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Pérez Del Villar C, Martínez-Legazpi P, Mombiela T, Chazo C, Desco M, Rodríguez-Pérez D, Benito Y, Barrio A, Gutiérrez-Ibañes E, Del Álamo JC, Elízaga J, Antoranz JC, Fernández-Avilés F, Yotti R, Bermejo J. The natural matching of harmonic responses in the pulmonary circulation. J Physiol 2019; 597:3853-3865. [PMID: 31187875 PMCID: PMC9328395 DOI: 10.1113/jp278050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/07/2019] [Indexed: 12/05/2022] Open
Abstract
Key points The right ventricle of the mammal heart is highly sensitive to the afterload imposed by a combination of the pulmonary circulation and the retrograde contribution of the left heart. Right ventricular afterload can be analysed in terms of pulmonary artery input impedance, which we were able to decompose as the result of the harmonic frequency responses of the pulmonary vessels and the left heart attached in series. Using spectral methods, we found a natural matching between the pulmonary vasculature and the left chambers of the heart. This coupling implies that the upstream transmission of the left heart frequency‐response has favourable effects on the pulmonary tree. This physiological mechanism protects the right ventricle against acute changes in preload, and its impairment may be a relevant contribution to right ventricle dysfunction in pulmonary hypertension.
Abstract The right ventricle (RV) of the mammal heart is highly sensitive to the afterload imposed by the pulmonary circulation, and the left heart (LH) retrogradely contributes significantly to this vascular load. Transmission‐line theory anticipates that the degree of matching between the frequency responses of the pulmonary vasculature and the LH should modulate the global right haemodynamic burden. We measured simultaneous high‐fidelity flow (pulmonary artery) and pressure (pulmonary artery and left atrium) in 18 healthy minipigs under acute haemodynamic interventions. From these data, we decomposed the impedance spectra of the total right‐circulation system into the impedance of the pulmonary vessels and the harmonic response of the LH. For frequencies above the first harmonic, total impedance was below the pulmonary impedance during all phases (P < 0.001; pooled phases), demonstrating a favourable effect of the LH harmonic response on RV pulsatile load: the LH harmonic response was responsible for a 20% reduction of pulse pulmonary artery pressure (P < 0.001 vs. a theoretical purely‐resistive response) and a 15% increase of pulmonary compliance (P = 0.009). This effect on compliance was highest during acute volume overload. In the normal right circulation, the longitudinal impedance of the pulmonary vasculature is matched to the harmonic response of the LH in a way that efficiently reduces the pulmonary pulsatile vascular load. This source of interaction between the right and left circulations of mammals protects the RV against excessive afterload during acute volume transients and its disruption may be an important contributor to pulmonary hypertension. The right ventricle of the mammal heart is highly sensitive to the afterload imposed by a combination of the pulmonary circulation and the retrograde contribution of the left heart. Right ventricular afterload can be analysed in terms of pulmonary artery input impedance, which we were able to decompose as the result of the harmonic frequency responses of the pulmonary vessels and the left heart attached in series. Using spectral methods, we found a natural matching between the pulmonary vasculature and the left chambers of the heart. This coupling implies that the upstream transmission of the left heart frequency‐response has favourable effects on the pulmonary tree. This physiological mechanism protects the right ventricle against acute changes in preload, and its impairment may be a relevant contribution to right ventricle dysfunction in pulmonary hypertension.
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Affiliation(s)
- Candelas Pérez Del Villar
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Pablo Martínez-Legazpi
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Teresa Mombiela
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Christian Chazo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Desco
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Daniel Rodríguez-Pérez
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Yolanda Benito
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Alicia Barrio
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Gutiérrez-Ibañes
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan C Del Álamo
- Mechanical and Aerospace Engineering Department, University of California San Diego, and the Institute for Engineering in Medicine, University of California San Diego, La Jolla, CA, USA
| | - Jaime Elízaga
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - José Carlos Antoranz
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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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.
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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
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Taylor RJ, Umar F, Lin ELS, Ahmed A, Moody WE, Mazur W, Stegemann B, Townend JN, Steeds RP, Leyva F. Mechanical effects of left ventricular midwall fibrosis in non-ischemic cardiomyopathy. J Cardiovasc Magn Reson 2016; 18:1. [PMID: 26732096 PMCID: PMC4700639 DOI: 10.1186/s12968-015-0221-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left ventricular (LV) mid-wall fibrosis (MWF), which occurs in about a quarter of patients with non-ischemic cardiomyopathy (NICM), is associated with high risk of pump failure. The mid LV wall is the site of circumferential myocardial fibers. We sought to determine the effect of MWF on LV myocardial mechanics. METHODS Patients with NICM (n = 116; age: 62.8 ± 13.2 years; 67% male) underwent late gadolinium enhancement cardiovascular magnetic resonance (CMR) and were categorized according to the presence (+) or absence (-) of MWF. Feature tracking (FT) CMR was used to assess myocardial deformation. RESULTS Despite a similar LVEF (24.3 vs. 27.5%, p = 0.20), patients with MWF (32 [24%]) had lower global circumferential strain (Ɛcc: -6.6% vs. -9.4 %, P = 0.004), but similar longitudinal (Ɛll: -7.6 % vs. -9.4 %, p = 0.053) and radial (Ɛrr: 14.6% vs. 17.8% p = 0.18) strain. Compared with - MWF, + MWF was associated with reduced LV systolic, circumferential strain rate (-0.38 ± 0.1 vs. -0.56 ± 0.3 s(-1), p = 0.005) and peak LV twist (4.65 vs. 6.31°, p = 0.004), as well as rigid LV body rotation (64 % vs. 28 %, P <0.001). In addition, +MWF was associated with reduced LV diastolic strain rates (DSRcc: 0.34 vs. 0.46 s(-1); DSRll: 0.38 vs. 0.50s(-1); DSRrr: -0.55 vs. -0.75 s(-1); all p <0.05). CONCLUSIONS MWF is associated with reduced LV global circumferential strain, strain rate and torsion. In addition, MWF is associated with rigid LV body rotation and reduced diastolic strain rates. These systolic and diastolic disturbances may be related to the increased risk of pump failure observed in patients with NICM and MWF.
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Affiliation(s)
- Robin J Taylor
- Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
| | - Fraz Umar
- Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
| | - Erica L S Lin
- Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
| | - Amar Ahmed
- Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
| | - William E Moody
- Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
| | - Wojciech Mazur
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA.
| | | | - Jonathan N Townend
- Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
| | - Richard P Steeds
- Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
| | - Francisco Leyva
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
- Aston Medical Research Institute, Aston Medical School, University of Aston, Birmingham, UK.
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Değirmenci H, Demirelli S, Arısoy A, Ermiş E, Araz Ö, Bakırcı EM, Hamur H, Büyüklü M, Topal E. Myocardial deformation and total atrial conduction time in the prediction of cardiac involvement in patients with pulmonary sarcoidosis. CLINICAL RESPIRATORY JOURNAL 2015; 11:68-77. [DOI: 10.1111/crj.12307] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/23/2015] [Accepted: 04/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Hüsnü Değirmenci
- Faculty of Medicine; Cardiology; Erzincan University; Erzincan Turkey
| | - Selami Demirelli
- Department of Cardiology; Education and Research Hospital; Erzurum Turkey
| | - Arif Arısoy
- Faculty of Medicine; Cardiology; Gaziosmanpasa University; Tokat Turkey
| | - Emrah Ermiş
- Department of Cardiology; Education and Research Hospital; Erzurum Turkey
| | - Ömer Araz
- Faculty of Medicine; Pulmonary of Disease; Ataturk University; Erzurum Turkey
| | | | - Hikmet Hamur
- Faculty of Medicine; Cardiology; Erzincan University; Erzincan Turkey
| | - Mutlu Büyüklü
- Faculty of Medicine; Cardiology; Erzincan University; Erzincan Turkey
| | - Ergün Topal
- Faculty of Medicine; Cardiology; Erzincan University; Erzincan Turkey
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D'Ascenzi F, Caselli S, Solari M, Pelliccia A, Cameli M, Focardi M, Padeletti M, Corrado D, Bonifazi M, Mondillo S. Novel echocardiographic techniques for the evaluation of athletes' heart: A focus on speckle-tracking echocardiography. Eur J Prev Cardiol 2015; 23:437-46. [PMID: 25990017 DOI: 10.1177/2047487315586095] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The development and rapid dissemination of two-dimensional echocardiography led to important further advances in our understanding of athletes' heart that has been the subject of several echocardiographic studies involving many thousands of athletes. The description of ventricular chamber enlargement, myocardial hypertrophy and atrial dilatation has led to a more comprehensive understanding of cardiac adaptation to exercise conditioning. Most recently, advanced echocardiographic techniques have begun to clarify significant functional adaptations of the myocardium that accompany previously reported morphological features of athletes' heart. In particular, speckle-tracking echocardiography (STE) has recently provided further insights into the characterisation of myocardial properties. DISCUSSION STE is a relatively new, largely angle-independent, non-invasive imaging technique that allows for an objective and quantitative evaluation of global and regional myocardial function. STE has enhanced our understanding of athletes' heart through a comprehensive characterisation of biventricular and biatrial function, providing novel insights into the investigation of physiological adaptation of the heart to exercise conditioning. These peculiarities can provide further useful data to distinguish between athletes' heart and cardiomyopathies. Furthermore, STE represents a promising tool to address new concerns on right ventricular function and to increase understanding of the complexity of the non-systemic circulation, especially in the athletic population. CONCLUSION This review article analyses new data on cardiac function in athletes by novel echocardiographic techniques with a particular attention to the application of STE to characterise biventricular and biatrial function in athletes.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | | | - Marco Solari
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | | | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Margherita Padeletti
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Marco Bonifazi
- Department of Medicine, Surgery and NeuroScience, University of Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
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Barutçu A, Bekler A, Temiz A, Kırılmaz B, Yener AÜ, Tan YZ, Gazi E, Altun B. Left Ventricular Twist Mechanics Are Impaired in Patients with Coronary Slow Flow. Echocardiography 2015; 32:1647-54. [DOI: 10.1111/echo.12918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ahmet Barutçu
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Adem Bekler
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Ahmet Temiz
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Bahadır Kırılmaz
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Ali Ümit Yener
- Faculty of Medicine; Department of Cardiovascular Surgery; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Yusuf Ziya Tan
- Faculty of Medicine; Department of Nuclear Medicine; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Emine Gazi
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Burak Altun
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
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Demirelli S, Degirmenci H, Bilen H, Ermis E, Duman H, Arisoy A, Bakirci EM, Ipek E, Askin L. Left ventricular mechanics in Behcet's disease: a speckle tracking echocardiographic study. Bosn J Basic Med Sci 2014; 14:160-4. [PMID: 25172976 DOI: 10.17305/bjbms.2014.3.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 07/21/2014] [Accepted: 07/30/2014] [Indexed: 11/16/2022] Open
Abstract
Although cardiac involvement is rarely seen in Behcet's disease (BD), it is essential to detect subclinical left ventricular (LV) dysfunction for prognostic purposes. Herein we aimed to show the role of two dimensional (2D) speckle tracking echocardiography (STE) in determination of subclinical LV dysfunction in patients with BD. 30 patients diagnosed as BD due to International Study Group Behcet's diagnostic criteria and 25 control subjects underwent Doppler echocardiography including pulsed tissue Doppler of the mitral annulus and speckle-tracking echocardiography. LV peak longitudinal strain and strain rate (SR) was calculated in four-chamber (4C), apical long-axis (LAX), and two-chamber (2C) views, and values of the three views were averaged LV global longitudinal strain (LV-GLS) and SR. LV torsion was determined as the net difference in the mean rotation between the apical and basal levels. There was not any significant difference in age and gender between groups. Patients with BD had significantly lower LV longitudinal strain and Sr measurements than the control group. Although LV basal rotation (LVR) basal values were similar in both groups, LVR-apical and LV torsion (LVTR) values were significantly higher in patient group. LVR-apical and LV-GLS were found to have a good positive corelation (r:0.44, p<0.001) (r: -0.56, r: -0.65,respectively. p<0.001). There was a weak positive correlation between LVTR and LV-GLS (r: 0.29, p<0.05). We demonstrated that combined assessment of LV-GLS, LV-GLSR, LVTR and LVR-apical values detected by STE can be useful in determination of subclinical left ventricular dysfunction in BD.
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Affiliation(s)
- Selami Demirelli
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum.
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Ghosh E, Kovács SJ. Early Left Ventricular Diastolic Function Quantitation Using Directional Impedances. Ann Biomed Eng 2013; 41:1269-78. [DOI: 10.1007/s10439-013-0756-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 01/23/2013] [Indexed: 11/25/2022]
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Mossahebi S, Shmuylovich L, Kovács SJ. The thermodynamics of diastole: kinematic modeling-based derivation of the P-V loop to transmitral flow energy relation with in vivo validation. Am J Physiol Heart Circ Physiol 2011; 300:H514-21. [DOI: 10.1152/ajpheart.00814.2010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pressure-volume (P-V) loop-based analysis facilitates thermodynamic assessment of left ventricular function in terms of work and energy. Typically these quantities are calculated for a cardiac cycle using the entire P-V loop, although thermodynamic analysis may be applied to a selected phase of the cardiac cycle, specifically, diastole. Diastolic function is routinely quantified by analysis of transmitral Doppler E-wave contours. The first law of thermodynamics requires that energy (ε) computed from the Doppler E-wave (εE-wave) and the same portion of the P-V loop (εP-V E-wave) be equivalent. These energies have not been previously derived nor have their predicted equivalence been experimentally validated. To test the hypothesis that εP-V E-wave and εE-wave are equivalent, we used a validated kinematic model of filling to derive εE-wave in terms of chamber stiffness, relaxation/viscoelasticity, and load. For validation, simultaneous (conductance catheter) P-V and echocadiographic data from 12 subjects (205 total cardiac cycles) having a range of diastolic function were analyzed. For each E-wave, εE-wave was compared with εP-V E-wave calculated from simultaneous P-V data. Linear regression yielded the following: εP-V E-wave = αεE-wave + b ( R2 = 0.67), where α = 0.95 and b = 6 e−5. We conclude that E-wave-derived energy for suction-initiated early rapid filling εE-wave, quantitated via kinematic modeling, is equivalent to invasive P-V-defined filling energy. Hence, the thermodynamics of diastole via εE-wave generate a novel mechanism-based index of diastolic function suitable for in vivo phenotypic characterization.
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Affiliation(s)
- Sina Mossahebi
- Department of Physics, College of Arts and Sciences, Washington University, St. Louis, Missouri
| | | | - Sándor J. Kovács
- Cardiovascular Biophysics Laboratory, Cardiovascular Division,
- Division of Biology and Biomedical Sciences, School of Medicine, and
- Department of Physics, College of Arts and Sciences, Washington University, St. Louis, Missouri
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10
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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]
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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.
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Affiliation(s)
- Iris K Rüssel
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, the Netherlands.
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12
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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.
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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
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Zhang W, Kovács SJ. The diastatic pressure-volume relationship is not the same as the end-diastolic pressure-volume relationship. Am J Physiol Heart Circ Physiol 2008; 294:H2750-60. [PMID: 18424638 DOI: 10.1152/ajpheart.00200.2008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The end-diastolic pressure-volume (P-V) relationship (EDPVR) is routinely used to determine the passive left ventricular (LV) stiffness, although the diastatic P-V relationship (D-PVR) has also been measured. Based on the physiological difference between diastasis (the LV and atrium are relaxed and static) and end diastole (LV volume increased by atrial systole and the atrium is contracted), we hypothesized that, although both D-PVR and EDPVR include LV chamber stiffness information, they are two different, distinguishable P-V relations. Cardiac catheterization determined LV pressures, and conductance volumes in 31 subjects were analyzed. Physiological, beat-to-beat variation of the diastatic and end-diastolic P-V points were fit by linear and exponential functions to generate the D-PVR and EDPVR. The extrapolated exponential D-PVR underestimated LVEDP in 82% of the heart beats (P < 0.001). The extrapolated EDPVR overestimated pressure at diastasis in 84% of the heart beats (P < 0.001). If each subject's diastatic and end-diastolic P-V data were combined to form a continuous data set to be fit by one exponential relation, the goodness of fit was always worse than if the diastatic and end-diastolic data were grouped separately and fit by two distinct exponential relations. Diastatic chamber stiffness was less than EDPVR stiffness (defined by the slope of P-V relation) for all 31 subjects (0.16 +/- 0.11 vs. 0.24 +/- 0.15 mmHg/ml, P < 0.001). We conclude that the D-PVR and EDPVR are distinguishable. Because it is not coupled to a contracted atrium, the D-PVR conveys passive LV stiffness better than the EDPVR. Additional studies that fully elucidate the physiology and biology of diastasis in health and disease are in progress.
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Affiliation(s)
- Wei Zhang
- Cardiovascular Biophysics Laboratory, Cardiovascular Division, Department of Internal Medicine and Department of Physics, College of Arts and Sciences, Washington University, St. Louis, Missouri, USA
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Wu Y, Yu Y, Kovács SJ. Contraction-relaxation coupling mechanism characterization in the thermodynamic phase plane: normal vs. impaired left ventricular ejection fraction. J Appl Physiol (1985) 2007; 102:1367-73. [PMID: 17185496 DOI: 10.1152/japplphysiol.00593.2006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Using simultaneous pressure-volume measurements obtained during cardiac catheterization, we employ the thermodynamic phase-plane (TPP) method to characterize global contraction-relaxation coupling (CRC) between normal and impaired left ventricular (LV) ejection fraction (LVEF) groups. The cardiac cycle inscribes a closed loop in the TPP defined by the coordinates “potential” power [V(dP/d t), ergs/s] and “kinetic” power [P(dV/d t), ergs/s]. The TPP-derived indexes κ and ρ define the chamber's contractile and CRC attributes, respectively. Data from 33 subjects dichotomized as normal control ( n = 22, >50% LVEF) and impaired LVEF ( n = 11, <50% LVEF) were analyzed. The results were as follows: κ = 3.0 ± 1.1 and ρ = −0.38 ± 0.21 for controls and κ = 5.4 ± 1.6 and ρ = −1.14 ± 0.47 for the impaired LVEF group; κ and ρ are significantly higher for impaired LVEF than for control ( P < 0.001 for both). As κ increased, ρ decreased ( r = −0.69) for all subjects. Hence, ventricles with impaired LVEF are thermodynamically less efficient because they require more potential power per unit of delivered kinetic power than controls. We conclude that TPP-derived indexes of CRC facilitate assessment of chamber efficiency in thermodynamic terms and elucidate the dominant differentiating features in terms of CRC indexes.
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Affiliation(s)
- Yue Wu
- Cardiovascular Biophysics Laboratory, Washington Univ. Medical Center, St. Louis, MO 63110, USA
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