the potential for elite athletes to demonstrate further cardiac remodelling upon an increase in training volume. Moreover, little work explored potential side-specific cardiac remodelling. Therefore, we examined the impact of an increase in training volume across 9-months in elite rowers on left- and right-sided cardiac structure, function and mechanics (i. e. longitudinal, radial and circumferential strain, twist and strain-volume loops). As part of the preparations to the 2012 Olympic Games, twenty-seven elite rowers (26.4±3.7years, 19 male) underwent echocardiography prior to and post (9 months) an increase in training volume (24 to 30-35 h weekly). Training increased left ventricular structure, including wall thickness, diameter, volume, mass and LV twist (all p<0.05). Female rowers demonstrated larger adaptation in left ventricular diameter and mass compared to male rowers (both p<0.05). No changes were observed in other measures of left ventricular function in both sexes (all p>0.05). The 9-month intervention showed no change in right ventricular/atrial structure, function or mechanics (all p>0.05). In conclusion, our data revealed that 9-month increased training volume in elite rowers induced left-sided (but not right-sided) structural remodelling, concomitant with an increase in left ventricular twist, with some changes larger in women.
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Affiliation(s)
- Geert Kleinnibbelink
- Department of Physiology, Research Insitute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Nicole Panhuyzen-Goedkoop
- Department of Cardiology, Amsterdam University Medical Centres, AMC Amsterdam, Amsterdam, Netherlands.,Sports Cardiology, Sports Medical Centre Papendal, Arnhem, Netherlands
| | - Hugo Hulshof
- Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Arie van Dijk
- Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Dick H J Thijssen
- Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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9
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Hulshof HG, van Dijk AP, Hopman MTE, Heesakkers H, George KP, Oxborough DL, Thijssen DHJ. 5-Year prognostic value of the right ventricular strain-area loop in patients with pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2021; 22:188-195. [PMID: 32632438 PMCID: PMC7822639 DOI: 10.1093/ehjci/jeaa143] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/25/2019] [Accepted: 05/04/2020] [Indexed: 01/26/2023] Open
Abstract
Aims Patients with pre-capillary pulmonary hypertension (PH) show poor survival, often related to right ventricular (RV) dysfunction. In this study, we assessed the 5-year prognostic value of a novel echocardiographic measure that examines RV function through the temporal relation between RV strain (ϵ) and area (i.e. RV ϵ-area loop) for all-cause mortality in PH patients. Methods and results Echocardiographic assessments were performed in 143 PH patients (confirmed by right heart catheterization). Transthoracic echocardiography was utilized to assess RV ϵ-area loop. Using receiver operating characteristic curve-derived cut-off values, we stratified patients in low- vs. high-risk groups for all-cause mortality. Kaplan–Meier survival curves and uni-/multivariable cox-regression models were used to assess RV ϵ-area loop’s prognostic value (independent of established predictors: age, sex, N-terminal pro B-type natriuretic peptide, 6-min walking distance). During follow-up 45 (31%) patients died, who demonstrated lower systolic slope, peak ϵ, and late diastolic slope (all P < 0.05) at baseline. Univariate cox-regression analyses identified early systolic slope, systolic slope, peak ϵ, early diastolic uncoupling, and early/late diastolic slope to predict all-cause mortality (all P < 0.05), whilst peak ϵ possessed independent prognostic value (P < 0.05). High RV loop-score (i.e. based on number of abnormal characteristics) showed poorer survival compared to low RV loop-score (Kaplan–Meier: P < 0.01). RV loop-score improved risk stratification in high-risk patients when added to established predictors. Conclusion Our data demonstrate the potential for RV ϵ-area loops to independently predict all-cause mortality in patients with pre-capillary PH. The non-invasive nature and simplicity of measuring the RV ϵ-area loop, support the potential clinical relevance of (repeated) echocardiography assessment of PH patients.
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Affiliation(s)
- Hugo G Hulshof
- Department of Physiology, Research Institute for Health Sciences, Radboud University Medical Center, Philips van Leijdenlaan 15, 6525 EX Nijmegen, The Netherlands
| | - Arie P van Dijk
- Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10 6525 GA Nijmegen, The Netherlands
| | - Maria T E Hopman
- Department of Physiology, Research Institute for Health Sciences, Radboud University Medical Center, Philips van Leijdenlaan 15, 6525 EX Nijmegen, The Netherlands
| | - Hidde Heesakkers
- Department of Physiology, Research Institute for Health Sciences, Radboud University Medical Center, Philips van Leijdenlaan 15, 6525 EX Nijmegen, The Netherlands
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom Street, L3 3AF Liverpool, UK
| | - David L Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom Street, L3 3AF Liverpool, UK
| | - Dick H J Thijssen
- Department of Physiology, Research Institute for Health Sciences, Radboud University Medical Center, Philips van Leijdenlaan 15, 6525 EX Nijmegen, The Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom Street, L3 3AF Liverpool, UK
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10
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Kleinnibbelink G, van Dijk APJ, Fornasiero A, Speretta GF, Johnson C, Sculthorpe N, George KP, Somauroo JD, Thijssen DHJ, Oxborough DL. Acute exercise-induced changes in cardiac function relates to right ventricular remodeling following 12-wk hypoxic exercise training. J Appl Physiol (1985) 2021; 131:511-519. [PMID: 34110231 DOI: 10.1152/japplphysiol.01075.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Repeated ventricular exposure to alterations in workload may relate to subsequent cardiac remodeling. We examined whether baseline acute changes in right (RV) and left ventricular (LV) function relate to chronic cardiac adaptation to 12-wk exercise training. Twenty-one healthy individuals performed 12-wk high-intensity endurance running training under hypoxia (fraction of inspired oxygen: 14.5%). Resting transthoracic echocardiography was performed before and after the training program to assess ventricular structure, function, and mechanics (including strain-area/volume loops). In addition, we examined systolic cardiac function during recumbent exercise under hypoxia at baseline (heart rate of 110-120 beats/min, "stress echocardiography"). Fifteen individuals completed training (22.0 ± 2.4 yr, 10 males). Hypoxic exercise training increased RV size, including diameter and area (all P < 0.05). With exception of an increase in RV fractional area change (P = 0.03), RV function did not change post-training (all P > 0.05). Regarding the RV strain-area loop, lower systolic and diastolic slopes were found post-training (P < 0.05). No adaptation in LV structure, function, or mechanics was observed (all P > 0.05). To answer our primary aim, we found that a greater increase in RV fractional area change during baseline stress echocardiography (r = -0.67, P = 0.01) inversely correlated with adaptation in RV basal diameter following 12-wk training. In conclusion, 12-wk high-intensity running hypoxic exercise training induced right-sided structural remodeling, which was, in part, related to baseline increase in RV fractional area change to acute exercise. These data suggest that acute cardiac responses to exercise may relate to subsequent RV remodeling after exercise training in healthy individuals.NEW & NOTEWORTHY During exercise, the right ventricle is exposed to a disproportionally higher wall stress than the left ventricle, which is further exaggerated under hypoxia. In this study, we showed that 12-wk high-intensity running hypoxic exercise training induced right-sided structural remodeling, which was, in part, related to baseline cardiac increase in RV fractional area change to acute exercise. These data suggest that acute RV responses to exercise are related to subsequent right ventricular remodeling in healthy individuals upon hypoxic training.
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Affiliation(s)
- Geert Kleinnibbelink
- Department of Physiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Arie P J van Dijk
- Department of Physiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alessandro Fornasiero
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.,CeRiSM Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy
| | - Guilherme F Speretta
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.,Department of Physiological Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Christopher Johnson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Nicholas Sculthorpe
- Institute of Clinical Exercise and Health Science, School of Health and Life Sciences, University of the West of Scotland, Hamilton, United Kingdom
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - John D Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Dick H J Thijssen
- Department of Physiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - David L Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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11
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Kleinnibbelink G, van Dijk AP, Fornasiero A, Speretta GF, Johnson C, Hopman MT, Sculthorpe N, George KP, Somauroo JD, Thijssen DH, Oxborough DL. Exercise-Induced Cardiac Fatigue after a 45-Minute Bout of High-Intensity Running Exercise Is Not Altered under Hypoxia. J Am Soc Echocardiogr 2021; 34:511-521. [DOI: 10.1016/j.echo.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
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12
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Effects of Preload Manipulation on Right Ventricular Contractility: Invasive Pressure-Area Loop versus Non-invasive Strain-Area Loop. J Am Soc Echocardiogr 2021; 34:447-449. [DOI: 10.1016/j.echo.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022]
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13
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Mawad W, Mertens L, Pagano JJ, Riesenkampff E, Reichert MJE, Mital S, Kantor PF, Greenberg M, Liu P, Nathan PC, Grosse-Wortmann L. Effect of anthracycline therapy on myocardial function and markers of fibrotic remodelling in childhood cancer survivors. Eur Heart J Cardiovasc Imaging 2021; 22:435-442. [PMID: 32535624 PMCID: PMC7984732 DOI: 10.1093/ehjci/jeaa093] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/01/2019] [Accepted: 05/07/2020] [Indexed: 01/11/2023] Open
Abstract
AIMS Anthracyclines are a cornerstone of paediatric cancer treatment. We aimed to quantify myocardial cardiac magnetic resonance (CMR) native T1 (NT1) and extracellular volume fraction (ECV) as markers of fibrosis in a cohort of childhood cancer survivors (CCS). METHODS AND RESULTS A cohort of CCS in remission underwent CMR T1 mapping. Diastolic function was assessed by echocardiography. Results were compared to a cohort of normal controls of similar age and gender. Fifty-five CCS and 46 controls were included. Both groups had similar mean left ventricular (LV) NT1 values (999 ± 36 vs. 1007 ± 32 ms, P = 0.27); ECV was higher (25.6 ± 6.9 vs. 20.7 ± 2.4%, P = 0.003) and intracellular mass was lower (37.5 ± 8.4 vs. 43.3 ± 9.9g/m2, P = 0.02) in CCS. The CCS group had lower LV ejection fraction (EF) and LV mass index with otherwise normal diastolic function in all but one patient. The proportion of subjects with elevated ECV compared to controls did not differ between subgroups with normal or reduced LV EF (22% vs. 28%; P = 0.13) and no correlations were found between LVEF and ECV. While average values remained within normal range, mitral E/E' (6.6 ± 1.6 vs. 5.9 ± 0.9, P = 0.02) was higher in CCS. Neither NT1 nor ECV correlated with diastolic function indices or cumulative anthracycline dose. CONCLUSIONS There is evidence for mild diffuse extracellular volume expansion in some asymptomatic CCS; myocyte loss could be part of the mechanism, accompanied by subtle changes in systolic and diastolic function. These findings suggest mild myocardial damage and remodelling after anthracycline treatment in some CCS which requires continued monitoring.
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Affiliation(s)
- Wadi Mawad
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
- Department of Paediatrics, Montreal Children’s Hospital, McGill University Health Centre, 1001 Decarie Blvd,Montreal, QC, H4A 3J1, Canada
| | - Luc Mertens
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Joseph J Pagano
- Department of Paedatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, T6G 2B7, AB, Canada
| | - Eugenie Riesenkampff
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Marjolein J E Reichert
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Seema Mital
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Paul F Kantor
- Department of Pediatrics, Children's Hospital Los Angeles, Keck's School of Medicine of University of South California, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Mark Greenberg
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Peter Liu
- Department of Paedatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, 01 Smyth Rd, Ottawa, K1H 8L1, ON, Canada
| | - Paul C Nathan
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Lars Grosse-Wortmann
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
- Department of Pediatrics Doernbecher Children’s Hospital, Oregon Health and Science University, 700 SW Campus Drive, Portland, OR 97239, USA
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14
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Beaumont A, Campbell A, Unnithan V, Grace F, Knox A, Sculthorpe N. Long-term athletic training does not alter age-associated reductions of left-ventricular mid-diastolic lengthening or expansion at rest. Eur J Appl Physiol 2020; 120:2059-2073. [PMID: 32623518 PMCID: PMC7419356 DOI: 10.1007/s00421-020-04418-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 06/05/2020] [Indexed: 01/03/2023]
Abstract
Purpose The interaction of ageing and exercise training status on left-ventricular (LV) peak strain is unclear. Additionally, strain analysis across the entire cardiac cycle facilitates a more detailed assessment of deformation, yet this has not been implemented to characterize the ageing LV and in association with training status. This study investigated healthy ageing and training status on LV systolic and diastolic strain utilizing novel echocardiographic applications. Methods Forty healthy males were included and allocated into four groups; young recreationally active (YRA,n = 9; 28 ± 5 years), old recreationally active (ORA, n = 10; 68 ± 6), young trained (YT,n = 10; 27 ± 6 years), and old trained (OT, n = 11, 64 ± 4 years) groups. Two-dimensional speckle-tracking echocardiography was performed to ascertain peak LV longitudinal and circumferential strain (base and apex) strain within each myocardial layer and at 5% increments across the cardiac cycle. Results Older groups had lower diastolic longitudinal lengthening and circumferential expansion between 40–85% mid-diastole, regardless of training status (P < 0.05). Whereas, strain throughout systole was similar between groups (P > 0.05). Longitudinal and circumferential (base and apex) peak and layer-specific strain did not differ between groups (P > 0.05). Conclusion Novel applications of diastolic strain revealed lower age-associated LV longitudinal lengthening and circumferential expansion in older age. Yet, diastolic strain profiles did not differ based on chronic habits of exercise training and, thus, older trained men did not demonstrate an attenuation of age-associated differences in mid-diastolic LV strain. Electronic supplementary material The online version of this article (10.1007/s00421-020-04418-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Amy Campbell
- Institute of Clinical Exercise and Health Sciences, School of Science and Sport, University of the West of Scotland, Stephenson Place, Hamilton International Technology Park Blantyre, Glasgow, UK
| | - Viswanath Unnithan
- Institute of Clinical Exercise and Health Sciences, School of Science and Sport, University of the West of Scotland, Stephenson Place, Hamilton International Technology Park Blantyre, Glasgow, UK
| | - Fergal Grace
- Faculty of Health, School of Health Science and Psychology, Federation University Australia, Ballarat, VIC, Australia
| | - Allan Knox
- Exercise Science Department, California Lutheran University, Thousand Oaks, CA, USA
| | - Nicholas Sculthorpe
- Institute of Clinical Exercise and Health Sciences, School of Science and Sport, University of the West of Scotland, Stephenson Place, Hamilton International Technology Park Blantyre, Glasgow, UK.
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15
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Hubert A, Le Rolle V, Galli E, Bidaud A, Hernandez A, Donal E. New expectations for diastolic function assessment in transthoracic echocardiography based on a semi-automated computing of strain–volume loops. Eur Heart J Cardiovasc Imaging 2020; 21:1366-1371. [DOI: 10.1093/ehjci/jeaa123] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/26/2020] [Accepted: 04/22/2020] [Indexed: 01/28/2023] Open
Abstract
Abstract
Aims
Early diagnosis of heart failure with preserved ejection fraction (HFpEF) by determination of diastolic dysfunction is challenging. Strain–volume loop (SVL) is a new tool to analyse left ventricular function. We propose a new semi-automated method to calculate SVL area and explore the added value of this index for diastolic function assessment.
Method and results
Fifty patients (25 amyloidosis, 25 HFpEF) were included in the study and compared with 25 healthy control subjects. Left ventricular ejection fraction was preserved and similar between groups. Classical indices of diastolic function were pathological in HFpEF and amyloidosis groups with greater left atrial volume index, greater mitral average E/e’ ratio, faster tricuspid regurgitation (P < 0.0001 compared with controls). SVL analysis demonstrated a significant difference of the global area between groups, with the smaller area in amyloidosis group, the greater in controls and a mid-range value in HFpEF group (37 vs. 120 vs. 72 mL.%, respectively, P < 0.0001). Applying a linear discriminant analysis (LDA) classifier, results show a mean area under the curve of 0.91 for the comparison between HFpEF and amyloidosis groups.
Conclusion
SVLs area is efficient to identify patients with a diastolic dysfunction. This new semi-automated tool is very promising for future development of automated diagnosis with machine-learning algorithms.
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Affiliation(s)
- Arnaud Hubert
- Univ Rennes, CHU Rennes, Inserm, LTSI – UMR 1099, F-35000 Rennes, France
| | - Virginie Le Rolle
- Univ Rennes, CHU Rennes, Inserm, LTSI – UMR 1099, F-35000 Rennes, France
| | - Elena Galli
- Univ Rennes, CHU Rennes, Inserm, LTSI – UMR 1099, F-35000 Rennes, France
| | - Auriane Bidaud
- Univ Rennes, CHU Rennes, Inserm, LTSI – UMR 1099, F-35000 Rennes, France
| | - Alfredo Hernandez
- Univ Rennes, CHU Rennes, Inserm, LTSI – UMR 1099, F-35000 Rennes, France
| | - Erwan Donal
- Univ Rennes, CHU Rennes, Inserm, LTSI – UMR 1099, F-35000 Rennes, France
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16
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Hulshof HG, van Dijk AP, Hopman MTE, van der Sluijs CF, George KP, Oxborough DL, Thijssen DHJ. Acute impact of changes to hemodynamic load on the left ventricular strain-volume relationship in young and older men. Am J Physiol Regul Integr Comp Physiol 2020; 318:R743-R750. [DOI: 10.1152/ajpregu.00215.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Chronic changes in left ventricular (LV) hemodynamics, such as those induced by increased afterload (i.e., hypertension), mediate changes in LV function. This study examined the proof of concept that 1) the LV longitudinal strain (ε)-volume loop is sensitive to detecting an acute increase in afterload, and 2) these effects differ between healthy young versus older men. Thirty-five healthy male volunteers were recruited, including 19 young (24 ± 2 yr) and 16 older participants (67 ± 5 yr). Tests were performed before, during, and after 10-min recovery from acute manipulation of afterload. Real-time hemodynamic data were obtained and LV longitudinal ε-volume loops were calculated from four-chamber images using two-dimensional echocardiography. Inflation of the anti-gravity (anti-G) suit resulted in an immediate increase in heart rate, blood pressure, and systemic vascular resistance and a decrease in stroke volume (all P < 0.05). This was accompanied by a decrease in LV peak ε, slower slope of the ε-volume relationship during early diastole, and an increase in uncoupling (i.e., compared with systole; little change in ε per volume decline during early diastole and large changes in ε per volume decline during late diastole) (all P < 0.05). All values returned to baseline levels after recovery (all P > 0.05). Manipulation of cardiac hemodynamics caused comparable effects in young versus older men (all P > 0.05). Acute increases in afterload immediately change the diastolic phase of the LV longitudinal ε-volume loop in young and older men. This supports the potency of the LV longitudinal ε-volume loop to provide novel insights into dynamic cardiac function in humans in vivo.
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Affiliation(s)
- Hugo G. Hulshof
- Radboud Institute for Health Sciences, Departments of Physiology and Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arie P. van Dijk
- Radboud Institute for Health Sciences, Departments of Physiology and Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria T. E. Hopman
- Radboud Institute for Health Sciences, Departments of Physiology and Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris F. van der Sluijs
- Radboud Institute for Health Sciences, Departments of Physiology and Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Keith P. George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - David L. Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Dick H. J. Thijssen
- Radboud Institute for Health Sciences, Departments of Physiology and Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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17
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Leischik R, Dworrak B, Strauss M, Horlitz M, Pareja-Galeano H, de la Guía-Galipienso F, Lippi G, Lavie CJ, Perez MV, Sanchis-Gomar F. Special Article - Exercise-induced right ventricular injury or arrhythmogenic cardiomyopathy (ACM): The bright side and the dark side of the moon. Prog Cardiovasc Dis 2020; 63:671-681. [PMID: 32224113 DOI: 10.1016/j.pcad.2020.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023]
Abstract
There is still debate on the range of normal physiologic changes of the right ventricle or ventricular (RV) function in athletes. Genetic links to arrhythmogenic cardiomyopathy (ACM) are well-established. There is no current consensus on the importance of extensive exercise and exercise-induced injury to the RV. During the intensive exercise of endurance sports, the cardiac structures adapt to athletic load over time. Some athletes develop RV cardiomyopathy possibly caused by genetic predisposition, whilst others develop arrhythmias from the RV. Endurance sports lead to increased volume and pressure load in both ventricles and increased myocardial mass. The extent of volume increase and changes in myocardial structure contribute to impairment of RV function and pose a challenge in cardiovascular sports medicine. Genetic predisposition to ACM may play an important role in the risk of sudden cardiac death of athletes. In this review, we discuss and evaluate existing results and opinions. Intensive training in competitive dynamic/power and endurance sports leads to specific RV adaptation, but physiological adaptation without genetic predisposition does not necessarily lead to severe complications in endurance sports. Discriminating between physiological adaptation and pathological form of ACM or RV impairment provoked by reinforced exercise presents a challenge to clinical sports cardiologists.
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Affiliation(s)
- Roman Leischik
- Department of Cardiology, Section Prevention and Sports Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, 58095 Witten, Germany.
| | - Birgit Dworrak
- Department of Cardiology, Section Prevention and Sports Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, 58095 Witten, Germany
| | - Marcus Strauss
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure Medicine, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
| | - Mark Horlitz
- Department of Cardiology, Section Prevention and Sports Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, 58095 Witten, Germany
| | - Helios Pareja-Galeano
- Facultad de Ciencias del Deporte y Fisioterapia, Universidad Europea, 28670 Madrid, Spain
| | - Fernando de la Guía-Galipienso
- Cardiology Service of Marina Baixa Hospital, Alicante, Spain; REMA Sports Cardiology Clinic, 03700 Denia, Alicante, Spain
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, 37134 Verona, Italy
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 70121 New Orleans, LA, USA
| | - Marco V Perez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 94305-5110 Stanford, CA, USA
| | - Fabian Sanchis-Gomar
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 94305-5110 Stanford, CA, USA; Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
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18
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Beaumont A, Oxborough D, George K, Rowland TW, Sculthorpe N, Lord R, Unnithan VB. Superior cardiac mechanics without structural adaptations in pre-adolescent soccer players. Eur J Prev Cardiol 2019; 27:1494-1501. [PMID: 31779474 DOI: 10.1177/2047487319890177] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIMS This study aimed to evaluate left ventricular structure, function and mechanics, in highly-trained, pre-adolescent soccer players compared with age- and sex-matched controls. DESIGN The study design was a prospective, cross-sectional comparison of left ventricular structure, function and mechanics. METHODS Twenty-two male soccer players from two professional youth soccer academies (age: 12.0 ± 0.3 years) and 22 recreationally active controls (age: 11.7 ± 0.3 years) were recruited. Two-dimensional conventional and speckle tracking echocardiography were used to quantify left ventricular structure, function and peak/temporal values for left ventricular strain and twist, respectively. RESULTS End-diastolic volume index was larger in soccer players (51 ± 8 mm/(m2)1.5 vs. 45 ± 6 mm/(m2)1.5; p = 0.007) and concentricity was lower in soccer players (4.3 ± 0.7 g/(mL)0.667 vs. 4.9 ± 1.0 g/(mL)0.667; p = 0.017), without differences in mean wall thickness between groups (6.0 ± 0.4 mm vs. 6.1 ± 0.5 mm; p = 0.754). Peak circumferential strain at the base (-22.2% ± 2.5% vs. -20.5% ± 2.5%; p = 0.029) and papillary muscle levels (-20.1% ± 1.5% vs. -18.3% ± 2.5%; p = 0.007) were greater in soccer players. Peak left ventricular twist was larger in soccer players (16.92° ± 7.55° vs. 12.34° ± 4.99°; p = 0.035) and longitudinal early diastolic strain rate was greater in soccer players (2.22 ± 0.40 s-1 vs. 2.02 ± 0.46 s-1; p = 0.025). CONCLUSIONS Highly-trained soccer players demonstrated augmented cardiac mechanics with greater circumferential strains, twist and faster diastolic lengthening in the absence of differences in wall thickness between soccer players and controls.
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Affiliation(s)
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Thomas W Rowland
- Institute of Clinical Exercise and Health Science, School of Health and Life Sciences, University of the West of Scotland, Hamilton, UK
| | - Nicholas Sculthorpe
- Institute of Clinical Exercise and Health Science, School of Health and Life Sciences, University of the West of Scotland, Hamilton, UK
| | - Rachel Lord
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, UK
| | - Viswanath B Unnithan
- Institute of Clinical Exercise and Health Science, School of Health and Life Sciences, University of the West of Scotland, Hamilton, UK
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19
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Hulshof HG, van Oorschot F, van Dijk AP, Hopman MTE, George KP, Oxborough DL, Thijssen DHJ. Changes in dynamic left ventricular function, assessed by the strain-volume loop, relate to reverse remodeling after aortic valve replacement. J Appl Physiol (1985) 2019; 127:415-422. [DOI: 10.1152/japplphysiol.00190.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aortic valve replacement (AVR) leads to remodeling of the left ventricle (LV). Adopting a novel technique to examine dynamic LV function, our study explored whether post-AVR changes in dynamic LV function and/or changes in aortic valve characteristics are associated with LV mass regression during follow-up. We retrospectively analyzed 30 participants with severe aortic stenosis who underwent standard transthoracic echocardiographic assessment before AVR [88 (IQR or interquartile range: 22–143) days], post-AVR [13 (6–22) days], and during follow-up [455 (226–907) days]. We assessed standard measures of LV structure, function, and aortic valve characteristics. Novel insight into dynamic LV function was provided through a four-chamber image by examination of the temporal relation between LV longitudinal strain (ε) and volume (ε-volume loops), representing the contribution of LV mechanics to volume change. AVR resulted in immediate changes in structural valve characteristics, alongside a reduced LV longitudinal peak ε and improved coherence between the diastolic and systolic part of the ε-volume loop (all P < 0.05). Follow-up revealed a decrease in LV mass ( P < 0.05) and improvements in LV ejection fraction and LV longitudinal peak ε ( P < 0.05). A significant relationship was present between decline in LV mass during follow-up and post-AVR improvement in coherence of the ε-volume loops ( r = 0.439, P = 0.03), but not with post-AVR changes in aortic valve characteristics or LV function (all P > 0.05). We found that post-AVR improvements in dynamic LV function are related to long-term remodeling of the LV. This highlights the potential importance of assessing dynamic LV function for cardiac adaptations in vivo. NEW & NOTEWORTHY Combining temporal measures of left ventricular longitudinal strain and volume (strain-volume loop) provides novel insights in dynamic cardiac function. In patients with aortic stenosis who underwent aortic valve replacement, postsurgical changes in the strain-volume loop are associated with regression of left ventricular mass during follow-up. This provides novel insight into the relation between postsurgery changes in cardiac hemodynamics and long-term structural remodeling, but also supports the potential utility of the assessment of dynamic cardiac function.
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Affiliation(s)
- Hugo G. Hulshof
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederieke van Oorschot
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arie P. van Dijk
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria T. E. Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Keith P. George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - David L. Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Dick H. J. Thijssen
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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20
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Oxborough DL, Spence A, George KP, Van Oorschot F, Thijssen DHT, Green DJ. Impact of 24 weeks of supervised endurance versus resistance exercise training on left ventricular mechanics in healthy untrained humans. J Appl Physiol (1985) 2019; 126:1095-1102. [DOI: 10.1152/japplphysiol.00405.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In addition to the well-known cardiac structural adaptation to exercise training, little work has examined changes in left ventricle (LV) mechanics. With new regional and global indexes available we sought to determine the effect of 24-wk endurance versus resistance training on LV mechanics. Twenty-three male subjects were randomly allocated to a 24-wk endurance or resistance training program. Pre- and posttraining two-dimensional echocardiographic images were acquired. Global LV mechanics [strain (ε)] were recorded in longitudinal, circumferential, and radial planes. Rotation was assessed at apical and basal levels. In addition, longitudinal ε-volume loops, across the cardiac cycle, were constructed from simultaneous LV ε (longitudinal and transverse strain) and volume measurements across the cardiac cycle as a novel measure of LV mechanics. Marginal differences in ε and rotation data were found between groups. After training, we found no change in global peak ε data. Peak basal rotation significantly increased after training, with changes in the endurance group (−2.2 ± 1.9° to −4.5 ± 3.3°) and the resistance group (−2.9 ± 3.0° to −3.4 ± 2.9°). LV ε-volume loops revealed a modest rightward shift in both groups. Although most global and regional indexes of LV mechanics were not significantly altered, 24 wk of intense supervised exercise training increased basal rotation. Further studies that assess LV mechanics in larger cohorts of subjects and those with cardiovascular disease and risk factors may reveal important training impacts. NEW & NOTEWORTHY This study builds on previous work by our group and presents a comprehensive assessment of cardiac mechanics after dichotomous exercise training programs. We highlight novel findings in addition to the inclusion of strain-volume loops, which shed light on subtle differences in longitudinal and transverse contribution to volume change throughout the cardiac cycle. Our findings suggest that training has an impact on basal rotation and possibly strain-volume loops.
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Affiliation(s)
- David L. Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Angela Spence
- School of Human Sciences (Exercise and Sports Science), The University of Western Australia, Nedlands, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
| | - Keith P. George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Frederieke Van Oorschot
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Dick H. T. Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Daniel J. Green
- School of Human Sciences (Exercise and Sports Science), The University of Western Australia, Nedlands, Western Australia, Australia
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Zhu M, Chen H, Fulati Z, Liu Y, Su Y, Shu X. The value of left ventricular strain-volume loops in predicting response to cardiac resynchronization therapy. Cardiovasc Ultrasound 2019; 17:3. [PMID: 30777069 PMCID: PMC6379938 DOI: 10.1186/s12947-019-0153-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Three-dimensional (3D) speckle tracking imaging (STI) allows the simultaneous assessment of left ventricular (LV) strain and volume. We aim to explore the value of LV strain-volume loops in predicting response to cardiac resynchronization therapy (CRT). METHODS Forty heart failure (HF) patients scheduled for CRT and twenty healthy individuals were enrolled. All subjects received a 3D echocardiography and 3D STI analysis to acquire LV global and segmental principal strain (PS) and volume simultaneously. Values were plotted in a Cartesian system to construct PS-volume loop which was assessed using the two characteristics of the linear fitting curve: the slope and the coefficient of determination (R2-S/D coupling). RESULTS HF patients at baseline showed significantly lower slope and R2-S/D coupling of all PS-volume loops than healthy subjects. As for as comparing Segmental PS-Global volume loop at baseline, Midseptal R2-S/D coupling was lower and Midlateral slope was higher in CRT responders than in non-responders. For each individual, the abnormal segmental heterogeneity of Midseptal slope and R2-S/D coupling were lower than Midlateral was observed only in responders. At follow-up, significant improvements of the Midseptal slope and R2-S/D coupling were observed in responders. Midseptal R2-S/D coupling at baseline was an independent predictor of CRT response and the cut-off value of 0.55 was recommended with sensitivity of 89% and specificity of 77%. CONCLUSIONS Analysis of strain-volume loops could provide unique information for predicting response to CRT. Assessment of septal myocardial wasted work at baseline is helpful to improve patient selection for CRT.
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Affiliation(s)
- Mengruo Zhu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China.,Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032, China
| | - Haiyan Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China
| | - Zibire Fulati
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China
| | - Yang Liu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China
| | - Yangang Su
- Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China. .,Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032, China.
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22
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Forsythe L, George K, Oxborough D. Speckle Tracking Echocardiography for the Assessment of the Athlete's Heart: Is It Ready for Daily Practice? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:83. [PMID: 30146663 PMCID: PMC6132779 DOI: 10.1007/s11936-018-0677-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW To describe the use of speckle tracking echocardiography (STE) in the biventricular assessment of athletes' heart (AH). Can STE aid differential diagnosis during pre-participation cardiac screening (PCS) of athletes? RECENT FINDINGS Data from recent patient, population and athlete studies suggest potential discriminatory value of STE, alongside standard echocardiographic measurements, in the early detection of clinically relevant systolic dysfunction. STE can also contribute to subsequent prognosis and risk stratification. Despite some heterogeneity in STE data in athletes, left ventricular global longitudinal strain (GLS) and right ventricular longitudinal strain (RV ɛ) indices can add to differential diagnostic protocols in PCS. STE should be used in addition to standard echocardiographic tools and be conducted by an experienced operator with significant knowledge of the AH. Other indices, including left ventricular circumferential strain and twist, may provide insight, but further research in clinical and athletic populations is warranted. This review also raises the potential role for STE measures performed during exercise as well as in serial follow-up as a method to improve diagnostic yield.
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Affiliation(s)
- Lynsey Forsythe
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Liverpool, L3 3AF, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Liverpool, L3 3AF, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Liverpool, L3 3AF, UK.
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23
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Qasem M, George K, Somauroo J, Forsythe L, Brown B, Oxborough D. Right ventricular function in elite male athletes meeting the structural echocardiographic task force criteria for arrhythmogenic right ventricular cardiomyopathy. J Sports Sci 2018; 37:306-312. [PMID: 30022711 DOI: 10.1080/02640414.2018.1499392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Athlete pre-participation screening is focused on detecting pathological conditions like arrhythmogenic right ventricular cardiomyopathy (ARVC). The diagnosis of ARVC is established by applying the revised 2010 ARVC Task Force Criteria (TFC) that assesses RV structure and function. Some athletes may meet structural TFC without having ARVC but we do not know the consequences for RV function. This study compared RV structural and functional indices in male athletes that meet the structural TFC (MTFC) for ARVC and those that do not (NMTFC). We recruited 214 male elite athletes. All participants underwent 2D, Doppler, tissue Doppler and strain (ε) echocardiography with a focused and comprehensive assessment of the right heart. Athletes were grouped on RV structural data: MTFC n = 34; NMTFC n = 180. Functional data were compared between groups. By selection, MTFC had larger absolute and scaled RV outflow tract (RVOT) diameter compared to NMTFC (P ˂0.05) but these athletes did not develop a proportional increase in the RV inflow dimensions. There was no difference in global conventional RV systolic function between both groups however, there was significantly lower global RV ε in athletes that MTFC which can be explained, in part, by the RVOT dimension.
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Affiliation(s)
- Mohammad Qasem
- a Research Institute for Sport and Exercise Sciences , Liverpool John Moores University , Liverpool , UK
| | - Keith George
- a Research Institute for Sport and Exercise Sciences , Liverpool John Moores University , Liverpool , UK
| | - John Somauroo
- a Research Institute for Sport and Exercise Sciences , Liverpool John Moores University , Liverpool , UK
| | - Lynsey Forsythe
- a Research Institute for Sport and Exercise Sciences , Liverpool John Moores University , Liverpool , UK
| | - Benjamin Brown
- a Research Institute for Sport and Exercise Sciences , Liverpool John Moores University , Liverpool , UK
| | - David Oxborough
- a Research Institute for Sport and Exercise Sciences , Liverpool John Moores University , Liverpool , UK
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Left Ventricular Speckle Tracking-Derived Cardiac Strain and Cardiac Twist Mechanics in Athletes: A Systematic Review and Meta-Analysis of Controlled Studies. Sports Med 2018; 47:1145-1170. [PMID: 27889869 PMCID: PMC5432587 DOI: 10.1007/s40279-016-0644-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The athlete’s heart is associated with physiological remodeling as a consequence of repetitive cardiac loading. The effect of exercise training on left ventricular (LV) cardiac strain and twist mechanics are equivocal, and no meta-analysis has been conducted to date. Objective The objective of this systematic review and meta-analysis was to review the literature pertaining to the effect of different forms of athletic training on cardiac strain and twist mechanics and determine the influence of traditional and contemporary sporting classifications on cardiac strain and twist mechanics. Methods We searched PubMed/MEDLINE, Web of Science, and ScienceDirect for controlled studies of aged-matched male participants aged 18–45 years that used two-dimensional (2D) speckle tracking with a defined athlete sporting discipline and a control group not engaged in training programs. Data were extracted independently by two reviewers. Random-effects meta-analyses, subgroup analyses, and meta-regressions were conducted. Results Our review included 13 studies with 945 participants (controls n = 355; athletes n = 590). Meta-analyses showed no athlete–control differences in LV strain or twist mechanics. However, moderator analyses showed greater LV twist in high-static low-dynamic athletes (d = –0.76, 95% confidence interval [CI] –1.32 to –0.20; p < 0.01) than in controls. Peak untwisting velocity (PUV) was greater in high-static low-dynamic athletes (d = –0.43, 95% CI –0.84 to –0.03; p < 0.05) but less than controls in high-static high-dynamic athletes (d = 0.79, 95% CI 0.002–1.58; p = 0.05). Elite endurance athletes had significantly less twist and apical rotation than controls (d = 0.68, 95% CI 0.19–1.16, p < 0.01; d = 0.64, 95% CI 0.27–1.00, p = 0.001, respectively) but no differences in basal rotation. Meta-regressions showed LV mass index was positively associated with global longitudinal (b = 0.01, 95% CI 0.002–0.02; p < 0.05), whereas systolic blood pressure was negatively associated with PUV (b = –0.06, 95% CI –0.13 to –0.001; p = 0.05). Conclusion Echocardiographic 2D speckle tracking can identify subtle physiological differences in adaptations to cardiac strain and twist mechanics between athletes and healthy controls. Differences in speckle tracking echocardiography-derived parameters can be identified using suitable sporting categorizations.
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25
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Rundqvist L, Engvall J, Faresjö M, Carlsson E, Blomstrand P. Regular endurance training in adolescents impacts atrial and ventricular size and function. Eur Heart J Cardiovasc Imaging 2018; 18:681-687. [PMID: 27406576 DOI: 10.1093/ehjci/jew150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/23/2016] [Indexed: 12/24/2022] Open
Abstract
Aims The aims of the study were to explore the effects of long-term endurance exercise on atrial and ventricular size and function in adolescents and to examine whether these changes are related to maximal oxygen uptake (VO2max). Methods and results Twenty-seven long-term endurance-trained adolescents aged 13-19 years were individually matched by age and gender with 27 controls. All participants, 22 girls and 32 boys, underwent an echocardiographic examination at rest, including standard and colour tissue Doppler investigation. VO2max was assessed during treadmill exercise. All heart dimensions indexed for body size were larger in the physically active group compared with controls: left ventricular end-diastolic volume 60 vs. 50 mL/m2 (P <0.001), left atrial volume 27 vs. 19 mL/m2 (P < 0.001), and right ventricular (RV) and right atrial area 15 vs. 13 and 9 vs. 7 cm2/m2, respectively (P <0.001 for both). There were strong associations between the size of the cardiac chambers and VO2max. Further, we found improved systolic function in the active group compared with controls: left ventricular ejection fraction 61 vs. 59% (P= 0.036), tricuspid annular plane systolic excursion 12 vs. 10 mm/m2 (P= 0.008), and RV early peak systolic velocity s' 11 vs. 10 cm/s (P = 0.031). Conclusion Cardiac remodelling to long-term endurance exercise in adolescents is manifested by an increase in atrial as well as ventricular dimensions. The physically active group also demonstrated functional remodelling with an increase in TAPSE and systolic RV wall velocity. These findings have practical implications when assessing cardiac enlargement and function in physically active youngsters.
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Affiliation(s)
- Louise Rundqvist
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, P.O Box 1026, Jönköping SE-551 11, Sweden
| | - Jan Engvall
- Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Maria Faresjö
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, P.O Box 1026, Jönköping SE-551 11, Sweden
| | - Emma Carlsson
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, P.O Box 1026, Jönköping SE-551 11, Sweden
| | - Peter Blomstrand
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, P.O Box 1026, Jönköping SE-551 11, Sweden
- Department of Clinical Physiology, Region Jönköping County, Jönköping, Sweden
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26
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Oxborough D, Augustine D, Gati S, George K, Harkness A, Mathew T, Papadakis M, Ring L, Robinson S, Sandoval J, Sarwar R, Sharma S, Sharma V, Sheikh N, Somauroo J, Stout M, Willis J, Zaidi A. A guideline update for the practice of echocardiography in the cardiac screening of sports participants: a joint policy statement from the British Society of Echocardiography and Cardiac Risk in the Young. Echo Res Pract 2018; 5:G1-G10. [PMID: 29551755 PMCID: PMC5861331 DOI: 10.1530/erp-17-0075] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/02/2018] [Indexed: 12/19/2022] Open
Abstract
Sudden cardiac death (SCD) in an athlete is a rare but tragic event. In view of this, pre-participation cardiac screening is mandatory across many sporting disciplines to identify those athletes at risk. Echocardiography is a primary investigation utilized in the pre-participation setting and in 2013 the British Society of Echocardiography and Cardiac Risk in the Young produced a joint policy document providing guidance on the role of echocardiography in this setting. Recent developments in our understanding of the athlete’s heart and the application of echocardiography have prompted this 2018 update.
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Affiliation(s)
- David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Sabiha Gati
- Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Allan Harkness
- Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - Thomas Mathew
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Liam Ring
- West Suffolk Hospital NHS Foundation Trust, Bury St Edmonds, UK
| | | | | | - Rizwan Sarwar
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Vishal Sharma
- Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK
| | | | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Martin Stout
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - James Willis
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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27
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Lilli A, Casolo G. Strain-volume loops in severe aortic valve disease. J Physiol 2018; 596:735. [PMID: 29131342 DOI: 10.1113/jp275268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Influence of different dynamic sporting disciplines on right ventricular Structure and function in elite male athletes. Int J Cardiovasc Imaging 2018; 34:1067-1074. [DOI: 10.1007/s10554-018-1316-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/02/2018] [Indexed: 01/22/2023]
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Schneider C, Forsythe L, Somauroo J, George K, Oxborough D. The impact of preload reduction with head-up tilt testing on longitudinal and transverse left ventricular mechanics: a study utilizing deformation volume analysis. Echo Res Pract 2018; 5:11-18. [PMID: 29339401 PMCID: PMC5776152 DOI: 10.1530/erp-17-0064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background Left ventricular (LV) function is dependent on load, intrinsic contractility and
relaxation with a variable impact on specific mechanics. Strain (ε) imaging
allows the assessment of cardiac function; however, the direct relationship between
volume and strain is currently unknown. The aim of this study was to establish the
impact of preload reduction through head-up tilt (HUT) testing on
simultaneous left ventricular (LV) longitudinal and transverse
function and their respective contribution to volume change. Methods A focused transthoracic echocardiogram was performed on 10 healthy male participants
(23 ± 3 years) in the supine position and following 1 min
and 5 min of HUT testing. Raw temporal longitudinal ε (Ls) and transverse
ε (Ts) values were exported and divided into 5% increments across the cardiac
cycle and corresponding LV volumes were traced at each 5% increment. This provided
simultaneous LV longitudinal and transverse ε and volume loops (deformation
volume analysis – DVA). Results There was a leftward shift of the ε-volume loop from supine to 1 min and
5 min of HUT (P < 0.001). Moreover,
longitudinal shortening was reduced (P < 0.001)
with a concomitant increase in transverse thickening from supine to 1 min, which
was further augmented at 5 min (P = 0.018). Conclusions Preload reduction occurs within 1 min of HUT but does not further reduce at
5 min. This decline is associated with a decrease in longitudinal ε and
concomitant increase in transverse ε. Consequently, augmented transverse
relaxation appears to be an important factor in the maintenance of LV filling in the
setting of reduced preload. DVA provides information on the relative contribution of
mechanics to a change in LV volume and may have a role in the assessment of clinical
populations.
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Affiliation(s)
- Caroline Schneider
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lynsey Forsythe
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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Johnson C, Forsythe L, Somauroo J, Papadakis M, George K, Oxborough D. Cardiac structure and function in elite Native Hawaiian and Pacific Islander Rugby Football League athletes: an exploratory study. Int J Cardiovasc Imaging 2017; 34:725-734. [PMID: 29189933 PMCID: PMC5889413 DOI: 10.1007/s10554-017-1285-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/22/2017] [Indexed: 11/09/2022]
Abstract
The aim of this exploratory study was to define the Athletes Heart (AH) phenotype in Native Hawaiian & Pacific Islander (NH&PI) Rugby Football League (RFL) athletes. Specifically, (1) to describe conventional echocardiographic indices of left ventricle (LV) and right ventricle (RV) structure and function in NH&PI RFL players and matched RFL Caucasian controls (CC) and (2) to demonstrate LV and RV mechanics in these populations. Ethnicity is a contributory factor to the phenotypical expression of the AH. There are no data describing the cardiac phenotype in NH&PI athletes. Twenty-one male elite NH&PI RFL athletes were evaluated using conventional echocardiography and myocardial speckle tracking, allowing the assessment of global longitudinal strain (ε) and strain rate (SR); and basal, mid and global radial and circumferential ε and SR. Basal and apical rotation and twist were also assessed. Results were compared with age-matched Caucasian counterparts (CC; n = 21). LV mass [42 ± 9 versus 37 ± 4 g/(m2.7)], mean LV wall thickness (MWT: 9.5 ± 0.7 and 8.7 ± 0.4 mm), relative wall thickness (RWT: 0.35 ± 0.04 and 0.31 ± 0.03) and RV wall thickness (5 ± 1 and 4 ± 1 mm, all p < 0.05) were greater in NH&PI compared with CC. LV and RV cavity dimensions and standard indices of LV and RV systolic and diastolic function were similar between groups. NH&PI demonstrated reduced peak LV mid circumferential ε and early diastolic SR, as well as reduced global radial ε. There was reduced basal rotation at 25–35% systole, reduced apical rotation at 25–40% and 60–100% systole and reduced twist at 85–95% systole in NH&PI athletes. There were no differences between the two groups in RV wall mechanics. When compared to Caucasian controls, NH&PI rugby players have a greater LV mass, MWT and RWT with concomitant reductions in circumferential and twist mechanics. This data acts to prompt further research in NH&PI athletes.
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Affiliation(s)
- Christopher Johnson
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Lynsey Forsythe
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St Georges, University of London, London, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK.
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31
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Jang S, Vanderpool RR, Avazmohammadi R, Lapshin E, Bachman TN, Sacks M, Simon MA. Biomechanical and Hemodynamic Measures of Right Ventricular Diastolic Function: Translating Tissue Biomechanics to Clinical Relevance. J Am Heart Assoc 2017; 6:JAHA.117.006084. [PMID: 28899895 PMCID: PMC5634275 DOI: 10.1161/jaha.117.006084] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Right ventricular (RV) diastolic function has been associated with outcomes for patients with pulmonary hypertension; however, the relationship between biomechanics and hemodynamics in the right ventricle has not been studied. Methods and Results Rat models of RV pressure overload were obtained via pulmonary artery banding (PAB; control, n=7; PAB, n=5). At 3 weeks after banding, RV hemodynamics were measured using a conductance catheter. Biaxial mechanical properties of the RV free wall myocardium were obtained to extrapolate longitudinal and circumferential elastic modulus in low and high strain regions (E1 and E2, respectively). Hemodynamic analysis revealed significantly increased end‐diastolic elastance (Eed) in PAB (control: 55.1 mm Hg/mL [interquartile range: 44.7–85.4 mm Hg/mL]; PAB: 146.6 mm Hg/mL [interquartile range: 105.8–155.0 mm Hg/mL]; P=0.010). Longitudinal E1 was increased in PAB (control: 7.2 kPa [interquartile range: 6.7–18.1 kPa]; PAB: 34.2 kPa [interquartile range: 18.1–44.6 kPa]; P=0.018), whereas there were no significant changes in longitudinal E2 or circumferential E1 and E2. Last, wall stress was calculated from hemodynamic data by modeling the right ventricle as a sphere: stress=Pressure×radius2×thickness. Conclusions RV pressure overload in PAB rats resulted in an increase in diastolic myocardial stiffness reflected both hemodynamically, by an increase in Eed, and biomechanically, by an increase in longitudinal E1. Modest increases in tissue biomechanical stiffness are associated with large increases in Eed. Hemodynamic measurements of RV diastolic function can be used to predict biomechanical changes in the myocardium.
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Affiliation(s)
- Sae Jang
- School of Medicine, University of Pittsburgh, PA
| | | | - Reza Avazmohammadi
- Institute for Computational Engineering and Sciences, University of Texas at Austin, TX
| | | | - Timothy N Bachman
- Vascular Medicine Institute, University of Pittsburgh, PA.,Department of Bioengineering, University of Pittsburgh, PA
| | - Michael Sacks
- Institute for Computational Engineering and Sciences, University of Texas at Austin, TX
| | - Marc A Simon
- School of Medicine, University of Pittsburgh, PA .,Heart and Vascular Institute, University of Pittsburgh, PA.,Vascular Medicine Institute, University of Pittsburgh, PA.,Department of Bioengineering, University of Pittsburgh, PA
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32
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Hulshof HG, van Dijk AP, George KP, Merkus D, Stam K, van Duin RW, van Tertholen K, Hopman MTE, Haddad F, Thijssen DHJ, Oxborough DL. Echocardiographic-Derived Strain-Area Loop of the Right Ventricle is Related to Pulmonary Vascular Resistance in Pulmonary Arterial Hypertension. JACC Cardiovasc Imaging 2017; 10:1286-1288. [PMID: 28823749 DOI: 10.1016/j.jcmg.2017.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
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Reiber JHC, De Sutter J, Schoenhagen P, Stillman AE, Vande Veire NRL. Cardiovascular imaging 2016 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2017; 33:761-770. [PMID: 28315986 PMCID: PMC5406479 DOI: 10.1007/s10554-017-1111-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Johan H C Reiber
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands.
| | - Johan De Sutter
- Department of Cardiology, AZ Maria Middelares Gent and University Gent, Ghent, Belgium
| | - Paul Schoenhagen
- Department of Radiology, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Arthur E Stillman
- Department of Radiology, Emory University Hospital, Atlanta, GA, USA
| | - Nico R L Vande Veire
- Department of Cardiology, AZ Maria Middelares Gent and Free University Brussels, Brussels, Belgium
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Hulshof HG, van Dijk AP, George KP, Hopman MTE, Thijssen DHJ, Oxborough DL. Exploratory assessment of left ventricular strain-volume loops in severe aortic valve diseases. J Physiol 2017; 595:3961-3971. [PMID: 28117492 DOI: 10.1113/jp273526] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/18/2017] [Indexed: 12/31/2022] Open
Abstract
KEY POINTS Severe aortic valve diseases are common cardiac abnormalities that are associated with poor long-term survival. Before any reduction in left ventricular (LV) function, the left ventricle undergoes structural remodelling under the influence of changing haemodynamic conditions. In this study, we combined temporal changes in LV structure (volume) with alterations in LV functional characteristics (strain, ԑ) into a ԑ-volume loop, in order to provide novel insight into the haemodynamic cardiac consequences of aortic valve diseases in those with preserved LV ejection fraction. We showed that our novel ԑ-volume loop and the specific loop characteristics provide additional insight into the functional and mechanical haemodynamic consequences of severe aortic valve diseases (with preserved LV ejection fraction). Finally, we showed that the ԑ-volume loop characteristics provide discriminative capacity compared with conventional measures of LV function. ABSTRACT The purpose of this study was to examine left ventricular (LV) strain (ԑ)-volume loops to provide novel insight into the haemodynamic cardiac consequences of aortic valve stenosis (AS) and aortic valve regurgitation (AR). Twenty-seven participants were retrospectively recruited: AR (n = 7), AS (n = 10) and control subjects (n = 10). Standard transthoracic echocardiography was used to obtain apical four-chamber images to construct ԑ-volume relationships, which were assessed using the following parameters: early systolic ԑ (ԑ_ES); slope of ԑ-volume relationship during systole (Sslope); end-systolic peak ԑ (peak ԑ); and diastolic uncoupling (systolic ԑ-diastolic ԑ at same volume) during early diastole (UNCOUP_ED) and late diastole (UNCOUP_LD). Receiver operating characteristic curves were used to determine the ability to detect impaired LV function. Although LV ejection fraction was comparable between groups, longitudinal peak ԑ was reduced compared with control subjects. In contrast, ԑ_ES and Sslope were lower in both pathologies compared with control subejcts (P < 0.01), but also different between AS and AR (P < 0.05). UNCOUP_ED and UNCOUP_LD were significantly higher in both patient groups compared with control subjects (P < 0.05). Receiver operating characteristic curves revealed that loop characteristics (AUC = 0.99, 1.00 and 1.00; all P < 0.01) were better able then peak ԑ (AUC = 0.75, 0.89 and 0.76; P = 0.06, <0.01 and 0.08, respectively) and LV ejection fraction (AUC = 0.56, 0.69 and 0.69; all P > 0.05) to distinguish AS vs control, AR vs control and AS vs AR groups, respectively. Temporal changes in ԑ-volume characteristics provide novel insight into the haemodynamic cardiac impact of AS and AR. Contrary to traditional measures (i.e. ejection fraction, peak ԑ), these novel measures successfully distinguish between the haemodynamic cardiac impact of AS and AR.
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Affiliation(s)
- Hugo G Hulshof
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arie P van Dijk
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Maria T E Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dick H J Thijssen
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - David L Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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