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Janssens KLPM, Bovendeerd PHM. Impact of cardiac patch alignment on restoring post-infarct ventricular function. Biomech Model Mechanobiol 2024:10.1007/s10237-024-01877-9. [PMID: 39088120 DOI: 10.1007/s10237-024-01877-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 07/12/2024] [Indexed: 08/02/2024]
Abstract
Acute myocardial infarction (MI) leads to a loss of cardiac function which, following adverse ventricular remodeling (AVR), can ultimately result in heart failure. Tissue-engineered contractile patches placed over the infarct offer potential for restoring cardiac function and reducing AVR. In this computational study, we investigate how improvement of pump function depends on the orientation of the cardiac patch and the fibers therein relative to the left ventricle (LV). Additionally, we examine how model outcome depends on the choice of material properties for healthy and infarct tissue. In a finite element model of LV mechanics, an infarction was induced by eliminating active stress generation and increasing passive tissue stiffness in a region comprising 15% of the LV wall volume. The cardiac patch was modeled as a rectangular piece of healthy myocardium with a volume of 25% of the infarcted tissue. The orientation of the patch was varied from 0 to 150 ∘ relative to the circumferential plane. The infarct reduced stroke work by 34% compared to the healthy heart. Optimal patch support was achieved when the patch was oriented parallel to the subepicardial fiber direction, restoring 9% of lost functionality. Typically, about one-third of the total recovery was attributed to the patch, while the remainder resulted from restored functionality in native myocardium adjacent to the infarct. The patch contributes to cardiac function through two mechanisms. A contribution of tissue in the patch and an increased contribution of native tissue, due to favorable changes in mechanical boundary conditions.
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Affiliation(s)
- Koen L P M Janssens
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600MB, Eindhoven, The Netherlands.
| | - Peter H M Bovendeerd
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600MB, Eindhoven, The Netherlands
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2
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Mendiola EA, Neelakantan S, Xiang Q, Merchant S, Li K, Hsu EW, Dixon RAF, Vanderslice P, Avazmohammadi R. Contractile Adaptation of the Left Ventricle Post-myocardial Infarction: Predictions by Rodent-Specific Computational Modeling. Ann Biomed Eng 2023; 51:846-863. [PMID: 36394778 PMCID: PMC10023390 DOI: 10.1007/s10439-022-03102-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/02/2022] [Indexed: 11/19/2022]
Abstract
Myocardial infarction (MI) results in cardiac myocyte death and the formation of a fibrotic scar in the left ventricular free wall (LVFW). Following an acute MI, LVFW remodeling takes place consisting of several alterations in the structure and properties of cellular and extracellular components with a heterogeneous pattern across the LVFW. The normal function of the heart is strongly influenced by the passive and active biomechanical behavior of the LVFW, and progressive myocardial structural remodeling can have a detrimental effect on both diastolic and systolic functions of the LV leading to heart failure. Despite important advances in understanding LVFW passive remodeling in the setting of MI, heterogeneous remodeling in the LVFW active properties and its relationship to organ-level LV function remain understudied. To address these gaps, we developed high-fidelity finite-element (FE) rodent computational cardiac models (RCCMs) of MI using extensive datasets from MI rat hearts representing the heart remodeling from one-week (1-wk) to four-week (4-wk) post-MI timepoints. The rat-specific models (n = 2 for each timepoint) integrate detailed imaging data of the heart geometry, myocardial fiber architecture, and infarct zone determined using late gadolinium enhancement prior to terminal measurements. The computational models predicted a significantly higher level of active tension in remote myocardium in early post-MI hearts (1-wk post-MI) followed by a return to near the control level in late-stage MI (3- and 4-wk post-MI). The late-stage MI rats showed smaller myofiber ranges in the remote region and in-silico experiments using RCCMs suggested that the smaller fiber helicity is consistent with lower contractile forces needed to meet the measured ejection fractions in late-stage MI. In contrast, in-silico experiments predicted that collagen fiber transmural orientation in the infarct region has little influence on organ-level function. In addition, our MI RCCMs indicated that reduced and potentially positive circumferential strains in the infarct region at end-systole can be used to infer information about the time-varying properties of the infarct region. The detailed description of regional passive and active remodeling patterns can complement and enhance the traditional measures of LV anatomy and function that often lead to a gross and limited assessment of cardiac performance. The translation and implementation of our model in patient-specific organ-level simulations offer to advance the investigation of individualized prognosis and intervention for MI.
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Affiliation(s)
- Emilio A Mendiola
- Computational Cardiovascular Bioengineering Laboratory, Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | - Sunder Neelakantan
- Computational Cardiovascular Bioengineering Laboratory, Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | - Qian Xiang
- Department of Molecular Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Samer Merchant
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Ke Li
- Department of Molecular Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Edward W Hsu
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Richard A F Dixon
- Department of Molecular Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Peter Vanderslice
- Department of Molecular Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Reza Avazmohammadi
- Computational Cardiovascular Bioengineering Laboratory, Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA.
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, TX, USA.
- Department of Cardiovascular Sciences, Houston Methodist Academic Institute, Houston, TX, USA.
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3
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Mansell DS, Bruno VD, Sammut E, Chiribiri A, Johnson T, Khaliulin I, Lopez DB, Gill HS, Fraser KH, Murphy M, Krieg T, Suleiman MS, George S, Ascione R, Cookson AN. Acute regional changes in myocardial strain may predict ventricular remodelling after myocardial infarction in a large animal model. Sci Rep 2021; 11:18322. [PMID: 34526592 PMCID: PMC8443552 DOI: 10.1038/s41598-021-97834-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
To identify predictors of left ventricular remodelling (LVR) post-myocardial infarction (MI) and related molecular signatures, a porcine model of closed-chest balloon MI was used along with serial cardiac magnetic resonance imaging (CMRI) up to 5-6 weeks post-MI. Changes in myocardial strain and strain rates were derived from CMRI data. Tissue proteomics was compared between infarcted and non-infarcted territories. Peak values of left ventricular (LV) apical circumferential strain (ACS) changed over time together with peak global circumferential strain (GCS) while peak GLS epicardial strains or strain rates did not change over time. Early LVR post-MI enhanced abundance of 39 proteins in infarcted LV territories, 21 of which correlated with LV equatorial circumferential strain rate. The strongest associations were observed for D-3-phosphoglycerate dehydrogenase (D-3PGDH), cysteine and glycine-rich protein-2, and secreted frizzled-related protein 1 (sFRP1). This study shows that early changes in regional peak ACS persist at 5-6 weeks post-MI, when early LVR is observed along with increased tissue levels of D-3PGDH and sFRP1. More studies are needed to ascertain if the observed increase in tissue levels of D-3PGDH and sFRP1 might be casually involved in the pathogenesis of adverse LV remodelling.
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Affiliation(s)
- D S Mansell
- Department of Mechanical Engineering, University of Bath, Bath, BA2 7AY, UK
| | - V D Bruno
- Department of Translational Science, Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, Bristol Royal Infirmary, Level 7, University of Bristol, Bristol, BS2 8HW, UK
| | - E Sammut
- Department of Translational Science, Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, Bristol Royal Infirmary, Level 7, University of Bristol, Bristol, BS2 8HW, UK
| | - A Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - T Johnson
- Department of Translational Science, Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, Bristol Royal Infirmary, Level 7, University of Bristol, Bristol, BS2 8HW, UK
| | - I Khaliulin
- Department of Translational Science, Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, Bristol Royal Infirmary, Level 7, University of Bristol, Bristol, BS2 8HW, UK
| | - D Baz Lopez
- Department of Translational Science, Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, Bristol Royal Infirmary, Level 7, University of Bristol, Bristol, BS2 8HW, UK
| | - H S Gill
- Department of Mechanical Engineering, University of Bath, Bath, BA2 7AY, UK
| | - K H Fraser
- Department of Mechanical Engineering, University of Bath, Bath, BA2 7AY, UK
| | - M Murphy
- MRC Mitochondrial Biology Unit, The Keith Peters Building, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0XY, UK
| | - T Krieg
- Department of Medicine, University of Cambridge, Addenbrookes Hospital, Hills Rd, Box 157, Cambridge, CB2 0QQ, UK
| | - M S Suleiman
- Department of Translational Science, Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, Bristol Royal Infirmary, Level 7, University of Bristol, Bristol, BS2 8HW, UK
| | - S George
- Department of Translational Science, Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, Bristol Royal Infirmary, Level 7, University of Bristol, Bristol, BS2 8HW, UK
| | - R Ascione
- Department of Translational Science, Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, Bristol Royal Infirmary, Level 7, University of Bristol, Bristol, BS2 8HW, UK.
| | - A N Cookson
- Department of Mechanical Engineering, University of Bath, Bath, BA2 7AY, UK
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4
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Torres WM, Jacobs J, Doviak H, Barlow SC, Zile MR, Shazly T, Spinale FG. Regional and temporal changes in left ventricular strain and stiffness in a porcine model of myocardial infarction. Am J Physiol Heart Circ Physiol 2018; 315:H958-H967. [PMID: 30004234 DOI: 10.1152/ajpheart.00279.2018] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The aim of the present study was to serially track how myocardial infarction (MI) impacts regional myocardial strain and mechanical properties of the left ventricle (LV) in a large animal model. Post-MI remodeling has distinct regional effects throughout the LV myocardium. Regional quantification of LV biomechanical behavior could help explain changes in global function and thus advance clinical assessment of post-MI remodeling. The present study is based on a porcine MI model to characterize LV biomechanics over 28 days post-MI via speckle-tracking echocardiography (STE). Regional myocardial strain and strain rate were recorded in the circumferential, radial, and longitudinal directions at baseline and at 3, 14, and 28 days post-MI. Regional myocardial wall stress was calculated using standard echocardiographic metrics of geometry and Doppler-derived hemodynamic measurements. Regional diastolic myocardial stiffness was calculated from the resultant stress-strain relations. Peak strain and phasic strain rates were nonuniformly reduced throughout the myocardium post-MI, whereas time to peak strain was increased to a similar degree in the MI region and border zone by 28 days post-MI. Elevations in diastolic myocardial stiffness in the MI region plateaued at 14 days post-MI, after which a significant reduction in MI regional stiffness in the longitudinal direction occurred between 14 and 28 days post-MI. Post-MI biomechanical changes in the LV myocardium were initially limited to the MI region but nonuniformly extended into the neighboring border zone and remote myocardium over 28 days post-MI. STE enabled quantification of regional and temporal differences in myocardial strain and diastolic stiffness, underscoring the potential of this technique for clinical assessment of post-MI remodeling. NEW & NOTEWORTHY For the first time, speckle-tracking echocardiography was used to serially track regional biomechanical behavior and mechanical properties postmyocardial infarction (post-MI). We found that changes initially confined to the MI region extended throughout the myocardium in a nonuniform fashion over 28 days post-MI. Speckle-tracking echocardiography-based evaluation of regional changes in left ventricular biomechanics could advance both clinical assessment of left ventricular remodeling and therapeutic strategies that target aberrant biomechanical behavior post-MI.
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Affiliation(s)
- William M Torres
- College of Engineering and Computing, University of South Carolina , Columbia, South Carolina.,Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the William Jennings Bryan Dorn Veteran Affairs Medical Center , Columbia, South Carolina
| | - Julia Jacobs
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the William Jennings Bryan Dorn Veteran Affairs Medical Center , Columbia, South Carolina
| | - Heather Doviak
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the William Jennings Bryan Dorn Veteran Affairs Medical Center , Columbia, South Carolina
| | - Shayne C Barlow
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the William Jennings Bryan Dorn Veteran Affairs Medical Center , Columbia, South Carolina
| | - Michael R Zile
- Medical University of South Carolina and Ralph H. Johnson Department of Veterans Affairs Medical Center , Charleston, South Carolina
| | - Tarek Shazly
- College of Engineering and Computing, University of South Carolina , Columbia, South Carolina
| | - Francis G Spinale
- College of Engineering and Computing, University of South Carolina , Columbia, South Carolina.,Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the William Jennings Bryan Dorn Veteran Affairs Medical Center , Columbia, South Carolina
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5
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Howard-Quijano K, McCabe M, Cheng A, Zhou W, Yamakawa K, Mazor E, Scovotti JC, Mahajan A. Left ventricular endocardial and epicardial strain changes with apical myocardial ischemia in an open-chest porcine model. Physiol Rep 2017; 4:4/24/e13042. [PMID: 28039400 PMCID: PMC5210372 DOI: 10.14814/phy2.13042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 11/24/2022] Open
Abstract
Early detection of acute myocardial ischemia is critical to prevent permanent myocardial damage. The impact of apical ischemia on global left ventricular (LV) function can be difficult to characterize using traditional volume‐based echocardiography measures. Myocardial strain imaging is a sensitive, quantitative marker of myocardial deformation that can measure ventricular function. Recent advances allow layer‐specific measurement of endo‐ and epicardial strain, enhancing the ability to evaluate myocardial ischemia. This study investigates the effects of apical ischemia on LV function using epi‐ and endocardial strain. We hypothesize that myocardial strain will identify changes in regional and global myocardial function associated with focal apical ischemia as compared to ejection fraction (EF), and that longitudinal strain will be a better indicator of myocardial dysfunction compared to circumferential or radial strain. In a porcine model (n = 9), acute ischemia was induced by left anterior descending coronary artery occlusion. Echocardiograms were performed at baseline, during 15‐min ischemia, and after reperfusion. Global longitudinal strain decreased with acute focal ischemia of the left ventricular apical region (baseline: −16.4% vs. ischemia: −12.2%; P = 0.010), with no change observed in global circumferential and radial strain or EF. Both endocardial and epicardial longitudinal strain decreased by 68% (P < 0.001) in the ischemic and peri‐ischemic zone, while circumferential and radial strain only decreased in endocardium of the ischemic zone. Longitudinal strain was more sensitive to ischemia, being able to detect changes in global LV function and thus may confer clinical diagnostic advantage in the evaluation of acute LV apical ischemia.
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Affiliation(s)
- Kimberly Howard-Quijano
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Melissa McCabe
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Alexander Cheng
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Wei Zhou
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Kentaro Yamakawa
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Einat Mazor
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Jennifer C Scovotti
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
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6
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Hu B, Zhou Q, Chen J, Tan T, Yao X, Song H, Guo R. Prediction for Improvement and Remodeling in First-Onset Myocardial Infarction by Speckle Tracking Echocardiography: Is Global or Regional Selection Better? ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2452-2460. [PMID: 28673476 DOI: 10.1016/j.ultrasmedbio.2017.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 05/16/2017] [Accepted: 06/02/2017] [Indexed: 06/07/2023]
Abstract
Cardiac function improvement and chamber remodeling after the onset of acute myocardial infarction (AMI) is crucial as it is closely related to the outcomes of patients. We sought to investigate the predictive value of left ventricular (LV) global and region of interest (ROI) assessment for prognosis of AMI patients by speckle tracking echocardiography (STE). We prospectively enrolled 81 first-onset AMI patients for baseline and 6-mo follow-up analysis. The echocardiography-derived parameters were compared in receiver operator characteristics (ROC) analysis for prediction of LV remodeling (LVR) (a minimum 20% increase of LV end-diastolic volume) and cardiac function improvement (a minimum 5% increase of LV ejection fraction). The ROI strain was selected by wall motion score index (WMSI) scores ≥2. The time of whole analysis process was recorded. Cut-off values of -9.92% for global circumferential strain (CS) and -5.53% for ROI CS predicted LVR. Cut-off values of -10.40% for global longitudinal strain (LS) and -5.33% for ROI LS predicted cardiac function improvement. Areas under curves of global and ROI parameters were comparable in ROC analysis (p > 0.05, all). The time of global analysis was less than the time of ROI analysis (p < 0.05) and the reproducibility of global analysis was slightly better than the ROI analysis. Our results demonstrated that STE was valuable for the prediction of LVR and cardiac function improvement after AMI. Compared with ROI parameters, global parameters were more integral and efficient as predictive factors with high predictive power, less analysis time and better reproducibility.
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Affiliation(s)
- Bo Hu
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, China
| | - Qing Zhou
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, China.
| | - Jinling Chen
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, China
| | - Tuantuan Tan
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, China
| | - Xue Yao
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, China
| | - Hongning Song
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, China
| | - Ruiqiang Guo
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, China
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Leitman M, Tyomkin V, Peleg E, Zyssman I, Rosenblatt S, Sucher E, Gercenshtein V, Vered Z. Speckle Tracking Imaging in Normal Stress Echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:717-724. [PMID: 27943379 DOI: 10.7863/ultra.16.04010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Exercise stress echocardiography is a widely used modality for the diagnosis and follow-up of patients with coronary artery disease. During the last decade, speckle tracking imaging has been used increasingly for accurate evaluation of cardiac function. This work aimed to assess speckle-tracking imaging parameters during nonischemic exercise stress echocardiography. METHODS During 2011 to 2014 we studied 46 patients without history of coronary artery disease, who completed exercise stress echocardiography protocol, had normal left ventricular function, a nonischemic response, and satisfactory image quality. These exams were analyzed with speckle-tracking imaging software at rest and at peak exercise. Peak strain and time-to-peak strain were measured at rest and after exercise. Clinical follow-up included a telephone contact 1 to 3 years after stress echo exam, confirming freedom from coronary events during this time. RESULTS Global and regional peak strain increased following exercise. Time-to-peak global and regional strain and time-to-peak strain adjusted to the heart rate were significantly shorter in all segments after exercise. Rest-to-stress ratio of time-to-peak strain adjusted to the heart rate was 2.0 to 2.8. CONCLUSIONS Global and regional peak strain rise during normal exercise echocardiography. Peak global and regional strain occur before or shortly after aortic valve closure at rest and after exercise, and the delay is more apparent at the basal segments. Time-to-peak strain normally shortens significantly during exercise; after adjustment to heart rate it shortens by a ratio of 2.0 to 2.8. These data may be useful for interpretation of future exercise stress speckle-tracking echocardiography studies.
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Affiliation(s)
- Marina Leitman
- Department of Cardiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Vladimir Tyomkin
- Department of Cardiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Eli Peleg
- Department of Cardiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Izhak Zyssman
- Department of Cardiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Simcha Rosenblatt
- Department of Cardiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Edgar Sucher
- Department of Cardiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Vered Gercenshtein
- Department of Cardiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Zvi Vered
- Department of Cardiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
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Blumberg Y, Ertracht O, Gershon I, Bachner-Hinenzon N, Reuveni T, Atar S. High-Intensity Training Improves Global and Segmental Strains in Severe Congestive Heart Failure. J Card Fail 2017; 23:392-402. [PMID: 28069473 DOI: 10.1016/j.cardfail.2016.12.010] [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] [Received: 07/28/2016] [Revised: 11/27/2016] [Accepted: 12/29/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND High-intensity training (HIT) is superior to moderate aerobic training (MAT) for improving quality of life in congestive heart failure (CHF) patients. Speckle-tracking echocardiography (STE) has recently been suggested for estimation of left ventricle global and regional function. We evaluated the utility of STE for characterizing differences in cardiac function following MAT or HIT in a CHF rat model. METHODS AND RESULTS After baseline physiologic assessment, CHF was induced by means of coronary artery ligation in Sprague-Dawley rats. Repeated measurements confirmed the presence of CHF (ejection fraction 52 ± 10%, global circumferential strain (GCS) 10.5 ± 4, and maximal oxygen uptake (V˙O2max) 71 ± 11 mL⋅min-1⋅kg-1; P < .001 vs baseline for all). Subsequently, rats were divided into training protocols: sedentary (SED), MAT, or HIT. After the training period, rats underwent the same measurements and were killed. Training intensity improved V˙O2max (73 ± 13 mL⋅min-1⋅kg-1 in MAT [P < .01 vs baseline] and 82 ± 6 mL⋅min-1⋅kg-1 in HIT [P < .05 vs baseline or SED] and ejection fraction (50 ± 21% in MAT [P < .001 vs baseline] and 66 ± 7% in HIT [P > .05 vs baseline]). In addition, strains of specific segments adjacent to the infarct zone regained basal values (P > .05 vs baseline), whereas global cardiac functional parameters as assessed with the use of 2-dimensional echocardiography did not improve. CONCLUSIONS High-intensity exercise training improved function in myocardial segments remote from the scar, which resulted in compensatory cardiac remodeling. This effect is prominent, yet it could be detected only with the use of STE.
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Affiliation(s)
- Yair Blumberg
- Eliachar Research Laboratory, Galilee Medical Center, Nahariya, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Offir Ertracht
- Eliachar Research Laboratory, Galilee Medical Center, Nahariya, Israel.
| | - Itai Gershon
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | | | - Tali Reuveni
- Eliachar Research Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Shaul Atar
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; Department of Cardiology, Galilee Medical Center, Nahariya, Israel
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