|
1
|
Chirinos JA, Phan TS, Syed AA, Hashmath Z, Oldland HG, Koppula MR, Tariq A, Javaid K, Miller R, Varakantam S, Dunde A, Neetha V, Akers SR. Late Systolic Myocardial Loading Is Associated With Left Atrial Dysfunction in Hypertension. Circ Cardiovasc Imaging 2017; 10:e006023. [PMID: 28592592 DOI: 10.1161/circimaging.116.006023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Late systolic load has been shown to cause diastolic dysfunction in animal models. Although the systolic loading sequence of the ventricular myocardium likely affects its coupling with the left atrium (LA), this issue has not been investigated in humans. We aimed to assess the relationship between the myocardial loading sequence and LA function in human hypertension. METHODS AND RESULTS We studied 260 subjects with hypertension and 19 normotensive age- and sex-matched controls. Time-resolved central pressure and left ventricular geometry were measured with carotid tonometry and cardiac magnetic resonance imaging, respectively, for computation of time-resolved ejection-phase myocardial wall stress (MWS). The ratio of late/early ejection-phase MWS time integrals was computed as an index of late systolic myocardial load. Atrial mechanics were measured with cine-steady-state free-precession magnetic resonance imaging using feature-tracking algorithms. Compared with normotensive controls, hypertensive participants demonstrated increased late/early ejection-phase MWS and reduced LA function. Greater levels of late/early ejection-phase MWS were associated with reduced LA conduit, reservoir, and booster pump LA function. In models that included early and late ejection-phase MWS as independent correlates of LA function, late systolic MWS was associated with lower, whereas early systolic MWS was associated with greater LA function, indicating an effect of the relative loading sequence (late versus early MWS) on LA function. These relationships persisted after adjustment for multiple potential confounders. CONCLUSIONS A myocardial loading sequence characterized by prominent late systolic MWS was independently associated with atrial dysfunction. In the context of available experimental data, our findings support the deleterious effects of late systolic loading on ventricular-atrial coupling.
Collapse
Affiliation(s)
- Julio A Chirinos
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA.
| | - Timothy S Phan
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Amer A Syed
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Zeba Hashmath
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Harry G Oldland
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Maheswara R Koppula
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Ali Tariq
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Khuzaima Javaid
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Rachana Miller
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Swapna Varakantam
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Anjaneyulu Dunde
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Vadde Neetha
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Scott R Akers
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| |
Collapse
|
|
4
|
Chirinos JA, Segers P, Rietzschel ER, De Buyzere ML, Raja MW, Claessens T, De Bacquer D, St. John Sutton M, Gillebert TC. Early and Late Systolic Wall Stress Differentially Relate to Myocardial Contraction and Relaxation in Middle-Aged Adults. Hypertension 2013; 61:296-303. [DOI: 10.1161/hypertensionaha.111.00530] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Julio A. Chirinos
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Patrick Segers
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Ernst R. Rietzschel
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Marc L. De Buyzere
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Muhammad W. Raja
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Tom Claessens
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Dirk De Bacquer
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Martin St. John Sutton
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Thierry C. Gillebert
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| |
Collapse
|