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Robinson S, Ring L, Oxborough D, Harkness A, Bennett S, Rana B, Sutaria N, Lo Giudice F, Shun-Shin M, Paton M, Duncan R, Willis J, Colebourn C, Bassindale G, Gatenby K, Belham M, Cole G, Augustine D, Smiseth OA. The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Res Pract 2024; 11:16. [PMID: 38825710 PMCID: PMC11145885 DOI: 10.1186/s44156-024-00051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258-271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59-G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a structured approach to the assessment of diastolic function and includes recommendations for the assessment of LV relaxation and filling pressures. Non-routine echocardiographic measures are described alongside guidance for application in specific circumstances. Provocative methods for revealing increased filling pressure on exertion are described and novel and emerging modalities considered. For rapid access to the core recommendations of the diastolic guideline, a quick-reference guide (additional file 1) accompanies the main guideline document. This describes in very brief detail the diastolic investigation in each patient group and includes all algorithms and core reference tables.
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Affiliation(s)
| | - Liam Ring
- West Suffolk Hospital NHS Trust, Bury St Edmunds, UK
| | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Sadie Bennett
- University Hospital of the North Midlands, Stoke-On-Trent, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | - Rae Duncan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | | | | | - Mark Belham
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Graham Cole
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Otto A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
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Shu Q, Wang Y, Lin X, Xie S, Wang Z, Wang S, Yin L. Assessment of fetal intraventricular diastolic fluid dynamics using ultrasound vector flow mapping. BMC Cardiovasc Disord 2023; 23:488. [PMID: 37794371 PMCID: PMC10552239 DOI: 10.1186/s12872-023-03524-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the feasibility of visualizing and quantifying the normal pattern of vortex formation in the left ventricle (LV) and right ventricle (RV) of the fetal heart during diastole using vector flow mapping (VFM). METHODS A total of 36 healthy fetuses in the second trimester (mean gestational age: 23 weeks, 2 days; range: 22-24 weeks) were enrolled in the study. Color Doppler signals were recorded in the four-chamber view to observe the phase of the diastolic vortices in the LV and RV. The vortex area and circulation were measured, and parameters such as intraventricular pressure difference (IVPD), intraventricular pressure gradient (IVPG), and average energy loss (EL_AVG) were evaluated at different diastolic phases, including isovolumic relaxation (D1), early diastole (D2), and late diastole (D3). RESULTS Healthy second-trimester fetal vortex formations were observed in both the LV and RV at the end of diastole, with the vortices rotating in a clockwise direction towards the outflow tract. There were no significant differences in vortex area and circulation between the two ventricles (p > 0.05). However, significant differences were found in IVPD, IVPG, and EL_AVG among the diastolic phases (D1, D2, and D3) (p < 0.05). Trends in IVPD, IVPG, and EL_AVG during diastole (D1-D2-D3) revealed increasing IVPD and EL_AVG values, as well as decreasing IVPG values. Furthermore, during D3, the RV exhibited significantly higher IVPD, IVPG, and EL_AVG compared to the LV (p > 0.05). CONCLUSION VFM is a valuable technique for analyzing the formation of vortices in the left and right ventricles during fetal diastole. The application of VFM technology has the potential to enhance the assessment of fetal cardiac parameters.
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Affiliation(s)
- Qinglan Shu
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Cardiovascular Ultrasound & Noninvasive Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Wang
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Cardiovascular Ultrasound & Noninvasive Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xinyi Lin
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shenghua Xie
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Cardiovascular Ultrasound & Noninvasive Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhengyang Wang
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Cardiovascular Ultrasound & Noninvasive Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Sijia Wang
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Cardiovascular Ultrasound & Noninvasive Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Lixue Yin
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
- Department of Cardiovascular Ultrasound & Noninvasive Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
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Evaluation of left ventricular blood flow kinetic energy in patients with hypertension by four-dimensional flow cardiovascular magnetic resonance imaging: a preliminary study. Eur Radiol 2023:10.1007/s00330-023-09449-8. [PMID: 36826498 DOI: 10.1007/s00330-023-09449-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES To evaluate the intra-cavity left ventricular (LV) blood flow kinetic energy (KE) parameters using four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) in patients with hypertension (HTN). METHODS Forty-two HTN patients and twenty age-/gender-matched healthy controls who underwent CMR including cines, pre-/post-T1 mapping, and whole-heart 4D flow imaging were retrospectively evaluated. HTN patients were further divided into two subgroups: with preserved ejection fraction (HTN-pEF) and with reduced ejection fraction (HTN-rEF). KE parameters were indexed to LV end-diastolic volume (EDV) to obtain averaged LV, minimal, systolic, diastolic, peak E-wave, peak A-wave, E-wave, and A-wave KEiEDV, as well as the proportion of in-plane LV KE (%), the time difference (TD). These parameters were compared between the HTN group and healthy controls, also between two subgroups. The correlation of LV blood flow KE parameters with LV function and extracellular volume fraction (ECV) were analyzed in the HTN group using multivariate regression analysis. RESULTS Peak E-wave KEiEDV in the HTN group was significantly lower (p = 0.01), while in-plane KE and TD were significantly higher (all p < 0.01) than those in healthy controls. Compared to the HTN-pEF subgroup, the proportion of in-plane KE and TD was significantly increased in the HTN-rEF subgroup (all p < 0.01). Only the proportion of in-plane KE demonstrated an independent correlation with ECV (β* = 0.59, p < 0.01). CONCLUSIONS The decreased peak E-wave KEiEDV and the increased proportion of in-plane KE, TD reflected the alterations of LV blood flow in HTN patients, and the proportion of in-plane KE was independently associated with ECV. KEY POINTS • 4D flow CMR demonstrated that the peak E-wave KEiEDV was decreased, while the in-plane KE and time difference (TD) were increased in hypertensive (HTN) patients. • The proportion of in-plane KE and TD was further increased in HTN patients with reduced ejection fraction than in HTN patients with preserved ejection fraction, and the proportion of in-plane KE was independently associated with extracellular volume fraction in HTN patients. • 4D flow CMR intra-cavity blood flow KE parameters might reveal the LV hemodynamic status in preclinical HTN patients.
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Anthony C, Akintoye E, Wang T, Klein A. Echo Doppler Parameters of Diastolic Function. Curr Cardiol Rep 2023; 25:235-247. [PMID: 36821063 DOI: 10.1007/s11886-023-01844-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight the echo Doppler parameters that form the cornerstone for the evaluation of diastolic function as per the guideline documents of the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI). In addition, the individual Doppler-based parameters will be explored, with commentary on the rationale behind their use and the multi-parametric approach to the assessment of diastolic dysfunction (DD) using echocardiography. RECENT FINDINGS Previous guidelines for assessment of diastolic function are complex with modest diagnostic performance and significant inter-observer variability. The most recent guidelines have made the evaluation of DD more streamlined with excellent correlation with invasive measures of LV filling pressures. This is a review of the echo-derived Doppler parameters that are integral in the diagnosis and gradation of DD. A brief description of the physiological principles that govern changes in echocardiographic parameters during normal and abnormal diastolic function is also discussed for the appropriate diagnosis of DD using non-invasive Doppler echocardiography techniques.
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Affiliation(s)
- Chris Anthony
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Emmanuel Akintoye
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Tom Wang
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Allan Klein
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA. .,Lerner College of Medicine of Case Western University, Cleveland, USA. .,Center for the Diagnosis and Treatment of Pericardial Disease, Cleveland, USA.
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Elhawaz A, Archer GT, Zafar H, Fidock B, Barker N, Jones R, Rothman A, Hose R, Al-Mohammad A, Briffa N, Hunter S, Braidley P, Hall IR, Grech E, van der Geest RJ, Gunn JP, Swift AJ, Wild JM, Garg P. Left ventricular blood flow kinetic energy is associated with the six-minute walk test and left ventricular remodelling post valvular intervention in aortic stenosis. Quant Imaging Med Surg 2021; 11:1470-1482. [PMID: 33816183 DOI: 10.21037/qims-20-586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Left ventricular (LV) kinetic energy (KE) assessment by four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) may offer incremental value over routine assessment in aortic stenosis (AS). The main objective of this study is to investigate the LV KE in patients with AS before and after the valve intervention. In addition, this study aimed to investigate if LV KE offers incremental value for its association to the six-minute walk test (6MWT) or LV remodelling post-intervention. Methods We recruited 18 patients with severe AS. All patients underwent transthoracic echocardiography for mean pressure gradient (mPG), CMR including 4D flow and 6MWT. Patients were invited for post-valve intervention follow-up CMR at 3 months and twelve patients returned for follow-up CMR. KE assessment of LV blood flow and the components (direct, delayed, retained and residual) were carried out for all cases. LV KE parameters were normalised to LV end-diastolic volume (LVEDV). Results For LV blood flow KE assessment, the metrics including time delay (TD) for peak E-wave from base to mid-ventricle (14±48 vs. 2.5±9.75 ms, P=0.04), direct (4.91±5.07 vs. 1.86±1.72 µJ, P=0.01) and delayed (2.46±3.13 vs. 1.38±1.15 µJ, P=0.03) components of LV blood flow demonstrated a significant change between pre- and post-valve intervention. Only LV KEiEDV (r=-0.53, P<0.01), diastolic KEiEDV (r=-0.53, P<0.01) and Ewave KEiEDV (r=-0.38, P=0.04) demonstrated association to the 6MWT. However, Pre-operative LV KEiEDV (r=0.67, P=0.02) demonstrated association to LV remodelling post valve intervention. Conclusions LV blood flow KE is associated with 6MWT and LV remodelling in patients with AS. LV KE assessment provides incremental value over routine LV function and pressure gradient (PG) assessment in AS.
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Affiliation(s)
- Alaa Elhawaz
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Gareth T Archer
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Hamza Zafar
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Benjamin Fidock
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Natasha Barker
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Rachel Jones
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alexander Rothman
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Rod Hose
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Abdallah Al-Mohammad
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Norman Briffa
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Steven Hunter
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Peter Braidley
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ian R Hall
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ever Grech
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rob J van der Geest
- Division of Image Processing, Leiden University Medical Centre, Leiden, The Netherlands
| | - Julian P Gunn
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - James M Wild
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Pankaj Garg
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
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Hernandez-Suarez DF, Kim Y, López FM, Ramakrishna H, López-Candales A. Qualitative Assessment of Color M-Mode Signals in the Evaluation of Left Ventricular Diastolic Function: A Proof of Concept Study. J Cardiothorac Vasc Anesth 2019; 33:2658-2662. [PMID: 31248799 DOI: 10.1053/j.jvca.2019.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Although the most recent American Society of Echocardiography guidelines are a major step forward in echocardiographic evaluation of diastolic function, the ability to differentiate between normal and abnormal function remains challenging. The authors aimed to determine whether qualitative assessments of color M-mode flow displays could be a useful parameter in the evaluation of left ventricular (LV) diastolic dysfunction. DESIGN Retrospective observational study. SETTING Tertiary care level hospital. PARTICIPANTS The study comprised echocardiographic data from 105 consecutive patients. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Patients were allocated into the following 3 groups according to the LV diastolic function based on current American Society of Echocardiography recommendation guidelines for LV diastolic dysfunction classification: group I-normal function (n = 40); group II-early relaxation abnormalities (grade I) (n = 50), and group III-elevated LV pressures (grade II) (n = 15). Patients with normal diastolic function were younger (45 ± 14 y) than those with diastolic dysfunction (group II: 64 ± 10 y and group III: 56 ± 15 y) (p < 0.05). Volumetric echocardiographic parameters and mitral inflow and mitral annulus tissue Doppler imaging measures were significantly different among the 3 studied groups (p < 0.05). Interestingly, qualitative assessment of color M-mode flows displayed distinctive signals based on the left ventricle filling properties. Intraobserver and interobserver variability to determine the reliability of these signals were robust (weighted kappa 0.84 ± 0.11 and 0.65 ± 0.13, respectively). CONCLUSION Qualitative assessment of color M-mode flow displays offers simple and reliable information of potential usefulness in the evaluation of LV diastolic function.
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Affiliation(s)
- Dagmar F Hernandez-Suarez
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
| | - Yeunjung Kim
- Division of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Francisco Menéndez López
- Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, AZ
| | - Angel López-Candales
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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Diastolic Assessment: Application of the New ASE Guidelines. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9474-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Garg P, Crandon S, Swoboda PP, Fent GJ, Foley JRJ, Chew PG, Brown LAE, Vijayan S, Hassell MECJ, Nijveldt R, Bissell M, Elbaz MSM, Al-Mohammad A, Westenberg JJM, Greenwood JP, van der Geest RJ, Plein S, Dall’Armellina E. Left ventricular blood flow kinetic energy after myocardial infarction - insights from 4D flow cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2018; 20:61. [PMID: 30165869 PMCID: PMC6117925 DOI: 10.1186/s12968-018-0483-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/20/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Myocardial infarction (MI) leads to complex changes in left ventricular (LV) haemodynamics that are linked to clinical outcomes. We hypothesize that LV blood flow kinetic energy (KE) is altered in MI and is associated with LV function and infarct characteristics. This study aimed to investigate the intra-cavity LV blood flow KE in controls and MI patients, using cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow assessment. METHODS Forty-eight patients with MI (acute-22; chronic-26) and 20 age/gender-matched healthy controls underwent CMR which included cines and whole-heart 4D flow. Patients also received late gadolinium enhancement imaging for infarct assessment. LV blood flow KE parameters were indexed to LV end-diastolic volume and include: averaged LV, minimal, systolic, diastolic, peak E-wave and peak A-wave KEiEDV. In addition, we investigated the in-plane proportion of LV KE (%) and the time difference (TD) to peak E-wave KE propagation from base to mid-ventricle was computed. Association of LV blood flow KE parameters to LV function and infarct size were investigated in all groups. RESULTS LV KEiEDV was higher in controls than in MI patients (8.5 ± 3 μJ/ml versus 6.5 ± 3 μJ/ml, P = 0.02). Additionally, systolic, minimal and diastolic peak E-wave KEiEDV were lower in MI (P < 0.05). In logistic-regression analysis, systolic KEiEDV (Beta = - 0.24, P < 0.01) demonstrated the strongest association with the presence of MI. In multiple-regression analysis, infarct size was most strongly associated with in-plane KE (r = 0.5, Beta = 1.1, P < 0.01). In patients with preserved LV ejection fraction (EF), minimal and in-plane KEiEDV were reduced (P < 0.05) and time difference to peak E-wave KE propagation during diastole increased (P < 0.05) when compared to controls with normal EF. CONCLUSIONS Reduction in LV systolic function results in reduction in systolic flow KEiEDV. Infarct size is independently associated with the proportion of in-plane LV KE. Degree of LV impairment is associated with TD of peak E-wave KE. In patient with preserved EF post MI, LV blood flow KE mapping demonstrated significant changes in the in-plane KE, the minimal KEiEDV and the TD. These three blood flow KE parameters may offer novel methods to identify and describe this patient population.
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Affiliation(s)
- Pankaj Garg
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Saul Crandon
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Peter P. Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Graham J. Fent
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - James R. J. Foley
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Pei G. Chew
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Louise A. E. Brown
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Sethumadhavan Vijayan
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Mariëlla E. C. J. Hassell
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Malenka Bissell
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Mohammed S. M. Elbaz
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jos J. M. Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - John P. Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Rob J. van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Erica Dall’Armellina
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
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Hernandez-Suarez DF, Palm D, Lopez-Menendez F, Mesa Pabon M, Lopez-Candales A. Left Ventricular Velocity of Propagation: A Useful Non-Invasive Measurement When Assessing Hemodynamic Alterations in Pulmonary Arterial Hypertension. Cardiol Res 2017; 8:44-51. [PMID: 28515821 PMCID: PMC5421485 DOI: 10.14740/cr541w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 11/25/2022] Open
Abstract
Background Left ventricular (LV) velocity of propagation (Vp) has been shown to be inversely related to the LV relaxation time constant. We sought to examine Vp from a group of chronic pulmonary hypertension (cPH) patients and compare these values to Vp obtained in normal individuals and patients with known LV diastolic dysfunction (LVDD). Methods Echo-Doppler data and Vp measurements were retrospectively collected from all patients. The studied population was divided into four groups. Group I comprised of 15 patients with normal LV diastole, group II included 27 patients with stage 1 LVDD, group III was made up of 27 patients with stage 2 LVDD, and group IV included 66 patients with cPH. Results In the cPH population studied, patients had smaller end-diastolic LV cavities with the highest Vp values but their early mitral inflow to Vp ratios were not different from healthy controls. In addition, Vp values and pulmonary wedge capillary pressures were significantly associated in patients with LV dysfunction or pulmonary hypertension (P < 0.01). Conclusions LVVp might be a useful non-invasive measurement to be routinely obtained in cPH patients as it probably not only reflects the compressive forces being exerted on the LV, known to increase Vp, but also might be quite useful for the non-invasive assessment of pulmonary capillary wedge pressures in these patients.
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Affiliation(s)
| | - Denada Palm
- Division of Cardiovascular Health and Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Francisco Lopez-Menendez
- Division of Cardiovascular Health and Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marcel Mesa Pabon
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Angel Lopez-Candales
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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Chan BT, Yeoh HK, Liew YM, Aziz YFA, Sridhar GS, Hamilton-Craig C, Platts D, Lim E. Left ventricular flow propagation velocity measurement: Is it cast in stone? Med Biol Eng Comput 2017; 55:1883-1893. [PMID: 28321684 DOI: 10.1007/s11517-017-1639-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
This study aims to investigate the measurement of left ventricular flow propagation velocity, V p, using phase contrast magnetic resonance imaging and to assess the discrepancies resulting from inflow jet direction and individual left ventricular size. Three V p measuring techniques, namely non-adaptive (NA), adaptive positions (AP) and adaptive vectors (AV) method, were suggested and compared. We performed the comparison on nine healthy volunteers and nine post-infarct patients at four measurement positions, respectively, at one-third, one-half, two-thirds and the conventional 4 cm distances from the mitral valve leaflet into the left ventricle. We found that the V p measurement was affected by both the inflow jet direction and measurement positions. Both NA and AP methods overestimated V p, especially in dilated left ventricles, while the AV method showed the strongest correlation with the isovolumic relaxation myocardial strain rate (r = 0.53, p < 0.05). Using the AV method, notable difference in mean V p was also observed between healthy volunteers and post-infarct patients at positions of: one-half (81 ± 31 vs. 58 ± 25 cm/s), two-thirds (89 ± 32 vs. 45 ± 15 cm/s) and 4 cm (98 ± 23 vs. 47 ± 13 cm/s) distances. The use of AV method and measurement position at one-half distance was found to be the most suitable method for assessing diastolic dysfunction given varying left ventricular sizes and inflow jet directions.
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Affiliation(s)
- Bee Ting Chan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hak Koon Yeoh
- Department of Chemical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Seri Kembangan Engineering Sdn. Bhd., 61-1, Jalan Anggerik Vanilla T, Kota Kemuning, 40460, Shah Alam, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | | | - Christian Hamilton-Craig
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, 4006, Australia
| | - David Platts
- School of Medicine, University of Queensland, Brisbane, QLD, 4006, Australia.,Department of Echocardiography, The Prince Charles Hospital, Chermside, QLD, 4032, Australia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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11
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Palmiero P, Zito A, Maiello M, Cameli M, Modesti PA, Muiesan ML, Novo S, Saba PS, Scicchitano P, Pedrinelli R, Ciccone MM. Left ventricular diastolic function in hypertension: methodological considerations and clinical implications. J Clin Med Res 2014; 7:137-44. [PMID: 25584097 PMCID: PMC4285058 DOI: 10.14740/jocmr2050w] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 12/30/2022] Open
Abstract
The assessment of left ventricular (LV) diastolic function should be an integral part of a routine examination of hypertensive patient; indeed when LV diastolic function is impaired, it is possible to have heart failure even with preserved LV ejection fraction. Left ventricular diastolic dysfunction (LVDD) occurs frequently and is associated to heart disease. Doppler echocardiography is the best tool for early LVDD diagnosis. Hypertension affects LV relaxation and when left ventricular hypertrophy (LVH) occurs, it decreases compliance too, so it is important to calculate Doppler echocardiography parameters, for diastolic function evaluation, in all hypertensive patients. The purpose of our review was to discuss about the strong relationship between LVDD and hypertension, and their relationship with LV systolic function. Furthermore, we aimed to assess the relationship between the arterial stiffness and LV structure and function in hypertensive patients.
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Affiliation(s)
| | - Annapaola Zito
- Cardiovascular Disease Section, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Maria Maiello
- ASL Department of Cardiology, Brindisi District, Italy
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Italy
| | - Pietro Amedeo Modesti
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Maria Lorenza Muiesan
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Salvatore Novo
- Department of Internal Medicine and Cardiovascular Diseases, Palermo, Italy
| | - Pier Sergio Saba
- Cardiologia, Azienda Ospedaliero-Universitaria di Sassari, Italy
| | - Pietro Scicchitano
- Cardiovascular Disease Section, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Roberto Pedrinelli
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Universita di Pisa, Pisa, Italy
| | - Marco Matteo Ciccone
- Cardiovascular Disease Section, Department of Emergency and Organ Transplantation, University of Bari, Italy
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12
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de Vecchi A, Gomez A, Pushparajah K, Schaeffter T, Nordsletten DA, Simpson JM, Penney GP, Smith NP. Towards a fast and efficient approach for modelling the patient-specific ventricular haemodynamics. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 116:3-10. [PMID: 25157924 DOI: 10.1016/j.pbiomolbio.2014.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/12/2014] [Indexed: 11/17/2022]
Abstract
Computer modelling of the heart has emerged over the past decade as a powerful technique to explore the cardiovascular pathophysiology and inform clinical diagnosis. The current state-of-the-art in biophysical modelling requires a wealth of, potentially invasive, clinical data for the parametrisation and validation of the models, a process that is still too long and complex to be compatible with the clinical decision-making time. Therefore, there remains a need for models that can be quickly customised to reconstruct physical processes difficult to measure directly in patients. In this paper, we propose a less resource-intensive approach to modelling, whereby computational fluid-dynamics (CFD) models are constrained exclusively by boundary motion derived from imaging data through a validated wall tracking algorithm. These models are generated and parametrised based solely on ultrasound data, whose acquisition is fast, inexpensive and routine in all patients. To maximise the time and computational efficiency, a semi-automated pipeline is embedded in an image processing workflow to personalise the models. Applying this approach to two patient cases, we demonstrate this tool can be directly used in the clinic to interpret and complement the available clinical data by providing a quantitative indication of clinical markers that cannot be easily derived from imaging, such as pressure gradients and the flow energy.
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Affiliation(s)
- A de Vecchi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - A Gomez
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - K Pushparajah
- Evelina London Children's Hospital, London SE1 7EH, UK
| | - T Schaeffter
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - D A Nordsletten
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - J M Simpson
- Evelina London Children's Hospital, London SE1 7EH, UK
| | - G P Penney
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - N P Smith
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK.
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13
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Hill JC, Bourque DP. Doppler Tissue Imaging Is More Sensitive Than Other Echocardiographic Markers in Identifying Abnormal Relaxation in Subclinical Hypertensive Disease and Normal Ejection Fraction. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2014. [DOI: 10.1177/8756479314530510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This report describes the use of echocardiographic measurements for the assessment of left ventricular diastolic function in two young patients with newly diagnosed hypertension. Measurements for the assessment of left ventricular relaxation and filling pressures included mitral inflow, Doppler tissue imaging (DTI), color M-mode propagation velocity slope, and the isovolumic relaxation time. The mitral inflow, propagation velocity, and isovolumic relaxation time measurements were all within normal limits; however, DTI measurements of the E′ velocity at the septal and lateral annulus were significantly reduced in both patients. Further visual inspection demonstrated discrete proximal septal wall thickening that is thought to be modulated by pressure loading (i.e., increased afterload due to hypertension) and ejection. These findings may represent a “transitional state” of early ventricular remodeling and organ failure in the development of hypertensive disease. In summary, DTI appears to be more sensitive compared to other markers in identifying abnormal relaxation in subclinical hypertensive disease and normal ejection fraction.
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Affiliation(s)
- Jeffrey C. Hill
- Hoffman Heart and Vascular Institute of Connecticut, Hartford, CT, USA
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14
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Yurtdaş M, Yaylali YT, Kaya Y, Özdemir M, Özkan İ, Aladağ N. Neutrophil-to-Lymphocyte Ratio May Predict Subclinical Atherosclerosis in Patients with Psoriasis. Echocardiography 2014; 31:1095-104. [DOI: 10.1111/echo.12511] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Mustafa Yurtdaş
- Department of Cardiology; Van Region Training and Research Hospital; Van Turkey
| | - Yalin T. Yaylali
- Department of Cardiology; School of Medicine; Pamukkale University; Denizli Turkey
| | - Yüksel Kaya
- Department of Cardiology; School of Medicine; Kafkas University; Kars Turkey
| | - Mahmut Özdemir
- Department of Cardiology; Van Region Training and Research Hospital; Van Turkey
| | - İlker Özkan
- Department of Dermatology; Lokman Hekim Hospital; Van Turkey
| | - Nesim Aladağ
- Department of Cardiology; Van Region Training and Research Hospital; Van Turkey
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15
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Chen M, Jin JM, Zhang Y, Gao Y, Liu SL. Assessment of left ventricular diastolic dysfunction based on the intraventricular velocity difference by vector flow mapping. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:2063-2071. [PMID: 24277887 DOI: 10.7863/ultra.32.12.2063] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The diastolic intraventricular velocity difference represents diastolic function of the left ventricle (LV). Here we analyzed the LV diastolic intraventricular velocity difference in patients with impaired LV function based on the ventricular flow rate profile by vector flow mapping. METHODS Patients with LV diastolic dysfunction were divided into 2 groups: chronic heart failure with restricted filling (group 1; n = 27) and hypertension with abnormal relaxation (group 2; n = 34). Healthy participants were identified as controls (group 3; n = 22). Left ventricular inflow color Doppler findings were analyzed by the vector profile model with the vector flow mapping technology offline. The flow velocity rates at the base and apex of the LV were measured from vector profiles with the vector flow mapping technology. The diastolic intraventricular velocity difference was calculated from flow velocity rates. RESULTS The diastolic intraventricular velocity difference calculated from vector flow mapping was significantly lower in both groups with LV diastolic dysfunction than the control group (mean ± SD, 79.95 ± 9.88 cm/s in controls versus 40.35 ± 6.80 cm/s in group 1 and 48.50 ± 6.03 cm/s in group 2; P < .001 for both). The diastolic intraventricular velocity difference had a significant association with the ejection fraction (P = .0002) and deceleration time (P = .0306). The peak atrial contraction velocity was negatively related to the diastolic intraventricular velocity difference (P = .0003). CONCLUSIONS The diastolic intraventricular velocity difference derived from the LV velocity rate by the vector profile model on vector flow mapping can be potentially used for quantitative assessment of LV diastolic function. Vector flow mapping proved to be clinically practical for reflecting LV diastolic dysfunction in pathologic states.
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Affiliation(s)
- Ming Chen
- Division of Noninvasive Cardiac Function, Heart Center, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pu Dong, 200120 Shanghai, China.
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16
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GUERRA M, BRÁS-SILVA C, AMORIM MJ, MOURA C, BASTOS P, LEITE-MOREIRA AF. Intraventricular Pressure Gradients in Heart Failure. Physiol Res 2013; 62:479-87. [DOI: 10.33549/physiolres.932531] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of the present study was to characterize intraventricular pressure gradients (IVPGs) in an animal model of chronic heart failure. New Zealand rabbits were treated with doxorubicin (heart failure group, n=5) or saline (control group, n=5) and instrumented with pressure catheters placed in the apex and outflow-tract of left ventricle (LV) and with sonomicrometer crystals placed in the apex and base of the LV free wall. In heart failure animals, ventricular filling was delayed and slower when compared with control animals. Moreover, the physiological nonuniformity observed between apical and basal segments in normal hearts was abolished in failing hearts. Simultaneously, physiological IVPGs observed during normal ventricular filling were entirely lost in heart failure animals. During ventricular emptying physiological nonuniformity between apical and basal segments observed in control animals was also abolished in heart failure animals. In failing hearts minimal length occurred later and almost at same time both in apical and in basal myocardial segments. Simultaneously, the characteristic IVPG pattern observed in healthy hearts during systole, which promotes ventricular emptying, was not observed in failing hearts. The present study showed that diastolic IVPGs, a marker of normal ventricular filling, and systolic IVPGs, a marker of normal ventricular emptying, are abolished in heart failure.
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Affiliation(s)
| | | | | | | | | | - A. F. LEITE-MOREIRA
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, Portugal
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17
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Nicoara A, Whitener G, Swaminathan M. Perioperative Diastolic Dysfunction. Semin Cardiothorac Vasc Anesth 2013; 18:218-36. [DOI: 10.1177/1089253213505686] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Left ventricular diastolic dysfunction (LVDD) has only recently been recognized as an important determinant of perioperative morbidity. Intraoperative echocardiographers have been slow to adopt assessment of LVDD into clinical practice. This has been partly attributable to the complex measurements required to characterize LVDD, which are in turn related to how our understanding of diastole has evolved. Additionally, the lack of effective therapeutic options has left many wondering whether it is worthwhile to characterize this pathology in the first place. However, therapies are developed more rapidly once a problem can be identified reliably. The assessment of LVDD is centered on how effectively the left ventricle can fill. Diastolic dysfunction affects intraventricular pressures and stiffness, which in turn affect the pressure relationship between the left atrium and the left ventricle thereby affecting transmitral flow. Since echocardiography can enable the measurement of flow velocities, transmitral diastolic filling flow patterns provide robust information on diastolic function. The impact of abnormal diastolic function on left atrial pressure has consequences for pulmonary venous flow, which can also be measured with echocardiography. However, given the limitations of flow velocity, direct measurement of tissue velocity can significantly improve the characterization of diastolic dysfunction. The evolution of Doppler and speckle-based methods of assessing tissue motion have vastly improved our understanding of diastolic function. With the development of simpler algorithms for categorization, and their gradual adoption by perioperative echocardiographers, LVDD should be better diagnosed and treated to improve postoperative outcomes.
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18
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Seo JH, Vedula V, Abraham T, Mittal R. Multiphysics computational models for cardiac flow and virtual cardiography. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2013; 29:850-869. [PMID: 23666911 DOI: 10.1002/cnm.2556] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/11/2013] [Accepted: 04/08/2013] [Indexed: 06/02/2023]
Abstract
A multiphysics simulation approach is developed for predicting cardiac flows as well as for conducting virtual echocardiography (ECHO) and phonocardiography (PC) of those flows. Intraventricular blood flow in pathological heart conditions is simulated by solving the three-dimensional incompressible Navier-Stokes equations with an immersed boundary method, and using this computational hemodynamic data, echocardiographic and phonocardiographic signals are synthesized by separate simulations that model the physics of ultrasound wave scattering and flow-induced sound, respectively. For virtual ECHO, a Doppler ultrasound image is reproduced through Lagrangian particle tracking of blood cell particles and application of sound wave scattering theory. For virtual PC, the generation and propagation of blood flow-induced sounds ('hemoacoustics') is directly simulated by a computational acoustics model. The virtual ECHO is applied to reproduce a color M-mode Doppler image for the left ventricle as well as continuous Doppler image for the outflow tract of the left ventricle, which can be verified directly against clinically acquired data. The potential of the virtual PC approach for providing new insights between disease and heart sounds is demonstrated by applying it to modeling systolic murmurs caused by hypertrophic cardiomyopathy.
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Affiliation(s)
- Jung Hee Seo
- Johns Hopkins University, Baltimore, MD 21218, USA
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19
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Chan BT, Abu Osman NA, Lim E, Chee KH, Abdul Aziz YF, Abed AA, Lovell NH, Dokos S. Sensitivity analysis of left ventricle with dilated cardiomyopathy in fluid structure simulation. PLoS One 2013; 8:e67097. [PMID: 23825628 PMCID: PMC3692440 DOI: 10.1371/journal.pone.0067097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/15/2013] [Indexed: 11/18/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is the most common myocardial disease. It not only leads to systolic dysfunction but also diastolic deficiency. We sought to investigate the effect of idiopathic and ischemic DCM on the intraventricular fluid dynamics and myocardial wall mechanics using a 2D axisymmetrical fluid structure interaction model. In addition, we also studied the individual effect of parameters related to DCM, i.e. peak E-wave velocity, end systolic volume, wall compliance and sphericity index on several important fluid dynamics and myocardial wall mechanics variables during ventricular filling. Intraventricular fluid dynamics and myocardial wall deformation are significantly impaired under DCM conditions, being demonstrated by low vortex intensity, low flow propagation velocity, low intraventricular pressure difference (IVPD) and strain rates, and high-end diastolic pressure and wall stress. Our sensitivity analysis results showed that flow propagation velocity substantially decreases with an increase in wall stiffness, and is relatively independent of preload at low-peak E-wave velocity. Early IVPD is mainly affected by the rate of change of the early filling velocity and end systolic volume which changes the ventriculo:annular ratio. Regional strain rate, on the other hand, is significantly correlated with regional stiffness, and therefore forms a useful indicator for myocardial regional ischemia. The sensitivity analysis results enhance our understanding of the mechanisms leading to clinically observable changes in patients with DCM.
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Affiliation(s)
- Bee Ting Chan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.
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20
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Guerra M, Amorim MJ, Brás-Silva C, Leite-Moreira AF. Intraventricular pressure gradients throughout the cardiac cycle: effects of ischaemia and modulation by afterload. Exp Physiol 2012; 98:149-60. [DOI: 10.1113/expphysiol.2012.066324] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Guerra M, Sampaio F, Brás-Silva C, Leite-Moreira AF. Left intraventricular diastolic and systolic pressure gradients. Exp Biol Med (Maywood) 2011; 236:1364-72. [DOI: 10.1258/ebm.2011.011134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
To describe left ventricular (LV) function comprehensively, it is crucial to characterize precisely transmitral, intraventricular and transaortic pressure–flow relations. The site of measurement is important; as the measurement location is moved from the mitral valve toward the apex and the outflow tract, important regional pressure differences are recorded inside the LV. These intraventricular pressure gradients (IVPGs) play an important role in ventricular filling in the normal heart and may be abolished by systolic or diastolic dysfunction. Despite their apparent importance in ventricular filling and diastolic function, IVPGs have never been utilized in clinical cardiology, due to the complexity of their acquisition. The application of Doppler echocardiography allows the reconstruction of diastolic IVPGs completely non-invasively, thus avoiding the risk and expense of a cardiac catheterization. Regional pressure gradients are also present during ventricular emptying but their correlation with systolic function is not so clear. The current minireview highlights theories and experimental data on invasive and non-invasive assessment of diastolic and systolic IVPGs and their role in LV filling and emptying. We also review the pathophysiological modulation of regional gradients, their importance in understanding and evaluating the complex phenomena underlying ventricular filling, as well as their potential clinical application.
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Affiliation(s)
- Miguel Guerra
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto
- Department of Cardiothoracic Surgery
| | - Francisco Sampaio
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Vila Nova de Gaia 4434-502
| | - Cármen Brás-Silva
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto
- Faculty of Nutrition and Food Sciences, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto
| | - Adelino F Leite-Moreira
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto
- Centre of Thoracic Surgery, Hospital São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
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22
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Matyal R, Skubas NJ, Shernan SK, Mahmood F. Perioperative assessment of diastolic dysfunction. Anesth Analg 2011; 113:449-72. [PMID: 21813627 DOI: 10.1213/ane.0b013e31822649ac] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Assessment of diastolic function should be a component of a comprehensive perioperative transesophageal echocardiographic examination. Abnormal diastolic function exists in >50% of patients presenting for cardiac and high-risk noncardiac surgery, and has been shown to be an independent predictor of adverse postoperative outcome. Normalcy of systolic function in 50% of patients with congestive heart failure implicates diastolic dysfunction as the probable etiology. Comprehensive evaluation of diastolic function requires the use of various, load-dependent Doppler techniques This is further complicated by the additional effects of dehydration and anesthetic drugs on myocardial relaxation and compliance as assessed by these Doppler measures. The availability of more sophisticated Doppler techniques, e.g., Doppler tissue imaging and flow propagation velocity, makes it possible to interrogate left ventricular diastolic function with greater precision, analyze specific stages of diastole, and to differentiate abnormalities of relaxation from compliance. Additionally, various Doppler-derived ratios can be used to estimate left ventricular filling pressures. The varying hemodynamic environment of the operating room mandates modification of the diagnostic algorithms used for ambulatory cardiac patients when left ventricular diastolic function is evaluated with transesophageal echocardiography in anesthetized surgical patients.
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Affiliation(s)
- Robina Matyal
- Department of Anesthesia and Critical Care Medicine, Beth Israel Deaconess Medical Center, CC-454, 1 Deaconess Rd., Boston, MA 02215, USA.
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23
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Barutçuoglu B, Parildar Z, Başol G, Gürgün C, Tekin Y, Bayindir O. The detection of left ventricular diastolic dysfunction in hypertensive patients: Performance of N-terminal probrain natriuretic peptide. Blood Press 2010; 19:212-7. [PMID: 20070249 DOI: 10.3109/08037050903552776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM Diastolic dysfunction (DD) results in increased cardiovascular risk in hypertensives. We studied the performance of N-terminal probrain natriuretic peptide (NT-proBNP) in detecting DD. MATERIALS AND METHODS 241 hypertensive patients admitted to cardiology polyclinics were included in this study. They were grouped according to the presence of DD. Group 1: Essential hypertensive patients without DD (n= 119); group 2: essential hypertensive patients with DD (n= 122). All underwent trans-thoracic echocardiography for the evaluation of transvalvular flow, morphology, left ventricular wall motion abnormalities and ejection fraction. NT-proBNP levels were measured by an electrochemiluminescence immunoassay. RESULTS The systolic blood pressure (BP) (mean+/-SD) was 140+/-12 mmHg in group 1 and 144+/-16 mmHg in group 2 (p=0.049), the diastolic BP (mean+/-SD) was 88+/-10 mmHg in group 1 and 90+/-14 mmHg in group 2 (p=0.043). The median (1st-3rd quartile) NT-proBNP level in group 2 was significantly higher than group 1 [121.05 (61.03-207.66) and 31.17 (17.07-54.09) pg/ml, respectively (p<0.001)]. In the receiver operating characteristics analysis, the area under the curve was 0.862 (95% CI 0.816-0.908). At the cut-off of 45 pg/ml, sensitivity was 86.9%, specificity was 62.4%, and at the cut-off 65 pg/ml, sensitivity was 74.6%, specificity was 83.8%. CONCLUSION Plasma NT-proBNP levels may be useful for identifying patients with DD and it is conceivable to use a cut-off level 65 pg/ml as a "rule in" test.
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Affiliation(s)
- Burcu Barutçuoglu
- Department of Clinical Biochemistry, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey.
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24
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Fujimoto N, Prasad A, Hastings JL, Arbab-Zadeh A, Bhella PS, Shibata S, Palmer D, Levine BD. Cardiovascular effects of 1 year of progressive and vigorous exercise training in previously sedentary individuals older than 65 years of age. Circulation 2010; 122:1797-805. [PMID: 20956204 DOI: 10.1161/circulationaha.110.973784] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Healthy but sedentary aging leads to cardiovascular stiffening, whereas life-long endurance training preserves left ventricular (LV) compliance. However, it is unknown whether exercise training started later in life can reverse the effects of sedentary behavior on the heart. METHODS AND RESULTS Twelve sedentary seniors and 12 Masters athletes were thoroughly screened for comorbidities. Subjects underwent invasive hemodynamic measurements with pulmonary artery catheterization to define Starling and LV pressure-volume curves; secondary functional outcomes included Doppler echocardiography, magnetic resonance imaging assessment of cardiac morphology, arterial stiffness (total aortic compliance and arterial elastance), and maximal exercise testing. Nine of 12 sedentary seniors (70.6±3 years; 6 male, 3 female) completed 1 year of endurance training followed by repeat measurements. Pulmonary capillary wedge pressures and LV end-diastolic volumes were measured at baseline, during decreased cardiac filling with lower-body negative pressure, and increased filling with saline infusion. LV compliance was assessed by the slope of the pressure-volume curve. Before training, Vo(2)max, LV mass, LV end-diastolic volume, and stroke volume were significantly smaller and the LV was less compliant in sedentary seniors than Masters athletes. One year of exercise training had little effect on cardiac compliance. However, it reduced arterial elastance and improved Vo(2)max by 19% (22.8±3.4 versus 27.2±4.3 mL/kg/mL; P<0.001). LV mass increased (10%, 64.5±7.9 versus 71.2±12.3 g/m(2); P=0.037) with no change in the mass-volume ratio. CONCLUSIONS Although 1 year of vigorous exercise training did not appear to favorably reverse cardiac stiffening in sedentary seniors, it nonetheless induced physiological LV remodeling and imparted favorable effects on arterial function and aerobic exercise capacity.
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Affiliation(s)
- Naoki Fujimoto
- Institute for Exercise and Environmental Medicine, Dallas, TX 75231, USA
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Gunes Y, Tuncer M, Guntekin U, Ceylan Y, Simsek H, Sahin M, Yildirim M. The relation between the color M-mode propagation velocity of the descending aorta and coronary and carotid atherosclerosis and flow-mediated dilatation. Echocardiography 2010; 27:300-5. [PMID: 20486958 DOI: 10.1111/j.1540-8175.2009.01019.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Common carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilatation (FMD) have correlated with coronary atherosclerosis. Recently, the color M-mode-derived propagation velocity of descending thoracic aorta (AVP) was shown to be associated with coronary artery disease (CAD). METHODS CIMT, FMD, and AVP were measured in 92 patients with CAD and 70 patients having normal coronary arteries (NCA) detected by coronary angiography. Patients with acute myocardial infarction, renal failure or hepatic failure, aneurysm of aorta, severe valvular heart disease, left ventricular ejection fraction <40%, atrial fibrillation, frequent premature beats, left bundle branch block, and inadequate echocardiographic image quality were excluded. RESULTS Compared to patients with normal coronary arteries, patients having CAD had significantly lower AVP (29.9 +/- 8.1 vs. 47.5 +/- 16.8 cm/sec, P < 0.001) and FMD (5.3 +/- 1.9 vs. 11.4 +/- 5.8%, P < 0.001) and higher CIMT (0.94 +/- 0.05 vs. 0.83 +/- 0.14 mm, P < 0.001) measurements. There were significant correlations between AVP and CIMT (r =-0.691, P < 0.001), AVP and FMD (r = 0.514, P < 0.001) and FMD and CIMT (r =-0.530, P < 0.001). CONCLUSIONS The transthoracic echocardiographic determination of the color M-mode propagation velocity of the descending aorta is a simple practical method and correlates well with the presence of carotid and coronary atherosclerosis and brachial endothelial function.
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Affiliation(s)
- Yilmaz Gunes
- Cardiology Department, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey. mail:
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de Waal EEC, De Boeck BWL, Kruitwagen CLJJ, Cramer MJM, Buhre WF. Effects of on-pump and off-pump coronary artery bypass grafting on left ventricular relaxation and compliance: a comprehensive perioperative echocardiography study. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:732-7. [PMID: 20421229 DOI: 10.1093/ejechocard/jeq055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS The short-term effect of coronary artery bypass grafting (CABG) on diastolic function is only moderately investigated. Furthermore, it remains unknown whether avoidance of cardioplegic arrest by an off-pump CABG procedure has advantages over on-pump procedure regarding diastolic relaxation and compliance. We investigated whether components of diastolic function would be improved the day after CABG depending on the type of the surgical procedure. METHODS AND RESULTS Spontaneously breathing on-pump (n = 20) and off-pump CABG (n = 12) patients underwent a comprehensive transthoracic echocardiography examination the day before and the day after elective CABG, including transmitral and pulmonary vein flow parameters, colour M-mode flow propagation velocity (Vp) and tissue Doppler assessment of the average mitral annulus diastolic velocity (Em). Isovolumic relaxation and E-wave deceleration time were corrected for heart rate (IVRTcHR and DTcHR). Left ventricular (LV) relaxation time (τ) and LV operating stiffness (LVOS) were calculated. Overall and independent from operation type and preload, CABG decreased IVRTcHR (107 ± 20 vs. 93 ± 15 ms) (P < 0.01) and τ (54 ± 10 vs. 45 ± 10 ms) (P < 0.01), increased Vp (49 ± 22 vs. 75 ± 37 cm/s) (P < 0.01), and increased Em (6.6 ± 2.0 vs. 7.3 ± 1.3 cm/s, P = 0.06), indicating improved relaxation. LVOS increased (0.13 ± 0.06 vs. 0.22 ± 0.05 mmHg/mL) (P < 0.01), compatible with an impaired compliance. A similar improvement in relaxation and impairment in compliance were observed in both groups. CONCLUSION Myocardial relaxation improved the day after CABG irrespective of the use of cardiopulmonary bypass with cardioplegic arrest. Impairment in compliance could not be prevented by the avoidance of cardioplegia.
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Affiliation(s)
- Eric E C de Waal
- Department of Perioperative and Emergency Care, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands.
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Silberman GA, Fan THM, Liu H, Jiao Z, Xiao HD, Lovelock JD, Boulden BM, Widder J, Fredd S, Bernstein KE, Wolska BM, Dikalov S, Harrison DG, Dudley SC. Uncoupled cardiac nitric oxide synthase mediates diastolic dysfunction. Circulation 2010; 121:519-28. [PMID: 20083682 PMCID: PMC2819317 DOI: 10.1161/circulationaha.109.883777] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Heart failure with preserved ejection fraction is 1 consequence of hypertension and is caused by impaired cardiac diastolic relaxation. Nitric oxide (NO) is a known modulator of cardiac relaxation. Hypertension can lead to a reduction in vascular NO, in part because NO synthase (NOS) becomes uncoupled when oxidative depletion of its cofactor tetrahydrobiopterin (BH(4)) occurs. Similar events may occur in the heart that lead to uncoupled NOS and diastolic dysfunction. METHODS AND RESULTS In a hypertensive mouse model, diastolic dysfunction was accompanied by cardiac oxidation, a reduction in cardiac BH(4), and uncoupled NOS. Compared with sham-operated animals, male mice with unilateral nephrectomy, with subcutaneous implantation of a controlled-release deoxycorticosterone acetate pellet, and given 1% saline to drink were mildly hypertensive and had diastolic dysfunction in the absence of systolic dysfunction or cardiac hypertrophy. The hypertensive mouse hearts showed increased oxidized biopterins, NOS-dependent superoxide production, reduced NO production, and dephosphorylated phospholamban. Feeding hypertensive mice BH(4) (5 mg/d), but not treating with hydralazine or tetrahydroneopterin, improved cardiac BH(4) stores, phosphorylated phospholamban levels, and diastolic dysfunction. Isolated cardiomyocyte experiments revealed impaired relaxation that was normalized with short-term BH(4) treatment. Targeted cardiac overexpression of angiotensin-converting enzyme also resulted in cardiac oxidation, NOS uncoupling, and diastolic dysfunction in the absence of hypertension. CONCLUSIONS Cardiac oxidation, independently of vascular changes, can lead to uncoupled cardiac NOS and diastolic dysfunction. BH(4) may represent a possible treatment for diastolic dysfunction.
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Affiliation(s)
- Gad A. Silberman
- Department of Medicine (Division of Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Tai-Hwang M. Fan
- Department of Medicine (Division of Cardiology), Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Atlanta, GA
| | - Hong Liu
- Department of Medicine (Division of Cardiology), Emory University School of Medicine, Atlanta, GA
- Section of Cardiology, University of Illinois at Chicago, Chicago, IL and the Jesse Brown VA Medical Center, Chicago IL
| | - Zhe Jiao
- Department of Medicine (Division of Cardiology), Emory University School of Medicine, Atlanta, GA
- Section of Cardiology, University of Illinois at Chicago, Chicago, IL and the Jesse Brown VA Medical Center, Chicago IL
| | - Hong D. Xiao
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Joshua D. Lovelock
- Section of Cardiology, University of Illinois at Chicago, Chicago, IL and the Jesse Brown VA Medical Center, Chicago IL
| | - Beth M. Boulden
- Department of Medicine (Division of Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Julian Widder
- Department of Medicine (Division of Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Scott Fredd
- Department of Medicine (Division of Cardiology), Emory University School of Medicine, Atlanta, GA
| | | | - Beata M. Wolska
- Section of Cardiology, University of Illinois at Chicago, Chicago, IL and the Jesse Brown VA Medical Center, Chicago IL
| | - Sergey Dikalov
- Department of Medicine (Division of Cardiology), Emory University School of Medicine, Atlanta, GA
| | - David G. Harrison
- Department of Medicine (Division of Cardiology), Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Atlanta, GA
| | - Samuel C. Dudley
- Department of Medicine (Division of Cardiology), Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Atlanta, GA
- Section of Cardiology, University of Illinois at Chicago, Chicago, IL and the Jesse Brown VA Medical Center, Chicago IL
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Guntekin U, Gunes Y, Gunes A, Ceylan Y, Gumrukcuoglu HA, Yucel Y, Simsek H, Tuncer M. Noninvasive Assessment of Atherosclerosis in Patients with Isolated Hypertension. Echocardiography 2010; 27:155-60. [DOI: 10.1111/j.1540-8175.2009.00987.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Van Mieghem T, DeKoninck P, Steenhaut P, Deprest J. Methods for prenatal assessment of fetal cardiac function. Prenat Diagn 2009; 29:1193-203. [DOI: 10.1002/pd.2379] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Loerakker S, Cox L, van Heijst G, de Mol B, van de Vosse F. Influence of dilated cardiomyopathy and a left ventricular assist device on vortex dynamics in the left ventricle. Comput Methods Biomech Biomed Engin 2008; 11:649-60. [PMID: 18979303 DOI: 10.1080/10255840802469379] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Claessens TE, De Sutter J, Vanhercke D, Segers P, Verdonck PR. New echocardiographic applications for assessing global left ventricular diastolic function. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:823-41. [PMID: 17434662 DOI: 10.1016/j.ultrasmedbio.2006.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Revised: 12/11/2006] [Accepted: 12/22/2006] [Indexed: 05/14/2023]
Abstract
A number of promising and highly technological echocardiographic imaging tools have recently been introduced to assess left ventricular diastolic function (i.e., the capacity of the ventricle to relax and fill). They permit quantification of distinct features of intraventricular blood flow velocity and pressure fields and myocardial tissue velocities. However, accurate interpretation of the new images and clinical indices is still cumbersome, as basic knowledge about intraventricular hemodynamics and ventricular wall mechanics is often insufficient. This review article provides a comprehensive and original overview of the hemodynamical and mechanical events that occur during diastole and discusses how this new information can be used in the clinical and research setting to evaluate diastolic function in the healthy and the diseased heart. It furthermore aims to explain the underpinnings of the techniques in such a way that the underlying biomechanical concepts (fluid dynamics and wall mechanics) become less obscure to cardiologists and echocardiographers and such that the biomedical engineers are given some insights into the avalanche of diastolic performance indices that currently exist.
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Affiliation(s)
- Tom E Claessens
- Cardiovascular Mechanics and Biofluid Dynamics Research Unit, Institute of Biomedical Technology, Ghent University, Ghent, Belgium.
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Rovner A, Waggoner AD, Mathews SJ, Dávila-Román VG, de las Fuentes L. Role of Tissue Doppler and Color M-Mode Imaging for Evaluation of Diastolic Function in Ambulatory Patients with LV Systolic Dysfunction. Echocardiography 2007; 24:478-84. [PMID: 17456066 DOI: 10.1111/j.1540-8175.2007.00435.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Tissue Doppler imaging (TDI) and color M-mode (CMM) indices provide assessment of left ventricular (LV) relaxation when combined with pulse-wave Doppler (PWD)-derived transmitral inflow, allows for estimation of LV filling pressures. However, use of these indices in patients with LV systolic dysfunction (LVSD) has not been well characterized. METHODS AND RESULTS The study included 115 patients (age 58 +/- 11 years, 67% male) with LVSD (LV ejection fraction [LVEF] < 55%). Patients were grouped according to the diastolic LV filling pressure assessed by E/Em(septal) ratio as follows: 1) Normal (NFP), E/Em(septal) < 8; 2) Intermediate (IFP), E/Em(septal): 8-15; and 3) High (HFP), E/Em(septal) >15. Age-, gender-, and LVEF-adjusted analyses were performed. LV volumes and LVEF were significantly different between the groups (P < 0.01). PWD-derived E-wave velocity showed a significant stepwise increase across the three groups and the Em(septal) velocity demonstrated a stepwise decrease (P < 0.01 for both). CMM-derived diastolic intra-ventricular pressure gradient (IVPG) was significantly lower in the HFP compared to the other 2 groups (P < 0.01 for both); Vp was increased in the HFP compared to the other 2 groups (P < 0.01 for both), and Vp exhibited a U-shape relationship to LVEF. CONCLUSION In patients with LVSD, abnormal LV relaxation is uniformly observed regardless of LV filling pressure. PWD-derived E-wave velocity and the TDI-derived Em velocity are important measurements to identify elevated LV filling pressures. CMM-derived Vp and IVPG were of limited incremental value for the evaluation of diastolic function in patients with LVSD.
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Affiliation(s)
- Aleksandr Rovner
- Cardiovascular Imaging and Clinical Research Core Laboratory, Washington University School of Medicine, Cardiovascular Division, St. Louis, Missouri 63110, USA
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Rovner A, de las Fuentes L, Waggoner AD, Memon N, Chohan R, Dávila-Román VG. Characterization of left ventricular diastolic function in hypertension by use of Doppler tissue imaging and color M-mode techniques. J Am Soc Echocardiogr 2006; 19:872-9. [PMID: 16824996 DOI: 10.1016/j.echo.2006.01.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Indexed: 12/01/2022]
Abstract
BACKGROUND Abnormalities in left ventricular (LV) relaxation and/or increased filling pressures are indicators of LV diastolic dysfunction in patients with hypertension (HTN). The purpose of this study was to assess clinical use of pulsed wave Doppler, Doppler tissue imaging (DTI), and color M-mode (CMM) indices for determination of diastolic function in patients with HTN. METHODS In all, 278 ambulatory patients with normal LV systolic function were grouped according to the presence of HTN with and without LV hypertrophy (LVH) (determined by the 2-dimensional area-length method) as follows: healthy control subjects (NC, n = 122), HTN without LVH (HTN, n = 70), and HTN with LVH (HTN+LVH, n = 86). Pulsed wave Doppler-derived measurements included transmitral E- and A-wave velocities, E/A ratio, and deceleration and isovolumic relaxation time intervals; DTI-derived early diastolic (Em) velocities were obtained at 4 LV annular sites. CMM-derived flow propagation velocity and the intraventricular pressure gradient were also calculated. Analysis of covariance adjusted for age and sex of diastolic indices was performed to compare the differences among groups. RESULTS Only DTI-derived filling pressures demonstrated progressive statistically significant differences among all 3 groups (ie, HTN vs NC, HTN+LVH vs NC, and HTN vs HTN+LVH). However, CMM-derived flow propagation velocity and intraventricular pressure gradient indices were similar among the groups. CONCLUSION DTI is a robust method compared with pulsed wave Doppler- and CMM-derived indices for the quantitative assessment of LV relaxation and filling pressures in patients with HTN.
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Affiliation(s)
- Aleksandr Rovner
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri 63110, USA
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Markham LW, Michelfelder EC, Border WL, Khoury PR, Spicer RL, Wong BL, Benson DW, Cripe LH. Abnormalities of Diastolic Function Precede Dilated Cardiomyopathy Associated with Duchenne Muscular Dystrophy. J Am Soc Echocardiogr 2006; 19:865-71. [PMID: 16824995 DOI: 10.1016/j.echo.2006.02.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Indexed: 11/22/2022]
Affiliation(s)
- Larry W Markham
- Division of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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