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Shirzad M, Tari B, Dalton C, Van Riesen J, Marsala MJ, Heath M. Passive exercise increases cerebral blood flow velocity and supports a postexercise executive function benefit. Psychophysiology 2022; 59:e14132. [PMID: 35781673 DOI: 10.1111/psyp.14132] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/16/2022]
Abstract
Executive function entails high-level cognitive control supporting activities of daily living. Literature has shown that a single-bout of exercise involving volitional muscle activation (i.e., active exercise) improves executive function and that an increase in cerebral blood flow (CBF) may contribute to this benefit. It is, however, unknown whether non-volitional exercise (i.e., passive exercise) wherein an individual's limbs are moved via an external force elicits a similar executive function benefit. This is a salient question given that proprioceptive and feedforward drive from passive exercise increases CBF independent of the metabolic demands of active exercise. Here, in a procedural validation participants (n = 2) used a cycle ergometer to complete separate 20-min active and passive (via mechanically driven flywheel) exercise conditions and a non-exercise control condition. Electromyography showed that passive exercise did not increase agonist muscle activation or increase ventilation or gas exchange variables (i.e., V̇O2 and V̇CO2 ). In a main experiment participants (n = 28) completed the same exercise and control conditions and transcranial Doppler ultrasound showed that active and passive exercise (but not the control condition) increased CBF through the middle cerebral artery (ps <.001); albeit the magnitude was less during passive exercise. Notably, antisaccade reaction times prior to and immediately after each condition showed that active (p < .001) and passive (p = .034) exercise improved an oculomotor-based measure of executive function, whereas no benefit was observed in the control condition (p = .85). Accordingly, results evince that passive exercise 'boosts' an oculomotor-based measure of executive function and supports convergent evidence that increased CBF mediates this benefit.
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Affiliation(s)
- Mustafa Shirzad
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Benjamin Tari
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Connor Dalton
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - James Van Riesen
- Graduate Program in Neuroscience, University of Western Ontario, London, Ontario, Canada
| | - Michael J Marsala
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Matthew Heath
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Graduate Program in Neuroscience, University of Western Ontario, London, Ontario, Canada.,Canadian Centre for Activity and Aging, University of Western Ontario, London, Ontario, Canada
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Tari B, Shirzad M, Behboodpour N, Belfry GR, Heath M. Exercise intensity-specific changes to cerebral blood velocity do not modulate a postexercise executive function benefit. Neuropsychologia 2021; 161:108018. [PMID: 34487738 DOI: 10.1016/j.neuropsychologia.2021.108018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 12/20/2022]
Abstract
Executive function is transiently improved (i.e., <60-min) following a single bout of aerobic exercise. A candidate mechanism for this improvement is an exercise-mediated increase in cerebral blood flow (CBF). Further, it has been proposed that an increase in CBF across the continuum of increasing exercise intensities improves the magnitude of a postexercise executive function benefit (i.e., drive theory); however, this proposal has not been empirically tested. Here, participants completed four experimental sessions: a V̇O2peak test to determine cardiorespiratory fitness and estimated lactate threshold (LT), followed by separate 10-min sessions of light- (i.e., 25 W), moderate- (i.e., 80% estimated LT), and heavy-intensity (i.e., 15% of the difference between LT and V̇O2peak) aerobic exercise. An estimate of CBF during exercise was achieved via transcranial Doppler ultrasound and near-infrared spectroscopy to quantify blood velocity (BV) through the middle cerebral artery and deoxygenated hemoglobin (HHb), respectively. Executive function was assessed before and after each session via the executive-mediated antisaccade task (i.e., saccade mirror-symmetrical to a target). Results demonstrated that BV increased in relation to increasing exercise intensity, whereas HHb decreased by a comparable magnitude independent of intensity. In terms of executive function, null hypothesis and equivalence tests indicated a comparable magnitude postexercise reduction in antisaccade reaction time across exercise intensities. Accordingly, the magnitude of CBF change during exercise does not impact the magnitude of a postexercise executive function benefit.
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Affiliation(s)
- Benjamin Tari
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Mustafa Shirzad
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Nikan Behboodpour
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Glen R Belfry
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada; Canadian Centre for Activity and Aging, University of Western Ontario, 1201 Western Rd, London, ON, N6G 1H1, Canada
| | - Matthew Heath
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada; Canadian Centre for Activity and Aging, University of Western Ontario, 1201 Western Rd, London, ON, N6G 1H1, Canada; Graduate Program in Neuroscience, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.
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3
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Shim CY. Heart Failure with Preserved Ejection Fraction: the Major Unmet Need in Cardiology. Korean Circ J 2020; 50:1051-1061. [PMID: 33150751 PMCID: PMC7707983 DOI: 10.4070/kcj.2020.0338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) has recently been recognized as the single greatest unmet need in cardiovascular medicine. As the population ages and the comorbidity increases, the prevalence of HFpEF increases considerably. Even though there have been large numbers of studies on pathophysiology, diagnosis, and treatment of HFpEF for latest years, there are no current pharmacologic interventions that can reduce mortality. HFpEF is currently understood as a heterogeneous syndrome originated from the interplay of cardiac and extracardiac abnormalities recognized by systemic inflammation, endothelial and coronary microvascular dysfunction, cardiomyocyte dysfunction and skeletal muscle dysfunction. The difficult “jigsaw puzzle” called HFpEF has been filled with some pieces, but it is still not enough to meet clinical needs. Here, we review recent evidences and unsolved problems about HFpEF to improve our understanding of HFpEF. Finally, we hope to accelerate to completion of the problematic “jigsaw puzzle”.
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Affiliation(s)
- Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Samuel TJ, Beaudry R, Sarma S, Zaha V, Haykowsky MJ, Nelson MD. Diastolic Stress Testing Along the Heart Failure Continuum. Curr Heart Fail Rep 2019; 15:332-339. [PMID: 30171472 DOI: 10.1007/s11897-018-0409-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review summarizes recent developments highlighting the clinical utility of diastolic stress testing along the heart failure continuum. RECENT FINDINGS Invasive hemodynamic assessment of cardiac filling pressures during physiological stress is the gold-standard technique for unmasking diastolic dysfunction. Non-invasive surrogate techniques, such as Doppler ultrasound, have shown excellent agreement with invasive approaches and are now recommended by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. While cycle exercise is often advocated, recent evidence supports the use of isometric handgrip as a viable alternative stressor. Diastolic stress testing is a powerful tool to enhance detection of diastolic dysfunction, is able to differentiate between cardiac and non-cardiac pathology, and should be incorporated into routine clinical assessment.
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Affiliation(s)
- T Jake Samuel
- The University of Texas at Arlington, Engineering Research Building 453, 500 UTA Blvd, Arlington, TX, 76019, USA
| | - Rhys Beaudry
- The University of Texas at Arlington, Engineering Research Building 453, 500 UTA Blvd, Arlington, TX, 76019, USA
| | - Satyam Sarma
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Institute of Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA
| | - Vlad Zaha
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mark J Haykowsky
- The University of Texas at Arlington, Engineering Research Building 453, 500 UTA Blvd, Arlington, TX, 76019, USA
| | - Michael D Nelson
- The University of Texas at Arlington, Engineering Research Building 453, 500 UTA Blvd, Arlington, TX, 76019, USA.
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Ventricular Stiffness and Ventricular-Arterial Coupling in Heart Failure: What Is It, How to Assess, and Why? Heart Fail Clin 2019; 15:267-274. [PMID: 30832817 DOI: 10.1016/j.hfc.2018.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The heart and blood vessels are constantly interfering with each other in a closed system. For a few decades, the concept of ventricular-arterial coupling has been considered as a key pathogenesis of heart failure especially in heart failure with preserved ejection fraction.
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Roca F, Bellien J, Iacob M, Joannides R. Endothelium-dependent adaptation of arterial wall viscosity during blood flow increase is impaired in essential hypertension. Atherosclerosis 2019; 285:102-107. [PMID: 31051413 DOI: 10.1016/j.atherosclerosis.2019.04.208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/11/2019] [Accepted: 04/04/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Arterial wall viscosity (AWV) is regulated by endothelium-derived NO and epoxyeicosatrienoic acids (EETs) under baseline physiological conditions. Whether these factors regulate AWV during blood flow increase and whether this mechanism is affected in essential hypertensive patients (HT) remain unknown. METHODS The evolution of radial artery diameter, wall thickness and arterial pressure in response to an increase in flow induced by hand skin heating were measured in 18 untreated HT and 14 normotensive controls (NT) during local infusion of saline and the respective pharmacological inhibitors of NO-synthase and EETs synthesis by cytochrome P450, L-NMMA and/or fluconazole. AWV was estimated by the ratio of the viscous energy dissipated (WV) to the elastic energy stored (WE) obtained from the pressure-diameter relationship. Concomitant changes in operating conditions, which influence the AWV, were taken into account by calculating the midwall stress. RESULTS Baseline WV and WE were higher in HT than in NT but WV/WE was similar. In saline condition, WV/WE increased in HT during heating but not in NT. In the presence of L-NMMA and/or fluconazole, WV/WE increased during heating in NT. In contrast, these inhibitors did not modify the increase in WV/WE during heating in HT compared to saline. In all conditions, a larger increase in WV than WE was responsible for the increase in WV/WE. CONCLUSIONS The release of NO and EETs maintains a stable AWV during flow increase and this endothelial adaptive regulation is lost during essential hypertension, which may promote excessive viscous energy dissipation and cardiovascular uncoupling. Restoration of EETs availability with inhibitors of soluble epoxide hydrolase could thus constitute a promising pharmacological approach to restore the endothelial adaptive regulation of AWV.
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Affiliation(s)
- Frederic Roca
- Rouen University Hospital, Department of Pharmacology, F 76000, Rouen, France; Normandie Univ, UNIROUEN, Inserm U1096, F 76000, Rouen, France; University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France; Clinical Investigation Center CIC-CRB 1404, Rouen University Hospital, Rouen, France.
| | - Jeremy Bellien
- Rouen University Hospital, Department of Pharmacology, F 76000, Rouen, France; Normandie Univ, UNIROUEN, Inserm U1096, F 76000, Rouen, France; University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France; Clinical Investigation Center CIC-CRB 1404, Rouen University Hospital, Rouen, France
| | - Michele Iacob
- Rouen University Hospital, Department of Pharmacology, F 76000, Rouen, France; Normandie Univ, UNIROUEN, Inserm U1096, F 76000, Rouen, France
| | - Robinson Joannides
- Rouen University Hospital, Department of Pharmacology, F 76000, Rouen, France; Normandie Univ, UNIROUEN, Inserm U1096, F 76000, Rouen, France; University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France; Clinical Investigation Center CIC-CRB 1404, Rouen University Hospital, Rouen, France
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Shim CY, Kim D, Park S, Lee CJ, Cho HJ, Ha JW, Cho YJ, Hong GR. Effects of continuous positive airway pressure therapy on left ventricular diastolic function: a randomised, sham-controlled clinical trial. Eur Respir J 2018; 51:51/2/1701774. [DOI: 10.1183/13993003.01774-2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/30/2017] [Indexed: 11/05/2022]
Abstract
Continuous positive airway pressure (CPAP) therapy may decrease left ventricular (LV) loads and improve myocardial oxygenation. In this study, we investigated the effect of CPAP on LV diastolic function compared with sham treatment in patients with severe obstructive sleep apnoea (OSA).This 3-month prospective single-centre randomised sham-controlled trial analysed 52 patients with severe OSA. Patients were randomly assigned (1:1) to receive either CPAP or sham treatment for 3 months. The main investigator and patients were masked to the trial randomisation. The primary end-point was change of early diastolic mitral annular (e′) velocity over the 3-month period. Secondary end-points were pulse wave velocity (PWV), 24-h ambulatory blood pressure (BP) and variables of ventricular-vascular coupling at 3 months.After 3 months of follow-up, CPAP treatment significantly increased the e′ velocity, and was greater than the sham treatment (0.65±1.70 versus −0.61±1.85 cm·s−1, p=0.014). The PWV, 24-h mean diastolic BP, night-time diastolic BP, arterial elastance index and ventricular-vascular coupling index after 3 months of follow-up decreased significantly in the CPAP group.In patients with severe OSA, CPAP treatment for 3 months improved LV diastolic function more than sham treatment, and was accompanied by improvements in arterial stiffness and ventricular-vascular coupling.
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Bell V, McCabe EL, Larson MG, Rong J, Merz AA, Osypiuk E, Lehman BT, Stantchev P, Aragam J, Benjamin EJ, Hamburg NM, Vasan RS, Mitchell GF, Cheng S. Relations Between Aortic Stiffness and Left Ventricular Mechanical Function in the Community. J Am Heart Assoc 2017; 6:JAHA.116.004903. [PMID: 28069573 PMCID: PMC5523643 DOI: 10.1161/jaha.116.004903] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Aortic stiffness impairs optimal ventricular–vascular coupling and left ventricular systolic function, particularly in the long axis. Left ventricular global longitudinal strain (GLS) has recently emerged as a sensitive measure of early cardiac dysfunction. In this study, we investigated the relation between aortic stiffness and GLS in a large community‐based sample. Methods and Results In 2495 participants (age 39–90 years, 57% women) of the Framingham Offspring and Omni cohorts, free of cardiovascular disease, we performed tonometry to measure arterial hemodynamics and echocardiography to assess cardiac function. Aortic stiffness was evaluated as carotid–femoral pulse wave velocity and as characteristic impedance, and GLS was calculated using speckle tracking–based measurements. In multivariable analyses adjusting for age, sex, height, systolic blood pressure, augmentation index, left ventricular structure, and additional cardiovascular risk factors, increased carotid–femoral pulse wave velocity (B±SE: 0.122±0.030% strain per SD, P<0.0001) and characteristic impedance (0.090±0.029, P=0.002) were both associated with worse GLS. We observed effect modification by sex on the relation between characteristic impedance and GLS (P=0.004); in sex‐stratified multivariable analyses, the relation between greater characteristic impedance and worse GLS persisted in women (0.145±0.039, P=0.0003) but not in men (P=0.73). Conclusions Multiple measures of increased aortic stiffness were cross‐sectionally associated with worse GLS after adjusting for hemodynamic variables. Parallel reductions in left ventricular long axis shortening and proximal aortic longitudinal strain in individuals with a stiffened proximal aorta, from direct mechanical ventricular‐vascular coupling, offers an alternative explanation for the observed relations.
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Affiliation(s)
| | - Elizabeth L McCabe
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Martin G Larson
- Department of Biostatistics, Boston University School of Public Health, Boston, MA.,Framingham Heart Study, Framingham, MA
| | - Jian Rong
- Framingham Heart Study, Framingham, MA
| | - Allison A Merz
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | - Emelia J Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, MA.,Framingham Heart Study, Framingham, MA.,Preventive Medicine and Cardiology Sections, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Naomi M Hamburg
- Preventive Medicine and Cardiology Sections, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA.,Evans Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Ramachandran S Vasan
- Department of Epidemiology, Boston University School of Public Health, Boston, MA.,Framingham Heart Study, Framingham, MA.,Preventive Medicine and Cardiology Sections, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | | | - Susan Cheng
- Framingham Heart Study, Framingham, MA .,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
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Determinants and Prognostic Significance of Symptomatic Status in Patients with Moderately Dysfunctional Bicuspid Aortic Valves. PLoS One 2017; 12:e0169285. [PMID: 28060855 PMCID: PMC5218394 DOI: 10.1371/journal.pone.0169285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/14/2016] [Indexed: 11/23/2022] Open
Abstract
Background We aimed to identify the clinical and echocardiographic determinants of symptoms and their prognostic implications in patients with moderately dysfunctional bicuspid aortic valves (BAVs). Methods Among 1,019 subjects in the BAV registry treated in a single tertiary care center, the records of 127 patients (85 men, age 58±13 years) with moderately dysfunctional BAVs were comprehensively reviewed. The patients were divided into two groups based on symptom status: asymptomatic (n = 80) vs. symptomatic (n = 47). The primary end-point was defined as a composite of aortic valve surgery, hospitalization for heart failure, and any cause of death. Results The symptomatic group had a higher proportion of females, hypertension, aortic stenosis, and aortopathy than did the asymptomatic group. The symptomatic group showed lower e′ (5.5±1.7 vs. 6.5±2.2 cm/s, p = 0.003), higher E/e′ (13.3 ± 4.9 vs. 10.9±3.7, p = 0.002), and larger left atrial volume index (29.9±11.4 vs. 24.6±9.1 ml/m2, p = 0.006) than did the asymptomatic group. In multivariate logistic regression analysis, female gender (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.10–7.36, p = 0.031), hypertension (OR 3.07, 95% CI 1.20–7.82, p = 0.019), moderate aortic stenosis (OR 5.33 5.78, 95% CI 1.99–16.83, p = 0.001), E/e′ >15 (OR 3.82, 95% CI 1.03–11.19, p = 0.015), and aortopathy (OR 2.76, 95% CI 1.07–7.10, p = 0.035) were independently correlated with symptom status. The symptomatic group showed a significantly lower rate of event-free survival during the 8-year follow-up period (54±9% vs. 68±10%, p = 0.001). Conclusions In patients with moderately dysfunctional BAVs, the presence of moderate aortic stenosis, aortopathy, and diastolic dysfunction determines symptom status, along with female gender and hypertension. Symptom status was associated with clinical outcomes.
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Zhaojun LMD, Qian ZMD, Qing YMD, Jufang WMD, Lianfang DMD, Xianghong LMD. Gender Difference in Ventricular-vascular Coupling in Response to Exercises in Medical Graduate Students. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2017. [DOI: 10.37015/audt.2017.170001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Assessment of ventriculo-vascular properties in repaired coarctation using cardiac magnetic resonance-derived aortic, left atrial and left ventricular strain. Eur Radiol 2016; 27:167-177. [DOI: 10.1007/s00330-016-4373-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/10/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
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12
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Chowdhury SM, Butts RJ, Taylor CL, Bandisode VM, Chessa KS, Hlavacek AM, Shirali GS, Baker GH. Validation of Noninvasive Measures of Left Ventricular Mechanics in Children: A Simultaneous Echocardiographic and Conductance Catheterization Study. J Am Soc Echocardiogr 2016; 29:640-7. [PMID: 27025669 DOI: 10.1016/j.echo.2016.02.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The accuracy of echocardiography in evaluating left ventricular contractility has not been validated in children. The objective of this study was to compare echocardiographic measures of contractility with those derived from pressure-volume loop (PVL) analysis in children. METHODS Patients with relatively normal loading conditions undergoing routine left heart catheterization were prospectively enrolled. PVLs were obtained via conductance catheters. The gold-standard measure of contractility, end-systolic elastance (Ees), was obtained via balloon occlusion of one or both vena cavae. Echocardiograms were performed immediately after PVL analysis under the same anesthetic conditions. Single-beat estimations of echocardiographic Ees were calculated using four different methods. These estimates were calculated using a combination of noninvasive blood pressure readings, ventricular volumes derived from three-dimensional echocardiography, and Doppler time intervals. RESULTS Of 24 patients, 18 patients were heart transplant recipients, and six patients had small patent ductus arteriosus or small coronary fistulae. The mean age was 9.1 ± 5.6 years. The average invasive Ees was 3.04 ± 1.65 mm Hg/mL. Invasive Ees correlated best with echocardiographic Ees by the method of Tanoue (r = 0.85, P < .01), with a mean difference of -0.07 mm Hg/mL (95% limits of agreement, -2.0 to 1.4 mm Hg/mL). CONCLUSIONS Echocardiographic estimates of Ees correlate well with gold-standard measures obtained via conductance catheters in children with relatively normal loading conditions. The use of these noninvasive measures in accurately assessing left ventricular contractility appears promising and merits further study in children.
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Affiliation(s)
- Shahryar M Chowdhury
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
| | - Ryan J Butts
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Carolyn L Taylor
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Varsha M Bandisode
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Karen S Chessa
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Anthony M Hlavacek
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Girish S Shirali
- The Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - G Hamilton Baker
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
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Wang JZ, Zhang YL, Hu FS, He ZJ, Yang XJ, Ma ZC, Sun YN. A new tonometric device for radial augmentation index and subendocardial viability ratio: potential use in health screening. J Clin Hypertens (Greenwich) 2014; 16:707-12. [PMID: 25203355 DOI: 10.1111/jch.12396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/13/2014] [Accepted: 07/20/2014] [Indexed: 11/29/2022]
Abstract
Augmentation index (AIx) and subendocardial viability ratio (SEVR) are widely accepted indices of wave reflection and myocardial oxygen demand relative to supply. This study aimed to validate a new tonometric device (IIM-2010A) for obtaining AIx and SEVR from radial artery. A total of 68 outpatients (32 men and 36 women) aged 20 to 76 years (44.7±16.6 years) recruited from a health screening center participated in the study. AIx was obtained from radial pressure using the HEM-9000AI and IIM-2010A devices, while SEVR was measured from carotid pressure with the tonometric method and from radial pressure by the IIM-2010A device. In a subgroup of 24 patients, the measurements of AIx and SEVR were repeated after an interval of 10 minutes. The correlation of radial AIx between the IIM-2010A and HEM-9000AI devices was highly significant (r=0.956, P<.01). Radial SEVR determined from IIM-2010A was also highly related to carotid SEVR (r=0.864, P<.01), although the value was about 13.1% lower. There was no statistically significant difference between the repeated measurements of both indices. The lower coefficient of variation (2.9% vs 4.3% for AIx, 3.3% vs 4.1% for SEVR) and higher intraclass correlation coefficient (0.96 vs 0.91 for AIx, 0.93 vs 0.86 for SEVR) of IIM-2010A confirmed better short-term reproducibility, compared with the HEM-9000AI device and carotid tonometry. The new tonometric device IIM-2010A is effective and reproducible in calculating radial AIx and SEVR and has potential use in health screening.
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Affiliation(s)
- Jing-Zhi Wang
- Department of Automation, University of Science and Technology of China, Hefei, China; Research Center for Information Technology of Sports and Health, Institute of Intelligent Machines, Chinese Academy of Sciences, Hefei, China
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