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Asanuma T. Myocardial motion in acute ischemia: revealing invisible deformation by echocardiography. J Echocardiogr 2024; 22:71-78. [PMID: 38615090 DOI: 10.1007/s12574-024-00650-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/15/2024]
Abstract
Echocardiography has been used clinically to assess regional myocardial wall motion for the diagnosis of acute myocardial ischemia or stress-induced ischemia, but it is often difficult to distinguish hypokinetic motion from normal motion. Myocardial wall motion is affected by loading conditions as well as intrinsic contractility, making it challenging to define a normal range of wall motion. Therefore, hypokinesis is usually diagnosed by comparing target areas with other areas of myocardium considered normal (relative hypokinesis). Myocardial strain analysis by tissue Doppler echocardiography and speckle-tracking echocardiography has enabled objective and quantitative evaluation of regional myocardial wall motion. Peak systolic strain decreases during acute ischemia, but subtle and invisible myocardial motion, such as early systolic lengthening (ESL) and postsystolic shortening (PSS), also occurs, and the analysis of these subtle motions can improve the diagnostic accuracy of ischemia. However, the diagnosis of ischemic myocardium by strain analysis is not widely performed in clinical practice at this time due to several limitations. This article reviews the features of myocardial motion during acute ischemia, the mechanisms of ESL and PSS, the diagnosis of ischemic myocardium using strain analysis, and current approaches and future challenges to overcome the limitations in the detection of relative hypokinesis. This article also explains the use of ESL and PSS to detect myocardial ischemic memory that remains after brief ischemia.
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Affiliation(s)
- Toshihiko Asanuma
- Division of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo, Shimane, 693-8501, Japan.
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Sengupta PP, Chandrashekhar Y. Understanding Myocardial Biomechanics Through the Lens of Cardiac Imaging: A Shear Privilege. JACC Cardiovasc Imaging 2022; 15:2158-2160. [PMID: 36481089 DOI: 10.1016/j.jcmg.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Omar AMS, Botero DMR, Caraballo JA, Kim GH, Khachatoorian Y, Kliewer J, Rahman MAA, Rifaie O, Bella JN, Argulian E, Contreras J. Tissue Doppler derived biphasic velocities during the pre and post-ejection phases: patterns, concordance and hemodynamic significance in health and disease. Cardiovasc Ultrasound 2022; 20:17. [PMID: 35836184 PMCID: PMC9281174 DOI: 10.1186/s12947-022-00287-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-(PRE) and post-ejection (POE) velocities by mitral annular tissue Doppler (TD) are biphasic and may be related to myocardial deformations. We investigated the predominance and concordance of TD-PRE and POE velocities and their effect on myocardial functions in controls and in heart failure (HF) patients. METHODS Retrospectively, 84 HF patients [57.6 years, 28(33%) females, NYHA: 2.3 ± 0.6, EF: 55 ± 15%, 52(62%) preserved EF, and 32(38%) reduced EF], 42 normal young controls, and 26 asymptomatic age matched controls were included. Echocardiography was done and from mitral annular tissue Doppler recordings, the biphasic PRE and POE velocity signals were identified and compared between groups. RESULTS While controls had almost always predominantly positive PRE and negative POE, HF had more negative PRE and positive POE. Moreover, almost all controls exhibited normal concordance (positive PRE and negative POE). HF exhibited more abnormal concordance which was significantly associated with worse NYHA, and parameters of diastolic and systolic functions. Opposite PRE and POE velocities correlated significantly in all groups (PREp vs POEn: young:r = 0.52, p < 0.001, age controls:r = 0.79, p < 0.001, HFpEF: r = 0.56, p < 0.001, HFrEF: r = 0.42, p = 0.018; PREn vs POEp: young: r = 0.25,p = 0.1, age controls: r = 0.42, p = 0.04, HFpEF: r = 0.43, p = 0.004, HFrEF: r = 0.61, p < 0.001) and the ratios PRE-P/N and POE-N/P correlated significantly with E/e' in HF only. CONCLUSIONS In physiological state, TD signals are predominantly positive during PRE and negative during POE. Opposite PRE and POE velocities corelate, representing the PRE-generation and POE-reversal of shortening-stretch relationships, the attenuation of which in HF may be related to elevated LV filling pressures. In HF, partially or completely reversed concordance of PRE and POE is associated with progressive worsening of clinical and hemodynamic profiles.
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Affiliation(s)
- Alaa Mabrouk Salem Omar
- Department of Cardiology, Mount Sinai Morningside, 1111 Amsterdam avenue, NY, 10025, New York, USA. .,Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Internal Medicine, BronxCare Hospital Center, Bronx, NY, USA.
| | | | - Javier Arreaza Caraballo
- Department of Cardiology, Mount Sinai Morningside, 1111 Amsterdam avenue, NY, 10025, New York, USA
| | - Ga Hee Kim
- Department of Cardiology, Mount Sinai Morningside, 1111 Amsterdam avenue, NY, 10025, New York, USA
| | - Yeraz Khachatoorian
- Department of Cardiology, Mount Sinai Morningside, 1111 Amsterdam avenue, NY, 10025, New York, USA
| | - Jaclyn Kliewer
- Department of Internal Medicine, BronxCare Hospital Center, Bronx, NY, USA.,Department of General Surgery, HCA Florida Kendall Hospital, Miami, Florida, USA
| | | | - Osama Rifaie
- Depratment of Cardiology, Ain Shams University Hospital, Cairo, Egypt
| | - Jonathan N Bella
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Internal Medicine, BronxCare Hospital Center, Bronx, NY, USA
| | - Edgar Argulian
- Department of Cardiology, Mount Sinai Morningside, 1111 Amsterdam avenue, NY, 10025, New York, USA.,Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johanna Contreras
- Department of Cardiology, Mount Sinai Morningside, 1111 Amsterdam avenue, NY, 10025, New York, USA.,Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Echocardiographic tissue imaging evaluation of myocardial characteristics and function in cardiomyopathies. Heart Fail Rev 2020; 26:813-828. [PMID: 31950337 DOI: 10.1007/s10741-020-09918-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Current echocardiography techniques have allowed more precise assessment of cardiac structure and function of the several types of cardiomyopathies. Parameters derived from echocardiographic tissue imaging (ETI)-tissue Doppler, strain, strain rate, and others-are extensively used to provide a framework in the evaluation and management of cardiomyopathies. Generally, myocardial function assessed by ETI is depressed in all types of cardiomyopathies, non-ischemic dilated cardiomyopathy (DCM) in particular. In hypertrophic cardiomyopathy (HCM), ETI is useful to identify subclinical disease in family members of HCM, to differentiate HCM from other conditions causing cardiac hypertrophy and to predict cardiac events. ETI also for HCM allows addressing the mechanism behind left ventricular outflow tract obstruction and its improvement after therapeutic options. ETI provides cardiac amyloidosis with unique and specific findings such as "apical sparing." Nevertheless, ETI does not seem to provide as much information amenable to histological findings as recently emerging techniques of cardiac magnetic resonance imaging. This review introduces usefulness of ETI and some other ultrasound techniques for detecting clinical and subclinical characteristics of cardiomyopathies, focusing on DCM, HCM, and cardiac amyloidosis.
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Tyrankiewicz U, Skorka T, Orzylowska A, Jablonska M, Jasinski K, Jasztal A, Bar A, Kostogrys R, Chlopicki S. Comprehensive MRI for the detection of subtle alterations in diastolic cardiac function in apoE/LDLR(-/-) mice with advanced atherosclerosis. NMR IN BIOMEDICINE 2016; 29:833-840. [PMID: 27146203 DOI: 10.1002/nbm.3524] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 01/05/2016] [Accepted: 02/27/2016] [Indexed: 06/05/2023]
Abstract
ApoE/LDLR(-/-) mice represent a reliable model of atherosclerosis. However, it is not clear whether cardiac performance is impaired in this murine model of atherosclerosis. Here, we used MRI to characterize cardiac performance in vivo in apoE/LDLR(-/-) mice with advanced atherosclerosis. Six-month-old apoE/LDLR(-/-) mice and age-matched C57BL/6J mice (control) were examined using highly time-resolved cine-MRI [whole-chamber left ventricle (LV) imaging] and MR tagging (three slices: basal, mid-cavity and apical). Global and regional measures of cardiac function included LV volumes, kinetics, time-dependent parameters, strains and rotations. Histological analysis was performed using OMSB (orceine with Martius, Scarlet and Blue) and ORO (oil red-O) staining to demonstrate the presence of advanced coronary atherosclerosis. MR-tagging-based strain analysis in apoE/LDLR(-/-) mice revealed an increased frequency of radial and circumferential systolic stretch (25% and 50% of segments, respectively, p ≤ 0.012), increased radial post-systolic strain index (45% of segments, p = 0.009) and decreased LV untwisting rate (-30.3° (11.6°)/cycle, p = 0.004) when compared with control mice. Maximal strains and LV twist were unchanged. Most of the cine-MRI-based LV functional and anatomical parameters also remained unchanged in apoE/LDLR(-/-) mice, with only a lower filling rate, longer filling time, shorter isovolumetric contraction time and slower heart rate observed in comparison with control mice. The coronary arteries displayed severe atherosclerosis, as evidenced by histological analysis. Using comprehensive MRI methods, we have demonstrated that, despite severe coronary atherosclerosis in six-month-old apoE/LDLR(-/-) mice, cardiac performance including global parameters, twist and strains, was well preserved. Only subtle diastolic alterations, possibly of ischemic background, were uncovered. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Urszula Tyrankiewicz
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - Tomasz Skorka
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - Anna Orzylowska
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - Magdalena Jablonska
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - Krzysztof Jasinski
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - Agnieszka Jasztal
- Jagiellonian Center for Experimental Therapeutics (JCET), Jagiellonian University, Krakow, Poland
| | - Anna Bar
- Jagiellonian Center for Experimental Therapeutics (JCET), Jagiellonian University, Krakow, Poland
- Chair of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
| | - Renata Kostogrys
- Department of Human Nutrition, Faculty of Food Technology, University of Agriculture in Krakow, Krakow, Poland
| | - Stefan Chlopicki
- Jagiellonian Center for Experimental Therapeutics (JCET), Jagiellonian University, Krakow, Poland
- Chair of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
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Temporal deformation pattern in acute and late phases of ST-elevation myocardial infarction: incremental value of longitudinal post-systolic strain to assess myocardial viability. Clin Res Cardiol 2016; 105:815-26. [DOI: 10.1007/s00392-016-0989-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
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Koshkelashvili N, Codolosa JN, Goykhman I, Romero-Corral A, Pressman GS. Distribution of Mitral Annular and Aortic Valve Calcium as Assessed by Unenhanced Multidetector Computed Tomography. Am J Cardiol 2015; 116:1923-7. [PMID: 26517948 DOI: 10.1016/j.amjcard.2015.09.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/09/2015] [Accepted: 09/09/2015] [Indexed: 12/01/2022]
Abstract
Aging is associated with calcium deposits in various cardiovascular structures, but patterns of calcium deposition, if any, are unknown. In search of such patterns, we performed quantitative assessment of mitral annular calcium (MAC) and aortic valve calcium (AVC) in a broad clinical sample. Templates were created from gated computed tomography (CT) scans depicting the aortic valve cusps and mitral annular segments in relation to surrounding structures. These were then applied to CT reconstructions from ungated, clinically indicated CT scans of 318 subjects, aged ≥65 years. Calcium location was assigned using the templates and quantified by the Agatston method. Mean age was 76 ± 7.3 years; 48% were men and 58% were white. Whites had higher prevalence (p = 0.03) and density of AVC than blacks (p = 0.02), and a trend toward increased MAC (p = 0.06). Prevalence of AVC was similar between men and women, but AVC scores were higher in men (p = 0.008); this difference was entirely accounted for by whites. Within the aortic valve, the left cusp was more frequently calcified than the others. MAC was most common in the posterior mitral annulus, especially its middle (P2) segment. For the anterior mitral annulus, the medial (A3) segment calcified most often. In conclusion, AVC is more common in whites than blacks, and more intense in men, but only in whites. Furthermore, calcium deposits in the mitral annulus and aortic valve favor certain locations.
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Affiliation(s)
| | - Jose N Codolosa
- The Institute for Heart and Vascular Health, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Igor Goykhman
- Department of Radiology, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Abel Romero-Corral
- The Institute for Heart and Vascular Health, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Gregg S Pressman
- The Institute for Heart and Vascular Health, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania.
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Mitral Annular Dynamics in Mitral Annular Calcification: A Three-Dimensional Imaging Study. J Am Soc Echocardiogr 2015; 28:786-94. [DOI: 10.1016/j.echo.2015.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Indexed: 11/21/2022]
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Sengupta PP, Kramer CM, Narula J. Cardiac Resynchronization: The Flow of Activation Sequence. JACC Cardiovasc Imaging 2013; 6:924-6. [DOI: 10.1016/j.jcmg.2013.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abe H, Caracciolo G, Kheradvar A, Pedrizzetti G, Khandheria BK, Narula J, Sengupta PP. Contrast echocardiography for assessing left ventricular vortex strength in heart failure: a prospective cohort study. ACTA ACUST UNITED AC 2013; 14:1049-60. [DOI: 10.1093/ehjci/jet049] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sengupta PP, Narula J. LV segmentation and mechanics in HCM: twisting the Rubik's Cube into perfection! JACC Cardiovasc Imaging 2012; 5:765-8. [PMID: 22789952 DOI: 10.1016/j.jcmg.2012.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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van Houwelingen MJ, Merkus D, te Lintel Hekkert M, van Dijk G, Hoeks APG, Duncker DJ. Initiation of ventricular contraction as reflected in the aortic pressure waveform. Physiol Meas 2012; 33:557-69. [PMID: 22415053 DOI: 10.1088/0967-3334/33/4/557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Prior to aortic valve opening, aortic pressure is perturbed by ventricular contraction. The onset of this pressure perturbation coincides with the onset of the left ventricular (LV) isovolumic contraction, and hence will be referred to as the start of the arterially detected isovolumic contraction (AIC(start)). In the present study we test the hypothesis that the pressure perturbation indeed has a cardiac origin. In ten Yorkshire-Landrace swine, waveform intensity analysis demonstrated that AIC(start) was followed by a positive intensity wave (0.3 × 10(5) ± 0.3 × 10(5) W (m(2) s(2))(-1)). Timing analysis of LV and aortic pressure waveform showed that AIC(start) was preceded by a LV pressure perturbation (3.8 ± 1.8 ms, p < 0.001). These novel cardiac timing and aortic wave intensity findings reveal the cardiac origin of the pressure perturbation. In 15 Yorkshire-Landrace swine, myocardial motion analysis showed a significantly higher rate of segment shortening during the first part of the LV pressure perturbation. Therefore, both the LV and aortic pressure perturbation are most likely caused by the early phase of myocardial contraction, which also causes mitral valve closure. Consequently, AIC(start) is useful in the determination of the isovolumic contraction period, a well-known marker to quantify cardiac dysfunction.
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Affiliation(s)
- Marc J van Houwelingen
- Experimental Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands.
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van Dalen BM, Caliskan K, Soliman OI, Kauer F, van der Zwaan HB, Vletter WB, van Vark LC, ten Cate FJ, Geleijnse ML. Diagnostic Value of Rigid Body Rotation in Noncompaction Cardiomyopathy. J Am Soc Echocardiogr 2011; 24:548-55. [DOI: 10.1016/j.echo.2011.01.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Indexed: 10/18/2022]
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Sengupta SP, Sengupta PP, Narula J. Echocardiographic Investigations of Myocardial Function in Mitral Stenosis: Making Sense of the Echolalia. Cardiology 2011; 119:142-4. [DOI: 10.1159/000331404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2011] [Indexed: 11/19/2022]
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Cho EJ, Caracciolo G, Khandheria BK, Steidley DE, Scott R, Abhayaratna WP, Chandrasekaran K, Sengupta PP. Tissue Doppler image-derived measurements during isovolumic contraction predict exercise capacity in patients with reduced left ventricular ejection fraction. JACC Cardiovasc Imaging 2010; 3:1-9. [PMID: 20129524 DOI: 10.1016/j.jcmg.2009.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 08/10/2009] [Accepted: 08/11/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We explored the incremental value of quantification of tissue Doppler (TD) velocity during the brief isovolumic contraction (IVC) phase of the cardiac cycle for the prediction of exercise performance in patients referred for cardiopulmonary exercise testing (CPET). BACKGROUND Experimental studies have shown that rapid left ventricular (LV) shape change during IVC is essential for optimal onset of LV ejection. However, the incremental value of measuring IVC velocities in clinical settings remains unclear. METHODS A total of 82 subjects (age 53+/-14 years, 56 men) were studied with echocardiography and CPET. Reduced LV ejection fraction (EF) (EF<50%) was present in 38 (46%) subjects. Pulsed-wave annular TD velocities were averaged from the LV lateral and septal annulus during isovolumic contraction (IVCa), ejection, isovolumic relaxation, and early and late diastole (Aa) and compared with peak oxygen consumption (VO2) and percentage of the predicted peak VO2 (% predicted peak VO2) obtained from CPET. RESULTS Patients with reduced EF had lower IVCa (6.3 vs. 4.5 cm/s, p=0.04), ejection (7.7 vs. 5.5 cm/s, p<0.001), and Aa velocities (7.9 vs. 6.6 cm/s, p=0.04). Similarly, % predicted peak VO2 was lower in patients with reduced EF (52.9% vs. 73.1%, p<0.001) and correlated with the variations in IVCa (r=0.7, p=0.001). Multivariate analysis of 2-dimensional and Doppler variables in the presence of reduced LV EF revealed only IVCa and Aa as independent predictors of % predicted peak VO2 (r2=0.612, p=0.02 for IVCa and p=0.009 for Aa). The overall performance of IVCa in the prediction of exercise capacity was good (area under the curve=0.86, p<0.001). CONCLUSIONS Assessment of TD-derived IVC and atrial stretch velocities provide independent prediction of exercise capacity in patients with reduced LV EF. Assessment of LV pre-ejectional stretch and shortening mechanics at rest may be useful for determining the myocardial functional reserve of patients with reduced EF.
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Affiliation(s)
- Eun Joo Cho
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
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