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Zhao LT, Liu L, Meng PP, Wang YH, Li M, Yang J, Gu TX, Ma CY. Effect of pericardial incision on left ventricular morphology and systolic function in patients during coronary artery bypass grafting. Cardiovasc Ultrasound 2020; 18:27. [PMID: 32693817 PMCID: PMC7374912 DOI: 10.1186/s12947-020-00206-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/21/2020] [Indexed: 12/21/2022] Open
Abstract
Background Accurate assessment of left ventricular (LV) systolic function is important after coronary artery bypass grafting (CABG). LV ejection fraction (LVEF) is conventionally used to evaluate LV systolic function; deformation parameters can be used to detect subtle LV systolic dysfunction. It is unclear whether an incised pericardium without sutures during CABG could affect LV morphology and function. We investigated the effect of pericardial incision on LV morphology and systolic function during CABG. Methods Intraoperative transesophageal echocardiography was performed in 27 patients during elective off-pump beating heart CABG 5 min before and after pericardial incision. LV longitudinal and mid-cavity transversal diameters, sphericity index, volumes, and LVEF were measured. LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and twist obtained by two-dimensional speckle tracking echocardiography were measured simultaneously. Results LV mid-cavity transversal diameter increased, while the LV sphericity index decreased (P < 0.001) immediately after pericardial incision. The GLS, GCS, and twist significantly decreased, while the GRS notably increased (P < 0.001). The LV volumes and LVEF remained unchanged. Conclusions Pericardial incision immediately transformed LV morphology from an ellipsoid to sphere, with decreased longitudinal and circumferential strain and twist, and increased radial strain, while LVEF remained unchanged. This should be considered when evaluating LV systolic function in patients after CABG.
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Affiliation(s)
- Lan-Ting Zhao
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Lu Liu
- Department of Cardiac Surgery, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Ping-Ping Meng
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Yong-Huai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Meng Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Tian-Xiang Gu
- Department of Cardiac Surgery, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China.
| | - Chun-Yan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China.
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2
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Grattan M, Mertens L, Grosse-Wortmann L, Friedberg MK, Cifra B, Dragulescu A. Ventricular Torsion in Young Patients With Single-Ventricle Anatomy. J Am Soc Echocardiogr 2018; 31:1288-1296. [PMID: 30340887 DOI: 10.1016/j.echo.2018.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND In normal left ventricles, clockwise basal rotation and counterclockwise apical rotation result in systolic torsion. Torsion is important for contractile efficiency and may be especially important in single-ventricle (SV) physiology. However, little is known about torsion in patients with SVs. The aim of this study was to measure torsion in SVs and to determine its relationship with other measures of ventricular function. The hypothesis was that torsion would be decreased in all SVs, most significantly in single right ventricles, and that it would correlate with other measures of ventricular function. METHODS A prospective cross-sectional study was performed in 61 patients with SVs undergoing pre- or post-Fontan cardiac catheterization and 30 matched control subjects. Echocardiography, catheterization, and cardiac magnetic resonance imaging were performed under the same anesthetic. Torsion and strain were measured using speckle-tracking echocardiography. Intracardiac pressures, pulmonary vascular resistance, and cardiac magnetic resonance imaging-derived ventricular volume and ejection fraction were measured. RESULTS Thirty-five patients were left ventricular dominant, 15 were right ventricular dominant, 10 were codominant, and one had indeterminate morphology. Thirty-seven patients were pre-Fontan and 24 were post-Fontan. Patients with SVs had similar overall torsion as control subjects (median, 1.7°/cm vs 1.65°/cm; P = NS); however, they had decreased or reversed basal rotation (-0.32°/cm vs -0.93°/cm, P < .0001) and increased apical rotation (1.45°/cm vs 1.06°/cm, P = .0065). There were no differences on the basis of ventricular dominance or palliative stage. Torsion did not significantly correlate with other echocardiographic, catheter-based, or cardiac magnetic resonance imaging measures of cardiac function. CONCLUSIONS Single left and right ventricles exhibit preserved torsion, mainly because of preserved or increased apical rotation. Possible mechanisms of torsion in single right ventricles include myofiber remodeling and altered ventricular-ventricular interactions. Understanding myocardial deformation in SVs will improve the ability to interpret ventricular function in this precarious population.
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Affiliation(s)
- Michael Grattan
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Paediatrics, LHSC Children's Hospital, University of Western Ontario, London, Ontario, Canada
| | - Luc Mertens
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lars Grosse-Wortmann
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mark K Friedberg
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Cifra
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andreea Dragulescu
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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Armoni-Domany K, Kapusta L, Sivan Y, Gut G, Rotstein A, Shiran SI. Is This Heart Normal? Am J Respir Crit Care Med 2017; 194:1546-1547. [PMID: 27532940 DOI: 10.1164/rccm.201606-1236im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Livia Kapusta
- 2 Department of Pediatric Cardiology, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yakov Sivan
- 1 Department of Pediatric Pulmonology, Critical Care and Sleep Medicine and
| | - Guy Gut
- 1 Department of Pediatric Pulmonology, Critical Care and Sleep Medicine and
| | - Amichay Rotstein
- 3 Division of Pediatric Cardiology, Schneider Children's Medical Center of Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Shelly I Shiran
- 4 Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kim MJ, Kim HK, Jung JH, Yoon YE, Kim HL, Park JB, Lee SP, Kim YJ, Cho GY, Sohn DW, Oh JK. Echocardiographic diagnosis of total or left congenital pericardial absence with positional change. Heart 2017; 103:1203-1209. [DOI: 10.1136/heartjnl-2016-310870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/25/2017] [Accepted: 02/02/2017] [Indexed: 11/03/2022] Open
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Madeira M, Teixeira R, Costa M, Gonçalves L, Klein AL. Two-dimensional speckle tracking cardiac mechanics and constrictive pericarditis: systematic review. Echocardiography 2016; 33:1589-1599. [DOI: 10.1111/echo.13293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Marta Madeira
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Geral; Coimbra Portugal
| | - Rogério Teixeira
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Geral; Coimbra Portugal
- Faculty of Medicine, University of Coimbra; Coimbra Portugal
| | - Marco Costa
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Geral; Coimbra Portugal
| | - Lino Gonçalves
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Geral; Coimbra Portugal
- Faculty of Medicine, University of Coimbra; Coimbra Portugal
| | - Allan L. Klein
- Heart and Vascular Institute; Center for the Diagnosis and Treatment of Pericardial Diseases; Cleveland Clinic; Cleveland OH USA
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Oki T, Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Yamada H, Nakatani S. Challenges for 'diastology': contributions from Japanese researchers. J Echocardiogr 2016; 14:93-103. [PMID: 27539160 DOI: 10.1007/s12574-016-0307-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 01/08/2023]
Abstract
Diastology is a study to treat diastole of the heart. Transmitral flow and pulmonary venous flow velocities recorded by pulsed Doppler echocardiography provide more important information about left ventricular (LV) diastolic dysfunction [left atrial (LA)-LV coupling] than cardiac catheterization in clinical practice; however, these waveforms are influenced by loading conditions, particularly preload. The early diastolic mitral annular and LV wall motion indices measured by tissue Doppler echocardiography can evaluate LV relaxation abnormality and filling pressure by being relatively preload independent. In addition, the role of concomitant systolic longitudinal dysfunction is well characterized in asymptomatic patients and in patients with heart failure and preserved ejection fraction. Two-dimensional speckle tracking echocardiography is an angle-independent method, and has the potential to evaluate the contraction and relaxation abnormalities in the longitudinal, circumferential, and radial directions of the LV myocardium as well as LV torsion/untwisting and, moreover, deformation of the LA myocardium and large arterial wall. As a result, this new technique can facilitate the early detection of impaired LA-LV-arterial coupling in patients before occurrence of overt heart failure symptoms.
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Affiliation(s)
- Takashi Oki
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan.
| | - Hirokazu Miyoshi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Yoshifumi Oishi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Yukio Mizuguchi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Arata Iuchi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
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Li L, Deng YB, Liu K, Guo LD, Liu HY, Zhou W, Tang QY. Long-Term Effects of Pericardiectomy on Left Ventricular Mechanics Evaluated by Using Speckle Tracking Echocardiography in Patients with Constrictive Pericarditis. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:421-429. [PMID: 26653938 DOI: 10.1016/j.ultrasmedbio.2015.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/21/2015] [Accepted: 10/29/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate long-term changes in left ventricular (LV) mechanics after pericardiectomy in patients with constrictive pericarditis (CP) and to correlate post-operative LV mechanics with clinical status. A total of 24 patients with CP underwent serial speckle tracking echocardiography 1 wk before and 1, 6 and 12 mo after pericardiectomy. Global LV longitudinal, circumferential and radial strains, along with LV twist, were measured. Twenty-three healthy volunteers were served as control patients. Although global LV longitudinal, circumferential and radial strains obtained 6 mo after pericardiectomy increased compared with those for pre-pericardiectomy, they were still significantly lower than those for control patients. Further improvements occurred over time with normalization of global LV longitudinal and radial strains 12 mo after pericardiectomy, but global circumferential strain obtained 12 mo after pericardiectomy was still lower than that for control patients. LV twist remained unchanged after pericardiectomy. In addition, the improvements in global LV circumferential strain after pericardiectomy were associated with improvements in clinical symptoms (p < 0.001). These findings suggest that the global LV circumferential strain may be a promising parameter in the evaluation of the effectiveness of pericardiectomy.
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Affiliation(s)
- Li Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - You-Bin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Kun Liu
- Department of Medical Ultrasound, Minda Hospital of Hubei University For Nationalities, Enshi, China
| | - Ling-Dan Guo
- Department of Medical Ultrasound, Wuhan Center Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong-Yun Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiao-Ying Tang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Shah AB, Kronzon I. Congenital defects of the pericardium: a review. Eur Heart J Cardiovasc Imaging 2015; 16:821-7. [PMID: 26003149 DOI: 10.1093/ehjci/jev119] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/15/2015] [Indexed: 12/15/2022] Open
Abstract
Pericardial defects are a rare disorder that can be characterized as acquired or congenital. Congenital defects can be further characterized by location and size of the defect, e.g. left- or right-sided and partial or complete absence of the pericardium. While physical examination and electrocardiogram are not diagnostic, chest radiographs and echocardiography have findings that should alert the clinician to the absence of the pericardium as a possible diagnosis. Despite its limitations with visualizing the normal pericardium in areas of minimal adipose, cardiac magnetic resonance is currently the gold standard for diagnosing the congenital absence of the pericardium. Patients have a similar life expectancy to those without pericardial defects; however in certain cases, herniation and strangulation of cardiac chambers can be life threatening and lead to sudden cardiac death. Treatment is tailored to the patient's symptoms, presentation, and the size and location of the defect.
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Affiliation(s)
- Ankit B Shah
- Lenox Hill Hospital, 100 East 77th Street, 2nd Floor Non-invasive Cardiology, New York, NY 10075, USA
| | - Itzhak Kronzon
- Lenox Hill Hospital, 100 East 77th Street, 2nd Floor Non-invasive Cardiology, New York, NY 10075, USA
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10
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Barutçu A, Bekler A, Temiz A, Kırılmaz B, Yener AÜ, Tan YZ, Gazi E, Altun B. Left Ventricular Twist Mechanics Are Impaired in Patients with Coronary Slow Flow. Echocardiography 2015; 32:1647-54. [DOI: 10.1111/echo.12918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ahmet Barutçu
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Adem Bekler
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Ahmet Temiz
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Bahadır Kırılmaz
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Ali Ümit Yener
- Faculty of Medicine; Department of Cardiovascular Surgery; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Yusuf Ziya Tan
- Faculty of Medicine; Department of Nuclear Medicine; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Emine Gazi
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Burak Altun
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
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11
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Pokharel P, Yoon AJ, Bella JN. Noninvasive measurement and clinical relevance of myocardial twist and torsion. Expert Rev Cardiovasc Ther 2014; 12:1305-15. [DOI: 10.1586/14779072.2014.970179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Cosyns B, Plein S, Nihoyanopoulos P, Smiseth O, Achenbach S, Andrade MJ, Pepi M, Ristic A, Imazio M, Paelinck B, Lancellotti P. European Association of Cardiovascular Imaging (EACVI) position paper: Multimodality imaging in pericardial disease. Eur Heart J Cardiovasc Imaging 2014; 16:12-31. [PMID: 25248336 DOI: 10.1093/ehjci/jeu128] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Although pericardial diseases are common in the daily clinical practice and can result in a significant morbidity and mortality, imaging of patients with suspected or known pericardial disorders remain challenging. Multimodality imaging is part of the management of pericardial diseases. Echocardiography, cardiac computed tomography, and cardiovascular magnetic resonance are often used as complementary imaging modalities. The choice of one or multiple imaging modalities is driven by the clinical context or conditions of the patient. The scope of the present document is to highlight the respective role of each technique according to the clinical context in the diagnosis and management of pericardial diseases.
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Affiliation(s)
- Bernard Cosyns
- Department of Cardiology, Universtair Ziekenhuis Brussel, Centrum Voor Hart-en Vaatziekten and CHIREC, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Sven Plein
- The Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
| | - Petros Nihoyanopoulos
- Department of Cardiology, Imperial College, NHLI Hammersmith Hospital London, London, UK
| | - Otto Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Stephan Achenbach
- Department of Cardiology, University Hospital Erlangen, Medizinische Klinik 2, Erlangen, Germany
| | - Maria Joao Andrade
- Department of Cardiology, Hospital Santa Cruz, Instituto Cardiovascular de Lisboa, Lisboa, Portugal
| | - Mauro Pepi
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Arsen Ristic
- Department of Cardiology, Clinical Center of Serbia, Belgrad, Serbia
| | - Massimo Imazio
- Department of Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Bernard Paelinck
- Cardiac Imaging, Department of Cardiac Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liege Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Liege, Belgium
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Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, Hung J, Garcia MJ, Kronzon I, Oh JK, Rodriguez ER, Schaff HV, Schoenhagen P, Tan CD, White RD. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2013; 26:965-1012.e15. [PMID: 23998693 DOI: 10.1016/j.echo.2013.06.023] [Citation(s) in RCA: 405] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Left ventricular systolic strain of the cardiac allograft evaluated with three-dimensional speckle tracking echocardiography. ACTA ACUST UNITED AC 2013; 33:765-769. [PMID: 24142734 DOI: 10.1007/s11596-013-1194-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 08/26/2013] [Indexed: 10/26/2022]
Abstract
Three-dimensional speckle tracking echocardiography was employed to evaluate the changes of left ventricular systolic strain in 23 heart transplant recipients at 1st, 3rd, 6th and 12th month after heart transplantation, and 23 healthy subjects served as controls. The three-dimensional full-volume echocardiographic images of left ventricle were recorded and then were analyzed using EchoPAC software. The strain curves and peak systolic strain values for each segment and overall left ventricular wall were obtained. Left ventricular global peak longitudinal strain (GPSL), global peak radial strain (GPSR), global peak circumferential strain (GPSC) and global peak area strain (GPSA) were measured and then statistically analyzed. There were no significant differences in left ventricular ejection fraction (LVEF) and cardiac output (CO) between heart transplant recipients and controls. The GPSL in heart transplant recipients at 1st month after surgery was significantly lower than that in controls, but close to the normal value at 3rd month after surgery and later. The GPSC, GPSA and GPSR were significantly lower in heart transplant recipients at 1st, 3rd, 6th and 12th month after surgery than those in controls. It is suggested that three-dimensional speckle tracking echocardiography can be used for monitoring changes of left ventricular systolic strains and evaluating left ventricular systolic function in cardiac allograft.
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Effect of Pharmacologic Increases in Afterload on Left Ventricular Rotation and Strain in a Rabbit Model. J Am Soc Echocardiogr 2013; 26:674-82. [DOI: 10.1016/j.echo.2013.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Indexed: 11/20/2022]
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Weiner RB, Weyman AE, Kim JH, Wang TJ, Picard MH, Baggish AL. The impact of isometric handgrip testing on left ventricular twist mechanics. J Physiol 2012; 590:5141-50. [PMID: 22890704 DOI: 10.1113/jphysiol.2012.236166] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Left ventricular (LV) rotation occurs due to contraction of obliquely oriented myocardial fibres. Left ventricular twist (LVT) results from rotation of the apex and base in opposite directions. Although LVT is altered in various cardiac diseases, physiological factors that affect LVT remain incompletely understood. Isometric handgrip testing (IHGT), a well-established laboratory-based technique to increase LV afterload, was performed for 3 min at 40% maximum force generation in healthy human subjects (n = 18, mean age 29.7 ± 2.7 years). Speckle-tracking echocardiography was used to measure LV volumes, LV apical and basal rotation, peak systolic LVT and peak early diastolic untwisting rate (UTR) at rest and at peak IHGT. IHGT led to significant increase in systemic blood pressure (systolic, 120.6 ± 9.7 vs. 155.6 ± 14.5 mmHg, P < 0.001; diastolic, 67.5 ± 6.4 vs. 94.1 ± 21.1 mmHg, P < 0.001) and LV end-systolic volume (44.2 ± 7.8 vs. 50.5 ± 10.8 ml, P = 0.005), as well as a significant increase in heart rate (62.8 ± 11.7 vs. 84.7 ± 13.8 beats min−1; P < 0.001). IHGT produced a significant acute reduction in LV stroke volume (63.9 ± 12.0 vs. 49.4 ± 7.8 ml, P < 0.001). In this setting, there was a significant decrease in peak systolic apical rotation (11.9 ± 3.0 vs. 8.6 ± 2.2 deg, P < 0.001) and a resultant 25% decrease in peak systolic LVT (16.6 ± 2.8 vs. 12.5 ± 2.8 deg, P < 0.001). The magnitude of peak early diastolic UTR did not change (−114.5 ± 26.4 vs. −110.6 ± 39.8 deg s−1, P = 0.71). Peak systolic apical rotation and LVT decrease during IHGT in healthy humans. This impairment of LV twist mechanics may in part underlie the LV dysfunction that can occur in the clinical context of acute increase in afterload.
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Affiliation(s)
- Rory B Weiner
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA.
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Phillips AA, Cote AT, Bredin SSD, Warburton DER. Heart disease and left ventricular rotation - a systematic review and quantitative summary. BMC Cardiovasc Disord 2012; 12:46. [PMID: 22726250 PMCID: PMC3423007 DOI: 10.1186/1471-2261-12-46] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 06/24/2012] [Indexed: 11/12/2022] Open
Abstract
Background Left ventricular (LV) rotation is increasingly examined in those with heart disease. The available evidence measuring LV rotation in those with heart diseases has not been systematically reviewed. Methods To review systematically the evidence measuring LV rotational changes in various heart diseases compared to healthy controls, literature searches were conducted for appropriate articles using several electronic databases (e.g., MEDLINE, EMBASE). All randomized-controlled trials, prospective cohort and case–controlled studies that assessed LV rotation in relation to various heart conditions were included. Three independent reviewers evaluated each investigation’s quality using validated scales. Results were tabulated and levels of evidence assigned. Results A total of 1,782 studies were found through the systematic literature search. Upon review of the articles, 47 were included. The articles were separated into those investigating changes in LV rotation in participants with: aortic stenosis, myocardial infarction, hypertrophic cardiomyopathy, dilated cardiomyopathy, non-compaction, restrictive cardiomyopathy/ constrictive pericarditis, heart failure, diastolic dysfunction, heart transplant, implanted pacemaker, coronary artery disease and cardiovascular disease risk factors. Evidence showing changes in LV rotation due to various types of heart disease was supported by evidence with limited to moderate methodological quality. Conclusions Despite a relatively low quality and volume of evidence, the literature consistently shows that heart disease leads to marked changes in LV rotation, while rotational systolic-diastolic coupling is preserved. No prognostic information exists on the potential value of rotational measures of LV function. The literature suggests that measures of LV rotation may aid in diagnosing subclinical aortic stenosis and diastolic dysfunction.
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Affiliation(s)
- Aaron A Phillips
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Moen CA, Salminen PR, Dahle GO, Hjertaas JJ, Grong K, Matre K. Multi-layer radial systolic strain vs. one-layer strain for confirming reperfusion from a significant non-occlusive coronary stenosis. Eur Heart J Cardiovasc Imaging 2012; 14:24-37. [PMID: 22531463 DOI: 10.1093/ehjci/jes082] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The aim of this study was to investigate whether multi-layer radial strain and strain rate analysis is superior to one-layer strain analysis for confirming reperfusion following a non-occlusive coronary stenosis. METHODS AND RESULTS In 10 anaesthetized pigs, an extracorporeal shunt was inserted from the brachiocephalic to the left anterior descending coronary artery. Microspheres were injected and left ventricular (LV) short- and long-axis echocardiographic views were recorded with the open shunt, during the 120 min of severe stenosis and 20 min (early) and 100 min (late) after reperfusion. The anterior wall was analysed for radial one-layer and three-layer tissue Doppler imaging (TDI) strain and strain rate, in addition to radial, circumferential, and longitudinal speckle-tracking echocardiography (STE) strain. During stenosis, perfusion was reduced in the two inner wall layers (P< 0.01). All peak systolic strain and strain rate parameters were reduced, whereas post-systolic longitudinal strain and post-systolic strain in the two inner layers increased (P< 0.001). At early reperfusion, hyperaemia was evident in all layers (P< 0.01). Peak systolic TDI strain and strain rate increased in the mid- and subendocardial layer, whereas post-systolic strain decreased (P< 0.05). Peak systolic STE strain increased in the circumferential and longitudinal direction, whereas post-systolic longitudinal strain decreased (P< 0.05). At late reperfusion, strain and strain rate were unchanged while perfusion returned to baseline values in the mid- and subendocardium. CONCLUSION Both multi-layer radial TDI strain and strain rate and one-layer STE strain measurements in the circumferential and longitudinal direction can confirm reperfusion early after a non-occlusive coronary stenosis. An advantage of multi-layer analysis was not evident.
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Iwasaki M, Masuda K, Asanuma T, Nakatani S. Effects of mechanical limitation of apical rotation on left ventricular relaxation and end-diastolic pressure. Am J Physiol Heart Circ Physiol 2011; 301:H1456-60. [DOI: 10.1152/ajpheart.00316.2011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Left ventricular (LV) twist is thought to play an important role in cardiac function. However, how twist affects systolic or diastolic function is not understood in detail. We acquired apical and basal short-axis images of dogs undergoing open-chest procedures ( n = 15) using a GE Vivid 7 at baseline and during the use of an apical suction device (Starfish) to limit apical rotation. We measured LV pressure and stroke volume using a micromanometer-tipped catheter and an ultrasonic flow probe, respectively. Peak radial strain, peak rotation, peak twist, peak systolic twisting rate (TR), peak untwisting rate during isovolumic relaxation period (URIVR), and peak early diastolic untwisting rate after mitral valve opening (URE) were determined using speckle tracking echocardiography. Immobilizing the apex with gentle suction significantly decreased apical rotation (−50 ± 27%) and slightly increased basal rotation, resulting in a significant decrease in twist. The time constant of LV relaxation (τ) was prolonged, and LV end-diastolic pressure increased. TR and URIVR decreased. LV systolic pressure, peak positive and negative first derivative of LV pressure (±dP/d t), stroke volume, radial strain, and URE were not changed. The correlation between τ and URIVR ( r = 0.63, P = 0.0006) was stronger than that between peak +dP/d t and TR ( r = 0.46, P = 0.01). Diastolic function was impaired with reduced apical rotation and URIVR when the apex of the heart was immobilized using an apical suction device.
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Affiliation(s)
- Mariko Iwasaki
- Department of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kasumi Masuda
- Department of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toshihiko Asanuma
- Department of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Nakatani
- Department of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
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Cameli M, Ballo P, Righini FM, Caputo M, Lisi M, Mondillo S. Physiologic Determinants of Left Ventricular Systolic Torsion Assessed by Speckle Tracking Echocardiography in Healthy Subjects. Echocardiography 2011; 28:641-8. [DOI: 10.1111/j.1540-8175.2011.01406.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Leitman M, Bachner-Hinenzon N, Adam D, Fuchs T, Theodorovich N, Peleg E, Krakover R, Moravsky G, Uriel N, Vered Z. Speckle tracking imaging in acute inflammatory pericardial diseases. Echocardiography 2011; 28:548-55. [PMID: 21539601 DOI: 10.1111/j.1540-8175.2010.01371.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Left ventricular (LV) function in acute perimyocarditis is variable. We evaluated LV function in patients with acute perimyocarditis with speckle tracking. METHODS Thirty-eight patients with acute perimyocarditis and 20 normal subjects underwent echocardiographic examination. Three-layers strain and twist angle were assessed with a speckle tracking. Follow-up echo was available in 21 patients. RESULTS Strain was higher in normal subjects than in patients with perimyocarditis. Twist angle was reduced in perimyocarditis--10.9° ± 5.4 versus 17.6° ± 5.8, P < 0.001. Longitudinal strain and twist angle were higher in normal subjects than in patients with perimyocarditis and apparently normal LV function. Follow-up echo in 21 patients revealed improvement in longitudinal strain. CONCLUSIONS Patients with acute perimyocarditis have lower twist angle, longitudinal and circumferential strain. Patients with perimyocarditis and normal function have lower longitudinal strain and twist angle. Short-term follow-up demonstrated improvement in clinical parameters and longitudinal strain despite of residual regional LV dysfunction.
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Affiliation(s)
- Marina Leitman
- Department of Cardiology, Assaf Harofeh Medical Center and Tel Aviv University, Tel Aviv, Israel.
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Nakatani S. Left ventricular rotation and twist: why should we learn? J Cardiovasc Ultrasound 2011; 19:1-6. [PMID: 21519484 PMCID: PMC3079077 DOI: 10.4250/jcu.2011.19.1.1] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 02/27/2011] [Accepted: 03/02/2011] [Indexed: 02/04/2023] Open
Abstract
The left ventricle twists in systole storing potential energy and untwists (recoils) in diastole releasing the energy. Twist aids left ventricular ejection and untwist aids relaxation and ventricular filling. Therefore, rotation and torsion are important in cardiac mechanics. However, the methodology of their investigations is limited to invasive techniques or magnetic resonance imaging. With the advent of speckle tracking echocardiography, however, rotation and torsion (twist) become familiar to echocardiographers. In this review, I outline the mechanism and influencing factors of rotation and torsion with the anticipation of the routine use of these measurements in clinical practice.
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Affiliation(s)
- Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
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Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr 2010; 23:351-69; quiz 453-5. [PMID: 20362924 DOI: 10.1016/j.echo.2010.02.015] [Citation(s) in RCA: 751] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The authors summarize the recent developments in speckle-tracking echocardiography (STE), a relatively new technique that can be used in conjunction with two-dimensional or three-dimensional echocardiography for resolving the multidirectional components of left ventricular (LV) deformation. The tracking system is based on grayscale B-mode images and is obtained by automatic measurement of the distance between 2 pixels of an LV segment during the cardiac cycle, independent of the angle of insonation. The integration of STE with real-time cardiac ultrasound imaging overcomes some of the limitations of previous work in the field and has the potential to provide a unified framework to more accurately quantify the regional and global function of the left ventricle. STE holds promise to reduce interobserver and intraobserver variability in assessing regional LV function and to improve patient care while reducing health care costs through the early identification of subclinical disease. Following a brief overview of the approach, the authors pool the initial observations from clinical studies on the development, validation, merits, and limitations of STE.
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Weiner RB, Weyman AE, Khan AM, Reingold JS, Chen-Tournoux AA, Scherrer-Crosbie M, Picard MH, Wang TJ, Baggish AL. Preload dependency of left ventricular torsion: the impact of normal saline infusion. Circ Cardiovasc Imaging 2010; 3:672-8. [PMID: 20826594 DOI: 10.1161/circimaging.109.932921] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND left ventricular (LV) rotation results from contraction of obliquely oriented myocardial fibers. The net difference between systolic apical counterclockwise rotation and basal clockwise rotation is left ventricular torsion (LVT). Although LVT is altered in various cardiac diseases, determinants of LVT are incompletely understood. METHODS AND RESULTS LV end-diastolic volume, LV apical and basal rotation, peak systolic LVT, and peak early diastolic untwisting rate were measured by speckle-tracking echocardiography in healthy subjects (n=8) before and after infusion of a weight-based normal saline bolus (2.1±0.3 L). Saline infusion led to a significant increase in end-diastolic LV internal diameter (45.9±3.7 versus 47.6±4.2 mm; P=0.002) and LV end-diastolic volume (90.0±21.6 versus 98.3±19.6 mL; P=0.01). Stroke volume (51.3±10.9 versus 63.0±15.5 mL; P=0.003) and cardiac output (3.4±0.8 versus 4.4±1.5 L/min; P=0.007) increased, whereas there was no change in heart rate and blood pressure. There was a significant increase in the magnitude of peak systolic apical rotation (7.5±2.4° versus 10.5±2.8°; P<0.001) but no change in basal rotation (-4.1±2.3° versus -4.8±3.1°; P=0.44). Accordingly, peak systolic LVT increased by 33% after saline infusion (11.2±1.3° versus 14.9±1.7°; P<0.001). This saline-induced increase in LVT was associated with a marked increase in peak early diastolic untwisting rate (72.3±21.4 versus 136.8±30.0 degrees/s; P<0.001). CONCLUSIONS peak systolic LVT and peak early diastolic untwisting rate are preload-dependent. Changes in LV preload should be considered when interpreting results of future LVT studies.
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Affiliation(s)
- Rory B Weiner
- Division of Cardiology, Massachusetts General Hospital, Boston, Mass., USA
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Mizuguchi Y, Oishi Y, Miyoshi H, Iuchi A, Nagase N, Ara N, Oki T. Possible mechanisms of left ventricular torsion evaluated by cardioreparative effects of telmisartan in patients with hypertension. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:690-7. [DOI: 10.1093/ejechocard/jeq044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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van Dalen BM, Kauer F, Vletter WB, Soliman OII, van der Zwaan HB, ten Cate FJ, Geleijnse ML. Influence of cardiac shape on left ventricular twist. J Appl Physiol (1985) 2010; 108:146-51. [DOI: 10.1152/japplphysiol.00419.2009] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The dynamic interaction between subendocardial and subepicardial fibre helices in the left ventricle (LV) leads to a twisting deformation, which has an important role in LV function. This study sought to assess the influence of cardiac shape on LV twist in the normal and dilated human heart. The study comprised 45 dilated cardiomyopathy (DCM) patients and 60 for age- and gender-matched healthy volunteers. Speckle tracking echocardiography was used to determine basal and apical LV peak systolic rotation (Rotmax) and instantaneous LV peak systolic twist (Twistmax). LV sphericity index was calculated by dividing the LV maximal long-axis internal dimension by the maximal short-axis internal dimension at end-diastole. A parabolic relation between the sphericity index and apical Rotmaxor Twistmaxwas identified in the total study population ( R2= 0.56 and R2= 0.54, respectively; both P < 0.001) and healthy volunteers ( R2= 0.39 and R2= 0.25, respectively; both P < 0.001), whereas these relations were linear in DCM patients ( R2= 0.40 and R2= 0.43, respectively; both P < 0.001). In a multivariate analysis, LV sphericity index was the strongest independent predictor of apical Rotmaxand Twistmax. In conclusion, LV apical rotation and twist are significantly influenced by LV configuration. Taking the important function of LV twist into account, this finding highlights the vital influence of cardiac shape on LV systolic function.
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Affiliation(s)
- Bas M. van Dalen
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Floris Kauer
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wim B. Vletter
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Osama I. I. Soliman
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Heleen B. van der Zwaan
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Folkert J. ten Cate
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marcel L. Geleijnse
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
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Mizuguchi Y, Oishi Y, Miyoshi H, Iuchi A, Nagase N, Oki T. Concentric left ventricular hypertrophy brings deterioration of systolic longitudinal, circumferential, and radial myocardial deformation in hypertensive patients with preserved left ventricular pump function. J Cardiol 2010; 55:23-33. [DOI: 10.1016/j.jjcc.2009.07.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 07/22/2009] [Accepted: 07/23/2009] [Indexed: 10/20/2022]
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van Dalen BM, Soliman OII, Kauer F, Vletter WB, Zwaan HBVD, Cate FJT, Geleijnse ML. Alterations in left ventricular untwisting with ageing. Circ J 2009; 74:101-8. [PMID: 19966501 DOI: 10.1253/circj.cj-09-0436] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In order to gain further insight into age-associated changes of left ventricular (LV) diastolic function, the purpose of the current study was to investigate alterations in LV untwisting with ageing. METHODS AND RESULTS The study comprised 75 healthy volunteers, classified into 3 groups: age 16-35 (n=25), 36-55 (n=25) and 56-75 (n=25) years. LV untwisting (as a percentage of peak systolic twist) at 5%, 10%, 15% and 50% of diastole, peak diastolic untwisting velocity, time-to-peak diastolic untwisting velocity and untwisting rate (mean untwisting velocity during the time interval from peak systolic twist to mitral valve opening) were assessed using speckle-tracking echocardiography. Untwisting at 5%, 10%, 15% and 50% of diastole decreased with ageing. Although the peak diastolic untwisting velocity and untwisting rate were not significantly different between the age groups, when normalized for LV peak systolic twist, these parameters decreased with advancing age (both P<0.01). Time-to-peak diastolic untwisting velocity increased with ageing (P<0.01). CONCLUSIONS Impairment of the relative peak diastolic untwisting velocity and untwisting rate, resulting in delayed LV untwisting, may help to explain diastolic dysfunction in the elderly. (Circ J 2010; 74: 101 - 108).
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Affiliation(s)
- Bas M van Dalen
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, The Netherlands
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Jiamsripong P, Alharthi MS, Calleja AM, McMahon EM, Mookadam F, Khandheria BK, Belohlavek M. Quantification of left ventricular twisting mechanics by velocity vector imaging in an animal model of pericardial adhesions. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1963-1972. [PMID: 19828233 DOI: 10.1016/j.ultrasmedbio.2009.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 05/26/2009] [Accepted: 06/04/2009] [Indexed: 05/28/2023]
Abstract
Diagnosis of constrictive pericarditis remains clinically challenging. Untwisting of the left ventricle (LV) is essential for normal LV diastolic function. Echocardiography is able to measure LV twisting mechanics. We designed an animal model of constrictive pericarditis to determine how pericardial-epicardial adhesions impair LV twisting mechanics. In eight open-chest pigs, the heart was exposed while preserving the pericardium. We simulated early constrictive pericarditis by pericardial constriction and patchy adhesions induced with instant glue and pericardial-epicardial stitches. Using Velocity Vector Imaging (VVI), LV magnitudes of twisting and untwisting were measured along with hemodynamic data at baseline and after the experimental intervention. Significant decreases in end-diastolic volume, ejection fraction, stroke volume, and late diastolic filling velocity reflected the effects of the pericardial adhesions. Magnitude of LV untwisting rate decreased from -80+/-23 degrees /s to -26+/-10 degrees /s (p=0.0009). LV twisting rate dropped from 78+/-20 degrees /s to 40+/-8 degrees /s (p=0.0039) and LV twist magnitude decreased from 9+/-2 degrees to 5+/-2 degrees (p=0.0081). Patchy pericardial adhesions are associated with reductions in LV untwisting rate and twisting magnitude, consistent with a negative impact of constrictive pericarditis on systolic and diastolic function. Impairments in LV twisting mechanics may have a diagnostic role in the detection of early stages of constrictive pericarditis.
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Affiliation(s)
- Panupong Jiamsripong
- Translational Ultrasound Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, USA
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Assessment of left ventricular torsion using speckle tracking echocardiography. CURRENT CARDIOVASCULAR IMAGING REPORTS 2009. [DOI: 10.1007/s12410-009-0045-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Centola M, Longo M, De Marco F, Cremonesi G, Marconi M, Danzi GB. Does echocardiography play a role in the clinical diagnosis of congenital absence of pericardium? A case presentation and a systematic review. J Cardiovasc Med (Hagerstown) 2009; 10:687-92. [DOI: 10.2459/jcm.0b013e32832b3d4a] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Maslow A, Schwartz C, Mahmood F, Singh A, Heerdt PM. Case report: paradoxical ventricular septal motion in the setting of primary right ventricular myocardial failure. Can J Anaesth 2009; 56:510-7. [PMID: 19475470 DOI: 10.1007/s12630-009-9108-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2008] [Revised: 03/30/2009] [Accepted: 04/06/2009] [Indexed: 11/24/2022] Open
Abstract
PURPOSE In this report, a case of right ventricular (RV) failure, hemodynamic instability, and systemic organ failure is described to highlight how paradoxical ventricular systolic septal motion (PVSM), or a rightward systolic displacement of the interventricular septum, may contribute to RV ejection. CLINICAL FEATURES Multiple inotropic medications and vasopressors were administered to treat right heart failure and systemic hypotension in a patient following combined aortic and mitral valve replacement. In the early postoperative period, echocardiographic evaluation revealed adequate left ventricular systolic function, akinesis of the RV myocardial tissues, and PVSM. In the presence of PVSM, RV fractional area of contraction was > or =35% despite akinesis of the primary RV myocardial walls. The PVSM appeared to contribute toward RV ejection. As a result, the need for multiple inotropes was re-evaluated, in considering that end-organ dysfunction was the result of systemic hypotension and prolonged vasopressor administration. After discontinuation of phosphodiesterase inhibitors, native vascular tone returned and the need for vasopressors declined. This was followed by recovery of systemic organ function. Echocardiographic re-evaluation two years later, revealed persistent akinesis of the RV myocardial tissues and PVSM, the latter appearing to contribute toward RV ejection. CONCLUSIONS This case highlights the importance of left to RV interactions, and how PVSM may mediate these hemodynamic interactions.
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Affiliation(s)
- Andrew Maslow
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI, USA.
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Mizuguchi Y, Oishi Y, Miyoshi H, Iuchi A, Nagase N, Oki T. The functional role of longitudinal, circumferential, and radial myocardial deformation for regulating the early impairment of left ventricular contraction and relaxation in patients with cardiovascular risk factors: a study with two-dimensional strain imaging. J Am Soc Echocardiogr 2009; 21:1138-44. [PMID: 18926389 DOI: 10.1016/j.echo.2008.07.016] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Two-dimensional strain imaging allows rapid and accurate analysis of regional left ventricular (LV) systolic and diastolic mechanics in the longitudinal, radial, and circumferential directions. The aim of this study was to assess precisely the differences in early impairment of LV myocardial contraction and relaxation among the 3 directions in 70 patients with cardiovascular risk factors and preserved LV pump function. METHODS The patients were classified into 2 groups according to the ratio of early diastolic to atrial systolic velocity (E/A) of transmitral flow: E/A > or = 1 (n = 35, 57 +/- 6.8 years) or E/A < 1 (n = 35, 60 +/- 4.9 years). The longitudinal strain and strain rate curves were determined in apical 2- and 4-chamber views, and radial and circumferential strain and strain rate curves and LV torsion curve were determined in the parasternal short-axis views. RESULTS The mean peak systolic longitudinal strain and strain rate were lower, whereas the mean peak systolic circumferential strain and strain rate were greater in the E/A < 1 group. There were no significant differences in the mean peak systolic radial strain and strain rate between the 2 groups. The mean peak early diastolic longitudinal strain rate was markedly lower in the E/A < 1 group. The mean peak LV strain rates during atrial systole in all 3 directions were greater in the E/A < 1 group. The mean peak LV systolic longitudinal strain and longitudinal strain rate during atrial systole were independent predictors related to E/A in all patients. There were no significant differences in torsion and torsional and untwisting rates between the 2 groups. CONCLUSION LV myocardial contraction and relaxation were first impaired in the longitudinal direction among the 3 directions in subclinical patients with cardiovascular risk factors. However, LV pump function and LV filling were compensated by circumferential shortening at ventricular systole and 3 directional lengthenings at atrial systole, respectively.
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Affiliation(s)
- Yukio Mizuguchi
- Cardiovascular Section, Higashi Tokushima National Hospital, National Hospital Organization, Tokushima, Japan.
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Dal-Bianco JP, Sengupta PP, Mookadam F, Chandrasekaran K, Tajik AJ, Khandheria BK. Role of Echocardiography in the Diagnosis of Constrictive Pericarditis. J Am Soc Echocardiogr 2009; 22:24-33; quiz 103-4. [DOI: 10.1016/j.echo.2008.11.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Indexed: 10/21/2022]
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Sengupta PP, Tajik AJ, Chandrasekaran K, Khandheria BK. Twist Mechanics of the Left Ventricle. JACC Cardiovasc Imaging 2008; 1:366-76. [DOI: 10.1016/j.jcmg.2008.02.006] [Citation(s) in RCA: 406] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 02/19/2008] [Accepted: 02/29/2008] [Indexed: 02/07/2023]
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