1
|
Simon J, Fung K, Raisi-Estabragh Z, Aung N, Khanji MY, Zsarnóczay E, Merkely B, Munroe PB, Harvey NC, Piechnik SK, Neubauer S, Leeson P, Petersen SE, Maurovich-Horvat P. Association between subclinical atherosclerosis and cardiac structure and function-results from the UK Biobank Study. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad010. [PMID: 37822973 PMCID: PMC10563379 DOI: 10.1093/ehjimp/qyad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/03/2023] [Indexed: 10/13/2023]
Abstract
Aims Heart failure (HF) is a major health problem and early diagnosis is important. Atherosclerosis is the main cause of HF and carotid intima-media thickness (IMT) is a recognized early measure of atherosclerosis. This study aimed to investigate whether increased carotid IMT is associated with changes in cardiac structure and function in middle-aged participants of the UK Biobank Study without overt cardiovascular disease. Methods and results Participants of the UK Biobank who underwent CMR and carotid ultrasound examinations were included in this study. Patients with heart failure, angina, atrial fibrillation, and history of myocardial infarction or stroke were excluded. We used multivariable linear regression models adjusted for age, sex, physical activity, body mass index, body surface area, hypertension, diabetes, smoking, ethnicity, socioeconomic status, alcohol intake, and laboratory parameters. In total, 4301 individuals (61.6 ± 7.5 years, 45.9% male) were included. Multivariable linear regression analyses showed that increasing quartiles of IMT was associated with increased left and right ventricular (LV and RV) and left atrial volumes and greater LV mass. Moreover, increased IMT was related to lower LV end-systolic circumferential strain, torsion, and both left and right atrial ejection fractions (all P < 0.05). Conclusion Increased IMT showed an independent association over traditional risk factors with enlargement of all four cardiac chambers, decreased function in both atria, greater LV mass, and subclinical LV dysfunction. There may be additional risk stratification that can be derived from the IMT to identify those most likely to have early cardiac structural/functional changes.
Collapse
Affiliation(s)
- Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Üllői út 78, H-1082 Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary, Városmajor u 68, H-1122 Budapest, Hungary
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
- Barts Health NHS Trust, Newham University Hospital, Glen Road, Plaistow, London E1 1BB, United Kingdom
| | - Emese Zsarnóczay
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Üllői út 78, H-1082 Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary, Városmajor u 68, H-1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary, Városmajor u 68, H-1122 Budapest, Hungary
| | - Patricia B Munroe
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Stefan K Piechnik
- National Institute for Health Research, Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Stefan Neubauer
- National Institute for Health Research, Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 1, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Üllői út 78, H-1082 Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary, Városmajor u 68, H-1122 Budapest, Hungary
| |
Collapse
|
2
|
Samaan AA, Said K, El Aroussy W, Hassan M, Romeih S, Al Sawy A, Fawzy ME, Yacoub M. Impact of balloon mitral valvuloplasty on left ventricular rotational deformation: Magnetic Resonance Imaging follow up study. Int J Cardiovasc Imaging 2020; 36:1543-1550. [PMID: 32328870 DOI: 10.1007/s10554-020-01856-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/17/2020] [Indexed: 11/25/2022]
Abstract
In patients with rheumatic mitral stenosis (MS), some previous studies have investigated the influence of balloon mitral valvuloplasty (BMV) on left ventricular (LV) systolic function. However, the impact of BMV on LV twisting motion in this clinical setting has not been studied before yet. To describe changes in LV torsion in patients with rheumatic MS following BMV. Thirty patients (median age 33 years, 22 women) with isolated severe MS were studied. CMR myocardial tissue tagging was used for assessment of LV rotational deformation. LV torsion was calculated as the twist value (the net difference between apical counterclockwise and basal clockwise rotation) normalized to the length of the ventricle and multiplied by the mean radius at the base and apex. All patients had CMR studies before, 6 months and 1 year after successful BMV. At baseline, patients had a mitral valve area of 0.9 (0.6-1.3) cm2, mean pressure gradient of 12.5 (8-24) mmHg across the valve as measured by transthoracic echocardiography. Median LV ejection fraction (LVEF) estimated by CMR was 57 (range: 45-69) %. A significant improvement in LV base-apex torsion was shown at 6 months (3.3° vs. 2.5°, p < 0.001) with a further improvement at 1 year (4.1° vs. 3.3°, p = 0.05). Similar pattern of change was seen in LV base-mid torsion with a significant increase at 6 months (3.6° vs. 2.3°, p < 0.001) and a further increase at 1 year (4.7° vs. 3.6°, p = 0.007). These changes were associated with a significant increase in LVEF (62% vs. 57%, p < 0.001) at 1 year following BMV. Successful BMV is associated with a significant improvement in LV torsion that is accompanied by a significant improvement in LVEF.
Collapse
Affiliation(s)
- Amir Anwar Samaan
- Department of Cardiovascular Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Aini Street, Cairo, 11956, Egypt.
- Department of Cardiology, Aswan Heart Centre, Aswan, Egypt.
| | - Karim Said
- Department of Cardiovascular Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Aini Street, Cairo, 11956, Egypt
| | - Wafaa El Aroussy
- Department of Cardiovascular Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Aini Street, Cairo, 11956, Egypt
| | - Mohamed Hassan
- Department of Cardiovascular Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Aini Street, Cairo, 11956, Egypt
- Department of Cardiology, Aswan Heart Centre, Aswan, Egypt
| | - Soha Romeih
- Department of Radiology, Aswan Heart Centre, Aswan, Egypt
| | - Amr Al Sawy
- Department of Radiology, Aswan Heart Centre, Aswan, Egypt
| | - Mohamed Eid Fawzy
- Department of Cardiovascular Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Aini Street, Cairo, 11956, Egypt
| | - Magdi Yacoub
- Department of Cardiothoracic Surgery, Aswan Heart Centre, Aswan, Egypt
- Department of Cardiothoracic Surgery, Imperial College London, London, UK
| |
Collapse
|
3
|
Jensen MT, Fung K, Aung N, Sanghvi MM, Chadalavada S, Paiva JM, Khanji MY, de Knegt MC, Lukaschuk E, Lee AM, Barutcu A, Maclean E, Carapella V, Cooper J, Young A, Piechnik SK, Neubauer S, Petersen SE. Changes in Cardiac Morphology and Function in Individuals With Diabetes Mellitus: The UK Biobank Cardiovascular Magnetic Resonance Substudy. Circ Cardiovasc Imaging 2019; 12:e009476. [PMID: 31522551 PMCID: PMC7099857 DOI: 10.1161/circimaging.119.009476] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/18/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with increased risk of cardiovascular disease. Detection of early cardiac changes before manifest disease develops is important. We investigated early alterations in cardiac structure and function associated with DM using cardiovascular magnetic resonance imaging. METHODS Participants from the UK Biobank Cardiovascular Magnetic Resonance Substudy, a community cohort study, without known cardiovascular disease and left ventricular ejection fraction ≥50% were included. Multivariable linear regression models were performed. The investigators were blinded to DM status. RESULTS A total of 3984 individuals, 45% men, (mean [SD]) age 61.3 (7.5) years, hereof 143 individuals (3.6%) with DM. There was no difference in left ventricular (LV) ejection fraction (DM versus no DM; coefficient [95% CI]: -0.86% [-1.8 to 0.5]; P=0.065), LV mass (-0.13 g/m2 [-1.6 to 1.3], P=0.86), or right ventricular ejection fraction (-0.23% [-1.2 to 0.8], P=0.65). However, both LV and right ventricular volumes were significantly smaller in DM, (LV end-diastolic volume/m2: -3.46 mL/m2 [-5.8 to -1.2], P=0.003, right ventricular end-diastolic volume/m2: -4.2 mL/m2 [-6.8 to -1.7], P=0.001, LV stroke volume/m2: -3.0 mL/m2 [-4.5 to -1.5], P<0.001; right ventricular stroke volume/m2: -3.8 mL/m2 [-6.5 to -1.1], P=0.005), LV mass/volume: 0.026 (0.01 to 0.04) g/mL, P=0.006. Both left atrial and right atrial emptying fraction were lower in DM (right atrial emptying fraction: -6.2% [-10.2 to -2.1], P=0.003; left atrial emptying fraction:-3.5% [-6.9 to -0.1], P=0.043). LV global circumferential strain was impaired in DM (coefficient [95% CI]: 0.38% [0.01 to 0.7], P=0.045). CONCLUSIONS In a low-risk general population without known cardiovascular disease and with preserved LV ejection fraction, DM is associated with early changes in all 4 cardiac chambers. These findings suggest that diabetic cardiomyopathy is not a regional condition of the LV but affects the heart globally.
Collapse
Affiliation(s)
- Magnus T. Jensen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
- Department of Cardiology, Copenhagen University Hospital Herlev- Gentofte, Hellerup, Denmark (M.T.J.)
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (M.T.J.)
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Mihir M. Sanghvi
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Sucharitha Chadalavada
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Jose M. Paiva
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Mohammed Y. Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Martina C. de Knegt
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Elena Lukaschuk
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Aaron M. Lee
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Ahmet Barutcu
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Edd Maclean
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
| | - Valentina Carapella
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
| | - Alistair Young
- Department of Biomedical Engineering, King’s College London, United Kingdom (A.Y.)
| | - Stefan K. Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Steffen E. Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| |
Collapse
|
4
|
Au JS, Oikawa SY, Morton RW, Phillips SM, MacDonald MJ, Stöhr EJ. Unaltered left ventricular mechanics and remodelling after 12 weeks of resistance exercise training – a longitudinal study in men. Appl Physiol Nutr Metab 2019; 44:820-826. [DOI: 10.1139/apnm-2018-0544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous longitudinal studies suggest that left ventricular (LV) structure is unaltered with resistance exercise training (RT) in young men. However, evidence from aerobic exercise training suggests that early changes in functional LV wall mechanics may occur prior to and independently of changes in LV size, although short-term changes in LV mechanics and structural remodelling in response to RT protocols have not been reported. Therefore, the purpose of this study was to examine the effects of RT on LV mechanics in healthy men performing 2 different time-under-tension protocols. Forty recreationally trained men (age: 23 ± 3 years) were randomized into 12 weeks of whole-body higher-repetition RT (20–25 repetitions/set to failure at ∼30%–50% 1 repetition maximum (1RM); n = 13), lower-repetition RT (8–12 repetitions/set to failure at ∼75%–90% 1RM; n = 13), or an active control period (n = 14). Speckle tracking echocardiography was performed at baseline and following the intervention period. Neither RT program altered standard measures of LV volumes (end-diastolic volume, end-systolic volume, or ejection fraction; P > 0.05) or indices of LV mechanics (total LV twist, untwisting rate, twist-to-shortening ratio, untwisting-to-twist ratio, or longitudinal strain; P > 0.05). This is the first longitudinal study to assess both LV size and mechanics after RT in healthy men, suggesting a maintenance of LV size and twist mechanics despite peripheral muscle adaptations to the training programs. These results provide no evidence for adverse LV structural or functional remodelling in response to RT in young men and support the positive role of RT in the maintenance of optimal cardiovascular function, even with strenuous RT.
Collapse
Affiliation(s)
- Jason S. Au
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Sara Y. Oikawa
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Robert W. Morton
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Stuart M. Phillips
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | | | - Eric J. Stöhr
- Discipline of Physiology & Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff CF5 2YB, Wales, UK
- Department of Medicine, Columbia University Irving Medical Centre, NY 10032, USA
| |
Collapse
|
5
|
Affiliation(s)
- Luigi P. Badano
- Istituto Auxologico Italiano, IRCCS, Dipartimento di Scienze Cardiovascolari, Neurologiche, Metaboliche, Ospedale S. Luca, Milano, Italy
| | - Denisa Muraru
- Istituto Auxologico Italiano, IRCCS, Dipartimento di Scienze Cardiovascolari, Neurologiche, Metaboliche, Ospedale S. Luca, Milano, Italy
| |
Collapse
|
6
|
Sartori C, Degiovanni A, Devecchi F, Devecchi P, Marino PN. Acute Modifications of Left Ventricular Torsional Mechanics Induced by Cardiac Resynchronization Therapy Affect Short-Term Reverse Remodeling. Circ J 2019; 83:386-394. [DOI: 10.1253/circj.cj-18-0858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chiara Sartori
- Clinical Cardiology, Eastern Piedmont University, Department of Translational Medicine, Hospital “Maggiore della Carità”
| | - Anna Degiovanni
- Clinical Cardiology, Eastern Piedmont University, Department of Translational Medicine, Hospital “Maggiore della Carità”
| | - Federica Devecchi
- Clinical Cardiology, Eastern Piedmont University, Department of Translational Medicine, Hospital “Maggiore della Carità”
| | - Paolo Devecchi
- Clinical Cardiology, Eastern Piedmont University, Department of Translational Medicine, Hospital “Maggiore della Carità”
| | - Paolo Nicola Marino
- Clinical Cardiology, Eastern Piedmont University, Department of Translational Medicine, Hospital “Maggiore della Carità”
| |
Collapse
|
7
|
Mora V, Roldán I, Romero E, Romero D, Bertolín J, Ugalde N, Pérez-Olivares C, Rodriguez-Israel M, Pérez-Gozalbo J, Lowenstein JA. Comprehensive assessment of left ventricular myocardial function by two-dimensional speckle-tracking echocardiography. Cardiovasc Ultrasound 2018; 16:16. [PMID: 30223828 PMCID: PMC6142420 DOI: 10.1186/s12947-018-0135-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
Background Left ventricular ejection fraction (LVEF) results from the combined action of longitudinal and circumferential contraction, radial thickening, and basal and apical rotation. The study of these parameters together may lead to an accurate assessment of the cardiac function. Methods Ninety healthy volunteers, categorized by gender and age (≤ 55 and > 55 years), were evaluated using two-dimensional speckle tracking echocardiography. Transversal views of the left ventricle (LV) were obtained to calculate circumferential strain and left ventricular twist, while three apical views were obtained to determine longitudinal strain (LS) and mitral annular plane systolic excursion (MAPSE). We established the integral myocardial function of the LV according to: 1. The Combined Deformation Parameter (CDP), which includes Deformation Product (DP) - Twist x LS (° x %) - and Deformation Index (DefI) -Twist / LS (° / %)-; and 2. the Torsion Index (TorI): Twist / MAPSE (° / cm). Results The mean age of our patients was 50.3 ± 11.1 years. CDP did not vary with gender or age. The average DP was − 432 ± 172 ° x %, and the average DefI was − 0.96 ± 0.36 ° / %. DP provides information about myocardial function (normal, pseudonormal, depressed), and the DefI quotient indicates which component (s) is/are affected in cases of abnormality. TorI was higher in volunteers over 55 years (16.5 ± 15.2 vs 13.1 ± 5.0 °/cm, p = 0.003), but did not vary with gender. Conclusions The proposed parameters integrate values of twisting and longitudinal shortening. They allow a complete physiological assessment of cardiac systolic function, and could be used for the early detection and characterization of its alteration.
Collapse
Affiliation(s)
- Vicente Mora
- Cardiology Department, Hospital Dr Peset, Valencia, Spain.
| | | | - Elena Romero
- Cardiology Department, Hospital Dr Peset, Valencia, Spain
| | - Diana Romero
- Cardiodiagnosis Department Medical Research of Buenos Aires, Buenos Aires, Argentina
| | | | - Natalia Ugalde
- Cardiodiagnosis Department Medical Research of Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Jorge A Lowenstein
- Cardiodiagnosis Department Medical Research of Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
8
|
Dabiri Y, Sack KL, Shaul S, Sengupta PP, Guccione JM. Relationship of Transmural Variations in Myofiber Contractility to Left Ventricular Ejection Fraction: Implications for Modeling Heart Failure Phenotype With Preserved Ejection Fraction. Front Physiol 2018; 9:1003. [PMID: 30197595 PMCID: PMC6117406 DOI: 10.3389/fphys.2018.01003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 07/09/2018] [Indexed: 12/13/2022] Open
Abstract
The pathophysiological mechanisms underlying preserved left ventricular (LV) ejection fraction (EF) in patients with heart failure and preserved ejection fraction (HFpEF) remain incompletely understood. We hypothesized that transmural variations in myofiber contractility with existence of subendocardial dysfunction and compensatory increased subepicardial contractility may underlie preservation of LVEF in patients with HFpEF. We quantified alterations in myocardial function in a mathematical model of the human LV that is based on the finite element method. The fiber-reinforced material formulation of the myocardium included passive and active properties. The passive material properties were determined such that the diastolic pressure-volume behavior of the LV was similar to that shown in published clinical studies of pressure-volume curves. To examine changes in active properties, we considered six scenarios: (1) normal properties throughout the LV wall; (2) decreased myocardial contractility in the subendocardium; (3) increased myocardial contractility in the subepicardium; (4) myocardial contractility decreased equally in all layers, (5) myocardial contractility decreased in the midmyocardium and subepicardium, (6) myocardial contractility decreased in the subepicardium. Our results indicate that decreased subendocardial contractility reduced LVEF from 53.2 to 40.5%. Increased contractility in the subepicardium recovered LVEF from 40.5 to 53.2%. Decreased contractility transmurally reduced LVEF and could not be recovered if subepicardial and midmyocardial contractility remained depressed. The computational results simulating the effects of transmural alterations in the ventricular tissue replicate the phenotypic patterns of LV dysfunction observed in clinical practice. In particular, data for LVEF, strain and displacement are consistent with previous clinical observations in patients with HFpEF, and substantiate the hypothesis that increased subepicardial contractility may compensate for subendocardial dysfunction and play a vital role in maintaining LVEF.
Collapse
Affiliation(s)
- Yaghoub Dabiri
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Kevin L Sack
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Semion Shaul
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Partho P Sengupta
- Section of Cardiology, West Virginia University Heart and Vascular Institute, West Virginia University, Morgantown, WV, United States
| | - Julius M Guccione
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
9
|
Sanz-Estébanez S, Cordero-Grande L, Sevilla T, Revilla-Orodea A, de Luis-García R, Martín-Fernández M, Alberola-López C. Vortical features for myocardial rotation assessment in hypertrophic cardiomyopathy using cardiac tagged magnetic resonance. Med Image Anal 2018; 47:191-202. [PMID: 29753999 DOI: 10.1016/j.media.2018.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 01/10/2018] [Accepted: 03/14/2018] [Indexed: 11/16/2022]
Abstract
Left ventricular rotational motion is a feature of normal and diseased cardiac function. However, classical torsion and twist measures rely on the definition of a rotational axis which may not exist. This paper reviews global and local rotation descriptors of myocardial motion and introduces new curl-based (vortical) features built from tensorial magnitudes, intended to provide better comprehension about fibrotic tissue characteristics mechanical properties. Fifty-six cardiomyopathy patients and twenty-two healthy volunteers have been studied using tagged magnetic resonance by means of harmonic phase analysis. Rotation descriptors are built, with no assumption about a regular geometrical model, from different approaches. The extracted vortical features have been tested by means of a sequential cardiomyopathy classification procedure; they have proven useful for the regional characterization of the left ventricular function by showing great separability not only between pathologic and healthy patients but also, and specifically, between heterogeneous phenotypes within cardiomyopathies.
Collapse
Affiliation(s)
- Santiago Sanz-Estébanez
- Laboratorio de Procesado de Imagen, Department of Teoría de la Señal y Comunicaciones e Ingeniería Telemática, ETSIT, Universidad de Valladolid, Campus Miguel Delibes s.n., Valladolid 40011, Spain. http://www.lpi.tel.uva.es/ssanest
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain and Department of Biomedical Engineering, Division of Imaging Science and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, U.K.
| | - Teresa Sevilla
- Unidad de Imagen Cardiaca, Hospital Clínico Universitario de Valladolid, CIBER de enfermedades cardiovasculares (CIBERCV), Valladolid 47005, Spain
| | - Ana Revilla-Orodea
- Unidad de Imagen Cardiaca, Hospital Clínico Universitario de Valladolid, CIBER de enfermedades cardiovasculares (CIBERCV), Valladolid 47005, Spain
| | - Rodrigo de Luis-García
- Laboratorio de Procesado de Imagen, Department of Teoría de la Señal y Comunicaciones e Ingeniería Telemática, ETSIT, Universidad de Valladolid, Campus Miguel Delibes s.n., Valladolid 40011, Spain.
| | - Marcos Martín-Fernández
- Laboratorio de Procesado de Imagen, Department of Teoría de la Señal y Comunicaciones e Ingeniería Telemática, ETSIT, Universidad de Valladolid, Campus Miguel Delibes s.n., Valladolid 40011, Spain.
| | - Carlos Alberola-López
- Laboratorio de Procesado de Imagen, Department of Teoría de la Señal y Comunicaciones e Ingeniería Telemática, ETSIT, Universidad de Valladolid, Campus Miguel Delibes s.n., Valladolid 40011, Spain.
| |
Collapse
|
10
|
Williams AM, Shave RE, Cheyne WS, Eves ND. The influence of adrenergic stimulation on sex differences in left ventricular twist mechanics. J Physiol 2017; 595:3973-3985. [PMID: 28188951 DOI: 10.1113/jp273368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 02/05/2017] [Indexed: 12/20/2022] Open
Abstract
KEY POINTS Sex differences in left ventricular (LV) mechanics occur during acute physiological challenges; however, it is unknown whether sex differences in LV mechanics are fundamentally regulated by differences in adrenergic control. Using two-dimensional echocardiography and speckle tracking analysis, this study compared LV mechanics in males and females matched for LV length during post-exercise ischaemia (PEI) and β1 -adrenergic receptor blockade. Our data demonstrate that while basal rotation was increased in males, LV twist was not significantly different between the sexes during PEI. In contrast, during β1 -adrenergic receptor blockade, LV apical rotation, twist and untwisting velocity were reduced in males compared to females. Significant relationships were observed between LV twist and LV internal diameter and sphericity index in females, but not males. These findings suggest that LV twist mechanics may be more sensitive to alterations in adrenergic stimulation in males, but more highly influenced by ventricular structure and geometry in females. ABSTRACT Sex differences in left ventricular (LV) mechanics exist at rest and during acute physiological stress. Differences in cardiac autonomic and adrenergic control may contribute to sex differences in LV mechanics and LV haemodynamics. Accordingly, this study aimed to investigate sex differences in LV mechanics with altered adrenergic stimulation achieved through post-handgrip-exercise ischaemia (PEI) and β1 -adrenergic receptor (AR) blockade. Twenty males (23 ± 5 years) and 20 females (22 ± 3 years) were specifically matched for LV length (males: 8.5 ± 0.5 cm, females: 8.2 ± 0.6 cm, P = 0.163), and two-dimensional speckle-tracking echocardiography was used to assess LV structure and function at baseline, during PEI and following administration of 5 mg bisoprolol (β1 -AR antagonist). During PEI, LV end-diastolic volume and stroke volume were increased in both groups (P < 0.001), as was end-systolic wall stress (P < 0.001). LV twist and apical rotation were not altered from baseline or different between the sexes; however, basal rotation increased in males (P = 0.035). During β1 -AR blockade, LV volumes were unchanged but blood pressure and heart rate were reduced in both groups (P < 0.001). LV apical rotation (P = 0.036) and twist (P = 0.029) were reduced in males with β1 -AR blockade but not females, resulting in lower apical rotation (males: 6.8 ± 2.1 deg, females: 8.8 ± 2.3 deg, P = 0.007) and twist (males: 8.6 ± 1.9 deg, females: 10.7 ± 2.8 deg, P = 0.008), and slower untwisting velocity (males: 68.2 ± 22.1 deg s-1 , females: 82.0 ± 18.7 deg s-1 , P = 0.046) compared to females. LV twist mechanics are reduced in males compared to females during reductions to adrenergic stimulation, providing preliminary evidence that LV twist mechanics may be more sensitive to adrenergic control in males than in females.
Collapse
Affiliation(s)
- Alexandra M Williams
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada
| | - Rob E Shave
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK
| | - William S Cheyne
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada
| | - Neil D Eves
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada
| |
Collapse
|
11
|
Alizadehasl A, Sadeghpour A, Hali R, Bakhshandeh Abkenar H, Badano L. Assessment of left and right ventricular rotational interdependence: A speckle tracking echocardiographic study. Echocardiography 2017; 34:415-421. [PMID: 28121047 DOI: 10.1111/echo.13452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE We sought to investigate the possible interdependence of the left (LV) and right ventricular (RV) rotational mechanics. BACKGROUND Although myocardial fiber architecture and the effect of various pathologic conditions on LV torsional mechanics have already been investigated through multiple studies using different methods, there is still a significant debate about the actual presence and functional significance of RV rotational mechanics. METHODS We perform a cross-sectional prospective study of 118 subjects, including 19 normal subjects (NS, 35±7 years), 34 patients with severe aortic stenosis (AS, 44±16 years), 26 patients with nonobstructive hypertrophic cardiomyopathies (HCM, 46±18), and 39 patients with nonischemic dilated cardiomyopathies (DCM, 39±13 years). LV and RV rotational parameters were measured using velocity vector imaging. Total LV and RV apical segment rotations as well as the rotation of the free wall of RV apex were measured separately. Interdependence of the LV and RV rotational mechanics was assessed using the Spearman rho test. RESULTS Both LV (7.3°±4.1° in NS, 11°±4.6° in AS, 7.7°±5.2° in HCM, and 1.9°±2° in DCM, P=<.0001) and RV apexes (4.7°±2° in NS, 6.1°±4° in AS, 3.2°±3.7° in HCM, and 2.4°±3.6° in DCM, P=<.0001) rotated counterclockwise in all the four study groups. Interventricular apical rotation interdependence was stronger in the AS (Spearman rho [ρ]: .716; P=.000) and in the HCM (ρ: .395; P=.04) subgroups than in the NS (ρ: .26; P=.27) and DCM (ρ: .215; P=.18). In DCM patients, RV apex rotation appeared to be independent of LV rotation. RV free wall apical rotation was larger than its corresponding value for the total apical segments in all studied groups. This difference was significant only in the AS (P=.007). CONCLUSION Our findings demonstrated a close correlation between RV and LV apical rotation parameters in different cardiac conditions as well as in normal subjects. However, in DCM patients, we also showed some independent rotation of the RV from the LV apex.
Collapse
Affiliation(s)
- Azin Alizadehasl
- Rajaie Cardiovascular Medical and Research Center, Echocardiography Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Anita Sadeghpour
- Rajaie Cardiovascular Medical and Research Center, Echocardiography Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Hali
- Rajaie Cardiovascular Medical and Research Center, Echocardiography Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Luigi Badano
- Department of Cardiac, Thoracic and Vascular Science, University of Padova, Padova, Italy
| |
Collapse
|
12
|
Stöhr EJ, Shave RE, Baggish AL, Weiner RB. Left ventricular twist mechanics in the context of normal physiology and cardiovascular disease: a review of studies using speckle tracking echocardiography. Am J Physiol Heart Circ Physiol 2016; 311:H633-44. [DOI: 10.1152/ajpheart.00104.2016] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/03/2016] [Indexed: 11/22/2022]
Abstract
The anatomy of the adult human left ventricle (LV) is the result of its complex interaction with its environment. From the fetal to the neonatal to the adult form, the human LV undergoes an anatomical transformation that finally results in the most complex of the four cardiac chambers. In its adult form, the human LV consists of two muscular helixes that surround the midventricular circumferential layer of muscle fibers. Contraction of these endocardial and epicardial helixes results in a twisting motion that is thought to minimize the transmural stress of the LV muscle. In the healthy myocardium, the LV twist response to stimuli that alter preload, afterload, or contractility has been described and is deemed relatively consistent and predictable. Conversely, the LV twist response in patient populations appears to be a little more variable and less predictable, yet it has revealed important insight into the effect of cardiovascular disease on LV mechanical function. This review discusses important methodological aspects of assessing LV twist and evaluates the LV twist responses to the main physiological and pathophysiological states. It is concluded that correct assessment of LV twist mechanics holds significant potential to advance our understanding of LV function in human health and cardiovascular disease.
Collapse
Affiliation(s)
- Eric J. Stöhr
- Discipline of Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; and
| | - Rob E. Shave
- Discipline of Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; and
| | - Aaron L. Baggish
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rory B. Weiner
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
13
|
Broussard JL, Nelson MD, Kolka CM, Bediako IA, Paszkiewicz RL, Smith L, Szczepaniak EW, Stefanovski D, Szczepaniak LS, Bergman RN. Rapid development of cardiac dysfunction in a canine model of insulin resistance and moderate obesity. Diabetologia 2016; 59:197-207. [PMID: 26376797 PMCID: PMC5310691 DOI: 10.1007/s00125-015-3767-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/26/2015] [Indexed: 12/30/2022]
Abstract
AIMS/HYPOTHESIS The worldwide incidence of obesity and diabetes continues to rise at an alarming rate. A major cause of the morbidity and mortality associated with obesity and diabetes is heart disease, yet the mechanisms that lead to cardiovascular complications remain unclear. METHODS We performed cardiac MRI to assess left ventricular morphology and function during the development of moderate obesity and insulin resistance in a well-established canine model (n = 26). To assess the influence of dietary fat composition, we randomised animals to a traditional lard diet (rich in saturated and monounsaturated fat; n = 12), a salmon oil diet (rich in polyunsaturated fat; n = 8) or a control diet (n = 6). RESULTS High-fat feeding with lard increased body weight and fasting insulin and markedly reduced insulin sensitivity. Lard feeding also significantly reduced left ventricular function, evidenced by a worsening of circumferential strain and impairment in left ventricular torsion. High-fat feeding with salmon oil increased body weight; however, salmon oil feeding did not impair insulin sensitivity or cardiac function. CONCLUSIONS/INTERPRETATION These data emphasise the importance of dietary fat composition on both metabolic and cardiac function, and have important implications for the relationship between diet and health.
Collapse
Affiliation(s)
- Josiane L Broussard
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Michael D Nelson
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cathryn M Kolka
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Isaac Asare Bediako
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Rebecca L Paszkiewicz
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Laura Smith
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edward W Szczepaniak
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Darko Stefanovski
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, USA
| | - Lidia S Szczepaniak
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Richard N Bergman
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
| |
Collapse
|
14
|
Osculati G, Revera M, Branzi G, Faini A, Malfatto G, Bilo G, Giuliano A, Gregorini F, Ciambellotti F, Lombardi C, Agostoni P, Mancia G, Parati G. Effects of hypobaric hypoxia exposure at high altitude on left ventricular twist in healthy subjects: data from HIGHCARE study on Mount Everest. Eur Heart J Cardiovasc Imaging 2015; 17:635-43. [PMID: 26142456 DOI: 10.1093/ehjci/jev166] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/04/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Previous studies investigating the effect of hypoxia on left ventricle focused on its global function, an approach that may not detect a selective dysfunction of subendocardial layers that are most sensitive to an inadequate oxygen supply. In the HIGHCARE study, aimed at exploring the effects of high altitude hypoxia on multiple biological variables and their modulation by an angiotensin receptor blocker, we addressed the effects of hypobaric hypoxia on both systolic and diastolic left ventricular geometry and function, focusing on echocardiographic assessment of left ventricle twist to indirectly examine subendocardial left ventricular systolic function. METHODS AND RESULTS In 39 healthy subjects, physiological and echocardiographic variables, including left ventricular twist and a simplified torsion-to-shortening ratio (sTSR), were recorded at sea level, at 3400 m, and at 5400 m altitude (Mount Everest base camp). Both left ventricular twist and sTSR were greater at 5400 m than at sea level (12.6° vs. 9.6° and 0.285 vs. 0.202, P < 0.05 for both), were linearly related to the reduction in arterial oxygen partial pressure (P < 0.01 for both), and were associated with significant changes in LV dimensions and contractility. No effects of angiotensin receptor blockade were observed on these variables throughout the study. CONCLUSION Our study, for the first time, demonstrates an increase in left ventricular twist at high altitude in healthy subjects exposed to high altitude hypoxia, suggesting the occurrence of subendocardial systolic dysfunction in such condition.
Collapse
Affiliation(s)
- Giuseppe Osculati
- Department Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy
| | - Miriam Revera
- Department Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy
| | - Giovanna Branzi
- Department Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy
| | - Andrea Faini
- Department Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy
| | - Gabriella Malfatto
- Department Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy
| | - Grzegorz Bilo
- Department Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy
| | - Andrea Giuliano
- Department Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy
| | - Francesca Gregorini
- Department Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy
| | - Francesca Ciambellotti
- Department Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy
| | - Carolina Lombardi
- Department Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, 20138 Milano, Italy Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | - Giuseppe Mancia
- Department Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy Department of Health Sciences, University of Milano-Bicocca, 20052 Monza, Italy
| | - Gianfranco Parati
- Department Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy Department of Health Sciences, University of Milano-Bicocca, 20052 Monza, Italy Chair of Cardiovascular Medicine, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
15
|
Erhayiem B, Pavitt S, Baxter P, Andrews J, Greenwood JP, Buch MH, Plein S. Coronary Artery Disease Evaluation in Rheumatoid Arthritis (CADERA): study protocol for a randomized controlled trial. Trials 2014; 15:436. [PMID: 25381560 PMCID: PMC4233100 DOI: 10.1186/1745-6215-15-436] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 10/24/2014] [Indexed: 02/06/2023] Open
Abstract
Background The incidence of cardiovascular disease (CVD) in rheumatoid arthritis (RA) is increased compared to the general population. Immune dysregulation and systemic inflammation are thought to be associated with this increased risk. Early diagnosis with immediate treatment and tight control of RA forms a central treatment paradigm. It remains unclear, however, whether using tumor necrosis factor inhibitors (TNFi) to achieve remission confer additional beneficial effects over standard therapy, especially on the development of CVD. Methods/Design Coronary Artery Disease Evaluation in Rheumatoid Arthritis (CADERA) is a prospective cardiovascular imaging study that bolts onto an existing single-centre, randomized controlled trial, VEDERA (Very Early versus Delayed Etanercept in Rheumatoid Arthritis). VEDERA will recruit 120 patients with early, treatment-naïve RA, randomized to TNFi therapy etanercept (ETN) combined with methotrexate (MTX), or therapy with MTX with or without additional synthetic disease modifying anti-rheumatic drugs with escalation to ETN following a ‘treat-to-target’ regimen. VEDERA patients will be recruited into CADERA and undergo cardiac magnetic resonance (CMR) assessment with; cine imaging, rest/stress adenosine perfusion, tissue-tagging, aortic distensibility, T1 mapping and late gadolinium imaging. Primary objectives are to detect the prevalence and change of cardiovascular abnormalities by CMR between TNFi and standard therapy over a 12-month period. All patients will enter an inflammatory arthritis registry for long-term follow-up. Discussion CADERA is a multi-parametric study describing cardiovascular abnormalities in early, treatment-naïve RA patients, with assessment of changes at one year between early biological therapy and conventional therapy. Trials registration This trial was registered with Current Controlled Trials (registration number: ISRCTN50167738) on 8 November 2013.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute for Cardiovascular and Metabolic Medicine, Worsley Building, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK.
| |
Collapse
|
16
|
Wu H, Yuan WX, Zhao X, Shi L, Wang D. Calculation of incompressible left ventricular torsion using cardiovascular magnetic resonance. Int J Cardiol 2014; 176:1100-3. [PMID: 25150489 DOI: 10.1016/j.ijcard.2014.07.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Huisi Wu
- College of Computer Science and Software Engineering, Shenzhen University, China.
| | - Wen-Xiang Yuan
- College of Chemistry and Chemical Engineering, Shenzhen University, China
| | - Xiaojin Zhao
- College of Electronic Science and Technology, Shenzhen University, China
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Defeng Wang
- Research Center for Medical Image Computing, The Chinese University of Hong Kong, Hong Kong; Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
17
|
From speckle tracking echocardiography to torsion: research tool today, clinical practice tomorrow. Curr Opin Crit Care 2014; 19:250-7. [PMID: 23519081 DOI: 10.1097/mcc.0b013e32836092b7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Speckle tracking is the latest available technology in echocardiography. However, the technology is still mainly used as a research tool. The potential applications of speckle tracking are many, including cardiac synchronization, regional wall motion analysis, and in the areas of cardiac mechanic studies. This review presents the background theory of speckle tracking echocardiography (STE) and how this technology can be extended to velocity vector analysis, strain, and torsion measurements. The interpretations of these measurements are covered. We also present some potential applications in the critical care setting. RECENT FINDINGS Speckle tracking is almost always available in high-end ultrasound machines. The technology has been applied to velocity vector analysis, strain and strain rate measurements, and twist and torsion analysis. Torsion analysis and velocity vector analyses are impossible without using speckle tracking. Speckle tracking-derived strain is superior to tissue Doppler strain because it is angle-independent. A number of studies demonstrated that STE is useful in left and right heart assessments and can be used in assessing preload and afterload. SUMMARY Speckle tracking can be used to measure instantaneous myocardial contractility, strain, and left ventricular torsion. It is still a research tool at present, but shows the promise of being a clinical tool in the future.
Collapse
|
18
|
van Dalen BM, Tzikas A, Soliman OII, Heuvelman HJ, Vletter WB, Ten Cate FJ, Geleijnse ML. Assessment of subendocardial contractile function in aortic stenosis: a study using speckle tracking echocardiography. Echocardiography 2013; 30:293-300. [PMID: 23347129 DOI: 10.1111/echo.12051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Angina and an electrocardiographic strain pattern are potential manifestations of subendocardial ischemia in aortic stenosis (AS). Left ventricular (LV) twist is known to increase proportionally to the severity of AS, which may be a result of loss of the inhibiting effect of the subendocardial fibers due to subendocardial dysfunction. It has also been shown that the ratio of LV twist to circumferential shortening of the endocardium (twist-to-shortening ratio [TSR]) is a reliable parameter of subendocardial dysfunction. The aim of this study was to investigate whether these markers are increased in AS patients with angina and/or electrocardiographic strain. METHODS The study comprised 60 AS patients with an aortic valve area <2.0 cm(2) and LV ejection fraction >50%, and 30 healthy-for age and gender matched-control subjects. LV rotation parameters were determined by speckle tracking echocardiography. RESULTS Comparison of patients without angina and strain (n = 22), with either angina or strain (n = 28), and with both angina and strain (n = 8), showed highest peak systolic LV apical rotation, peak systolic LV twist, and TSR, in patients with more signs of subendocardial ischemia. In a multivariate linear regression model, only severity of AS and the presence of angina and/or strain could be identified as independent predictors of peak systolic LV twist and TSR. CONCLUSIONS Peak systolic LV twist and TSR are increased in AS patients and related to the severity of AS and symptoms (angina) or electrocardiographic signs (strain) compatible with subendocardial ischemia.
Collapse
Affiliation(s)
- Bas M van Dalen
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
19
|
Relation of torsion and myocardial strains to LV ejection fraction in hypertension. JACC Cardiovasc Imaging 2012; 5:273-81. [PMID: 22421172 DOI: 10.1016/j.jcmg.2011.11.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 11/07/2011] [Accepted: 11/10/2011] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The goal of this study was to define the mechanism of preserved ejection fraction (EF) despite depressed myocardial strains in hypertension (HTN). BACKGROUND Concentric left ventricular (LV) remodeling in HTN may have normal or supranormal EF despite depressed myocardial strains. The reason for such discordance is not clear. The aim of this study was to comprehensively evaluate the LV mechanics in a well-defined HTN population to define underlying reasons for such a paradox. METHODS Sixty-seven patients with resistant HTN and 45 healthy control subjects were studied by cardiac magnetic resonance imaging and tissue tagging with 3-dimensional analysis. Amplitude and directional vector of longitudinal (Ell), circumferential (Ecc), and principal strain for maximal shortening (E3) were computed at basal, mid, and distal LV levels, respectively. LV torsion, defined as the rotation angle of apex relative to base, and LV twist, which accounts for the effects of differential LV remodeling on torsion for comparison among the 2 groups, were also calculated. RESULTS LV mass index and LV mass/LV end-diastolic volume ratio were significantly higher in the HTN group compared with controls, consistent with concentric LV remodeling. Ell and Ecc were significantly decreased in amplitude with altered directional vector in HTN compared with controls. However, the amplitude of E3 was similar in the 2 groups. Torsion and twist were significantly higher in HTN, which was mainly due to increase in apical rotation. The HTN group demonstrated significantly increased LV wall thickening compared with controls that resulted in greater LVEF in the HTN group compared with controls (70% vs. 65%, p < 0.001, respectively). CONCLUSIONS In compensated LV remodeling secondary to HTN, there is increased LV wall thickening with preserved E3 and increased torsion compared with normal controls. This, therefore, contributes to supranormal LVEF in HTN despite depressed longitudinal and circumferential strains.
Collapse
|
20
|
Ventricular torsion: an aid to ejection? JACC Cardiovasc Imaging 2012; 5:282-4. [PMID: 22421173 DOI: 10.1016/j.jcmg.2011.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 11/15/2011] [Accepted: 11/15/2011] [Indexed: 11/22/2022]
|
21
|
Young AA, Cowan BR. Evaluation of left ventricular torsion by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2012; 14:49. [PMID: 22827856 PMCID: PMC3461493 DOI: 10.1186/1532-429x-14-49] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 07/24/2012] [Indexed: 12/15/2022] Open
Abstract
Recently there has been considerable interest in LV torsion and its relationship with symptomatic and pre-symptomatic disease processes. Torsion gives useful additional information about myocardial tissue performance in both systolic and diastolic function. CMR assessment of LV torsion is simply and efficiently performed. However, there is currently a wide variation in the reporting of torsional motion and the procedures used for its calculation. For example, torsion has been presented as twist (degrees), twist per length (degrees/mm), shear angle (degrees), and shear strain (dimensionless). This paper reviews current clinical applications and shows how torsion can give insights into LV mechanics and the influence of LV geometry and myocyte fiber architecture on cardiac function. Finally, it provides recommendations for CMR measurement protocols, attempts to stimulate standardization of torsion calculation, and suggests areas of useful future research.
Collapse
Affiliation(s)
- Alistair A Young
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
| | - Brett R Cowan
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
| |
Collapse
|
22
|
Heart wall myofibers are arranged in minimal surfaces to optimize organ function. Proc Natl Acad Sci U S A 2012; 109:9248-53. [PMID: 22645368 DOI: 10.1073/pnas.1120785109] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Heart wall myofibers wind as helices around the ventricles, strengthening them in a manner analogous to the reinforcement of concrete cylindrical columns by spiral steel cables [Richart FE, et al. (1929) Univ of Illinois, Eng Exp Stn Bull 190]. A multitude of such fibers, arranged smoothly and regularly, contract and relax as an integrated functional unit as the heart beats. To orchestrate this motion, fiber tangling must be avoided and pumping should be efficient. Current models of myofiber orientation across the heart wall suggest groupings into sheets or bands, but the precise geometry of bundles of myofibers is unknown. Here we show that this arrangement takes the form of a special minimal surface, the generalized helicoid [Blair DE, Vanstone JR (1978) Minimal Submanifolds and Geodesics 13-16], closing the gap between individual myofibers and their collective wall structure. The model holds across species, with a smooth variation in its three curvature parameters within the myocardial wall providing tight fits to diffusion magnetic resonance images from the rat, the dog, and the human. Mathematically it explains how myofibers are bundled in the heart wall while economizing fiber length and optimizing ventricular ejection volume as they contract. The generalized helicoid provides a unique foundation for analyzing the fibrous composite of the heart wall and should therefore find applications in heart tissue engineering and in the study of heart muscle diseases.
Collapse
|
23
|
Zhong X, Gibberman LB, Spottiswoode BS, Gilliam AD, Meyer CH, French BA, Epstein FH. Comprehensive cardiovascular magnetic resonance of myocardial mechanics in mice using three-dimensional cine DENSE. J Cardiovasc Magn Reson 2011; 13:83. [PMID: 22208954 PMCID: PMC3278394 DOI: 10.1186/1532-429x-13-83] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 12/30/2011] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Quantitative noninvasive imaging of myocardial mechanics in mice enables studies of the roles of individual genes in cardiac function. We sought to develop comprehensive three-dimensional methods for imaging myocardial mechanics in mice. METHODS A 3D cine DENSE pulse sequence was implemented on a 7T small-bore scanner. The sequence used three-point phase cycling for artifact suppression and a stack-of-spirals k-space trajectory for efficient data acquisition. A semi-automatic 2D method was adapted for 3D image segmentation, and automated 3D methods to calculate strain, twist, and torsion were employed. A scan protocol that covered the majority of the left ventricle in a scan time of less than 25 minutes was developed, and seven healthy C57Bl/6 mice were studied. RESULTS Using these methods, multiphase normal and shear strains were measured, as were myocardial twist and torsion. Peak end-systolic values for the normal strains at the mid-ventricular level were 0.29 ± 0.17, -0.13 ± 0.03, and -0.18 ± 0.14 for E(rr), E(cc), and E(ll), respectively. Peak end-systolic values for the shear strains were 0.00 ± 0.08, 0.04 ± 0.12, and 0.03 ± 0.07 for E(rc), E(rl), and E(cl), respectively. The peak end-systolic normalized torsion was 5.6 ± 0.9°. CONCLUSIONS Using a 3D cine DENSE sequence tailored for cardiac imaging in mice at 7 T, a comprehensive assessment of 3D myocardial mechanics can be achieved with a scan time of less than 25 minutes and an image analysis time of approximately 1 hour.
Collapse
Affiliation(s)
| | | | - Bruce S Spottiswoode
- MRC/UCT Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa
| | | | - Craig H Meyer
- Radiology Department, University of Virginia, Charlottesville, USA
- Biomedical Engineering Department, University of Virginia, Charlottesville, USA
| | - Brent A French
- Biomedical Engineering Department, University of Virginia, Charlottesville, USA
| | - Frederick H Epstein
- Radiology Department, University of Virginia, Charlottesville, USA
- Biomedical Engineering Department, University of Virginia, Charlottesville, USA
| |
Collapse
|
24
|
Rüssel IK, Brouwer WP, Germans T, Knaapen P, Marcus TJ, van der Velden J, Götte MJW, van Rossum AC. Increased left ventricular torsion in hypertrophic cardiomyopathy mutation carriers with normal wall thickness. J Cardiovasc Magn Reson 2011; 13:3. [PMID: 21219655 PMCID: PMC3025877 DOI: 10.1186/1532-429x-13-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 01/10/2011] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Increased left ventricular (LV) torsion has been observed in patients with manifest familial hypertrophic cardiomyopathy (HCM), and is thought to be caused by subendocardial dysfunction. We hypothesize that increased LV torsion is already present in healthy mutation carriers with normal wall thickness. METHODS Seventeen carriers with an LV wall thickness <10 mm, and seventeen age and gender matched controls had cardiovascular magnetic resonance (CMR) cine imaging and tissue tagging. LV volumes and mass were calculated from the cine images. LV torsion, torsion rate, endocardial circumferential strain and torsion-to-endocardial-circumferential-shortening (TECS) ratio, which reflects the transmural distribution in contractile function, were determined using tissue tagging. RESULTS LV volumes, mass and circumferential strain were comparable between groups, whereas LV ejection fraction, torsion and TECS-ratio were increased in carriers compared to controls (63 ± 3% vs. 60 ± 3%, p = 0.04, 10.1 ± 2.5° vs. 7.7 ± 1.2°, p = 0.001, and 0.52 ± 0.14°/% vs. 0.42 ± 0.10°/%, p = 0.02, respectively). CONCLUSIONS Carriers with normal wall thickness display increased LV torsion and TECS-ratio with respect to controls, which might be due to subendocardial myocardial dysfunction. As similar abnormalities are observed in patients with manifest HCM, the changes in healthy carriers may be target for clinical intervention to delay or prevent the onset of hypertrophy.
Collapse
MESH Headings
- Adult
- Cardiomyopathy, Hypertrophic, Familial/genetics
- Cardiomyopathy, Hypertrophic, Familial/pathology
- Cardiomyopathy, Hypertrophic, Familial/physiopathology
- Case-Control Studies
- Female
- Humans
- Image Interpretation, Computer-Assisted
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Mutation
- Myocardial Contraction/genetics
- Netherlands
- Torsion Abnormality/genetics
- Torsion Abnormality/pathology
- Torsion Abnormality/physiopathology
- Ventricular Dysfunction, Left/genetics
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left/genetics
Collapse
Affiliation(s)
- Iris K Rüssel
- Department of Clinical Physics, Hagaziekenhuis, The Hague, The Netherlands
| | - Wessel P Brouwer
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - Tjeerd Germans
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Tim J Marcus
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Marco JW Götte
- Department of cardiology, Hagaziekenhuis, The Hague, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
25
|
Bachner-Hinenzon N, Ertracht O, Leitman M, Vered Z, Shimoni S, Beeri R, Binah O, Adam D. Layer-specific strain analysis by speckle tracking echocardiography reveals differences in left ventricular function between rats and humans. Am J Physiol Heart Circ Physiol 2010; 299:H664-72. [DOI: 10.1152/ajpheart.00017.2010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The rat heart is commonly used as an experimental model of the human heart in both health and disease states, assuming that heart function of rats and humans is alike. When studying a rat model, echocardiography is usually performed on sedated rats, whereas standard echocardiography on adult humans does not require any sedation. Since echocardiography results of sedated rats are usually inferred to alert humans, in the present study, we tested the hypothesis that differences in left ventricular (LV) function may be present between rats sedated by a low dose of ketamine-xylazine and alert humans. Echocardiography was applied to 110 healthy sedated rats and 120 healthy alert humans. Strain parameters were calculated from the scans using a layer-specific speckle tracking echocardiography program. The results showed that layer longitudinal strain is equal in rats and humans, whereas segmental strain is heterogeneous ( P < 0.05) in a different way in rats and humans ( P < 0.05). Furthermore, layer circumferential strain is larger in humans ( P < 0.001), and the segmental results showed different segmental heterogeneity in rats and humans ( P < 0.05). Radial strain was found to be homogeneous at the apex and papillary muscle levels in humans and heterogeneous in rats ( P < 0.001). Additionally, whereas LV twist was equal in rats and humans, in rats the rotation was larger at the apex ( P < 0.01) and smaller at the base ( P < 0.001). The torsion-to-shortening ratio parameter, which indicates the transmural distribution of contractile myofibers, was found to be equal in rats and humans. Thus, when evaluating LV function of sedated rats under ketamine-xylazine, it is recommended to measure the global longitudinal strain, LV twist, and torsion-to-shortening ratio, since no scaling is required when converting these parameters and inferring them to humans.
Collapse
Affiliation(s)
| | - Offir Ertracht
- Department of Physiology, Ruth and Bruce Rappaport Faculty of Medicine, and
- Rappaport Family Institute for Research in the Medical Sciences, Technion-Israel Institute of Technology, Haifa
| | - Marina Leitman
- Department of Cardiology, Assaf Harofeh Medical Center, Zerifin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - Zvi Vered
- Department of Cardiology, Assaf Harofeh Medical Center, Zerifin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - Sara Shimoni
- Department of Cardiology, Kaplan Medical Center, Rehovot; and
| | - Ronen Beeri
- The Cardiovascular Research Center, Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer Binah
- Department of Physiology, Ruth and Bruce Rappaport Faculty of Medicine, and
- Rappaport Family Institute for Research in the Medical Sciences, Technion-Israel Institute of Technology, Haifa
| | - Dan Adam
- Faculty of Biomedical Engineering and
| |
Collapse
|
26
|
Rüssel IK, Götte MJ, de Roest GJ, Marcus J, Tecelão SR, Allaart CP, de Cock CC, Heethaar RM, van Rossum AC. Loss of Opposite Left Ventricular Basal and Apical Rotation Predicts Acute Response to Cardiac Resynchronization Therapy and is Associated With Long-Term Reversed Remodeling. J Card Fail 2009; 15:717-25. [PMID: 19786261 DOI: 10.1016/j.cardfail.2009.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 03/02/2009] [Accepted: 04/13/2009] [Indexed: 11/27/2022]
|
27
|
Rüssel IK, Götte MJW, Bronzwaer JG, Knaapen P, Paulus WJ, van Rossum AC. Left ventricular torsion: an expanding role in the analysis of myocardial dysfunction. JACC Cardiovasc Imaging 2009; 2:648-55. [PMID: 19442954 DOI: 10.1016/j.jcmg.2009.03.001] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 02/09/2009] [Accepted: 03/09/2009] [Indexed: 12/17/2022]
Abstract
During left ventricular (LV) torsion, the base rotates in an overall clockwise direction and the apex rotates in a counterclockwise direction when viewed from apex to base. LV torsion is followed by rapid untwisting, which contributes to ventricular filling. Because LV torsion is directly related to fiber orientation, it might depict subclinical abnormalities in heart function. Recently, ultrasound speckle tracking was introduced for quantification of LV torsion. This fast, widely available technique may contribute to a more rapid introduction of LV torsion as a clinical tool for detection of myocardial dysfunction. However, knowledge of the exact function and structure of the heart is fundamental for understanding the value of LV torsion. LV torsion has been investigated with different measurement methods during the past 2 decades, using cardiac magnetic resonance as the gold standard. The results obtained over the years are helpful for developing a standardized method to quantify LV torsion and have facilitated the interpretation and value of LV torsion before it can be used as a clinical tool.
Collapse
Affiliation(s)
- Iris K Rüssel
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, the Netherlands.
| | | | | | | | | | | |
Collapse
|
28
|
Rüssel IK, Tecelão SR, Kuijer JPA, Heethaar RM, Marcus JT. Comparison of 2D and 3D calculation of left ventricular torsion as circumferential-longitudinal shear angle using cardiovascular magnetic resonance tagging. J Cardiovasc Magn Reson 2009; 11:8. [PMID: 19379480 PMCID: PMC2689859 DOI: 10.1186/1532-429x-11-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 04/20/2009] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To compare left ventricular (LV) torsion represented as the circumferential-longitudinal (CL) shear angle between 2D and 3D quantification, using cardiovascular magnetic resonance (CMR). METHODS CMR tagging was performed in six healthy volunteers. From this, LV torsion was calculated using a 2D and a 3D method. The cross-correlation between both methods was evaluated and comparisons were made using Bland-Altman analysis. RESULTS The cross-correlation between the curves was r2 = 0.97 +/- 0.02. No significant time-delay was observed between the curves. Bland-Altman analysis revealed a significant positive linear relationship between the difference and the average value of both analysis methods, with the 2D results showing larger values than the 3D. The difference between both methods can be explained by the definition of the 2D method. CONCLUSION LV torsion represented as CL shear quantified by the 2D and 3D analysis methods are strongly related. Therefore, it is suggested to use the faster 2D method for torsion calculation.
Collapse
Affiliation(s)
- Iris K Rüssel
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, the Netherlands
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Sandra R Tecelão
- Institute of Biophysics and Biomedical Engineering, University of Lisbon, Lisbon, Portugal
| | - Joost PA Kuijer
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, the Netherlands
| | - Robert M Heethaar
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, the Netherlands
| | - J Tim Marcus
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
29
|
Rüssel IK, Götte MJ, Kuijer JP, Marcus JT. Regional assessment of left ventricular torsion by CMR tagging. J Cardiovasc Magn Reson 2008; 10:26. [PMID: 18505572 PMCID: PMC2423368 DOI: 10.1186/1532-429x-10-26] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 05/27/2008] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To introduce a standardized method for calculation of left ventricular torsion by CMR tagging and to determine the accuracy of torsion analysis in regions using an analytical model. METHODS Torsion between base and apex, base and mid, and mid and apex levels was calculated using CSPAMM tagging and Harmonic Phase tracking. The accuracy of torsion analysis on a regional basis (circumferential segments and transmural layers) was analyzed using an analytical model of a deforming cylinder with a displaced axis of rotation (AoR). Regional peak torsion values from twelve healthy volunteers calculated by the described method were compared to literature. RESULTS The deviation from the analytical torsion per % AoR-displacement (of the radius) was 0.90 +/- 0.44% for the circumferential segments and only 0.05% for the transmural layers. In the subjects, circumferentially, anterolateral torsion was larger than inferior (12.4 +/- 3.9 degrees vs. 5.0 +/- 3.3 degrees , N.S.). Transmurally, endocardial torsion was smaller than epicardial (7.5 +/- 1.3 degrees vs. 8.0 +/- 1.5 degrees , p < 0.001). CONCLUSION Variability in the position of the AoR causes a large variability in torsion in circumferential segments. This effect was negligible for global torsion, and torsion calculated in transmural layers. Results were documented for the healthy human heart and are in agreement with data from literature.
Collapse
Affiliation(s)
- Iris K Rüssel
- Dept. of Physics and Medical Technology, Vrije Universiteit Medical Center, De Boelelaan 1118 1081 HV Amsterdam, the Netherlands
| | - Marco J Götte
- Dept. of Cardiology, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Joost P Kuijer
- Dept. of Physics and Medical Technology, Vrije Universiteit Medical Center, De Boelelaan 1118 1081 HV Amsterdam, the Netherlands
| | - J Tim Marcus
- Dept. of Physics and Medical Technology, Vrije Universiteit Medical Center, De Boelelaan 1118 1081 HV Amsterdam, the Netherlands
| |
Collapse
|
30
|
Li L, Liang Z, Ghista D, Leok Poh C, Sankaranarayanan M, San Tan R, Seng Tan Y. Determination of the left ventricular myofiber angle analytically and its significance. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2005:5719-22. [PMID: 17281556 DOI: 10.1109/iembs.2005.1615786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
It is known that the tremendous internal pressure build-up in the left ventricle (LV) cavity during isovolumic contraction is due to the contraction of the spirally woven myocardial fibers. In this paper, a biomathematical model is developed to investigate the fiber angle using the theory of elasticity. Simultaneously, another simplified model in order to reduce the mathematical complexity was also developed to determine the fiber angle. The results of these two models showed that both the myocardial fiber angles are in same magnitude.
Collapse
Affiliation(s)
- Liu Li
- Sch. of Mech. & Aerosp. Eng., Nanyang Technol. Univ. Singapore
| | | | | | | | | | | | | |
Collapse
|
31
|
Liu W, Ashford MW, Chen J, Watkins MP, Williams TA, Wickline SA, Yu X. MR tagging demonstrates quantitative differences in regional ventricular wall motion in mice, rats, and men. Am J Physiol Heart Circ Physiol 2006; 291:H2515-21. [PMID: 16751290 DOI: 10.1152/ajpheart.01016.2005] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Rats and genetically manipulated mouse models have played an important role in the exploration of molecular causes of cardiovascular diseases. However, it has not been fully investigated whether mice or rats and humans manifest similar patterns of ventricular wall motion. Although similarities in anatomy and myofiber architecture suggest that fundamental patterns of ventricular wall motion may be similar, the considerable differences in heart size, heart rate, and sarcomeric protein isoforms may yield quantitative differences in ventricular wall mechanics. To further our understanding of the basic mechanisms of myofiber contractile performance, we quantified regional and global indexes of ventricular wall motion in mice, rats, and men using magnetic resonance (MR) imaging. Both regular cine and tagged MR images at apical, midventricular, and basal levels were acquired from six male volunteers, six Fischer 344 rats, and seven C57BL/6 mice. Morphological parameters and ejection fraction were computed directly from cine images. Myocardial twist (rotation angle), torsion (net twist per unit length), circumferential strain, and normalized radial shortening were calculated by homogeneous strain analysis from tagged images. Our data show that ventricular twist was conserved among the three species, leading to a significantly smaller torsion, measured as net twist per unit length, in men. However, both circumferential strain and normalized radial shortening were the largest in male subjects. Although other parameters, such as circumferential-longitudinal shear strain, need to be evaluated, and the causes of these differences in contractile mechanics remain to be elucidated, the preservation of twist appears fundamental to cardiac function and should be considered in studies that extrapolate data from animals to humans.
Collapse
Affiliation(s)
- Wei Liu
- Dept. of Biomedical Engineering, Case Western Reserve Univ., Wickenden 427, 10900 Euclid Ave., Cleveland, OH 44106, USA
| | | | | | | | | | | | | |
Collapse
|
32
|
Lumens J, Delhaas T, Arts T, Cowan BR, Young AA. Impaired subendocardial contractile myofiber function in asymptomatic aged humans, as detected using MRI. Am J Physiol Heart Circ Physiol 2006; 291:H1573-9. [PMID: 16679404 DOI: 10.1152/ajpheart.00074.2006] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
With aging, structural and functional changes occur in the myocardium without obvious impairment of systolic left ventricular (LV) function. Transmural differences in myocardial vulnerability for these changes may result in increase of transmural inhomogeneity in contractile myofiber function. Subendocardial fibrosis and impairment of subendocardial perfusion due to hypertension might change the transmural distribution of contractile myofiber function. The ratio of LV torsion to endocardial circumferential shortening (torsion-to-shortening ratio; TSR) during systole reflects the transmural distribution of contractile myofiber function. We investigated whether the transmural distribution of systolic contractile myofiber function changes with age. Magnetic resonance tissue tagging was performed to derive LV torsion and endocardial circumferential shortening. TSR was quantified in asymptomatic young [age 23.2 (SD 2.6) yr, n = 15] and aged volunteers [age 68.8 (SD 4.4) yr, n = 16]. TSR and its standard deviation were significantly elevated in the aged group [0.47 (SD 0.12) aged vs. 0.34 (SD 0.05) young; P = 0.0004]. In the aged group, blood pressure and the ratio of LV wall mass to end-diastolic volume were mildly elevated but could not be correlated to the increase in TSR. There were no significant differences in other indexes of systolic LV function such as end-systolic volume and ejection fraction. The elevated systolic TSR in the asymptomatic aged subjects suggests that aging is associated with local loss of contractile myofiber function in the subendocardium relative to the subepicardium potentially caused by subclinical pathological incidents.
Collapse
Affiliation(s)
- Joost Lumens
- Dept. of Biophysics, Cardiovascular Research Institute Maastricht, Maastricht Univ., PO Box 616, 6200 MD Maastricht, The Netherlands.
| | | | | | | | | |
Collapse
|
33
|
Protsenko YL, Routkevitch SM, Gur'ev VY, Katsnelson LB, Solovyova O, Lookin ON, Balakin AA, Kohl P, Markhasin VS. Hybrid duplex: a novel method to study the contractile function of heterogeneous myocardium. Am J Physiol Heart Circ Physiol 2005; 289:H2733-46. [PMID: 16040718 DOI: 10.1152/ajpheart.00306.2005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In an earlier study, we experimentally mimicked the effects of mechanical interaction between different regions of the ventricular wall by allowing pairs of independently maintained cardiac muscle fibers to interact mechanically in series or in parallel. This simple physiological model of heterogeneous myocardium, which has been termed “duplex,” has provided new insight into basic effects of cardiac electromechanical heterogeneity. Here, we present a novel “hybrid duplex,” where one of the elements is an isolated cardiac muscle and the other a “virtual cardiac muscle.” The virtual muscle is represented by a computational model of cardiomyocyte electromechanical activity. We present in detail the computer-based digital control system that governs the mechanical interaction between virtual and biological muscle, the software used for data analysis, and working implementations of the model. Advantages of the hybrid duplex method are discussed, and experimental recordings are presented for illustration and as proof of the principle.
Collapse
Affiliation(s)
- Yuri L Protsenko
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Rm. 327, 91 Pervomayskaya ul., Ekaterinburg 620219, Russia.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Delhaas T, Kotte J, van der Toorn A, Snoep G, Prinzen FW, Arts T. Increase in left ventricular torsion-to-shortening ratio in children with valvular aortic stenosis. Magn Reson Med 2004; 51:135-9. [PMID: 14705053 DOI: 10.1002/mrm.10679] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Perfusion of left ventricular (LV) subendocardium in valvular aortic stenosis (AS) patients is impaired. It was expected that this may lead to a reduction of subendocardial fiber contraction and, consequently, to an increase of LV torsion per amount of ejection. Using MR tagging (MRT), it was investigated whether the torsion-to-shortening ratio (TSR) is elevated in valvular AS patients. Six asymptomatic children with valvular AS were investigated using echo Doppler, ECG, exercise test, and MRT. LV torsion and natural strain of the inner diameter were determined from measured tag displacements in two short-axis slices of the LV. In all AS patients TSR was approximately 40% increased (0.62 +/- 0.04 rad; mean +/- SD) as compared to pediatric (0.44 +/- 0.08 rad; n=5) and adult controls (0.46 +/- 0.08 rad; n=9), indicating subendocardial contractile dysfunction. With other techniques hitherto used this type of dysfunction could not be detected.
Collapse
Affiliation(s)
- Tammo Delhaas
- Department of Pediatrics, Cardiovascular Research Institute Maastricht, Maastricht University and University Hospital, Maastricht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
Magnetic resonance imaging (MRI) provides a noninvasive way to evaluate the biomechanical dynamics of the heart. MRI can provide spatially registered tomographic images of the heart in different phases of the cardiac cycle, which can be used to assess global cardiac function and regional endocardial surface motion. In addition, MRI can provide detailed information on the patterns of motion within the heart wall, permitting calculation of the evolution of regional strain and related motion variables within the wall. These show consistent patterns of spatial and temporal variation in normal subjects, which are affected by alterations of function due to disease. Although still an evolving technique, MRI shows promise as a new method for research and clinical evaluation of cardiac dynamics.
Collapse
Affiliation(s)
- Leon Axel
- Department of Radiology, University of Pennsylvania, Philadelphia 19104, USA.
| |
Collapse
|
36
|
Van Der Toorn A, Barenbrug P, Snoep G, Van Der Veen FH, Delhaas T, Prinzen FW, Maessen J, Arts T. Transmural gradients of cardiac myofiber shortening in aortic valve stenosis patients using MRI tagging. Am J Physiol Heart Circ Physiol 2002; 283:H1609-15. [PMID: 12234815 DOI: 10.1152/ajpheart.00239.2002] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aortic valve stenosis impairs subendocardial perfusion with a risk of irreversible subendocardial tissue damage. A likely precursor of damage is subendocardial contractile dysfunction, expressed by the parameter TransDif, which is defined as epicardial minus endocardial myofiber shortening, normalized to the mean value. With the use of magnetic resonance tagging in two short-axis slices of the left ventricle (LV), TransDif was derived from LV torsion and contraction during ejection. TransDif was determined in healthy volunteers (control, n = 9) and in patients with aortic valve stenosis before (AVSten, n = 9) and 3 mo after valve replacement (AVRepl, n = 7). In the control group, TransDif was 0.00 +/- 0.14 (mean +/- SD). In the AVSten group, TransDif increased to 0.96 +/- 0.62, suggesting impairment of subendocardial myofiber shortening. In the AVRepl group, TransDif decreased to 0.37 +/- 0.20 but was still elevated. In eight of nine AVSten patients, the TransDif value was elevated individually (P < 0.001), suggesting that the noninvasively determined parameter TransDif may provide important information in planning of treatment of aortic valve stenosis.
Collapse
Affiliation(s)
- A Van Der Toorn
- Department of Biophysics, Maastricht University, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Cardiac tagging permits non-invasive study of myocardial motion with high accuracy. Unfortunately, tagging contrast is impaired at later heart phases due to longitudinal relaxation. Histogram modification is presented as a method for improving contrast in later, faded images of a tagging series by altering these images such that their intensity histograms approximate the shape of the first, unfaded image of the series. This technique greatly improves the contrast and facilitates automatic detection of tags. Furthermore, a method is described for automatically tracking tag positions in short-axis images of the left ventricle modulated with a tagging grid. The method differs from previously reported methods in that, in one single filtering process in the Fourier domain, both the grid crossings as well as the grid centers are detected, and thus increased sampling resolution is obtained. The method was validated by applying a mathematical model of left ventricular motion to tagged images of the thigh muscle. The average discrepancy between theoretically predicted and automatically detected tag positions was 0.04 +/- 0.17 mm (mean +/- SD).
Collapse
Affiliation(s)
- M A Koerkamp
- Department of Radiology, University Hospital Maastricht, The Netherlands
| | | | | | | |
Collapse
|
38
|
Egmont-Petersen M, Arts T. Recognition of radiopaque markers in X-ray images using a neural network as nonlinear filter. Pattern Recognit Lett 1999. [DOI: 10.1016/s0167-8655(99)00024-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|