1
|
Taraldsen IA, Mogelvang R, Grund FF, Hassager C, Søgaard P, Kristensen CB. Increased preload and echocardiographic assessment of diastolic function. Echocardiography 2024; 41:e15917. [PMID: 39225615 DOI: 10.1111/echo.15917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 08/07/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024] Open
Abstract
AIMS Echocardiographic diastolic parameters are used to diagnose and monitor increased left ventricular filling pressure (LVFP) and we hypothesized that increased loading conditions cause increased E/e'. Our aim was to assess the effect of preload augmentation on diastolic parameters among both healthy subjects and subjects with known cardiac disease. METHODS AND RESULTS We included 129 subjects merged from two cohorts; one dialysis cohort (n = 47) and one infusion cohort (n = 82). Echocardiography was performed immediately before and after hemodialysis (HD) or saline infusion, under low and high loading conditions. Elevated LVFP was defined as septal E/e' ≥ 15 and/or lateral E/e' ≥ 13 at high-loading conditions. The population was divided according to elevated LVFP (n = 31) and normal LVFP (n = 98). The load difference for the population was 972 ± 460 mL, with no differences in load difference between elevated and normal LVFP (p NS). The subjects with elevated LVFP were older (63 ± 11 vs. 46 ± 16 years, p < .001), and had lower LV ejection fraction (50 ± 14 vs. 59 ± 8.1%, p < .01). After augmented preload, EDV increased in the normal LVFP group (p < .01) but remained unchanged in the elevated LVFP group (p NS). Both E and e' increased among the subjects with normal LVFP, whereas E/e' remained unchanged (∆E/e' +.1 [-.5-1.2]), p NS). Among the subjects with elevated, LVFP we observed increased E but not e', resulting in significantly increased E/e' (∆ average E/e' +2.4 [0-4.0], p < .01). CONCLUSION Augmented preload does not seem to affect E/e' among subjects with normal LVFP, whereas E/e' seems to increase significantly among subjects with elevated LVFP.
Collapse
Affiliation(s)
- Ida Arentz Taraldsen
- Department of Cardiology, The Heart Center, Rigshospitalet - University Hospital of Copenhagen, Copenhagen, Denmark
| | - Rasmus Mogelvang
- Department of Cardiology, The Heart Center, Rigshospitalet - University Hospital of Copenhagen, Copenhagen, Denmark
- Cardiovascular Research Unit, University of Southern Denmark, Svendborg, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Fasth Grund
- Department of Cardiology, The Heart Center, Rigshospitalet - University Hospital of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Rigshospitalet - University Hospital of Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Søgaard
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Burup Kristensen
- Department of Cardiology, The Heart Center, Rigshospitalet - University Hospital of Copenhagen, Copenhagen, Denmark
- Cardiology, Department of Clinical Sciences, Lund University Hospital, Lund, Sweden
| |
Collapse
|
2
|
Robinson S, Ring L, Oxborough D, Harkness A, Bennett S, Rana B, Sutaria N, Lo Giudice F, Shun-Shin M, Paton M, Duncan R, Willis J, Colebourn C, Bassindale G, Gatenby K, Belham M, Cole G, Augustine D, Smiseth OA. The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Res Pract 2024; 11:16. [PMID: 38825710 PMCID: PMC11145885 DOI: 10.1186/s44156-024-00051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258-271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59-G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a structured approach to the assessment of diastolic function and includes recommendations for the assessment of LV relaxation and filling pressures. Non-routine echocardiographic measures are described alongside guidance for application in specific circumstances. Provocative methods for revealing increased filling pressure on exertion are described and novel and emerging modalities considered. For rapid access to the core recommendations of the diastolic guideline, a quick-reference guide (additional file 1) accompanies the main guideline document. This describes in very brief detail the diastolic investigation in each patient group and includes all algorithms and core reference tables.
Collapse
Affiliation(s)
| | - Liam Ring
- West Suffolk Hospital NHS Trust, Bury St Edmunds, UK
| | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Sadie Bennett
- University Hospital of the North Midlands, Stoke-On-Trent, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | - Rae Duncan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | | | | | - Mark Belham
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Graham Cole
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Otto A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| |
Collapse
|
3
|
Ji M, Zhang L, Gao L, Lin Y, He Q, Xie M, Li Y. Application of Speckle Tracking Echocardiography for Evaluating Ventricular Function after Transcatheter Pulmonary Valve Replacement. Diagnostics (Basel) 2023; 14:88. [PMID: 38201397 PMCID: PMC10795743 DOI: 10.3390/diagnostics14010088] [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: 11/09/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Pulmonary regurgitation usually leads to right heart dilatation and eventually right heart dysfunction, which is associated with a poor prognosis. Transcatheter pulmonary valve replacement is a developing treatment for pulmonary valve dysfunction that can take the place of traditional surgery and make up for the shortcomings of a large injury. Echocardiography plays a significant role in assessing ventricular function; however, conventional echocardiographic parameters have several limitations. Speckle tracking echocardiography has been regarded as a more accurate tool for quantifying cardiac function than conventional echocardiography. Therefore, the aim of this review was to summarize the application of speckle tracking echocardiography for evaluating right and left ventricular functions in patients after transcatheter pulmonary valve replacement.
Collapse
Affiliation(s)
- Mengmeng Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (L.Z.); (L.G.); (Y.L.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (L.Z.); (L.G.); (Y.L.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lang Gao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (L.Z.); (L.G.); (Y.L.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yixia Lin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (L.Z.); (L.G.); (Y.L.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Qing He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (L.Z.); (L.G.); (Y.L.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (L.Z.); (L.G.); (Y.L.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
- Tongji Medical College and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (L.Z.); (L.G.); (Y.L.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| |
Collapse
|
4
|
Hirose M, Mandour AS, Goya S, Hamabe L, Matsuura K, Yoshida T, Watanabe M, Shimada K, Uemura A, Takahashi K, Tanaka R. Color M-Mode Echocardiography for Non-Invasive Assessment of the Intraventricular Pressure in Dogs Before and After Ductus Arteriosus Occlusion: A Retrospective Study. Front Vet Sci 2022; 9:908829. [PMID: 35903130 PMCID: PMC9315367 DOI: 10.3389/fvets.2022.908829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background Novel non-invasive evaluation of the intraventricular pressure differences and gradients (IVPD and IVPG) by color M-mode echocardiography (CMME) is a promising method in diastolic function evaluation. Patent ductus arteriosus (PDA) is a congenital heart defect which is associated with increased preload. The present work provides a clinical trial for the assessment of IVPD and IVPG changes in dogs before and after surgical occlusion of PDA. Materials and Methods A total of 12 client-owned dogs were enrolled in this study. PDA was confirmed using echocardiography, and all dogs underwent PDA occlusion. Conventional echocardiography and CMME were conducted on each patient on the operation day (Pre-PDA) and 48 h after its occlusion (Post-PDA). The total IVPD and total IVPG, as well as segmental intraventricular pressure (basal, mid-to-apical, mid, and apical) were measured from Euler's equation using specific software (MATLAB). Data were analyzed for variability and for the difference between pre- and post-PDA. The effect of PDA occlusion on the measured variables was calculated using biserial ranked correlation (rc). Results There was a significant reduction in end-diastolic volume, fraction shortening, stroke volume, and mitral inflow velocities (early and late) after PDA closure. CMME was feasible in all dogs, and the CMME indices showed moderate variability, except for the apical segment of IVPD and IVPG. After PDA closure, in comparison with the pre-PDA occlusion, there was a significant reduction in total IVPD (2.285 ± 0.374 vs. 1.748 ± 0.436 mmHg; P = 0.014), basal IVPD (1.177 ± 0.538 vs. 0.696 ± 0.144 mmHg; P = 0.012), total IVPG (1.141 ± 0.246 vs. 0.933 ± 0.208 mmHg; P = 0.032), and basal IVPG (0.578 ± 0.199 vs. 0.377 ± 0.113 mmHg; P = 0.001); meanwhile, mid, mid-to-apical, and apical segments of both IVPD and IVPG showed non-significant difference. The magnitude of PDA occlusion on the measured variables was clinically relevant and associated with a large effect size on total and basal IVPD and IVPG (rc > 0.6). Conclusion The current clinical study revealed matched response of IVPD and IVPG to the reduced preload rather than left ventricular relaxation. This result is an initial step in the clinical utility of CMME-derived IVPD and IVPG measurements in the diastolic function evaluation in dogs with PDA that warrants further clinical studies.
Collapse
Affiliation(s)
- Miki Hirose
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Ahmed S. Mandour
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
- Department of Animal Medicine (Internal Medicine), Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Seijirow Goya
- Department of Bioresource Sciences, Nihon University, Fujisawa, Japan
| | - Lina Hamabe
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Katsuhiro Matsuura
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Tomohiko Yoshida
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Momoko Watanabe
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Kazumi Shimada
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Akiko Uemura
- Division of Veterinary Research, Department of Veterinary Surgery, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo, Japan
| | - Ryou Tanaka
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| |
Collapse
|
5
|
Semerdzhieva NE, Denchev SV, Gospodinova MV. Left Ventricular Diastolic Function: Comparison of Slow Coronary Flow Phenomenon and Left Ventricular Hypertrophy in the Absence of Obstructive Coronary Disease. Cureus 2022; 14:e24789. [PMID: 35673304 PMCID: PMC9165915 DOI: 10.7759/cureus.24789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background An interplay of myocardial structural abnormalities and coronary arterial dysfunction underlies the worsening left ventricular compliance. The conventionally used angina drugs have demonstrated a beneficial effect on both angina and coronary flow in cases with microvascular dysfunction and non-obstructive coronary disease. Despite that, vasoactive therapy only partially affects diastolic function in this patient population. Purpose This retrospective study was planned to evaluate the association of myocardial mass, delayed epicardial coronary flow, and vasoactive drugs with parameters of diastolic function in two cohorts with preserved left ventricular function and non-obstructive coronary disease in patients with slow coronary flow phenomenon (SCFP) and patients with the hypertensive disease and left ventricular hypertrophy. Material and methods The epicardial coronary flow was evaluated in 48 patients with unstable angina in the absence of coronary stenosis >50%, by applying the methods of corrected thrombolysis in myocardial infraction frame count (cTFC). The abnormalities in the left ventricular function were assessed by echocardiography using PW-Doppler of the diastolic mitral inflow and tissue Doppler imaging. Twenty-one (43.8%) patients were diagnosed with SCFP, and twelve patients (25%) had slow epicardial coronary flow, hypertensive disease, and ventricular hypertrophy (SFLVH). The remaining 15 (31.3%) were patients with ventricular hypertrophy, hypertension, and non-delayed epicardial coronary flow (NFLVH). Results The patients with SFLVH showed reduced peak early diastolic lateral mitral annular velocity (e'L) when compared to SCFP (7.1±1.9cm/s vs 8.6±2.1 cm/s, p=0.045) and NFLVH (7.1±1.9 cm/s vs 8.7±1.8 cm/s, p=0.018). A borderline significant difference was observed for the peak early diastolic septal mitral annular velocity (e'S) between the patients with SFLVH and SCFP ( 7.0±1.3 cm/s vs 8.3±2.1 cm/s, p=0.057). The ratio of mitral diastolic inflow velocity to early diastolic velocity of the mitral annulus (E/e') in the SFLVH group was a tendency higher than E/e' of the patients with SCFP (9.8±3.1 vs. 8.2±2.1, p=0.084) and NFLVH (9.8±3.1 vs. 7.8±1.5, p=0.051) .In the group with left ventricular hypertrophy, E/e' >10 was more frequently observed in patients with a marked delay in the epicardial flow (33.1 ± 13.1 frames vs. 25.4 ± 11.8 frames, p=0.011) and higher left ventricular mass (146.9 ± 17.7 g/m2 vs. 126.1 ± 121.5 g/m2, p=0.027). Conclusions Patients with microvascular angina represent a diverse population. The echocardiographic parameters of left ventricular relaxation (e') and end-diastolic pressure (E/e') are abnormally altered in the population with left ventricular hypertrophy compared to SCFP. The delayed epicardial flow further impairs diastolic function in hypertensive patients with hypertrophy and non-obstructive coronary disease.
Collapse
|
6
|
Ovchinnikov AG, Ageev FT, Alekhin MN, Belenkov YN, Vasyuk YA, Galyavich AS, Gilyarevskiy SR, Lopatin YM, Mareev VY, Mareev YV, Mitkov VV, Potekhina AV, Prostakova TS, Rybakova MK, Saidova MA, Khadzegova AB, Chernov MY, Yuschuk EN, Boytsov SA. [The role of diastolic transthoracic stress echocardiography with incremental workload in the evaluation of heart failure with preserved ejection fraction: indications, methodology, interpretation. Expert consensus developed under the auspices of the National Medical Research Center of Cardiology, Society of Experts in Heart Failure (SEHF), and Russian Association of Experts in Ultrasound Diagnosis in Medicine (REUDM)]. ACTA ACUST UNITED AC 2021; 60:48-63. [PMID: 33522468 DOI: 10.18087/cardio.2020.12.n1219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/18/2022]
Abstract
Diagnosis of heart failure with preserved ejection fraction (HFpEF) is associated with certain difficulties since many patients with HFpEF have a slight left ventricular diastolic dysfunction and normal filling pressure at rest. Diagnosis of HFpEF is improved by using diastolic transthoracic stress-echocardiography with dosed exercise (or diastolic stress test), which allows detection of increased filling pressure during the exercise. The present expert consensus explains the requirement for using the diastolic stress test in diagnosing HFpEF from clinical and pathophysiological standpoints; defines indications for the test with a description of its methodological aspects; and addresses issues of using the test in special patient groups.
Collapse
Affiliation(s)
- A G Ovchinnikov
- National medical research center of cardiology, Moscow A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - F T Ageev
- National medical research center of cardiology, Moscow, Russia
| | - M N Alekhin
- Central State Medical Academy of the Presidential Administration of Russian Federation, Moscow, Russia
| | - Yu N Belenkov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Yu A Vasyuk
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - S R Gilyarevskiy
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Y M Lopatin
- Volgograd State Medical University, Volgograd, Russia Volgograd regional clinical cardiology center, Volgograd, Russia
| | - V Yu Mareev
- Lomonosov Moscow State University, Moscow, Russia
| | - Yu V Mareev
- National Research Center for Therapy and Preventive Medicine, Moscow, Russia Robertson Centre for Biostatistics, Glasgow, Great Britain
| | - V V Mitkov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A V Potekhina
- National medical research center of cardiology, Moscow, Russia
| | - T S Prostakova
- National medical research center of cardiology, Moscow, Russia
| | - M K Rybakova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - M A Saidova
- National medical research center of cardiology, Moscow, Russia
| | - A B Khadzegova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M Yu Chernov
- N.N. Burdenko Main Military Clinical Hospital, Moscow, Russia
| | - E N Yuschuk
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - S A Boytsov
- National medical research center of cardiology, Moscow, Russia
| |
Collapse
|
7
|
Hashimoto Y, Okamoto T. Arterial Stiffness and Left Ventricular Diastolic Function in Endurance Athletes. Int J Sports Med 2020; 42:497-505. [PMID: 33176384 DOI: 10.1055/a-1293-8430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The present study investigated the relationship between arterial stiffness and left ventricular diastolic function in endurance-trained athletes. Sixteen young male endurance-trained athletes and nine sedentary of similar age men participated in this study. Resting measures in carotid-femoral pulse wave velocity were obtained to assess arterial stiffness. Left ventricular diastolic function was assessed using 2-dimensional echocardiography. The athletes tended to have lower arterial stiffness than the controls (P=0.071). Transmitral A-waves in the athletes were significantly lower (P=0.018) than the controls, and left ventricular mass (P=0.034), transmitral E-wave/A-wave (P=0.005) and peak early diastolic mitral annular velocity at the septal site (P=0.005) in the athletes were significantly greater than the controls. A significant correlation was found between arterial stiffness and left ventricular diastolic function (E-wave: r=- 0.682, P=0.003, E-wave/A-wave: r=- 0.712, P=0.002, peak early diastolic mitral annular velocity at the septal site: r=- 0.557, P=0.025) in the athletes, whereas no correlation was found in controls. These results suggest that lower arterial stiffness is associated with higher left ventricular diastolic function in endurance-trained athletes.
Collapse
Affiliation(s)
- Yuto Hashimoto
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Takanobu Okamoto
- Department of Exercise Physiology, Nippon Sport Science University, Tokyo, Japan
| |
Collapse
|
8
|
Kashioulis P, Guron CW, Svensson MK, Hammarsten O, Saeed A, Guron G. Patients with moderate chronic kidney disease without heart disease have reduced coronary flow velocity reserve. ESC Heart Fail 2020; 7:2797-2806. [PMID: 32648666 PMCID: PMC7524098 DOI: 10.1002/ehf2.12878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/17/2020] [Accepted: 06/12/2020] [Indexed: 12/16/2022] Open
Abstract
Aims The overall aim was to identify sub‐clinical cardiac abnormalities by echocardiography in patients with chronic kidney disease (CKD) stages 3 and 4 and to investigate underlying mechanisms. Methods and results Ninety‐one patients with CKD stages 3 and 4, without a diagnosis of heart disease, and 41 healthy matched controls were included in this cross‐sectional study. Cardiac morphology and function were analysed with Doppler echocardiography and coronary flow velocity reserve (CFVR) in response to adenosine was measured in the left anterior descendent artery to detect coronary microvascular dysfunction (CMD). All study subjects had a left ventricular (LV) ejection fraction > 50%. Patients with CKD showed statistically significant increases in left atrial volume index and transmitral and pulmonary vein flow velocities during atrial contraction and prolonged LV isovolumetric relaxation time. Patients with CKD had significantly reduced CFVR vs. controls (2.74 ± 0.86 vs. 3.40 ± 0.89, P < 0.001), and 43% of patients were classified as having CMD compared with 9% of controls (P = 0.001). Conclusions Patients with CKD stages 3 and 4, without a diagnosis of heart disease, showed early abnormalities in LV diastolic function that did not fulfil the criteria for LV dysfunction according to current guidelines. A large proportion of CKD patients had CMD, suggesting that microvascular abnormalities may have a pathogenic role in the development of heart failure in this patient group.
Collapse
Affiliation(s)
- Pavlos Kashioulis
- Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Wallentin Guron
- Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria K Svensson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ola Hammarsten
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Aso Saeed
- Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gregor Guron
- Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
9
|
Aldhahi MI, Guccione AA, Chin LMK, Woolstenhulme J, Keyser RE. Modulation of left ventricular diastolic filling during exercise in persons with cervical motor incomplete spinal cord injury. Eur J Appl Physiol 2019; 119:2435-2447. [PMID: 31701273 PMCID: PMC10496443 DOI: 10.1007/s00421-019-04249-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/26/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE To characterize left ventricular diastolic function during an exertional challenge in adults with incomplete cervical spinal cord Injury (icSCI). METHODS In this cross-sectional study, a two-group convenience sample was used to compare left ventricular LV diastolic performance during a 5-10 W·min-1 incremental arm ergometer exercise protocol, using bioimpedance cardiography. Subjects were eight males with cervical incomplete spinal cord injury (icSCI; C5-C7: age 39 ± 14 years) versus eight able-bodied males (CON: age 38 ± 13 years). Left ventricular (LV) diastolic indices included end-diastolic volume (EDV) and early diastolic filling ratio (EDFR). LV ejection time (LVET), inotropic index (dZ/dT2) and stroke volume (SV) were compared between the groups at peak exercise, and maximum workload for the icSCI group (isomax). RESULTS EDV (at peak exercise:131.4 ± 7.3 vs 188.78 ± 9.4, p < 0.001; at isomax: 131.4 ± 7.3 vs 169 ± 23, p = 0.0009) and EDFR (at peak exercise 73 ± 14% vs 119 ± 11%, p = 0.006; at isomax 94 ± 10; p = 0.009) were significantly reduced in icSCI compared to CON, respectively. Significant differences in LVET (icSCI: 273 ± 48 vs CON: 305 ± 68; p = 0.1) and dZ/dT2 (icSCI: 0.64 ± 0.11 vs CON: 0.85 ± 0.31; p = 0.1) were not observed at isomax, despite a significant decrease in SV in the subjects with icSCI (77.1 ± 6.05 mL vs 105.8 ± 9.2 mL, p < 0.00) CONCLUSION: Left ventricular filling was impaired in the subjects with icSCI as evidenced at both peak exercise and isomax. It is likely that restrictions on the skeletal muscle pump mechanized the impairment but increased left ventricular wall stiffness could not be excluded as a mediator.
Collapse
Affiliation(s)
- Monira I Aldhahi
- Department of Rehabilitation Science, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Andrew A Guccione
- Department of Rehabilitation Science, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Lisa M K Chin
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA
| | | | - Randall E Keyser
- Department of Rehabilitation Science, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
| |
Collapse
|
10
|
Machine Learning for Electrocardiographic Diagnosis of Left Ventricular Early Diastolic Dysfunction. J Am Coll Cardiol 2019; 71:1661-1662. [PMID: 29650122 DOI: 10.1016/j.jacc.2018.02.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 11/21/2022]
|
11
|
Gillebert TC. Prediction of filling pressures and outcome in heart failure: can we improve E/e'? Eur Heart J Cardiovasc Imaging 2019; 20:655-657. [PMID: 30982850 DOI: 10.1093/ehjci/jez060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thierry C Gillebert
- Department of Cardiology, Ghent University and Ghent University Hospital, 8K12IE, Heymans Campus, Ghent, Belgium
| |
Collapse
|
12
|
Chinen D, Nagai T, Uemura K, Aikawa Y, Motokawa T, Asaumi Y, Ogo T, Kanzaki H, Noguchi T, Anzai T, Shimizu W, Ogawa H, Sugimachi M, Yasuda S. Clinical Usefulness of an Echo-Doppler Model in Predicting Elevated Pulmonary Capillary Wedge Pressure in Patients With Heart Failure. Am J Cardiol 2019; 123:1464-1469. [PMID: 30819432 DOI: 10.1016/j.amjcard.2019.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/23/2019] [Accepted: 01/31/2019] [Indexed: 11/25/2022]
Abstract
Although several tissue-Doppler imaging (TDI) models for pulmonary capillary wedge pressure (PCWP) estimation have been reported, their reliability remains uncertain. Our previous theoretical and experimental analyses suggest that right atrial pressure (RAP) corrected by tissue-Doppler imaging tricuspid/mitral annular peak systolic velocities (ST/SM) (RAP × ST/SM) reliably predicts elevated PCWP. We sought to investigate its clinical usefulness for predicting elevated PCWP in heart failure (HF) patients. Ninety-eight patients admitted with HF who underwent right heart catheterization were prospectively studied. RAP and PCWP were measured by right heart catheterization. Simultaneously, ST/SM, early diastolic transmitral flow velocity to mitral annular velocity ratio (E/Ea), and diameter of inferior vena cava at inspiration (IVCDi), a noninvasive surrogate for RAP, were measured by echocardiography. RAP correlated with IVCDi (R2 = 0.57). A significantly stronger correlation was observed between IVCDi corrected by ST/SM (IVCDi × ST/SM) and PCWP than between E/Ea and PCWP (R2 = 0.47 vs 0.18). Receiver-operating characteristic analyses indicated that IVCDi × ST/SM >16 mm predicted PCWP >18 mm Hg with 90% sensitivity and 77% specificity, and the area under the curve was 0.86, which was significantly larger than that of E/Ea (area under the curve=0.72). In conclusions, IVCDi × ST/SM is a new useful noninvasive model to predict elevated PCWP in HF patients.
Collapse
|
13
|
Effects of Thoracic Epidural Anesthesia on Neuronal Cardiac Regulation and Cardiac Function. Anesthesiology 2019; 130:472-491. [DOI: 10.1097/aln.0000000000002558] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Cardiac sympathetic blockade with high-thoracic epidural anesthesia is considered beneficial in patients undergoing major surgery because it offers protection in ischemic heart disease. Major outcome studies have failed to confirm such a benefit, however. In fact, there is growing concern about potential harm associated with the use of thoracic epidural anesthesia in high-risk patients, although underlying mechanisms have not been identified. Since the latest review on this subject, a number of clinical and experimental studies have provided new information on the complex interaction between thoracic epidural anesthesia–induced sympatholysis and cardiovascular control mechanisms. Perhaps these new insights may help identify conditions in which benefits of thoracic epidural anesthesia may not outweigh potential risks. For example, cardiac sympathectomy with high-thoracic epidural anesthesia decreases right ventricular function and attenuates its capacity to cope with increased right ventricular afterload. Although the clinical significance of this pathophysiologic interaction is unknown at present, it identifies a subgroup of patients with established or pending pulmonary hypertension for whom outcome studies are needed. Other new areas of interest include the impact of thoracic epidural anesthesia–induced sympatholysis on cardiovascular control in conditions associated with increased sympathetic tone, surgical stress, and hemodynamic disruption. It was considered appropriate to collect and analyze all recent scientific information on this subject to provide a comprehensive update on the cardiovascular effects of high-thoracic epidural anesthesia and cardiac sympathectomy in healthy and diseased patients.
Collapse
|
14
|
van Loon LM, van der Hoeven JG, Veltink PH, Lemson J. The influence of esmolol on right ventricular function in early experimental endotoxic shock. Physiol Rep 2018; 6:e13882. [PMID: 30318855 PMCID: PMC6186817 DOI: 10.14814/phy2.13882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/24/2022] Open
Abstract
The mechanism by which heart rate (HR) control with esmolol improves hemodynamics during septic shock remains unclear. Improved right ventricular (RV) function, thereby reducing venous congestion, may play a role. We assessed the effect of HR control with esmolol during sepsis on RV function, macrocirculation, microcirculation, end-organ-perfusion, and ventricular-arterial coupling. Sepsis was induced in 10 healthy anesthetized and mechanically ventilated sheep by continuous IV administration of lipopolysaccharide (LPS). Esmolol was infused after successful resuscitation of the septic shock, to reduce HR and stopped 30-min after reaching targeted HR reduction of 30%. Venous and arterial blood gases were sampled and the small intestines' microcirculation was assessed by using a hand-held video microscope (CytoCam-IDF). Arterial and venous pressures, and cardiac output (CO) were recorded continuously. An intraventricular micromanometer was used to assess the RV function. Ventricular-arterial coupling ratio (VACR) was estimated by catheterization-derived single beat estimation. The targeted HR reduction of >30% by esmolol infusion, after controlled resuscitation of the LPS induced septic shock, led to a deteriorated RV-function and macrocirculation, while the microcirculation remained depressed. Esmolol improved VACR by decreasing the RV end-systolic pressure. Stopping esmolol showed the reversibility of these effects on the RV and the macrocirculation. In this animal model of acute severe endotoxic septic shock, early administration of esmolol decreased RV-function resulting in venous congestion and an unimproved poor microcirculation despite improved cardiac mechanical efficiency.
Collapse
Affiliation(s)
- Lex M. van Loon
- Biomedical Signals and SystemsFaculty of Electrical Engineering, Mathematics and Computer ScienceTechnical Medical CentreUniversity of TwenteEnschedethe Netherlands
- Department of Critical Care Medicine (707)Radboud university medical centerNijmegenthe Netherlands
| | | | - Peter H. Veltink
- Biomedical Signals and SystemsFaculty of Electrical Engineering, Mathematics and Computer ScienceTechnical Medical CentreUniversity of TwenteEnschedethe Netherlands
| | - Joris Lemson
- Department of Critical Care Medicine (707)Radboud university medical centerNijmegenthe Netherlands
| |
Collapse
|
15
|
Clarke GD, Molina‐Wilkins M, Solis‐Herrera C, Mendez V, Monroy A, Cersosimo E, Chilton RJ, Abdul‐Ghani M, DeFronzo RA. Impaired left ventricular diastolic function in T2DM patients is closely related to glycemic control. Endocrinol Diabetes Metab 2018; 1:e00014. [PMID: 30815550 PMCID: PMC6354805 DOI: 10.1002/edm2.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/24/2018] [Accepted: 02/18/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction commonly is observed in individuals with type 2 diabetes mellitus (T2DM). We employed transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMRI) to investigate the hypothesis that LV diastolic dysfunction in T2DM is associated with poor glycemic control. METHODS Forty subjects, 21 with normal glucose tolerance (NGT) and 19 with T2DM, were studied with CMRI and TTE to assess LV function. Early-to-late transmitral flow ratio (E/A) and deceleration time (DecT) were assessed with both modalities. Normalized (to body surface area) end-diastolic volume (EDV/BSA) and normalized peak LV filling rate (pLVFR/BSA) were assessed with CMRI. Early transmitral flow velocity to septal velocity (E/e') and isovolumetric relaxation time (IVRT) were measured using TTE. Dimensional parameters were normalized to body surface area (BSA). RESULTS CMRI measurements demonstrated impaired E/A (1.13 ± 0.34 vs 1.62 ± 0.42, P < .001), increased DecT (174 ± 46 ms vs 146 ± 15, P = .005), as well as lower EDV/BSA (63 ± 10 vs 72 ± 9 mL/m2, P < .01) and pLVFR/BSA (189 ± 46 vs 221 ± 48 mL s-1 m-2, P < .05) in T2DM subjects. TTE measurements revealed lower E/A (1.1 ± 0.4 vs 1.4 ± 0.2, P < .001) and E/e' (6.8 ± 1.5 vs 8.7 ± 2.0, P < .0001) with higher DecT (203 ± 22 ms vs 179 ± 18, P < .001) and IVRT (106 ± 14 ms vs 92 ± 10, P < .001) in T2DM. Multiple parameters of LV function: E/ACMRI (r = -.50, P = .001), E/ATTE (r = -.46, P < .005), pLVFR/BSA (r = -.35, P < .05), E/e' (r = -.46, P < .005), EDV/BSACMRI (r = -.51, P < .0001), EDV/BSATTE (r = -.42, P < .01) were negatively correlated with HbA1c. All but E/e' also were inversely correlated with fasting plasma glucose (FPG). CONCLUSIONS Impaired LV diastolic function (DF) was found in T2DM subjects with both CMRI and TTE, and multiple LVDF parameters correlated negatively with HbA1c and FPG. These results indicate that impaired LVDF is inversely linked to glycemic control in T2DM patients.
Collapse
Affiliation(s)
- Geoffrey D. Clarke
- Department of RadiologyTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Marjorie Molina‐Wilkins
- Diabetes DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Carolina Solis‐Herrera
- Diabetes DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Verna Mendez
- Diabetes DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Adriana Monroy
- Diabetes DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Eugenio Cersosimo
- Diabetes DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Robert J. Chilton
- Cardiology DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Muhammad Abdul‐Ghani
- Diabetes DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Ralph A. DeFronzo
- Diabetes DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| |
Collapse
|
16
|
Salem JE, Laveau F, Ceccaldi A, Funck-Brentano C, Hulot JS, Mameri A, Barthelemy O, Helft G, Feuvre CL, Isnard R, Hammoudi N. Impact of negative inotropic drugs on accuracy of diastolic stress echocardiography for evaluation of left ventricular filling pressure. Sci Rep 2017; 7:9537. [PMID: 28842666 PMCID: PMC5573383 DOI: 10.1038/s41598-017-10301-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/19/2017] [Indexed: 01/08/2023] Open
Abstract
The ratio of early diastolic trans-mitral flow velocity to tissue-Doppler mitral annular early diastolic velocity (E/e′), and left ventricular end-diastolic pressure(LVEDP) have been shown to be correlated at rest, provided that patients are not on positive inotropic drugs. Data concerning the latter correlation during exercise stress are conflicting. Therefore, we investigated if use of negative inotropic drugs (NID), impacts the accuracy of E/e′ as a surrogate for LVEDP during low-level exercise. An exercise(50 watts) during cardiac invasive hemodynamic monitoring and an exercise echocardiography were performed prospectively within 24 hours in 54 patients (81%male, 62 ± 9years) with preserved LV Ejection-Fraction. Before exercise, the patients had scattered LVEDP (13.8 ± 5.8 mmHg) and septal E/e′ (8.7 ± 2.7). Half of them were on NID, mainly betablockers(n = 26). The correlation between septal-E/e′ and LVEDP was low for examinations performed at rest (r = 0.35,p = 0.01) with no significant impact of NID. For measurements performed at 50 Watts, NID had a significant impact on the association between septal-E/e′50 watts and LVEDP50 watts (β = −0.28,p = 0.03). Correlation between septal-E/e′50 watts and LVEDP50 watts persisted in patients on NID (r = 0.61,p = 0.001) while it disappeared in the group of patients with no NID (r = 0.15,p = 0.47). NID use is an important confounding factor to take into consideration when assessing exercise LVFP using stress E/e′ in patients with preserved LVEF.
Collapse
Affiliation(s)
- Joe-Elie Salem
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, CIC 1421, CIC-Paris Est, Cardiology department-Echocardiography Unit, Pharmacology department, INSERM-U1166 ICAN, Pitié-Salpêtrière Hospital, F-75013, Paris, France.
| | - Florent Laveau
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, CIC 1421, CIC-Paris Est, Cardiology department-Echocardiography Unit, Pharmacology department, INSERM-U1166 ICAN, Pitié-Salpêtrière Hospital, F-75013, Paris, France
| | - Alexandre Ceccaldi
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, CIC 1421, CIC-Paris Est, Cardiology department-Echocardiography Unit, Pharmacology department, INSERM-U1166 ICAN, Pitié-Salpêtrière Hospital, F-75013, Paris, France
| | - Christian Funck-Brentano
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, CIC 1421, CIC-Paris Est, Cardiology department-Echocardiography Unit, Pharmacology department, INSERM-U1166 ICAN, Pitié-Salpêtrière Hospital, F-75013, Paris, France
| | - Jean Sebastien Hulot
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, CIC 1421, CIC-Paris Est, Cardiology department-Echocardiography Unit, Pharmacology department, INSERM-U1166 ICAN, Pitié-Salpêtrière Hospital, F-75013, Paris, France
| | - Amel Mameri
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, CIC 1421, CIC-Paris Est, Cardiology department-Echocardiography Unit, Pharmacology department, INSERM-U1166 ICAN, Pitié-Salpêtrière Hospital, F-75013, Paris, France
| | - Olivier Barthelemy
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, CIC 1421, CIC-Paris Est, Cardiology department-Echocardiography Unit, Pharmacology department, INSERM-U1166 ICAN, Pitié-Salpêtrière Hospital, F-75013, Paris, France
| | - Gerard Helft
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, CIC 1421, CIC-Paris Est, Cardiology department-Echocardiography Unit, Pharmacology department, INSERM-U1166 ICAN, Pitié-Salpêtrière Hospital, F-75013, Paris, France
| | - Claude Le Feuvre
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, CIC 1421, CIC-Paris Est, Cardiology department-Echocardiography Unit, Pharmacology department, INSERM-U1166 ICAN, Pitié-Salpêtrière Hospital, F-75013, Paris, France
| | - Richard Isnard
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, CIC 1421, CIC-Paris Est, Cardiology department-Echocardiography Unit, Pharmacology department, INSERM-U1166 ICAN, Pitié-Salpêtrière Hospital, F-75013, Paris, France
| | - Nadjib Hammoudi
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, CIC 1421, CIC-Paris Est, Cardiology department-Echocardiography Unit, Pharmacology department, INSERM-U1166 ICAN, Pitié-Salpêtrière Hospital, F-75013, Paris, France
| |
Collapse
|
17
|
Ryu T, Song SY. Perioperative management of left ventricular diastolic dysfunction and heart failure: an anesthesiologist's perspective. Korean J Anesthesiol 2017; 70:3-12. [PMID: 28184260 PMCID: PMC5296384 DOI: 10.4097/kjae.2017.70.1.3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 12/12/2022] Open
Abstract
Anesthesiologists frequently see asymptomatic patients with diastolic dysfunction or heart failure for various surgeries. These patients typically show normal systolic function but abnormal diastolic parameters in their preoperative echocardiographic evaluations. The symptoms that are sometimes seen are similar to those of chronic obstructive pulmonary disease. Patients with diastolic dysfunction, and even with diastolic heart failure, have the potential to develop a hypertensive crisis or pulmonary congestion. Thus, in addition to conventional perioperative risk quantification, it may be important to consider the results of diastolic assessment for predicting the postoperative outcome and making better decisions. If anesthesiologists see female patients older than 70 years of age who have hypertension, diabetes, chronic renal disease, recent weight gain, or exercise intolerance, they should focus on the patient's diastologic echocardiography indicators such as left atrial enlargement or left ventricular hypertrophy. In addition, there is a need for perioperative strategies to mitigate diastolic dysfunction-related morbidity. Specifically, hypertension should be controlled, keeping pulse pressure below diastolic blood pressure, maintaining a sinus rhythm and normovolemia, and avoiding tachycardia and myocardial ischemia. There is no need to classify these diastolic dysfunction, but it is important to manage this condition to avoid worsening outcomes.
Collapse
Affiliation(s)
- Taeha Ryu
- Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Seok-Young Song
- Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea
| |
Collapse
|
18
|
Hammoudi N, Laveau F, Helft G, Cozic N, Barthelemy O, Ceccaldi A, Petroni T, Berman E, Komajda M, Michel PL, Mallet A, Le Feuvre C, Isnard R. Low level exercise echocardiography helps diagnose early stage heart failure with preserved ejection fraction: a study of echocardiography versus catheterization. Clin Res Cardiol 2016; 106:192-201. [PMID: 27695989 DOI: 10.1007/s00392-016-1039-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/23/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Increased left ventricular end-diastolic pressure (LVEDP) with exercise is an early sign of heart failure with preserved left ventricular ejection fraction (LVEF). The abnormal exercise increase in LVEDP is nonlinear, with most change occurring at low-level exercise. Data on non-invasive approach of this condition are scarce. Our objective was assessing E/e' to estimate low level exercise LVEDP using a direct invasive measurement as the reference method. METHODS AND RESULTS Sixty patients with LVEF >50 % prospectively underwent both exercise cardiac catheterization and echocardiography. E/e' was measured at rest and during low-level exercise. Abnormal LVEDP was defined as >16 mmHg. Patients with a history of coronary artery disease and/or abnormal LV morphology were classified as having apparent cardiac disease (CD). Thirty-four (57 %) patients had elevated LVEDP only during exercise. Most of the change in LVEDP occurred since the first exercise level (25 W). There was a correlation between LVEDP and septal E/e' at rest and during exercise. Lateral E/e' and E/average e' ratio had worse correlations with LVEDP. In the whole population, exercise septal E/e' at 25 W had the best accuracy for abnormal exercise LVEDP, area under curve (AUC) = 0.79. However, while low-level exercise septal E/e' had a high accuracy in CD patients (n = 26, AUC = 0.96), E/e' was not linked to LVEDP in patients without CD (n = 34). CONCLUSION Low-level exercise septal E/e' is valuable for predicting abnormal exercise LVEDP in patients with preserved LVEF and apparent CD. However, this new diagnosis approach appears not reliable in patients with normal LV morphology and without coronary artery disease. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov . Unique identifier: NCT01714752.
Collapse
Affiliation(s)
- Nadjib Hammoudi
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France.
| | - Florent Laveau
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Gérard Helft
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Nathalie Cozic
- Département de Biostatistiques, Centre Hospitalier Universitaire Pitié-Salpêtrière, Université Paris 6, Paris, France
| | - Olivier Barthelemy
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Alexandre Ceccaldi
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Thibaut Petroni
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Emmanuel Berman
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Michel Komajda
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Pierre-Louis Michel
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Alain Mallet
- Département de Biostatistiques, Centre Hospitalier Universitaire Pitié-Salpêtrière, Université Paris 6, Paris, France
| | - Claude Le Feuvre
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| | - Richard Isnard
- Université Paris 6, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), INSERM UMRS 1166, ACTION Study Group, Paris, 75013, France
| |
Collapse
|
19
|
Akyol A, Akdag S, Asker M, Gumrukcuoglu HA, Duz R, Demirel KC, Ozturk F, Yaman M, Sahin M, Simsek H, Tuncer M, Begenik H. Effects of lowered dialysate sodium on left ventricle function and brain natriuretic peptide in maintenance of hemodialysis patients. Hum Exp Toxicol 2016; 36:128-134. [DOI: 10.1177/0960327116639362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Impaired diastolic flow is characterized by decreased left ventricular (LV) filling diastole, abnormal LV distensibility, or delayed relaxation. B-Type natriuretic peptide (BNP) is an indicator of various cardiovascular diseases and body volume status. The aim of this study was to determine whether the lowering of dialysate sodium (Na) levels is effective on LV systolic and diastolic parameters and BNP in the maintenance of hemodialysis patients. Materials and Methods: The study included 49 chronic hemodialysis patients. Left atrium (LA) diameter and LV ejection fraction, LV systolic and diastolic diameter, deceleration time (DT), pulmonary artery pressure (PAP), inferior vena cava diameter (IVCD), early diastolic transmitral flow ( E) and late diastolic transmitral flow ( A) velocities, E/ A ratio, isovolumic relaxation time, peak early diastolic velocity ( E′), late diastolic velocity ( A′) of tissue Doppler mitral annulus, and flow propagation velocity of mitral inflow ( Vp) were measured before and 6 months after hemodialysis with low Na dialysate. Results: Six months after low Na hemodialysis, a decrease was observed in echocardiographic parameters such as PAP and IVCD ( p < 0.05, p < 0.001, and p < 0.001, respectively). However, a significant difference was not observed in LA diameter. In LV diastolic measurement of E and A waves, E/ A ratio, DT, Vp, septal E′ and A′, and lateral E′ and A′ exhibited significant improvement by low Na HD. BNP level was significantly reduced ( p < 0.001). Conclusions: Lowered dialysate Na concentration improves PAP, IVCD, and LV diastolic properties assessed by mitral inflow filling, tissue Doppler velocity, and mitral inflow velocity propagation.
Collapse
Affiliation(s)
- A Akyol
- Department of Cardiology, Yuzuncu Yil University, Van, Turkey
| | - S Akdag
- Department of Cardiology, Yuzuncu Yil University, Van, Turkey
| | - M Asker
- Department of Cardiology, Yuzuncu Yil University, Van, Turkey
| | - HA Gumrukcuoglu
- Department of Cardiology, Yuzuncu Yil University, Van, Turkey
| | - R Duz
- Department of Cardiology, Yuzuncu Yil University, Van, Turkey
| | - KC Demirel
- Department of Cardiology, Yuzuncu Yil University, Van, Turkey
| | - F Ozturk
- Department of Cardiology, Yuzuncu Yil University, Van, Turkey
| | - M Yaman
- Department of Cardiology, Yuzuncu Yil University, Van, Turkey
| | - M Sahin
- Department of Cardiology, Yuzuncu Yil University, Van, Turkey
| | - H Simsek
- Department of Cardiology, Yuzuncu Yil University, Van, Turkey
| | - M Tuncer
- Department of Cardiology, Yuzuncu Yil University, Van, Turkey
| | - H Begenik
- Department of Nephrology, Yuzuncu Yil University, Van, Turkey
| |
Collapse
|
20
|
The association among age, early mitral leaflet closure, cardiac structure, diastolic indices and NT-proBNP in an asymptomatic Taiwanese population. IJC HEART & VASCULATURE 2015; 8:114-121. [PMID: 28785690 PMCID: PMC5497255 DOI: 10.1016/j.ijcha.2015.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 11/24/2022]
Abstract
Background Advanced age is associated with left ventricular (LV) remodeling and impaired diastole. The association among aging, mitral leaflet closure (EF slope), cardiac structures, and diastolic indices in an asymptomatic Taiwanese population is largely unknown. Methods We studied 8103 asymptomatic participants (49.5 ± 11.6 years, 38.2% women) from a health evaluation cohort (2004–2012) in a tertiary center in Taiwan. Echo-derived LV structure/function, and M-mode based EF slope (mm/s) and serum NT-proBNP level were obtained. The association between EF slope and the other clinical or echo-based parameters was investigated. Results Average values for EF slope among various age groups in the Taiwanese population were determined for both genders. Advanced age was associated with reductions in EF slope (adjusted estimate: − 0.35/per decade). Reduced EF slope was associated with older age, higher blood pressure and greater body mass index in multivariate models (all p < 0.05). Reduced EF slope was correlated with greater cardiac concentricity, abnormal E′ and E/E′ (AUROC: 0.74 and 0.77, respectively, both p < 0.05) and elevated NT-proBNP (Coef: 5.98 pg/mL, per − 10 mm/s EF slope, 95% CI: 7.82 to 4.17, p < 0.001). EF-slope also clearly discriminated individuals with abnormal estimated LV filling (E/E′ categorized by < 8, ≥ 8 & < 15, ≥ 15, ANOVA p < 0.001). Conclusions EF-slope reduction in the asymptomatic Taiwanese population was correlated with age, several unfavorable LV remodeling, and impaired diastolic function parameters, and EF-slope can be an effective clinical diagnostic tool for identifying poor E′ and elevated LV filling pressure. In addition, our data provided reference values for EF-slope in various age groups.
Collapse
|
21
|
Santos M, Rivero J, McCullough SD, West E, Opotowsky AR, Waxman AB, Systrom DM, Shah AM. E/e' Ratio in Patients With Unexplained Dyspnea: Lack of Accuracy in Estimating Left Ventricular Filling Pressure. Circ Heart Fail 2015; 8:749-56. [PMID: 26067855 DOI: 10.1161/circheartfailure.115.002161] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elevated left ventricular filling pressure is a cardinal feature of heart failure with preserved ejection fraction. Mitral E/e' ratio has been proposed as a noninvasive measure of left ventricular filling pressure. We studied the accuracy of E/e' to estimate and track changes of left ventricular filling pressure in patients with unexplained dyspnea. METHODS AND RESULTS We performed supine and upright transthoracic echocardiography in 118 patients with unexplained dyspnea who underwent right heart catheterization. Supine E/e' ratio modestly but significantly correlated with supine pulmonary arterial wedge pressure (PAWP; r=0.36; P<0.001) and demonstrated poor agreement with PAWP values (Bland-Altman limits of agreement of -8.3 to 8.3 mm Hg; range, 6.5-21.2 mm Hg). Similarly, E/e' ratio cut off of 13 performed poorly in identifying patients with elevated left ventricular filling pressure (sensitivity 6%, specificity 90%). The receiver-operating characteristic area of E/e' was 0.65 (95% confidencce interval, 0.50-0.79). With change from the supine to upright position, PAWP decreased (-5±4 mm Hg; P<0.001) as did both E wave (-17±15 cm/s; P<0.001) and e' (-2.7±2.7 cm/s; P<0.001) velocities, whereas E/e' remained stable (+0.2±2.6; P=0.57). Positional change in PAWP correlated modestly with change in E-wave (r=0.37; P<0.001) velocity. There was no appreciable relationship between change in PAWP and change in average E/e' (r=-0.04; P=0.77) and in half the patients the change in PAWP and E/e' were directionally opposite. CONCLUSIONS In patients with unexplained dyspnea, E/e' ratio neither accurately estimates PAWP nor identifies patients with elevated PAWP consistent with heart failure with preserved ejection fraction. Positional changes in E/e' ratio do not reflect changes in PAWP.
Collapse
Affiliation(s)
- Mário Santos
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.)
| | - Jose Rivero
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.)
| | - Shane D McCullough
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.)
| | - Erin West
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.)
| | - Alexander R Opotowsky
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.)
| | - Aaron B Waxman
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.)
| | - David M Systrom
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.)
| | - Amil M Shah
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.).
| |
Collapse
|
22
|
Hodt A, Hisdal J, Stugaard M, Stranden E, Atar D, Steine K. Increased LV apical untwist during preload reduction in healthy humans: an echocardiographic speckle tracking study during lower body negative pressure. Physiol Rep 2015; 3:3/3/e12330. [PMID: 25802362 PMCID: PMC4393164 DOI: 10.14814/phy2.12330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We sought to investigate the effect of reduced preload on left ventricle (LV) untwist and early diastolic filling in healthy individuals. Twelve healthy men, 22 (22, 23) years of age, were examined at rest and during applied lower body negative pressure (LBNP) of −20 mmHg and −40 mmHg, respectively. Regional untwist and untwist rate during IVRT were calculated at LV basal, papillary, subpapillary, and apical short axis levels by two dimensional speckle tracking echocardiography. Left ventricle early diastolic filling was assessed by transmitral E-wave (E) peak velocity by pulsed Doppler and flow propagation velocity (Vp) by color M-mode Doppler and early diastolic pulsed Doppler tissue velocities (E') from septal and lateral mitral annulus. From rest to LBNP −40 mmHg, the LV untwist and untwist rate at subpapillary level increased from 2.3 (1.4, 3.5) to 4.5 (3.1, 7.6) degrees and from −36 (−51, −25) to −69 (−127, −42) °/s (P < 0.001, P = 0.003), respectively, while apical untwist and untwist rate increased from 3.9 (2.3, 4.3) to 7.6 (6.4, 10.5) degrees and from −51 (−69, −40) to −118 (−170, −84) °/s (P < 0.001, P < 0.001), respectively. Since untwist and untwist rate at the basal level were unchanged, this created markedly larger base to apical untwist and untwist rate gradients from rest to LBNP −40 mmHg. E, Vp, and E' were reduced by 34, 32, and 39%, respectively. LV untwist and untwist rate during IVRT were increased at apical levels, which might be a physiological mechanism to minimize the impairment in LV early diastolic filling during preload reduction.
Collapse
Affiliation(s)
- Anders Hodt
- Department of Cardiology B, Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway
| | - Jonny Hisdal
- Section of Vascular Investigations, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marie Stugaard
- Department of Cardiology, Hyogo Cancer Center, Akashi, Japan
| | - Einar Stranden
- Section of Vascular Investigations, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dan Atar
- Department of Cardiology B, Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway
| | - Kjetil Steine
- Department of Cardiology, Akershus University Hospital, Oslo, Norway
| |
Collapse
|
23
|
Effect of increasing age on the haemodynamic response to thoracic epidural anaesthesia. Eur J Anaesthesiol 2014; 31:597-605. [DOI: 10.1097/eja.0000000000000125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
24
|
Chowdhury SM, Hijazi ZM, Rhodes JF, Kar S, Makkar R, Mullen M, Cao QL, Mandinov L, Buckley J, Pietris NP, Shirali GS. Changes in speckle tracking echocardiography measures of ventricular function after percutaneous implantation of the Edwards SAPIEN transcatheter heart valve in the pulmonary position. Echocardiography 2014; 32:461-9. [PMID: 25047063 DOI: 10.1111/echo.12700] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patients with free pulmonary regurgitation or mixed pulmonary stenosis and regurgitation and severely dilated right ventricles (RV) show little improvement in ventricular function after pulmonary valve replacement when assessed by traditional echocardiographic markers. We evaluated changes in right and left ventricular (LV) function using speckle tracking echocardiography in patients after SAPIEN transcatheter pulmonary valve (TPV) placement. METHODS Echocardiograms were evaluated at baseline, discharge, 1 and 6 months after TPV placement in 24 patients from 4 centers. Speckle tracking measures of function included peak longitudinal strain, strain rate, and early diastolic strain rate. RV fractional area change, tricuspid annular plane systolic excursion, and left ventricular LV ejection fraction were assessed. Routine Doppler and tissue Doppler velocities were measured. RESULTS At baseline, all patients demonstrated moderate to severe pulmonary regurgitation; this improved following TPV placement. No significant changes were detected in conventional measures of RV or LV function at 6 months. RV longitudinal strain (-16.9% vs. -19.6%, P < 0.01), strain rate (-0.87 s(-1) vs. -1.16 s(-1) , P = 0.01), and LV longitudinal strain (-16.2% vs. -18.2%, P = 0.01) improved between baseline and 6 month follow-up. RV early diastolic strain rate, LV longitudinal strain rate and early diastolic strain rate showed no change. CONCLUSION Improvements in RV longitudinal strain, strain rate, and LV longitudinal strain are seen at 6 months post-TPV. Diastolic function does not appear to change at 6 months. Speckle tracking echocardiography may be more sensitive than traditional measures in detecting changes in systolic function after TPV implantation.
Collapse
Affiliation(s)
- Shahryar M Chowdhury
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Nicoara A, Whitener G, Swaminathan M. Perioperative Diastolic Dysfunction. Semin Cardiothorac Vasc Anesth 2013; 18:218-36. [DOI: 10.1177/1089253213505686] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Left ventricular diastolic dysfunction (LVDD) has only recently been recognized as an important determinant of perioperative morbidity. Intraoperative echocardiographers have been slow to adopt assessment of LVDD into clinical practice. This has been partly attributable to the complex measurements required to characterize LVDD, which are in turn related to how our understanding of diastole has evolved. Additionally, the lack of effective therapeutic options has left many wondering whether it is worthwhile to characterize this pathology in the first place. However, therapies are developed more rapidly once a problem can be identified reliably. The assessment of LVDD is centered on how effectively the left ventricle can fill. Diastolic dysfunction affects intraventricular pressures and stiffness, which in turn affect the pressure relationship between the left atrium and the left ventricle thereby affecting transmitral flow. Since echocardiography can enable the measurement of flow velocities, transmitral diastolic filling flow patterns provide robust information on diastolic function. The impact of abnormal diastolic function on left atrial pressure has consequences for pulmonary venous flow, which can also be measured with echocardiography. However, given the limitations of flow velocity, direct measurement of tissue velocity can significantly improve the characterization of diastolic dysfunction. The evolution of Doppler and speckle-based methods of assessing tissue motion have vastly improved our understanding of diastolic function. With the development of simpler algorithms for categorization, and their gradual adoption by perioperative echocardiographers, LVDD should be better diagnosed and treated to improve postoperative outcomes.
Collapse
|
26
|
Pauliks LB, Valdes-Cruz LM, Perryman R, Scholl FG. Right ventricular wall-motion changes after infant open heart surgery--a tissue Doppler study. Echocardiography 2013; 31:209-17. [PMID: 24103038 DOI: 10.1111/echo.12347] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Right ventricular (RV) dysfunction is a well-recognized complication of cardiopulmonary bypass surgery (CPB) in adults. Infants and neonates may also be at high risk for this due to immature myocardium. Conventional assessment of RV function is just qualitative, but novel tissue Doppler echocardiographic (TDI) markers including peak systolic strain rate (SR) and isovolumic contraction acceleration (IVA) permit noninvasive quantitation of RV function. This study assessed myocardial velocities, IVA and SR in infants and neonates undergoing open heart surgery using TDI to study regional myocardial function perioperatively. METHODS Transthoracic TDI data were obtained in the OR before and 24 hours post-CPB on 53 consecutive infants (age 0.39 ± 0.23 years). They were followed with TDI through hospital discharge. RESULTS Mean CPB time was 87 ± 49 min (cross-clamp 52 ± 26 min). Peak systolic (STDI ) and diastolic myocardial velocities (ETDI , ATDI ), IVA, and peak SR were recorded in RV and LV from standard views for offline analysis. Postoperatively, LV systolic function and diastolic longitudinal function were unchanged or improved from baseline. LV radial velocities were increased postoperatively indicating adequate support. In contrast, RV longitudinal systolic and diastolic function was significantly diminished after CPB. RV changes persisted through hospital discharge. CONCLUSIONS In infants and neonates, perioperative measurements of systolic and diastolic tissue Doppler parameters are feasible and revealed significant RV systolic and diastolic dysfunction post-CPB with preserved LV function. As such, TDI provides a sensitive tool to monitor the infant heart after CPB and may potentially be useful to assess different myocardial protection strategies.
Collapse
Affiliation(s)
- Linda B Pauliks
- Pediatric Cardiology, Penn State Hershey Medical College, Hershey, Pennsylvania
| | | | | | | |
Collapse
|
27
|
Chin JH, Lee EH, Kim WJ, Choi DK, Hahm KD, Sim JY, Choi IC. Positive end-expiratory pressure aggravates left ventricular diastolic relaxation further in patients with pre-existing relaxation abnormality. Br J Anaesth 2013; 111:368-73. [PMID: 23533256 DOI: 10.1093/bja/aet061] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Positive end-expiratory pressure (PEEP) has been known to adversely influence cardiac output. Even though left ventricular (LV) diastolic function significantly contributes to LV performance, the effects of PEEP on LV diastolic function remains controversial. We, therefore, aimed to examine the effects of PEEP on LV diastolic function by use of pulsed wave Doppler tissue imaging in patients with pre-existing LV relaxation abnormality. METHODS Seventeen patients with peak early diastolic velocity of lateral mitral annulus (E') <8.5 cm s(-1) among patients who underwent coronary artery bypass graft surgery were evaluated. Echocardiographic and haemodynamic variables were measured with 0, 5, and 10 cmH2O of PEEP. E' and deceleration time (DT) of peak early transmitral filling velocity (E) were used as echocardiographic indicators of LV diastolic function. RESULTS Mean arterial blood pressure decreased during 10 cmH2O PEEP, compared with that during 0 cmH2O PEEP. E' showed a gradual and significant decrease with an incremental increase in PEEP (6.9 ± 0.9, 5.8 ± 0.9, and 5.2 ± 1.2 cm s(-1) during 0, 5, and 10 cmH2O PEEP, respectively), and DT of E was prolonged during 10 cmH2O PEEP, compared with that during 0 cmH2O PEEP. CONCLUSIONS Increasing PEEP led to a progressive decline in LV relaxation in patients with pre-existing LV relaxation abnormality.
Collapse
Affiliation(s)
- J H Chin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2-dong, Songpa-gu, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
28
|
Wiersema U. Tissue Doppler imaging, volume responsiveness and impaired relaxation. Intensive Care Med 2013; 39:792. [PMID: 23340815 DOI: 10.1007/s00134-013-2816-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 11/25/2022]
|
29
|
Cevik A, Kula S, Olgunturk R, Saylan B, Pektas A, Oguz D, Tunaoglu S. Doppler tissue imaging provides an estimate of pulmonary arterial pressure in children with pulmonary hypertension due to congenital intracardiac shunts. CONGENIT HEART DIS 2012; 8:527-34. [PMID: 23280192 DOI: 10.1111/chd.12030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study is to determine the relationship between the cardiac catheterization findings and pulsed-wave (PW) Doppler and Doppler tissue imaging (DTI) in pulmonary arterial hypertension patients with congenital heart disease with intracardiac shunts. DESIGN AND PATIENTS The present study aims to determine the relationship between the cardiac catheterization findings and PW Doppler and Doppler tissue imaging (DTI) in patients who have pulmonary arterial hypertension patients due to congenital heart disease with intracardiac shunts. Echocardiographic measurements were performed at the catheter angiography laboratory with concurrent catheterization. Left and right ventricle inflow velocities were recorded with PW Doppler and DTI studies. Maximum tricuspid regurgitation velocity (TS) was recorded in cases with measurable levels by continuous-wave Doppler. Moreover, the correlations among the echocardiographic values and invasive hemodynamic measures such as systolic pulmonary arterial pressure (PAPsystolic), mean pulmonary arterial pressure (PAPmean), diastolic pulmonary arterial pressure (PAPdiastolic) and pulmonary vascular resistance index (PVRI) were evaluated. RESULTS A negative correlation was found between TE'/TA' and PAPsystolic, PAPdiastolic and PAPmean (P = 0.008, r = -0.480; P = 0.001, r = -0.584; P = 0.001, r = -0.567, respectively). ME/ME' was also found to be negatively correlated with PAPdiastolic, PAPmean and PVRI (P = 0.002, r = -0.556; P = 0.005, r = -0.502; P = 0.027, r = -0.411, respectively). The concurrent use of TE'/TA' (cut-off value <2.6) and TS had a sensitivity of 79% and a specificity of 93% for distinguishing between patients with healthy controls. CONCLUSION When used in conjunction with conventional methods, TE'/TA' has the highest sensitivity and specificity in distinguishing between patients and healthy controls.
Collapse
Affiliation(s)
- Ayhan Cevik
- Department of Pediatric Cardiology, Gazi University Medical Faculty Hospital, Ankara, Turkey
| | | | | | | | | | | | | |
Collapse
|
30
|
Improvement of left ventricular relaxation as assessed by tissue Doppler imaging in fluid-responsive critically ill septic patients. Intensive Care Med 2012; 38:1461-70. [DOI: 10.1007/s00134-012-2618-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
|
31
|
A’roch R, Gustafsson U, Johansson G, Poelaert J, Haney M. Left ventricular strain and peak systolic velocity: responses to controlled changes in load and contractility, explored in a porcine model. Cardiovasc Ultrasound 2012; 10:22. [PMID: 22640913 PMCID: PMC3489788 DOI: 10.1186/1476-7120-10-22] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 05/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tissue velocity echocardiography is increasingly used to evaluate global and regional cardiac function. Previous studies have suggested that the quantitative measurements obtained during ejection are reliable indices of contractility, though their load-sensitivity has been studied in different settings, but still remains a matter of controversy. We sought to characterize the effects of acute load change (both preload and afterload) and change in inotropic state on peak systolic velocity and strain as a measure of LV contractility. METHODS Thirteen anesthetized juvenile pigs were studied, using direct measurement of left ventricular pressure and volume and transthoracic echocardiography. Transient inflation of a vena cava balloon catheter produced controlled load alterations. At least eight consecutive beats in the sequence were analyzed with tissue velocity echocardiography during the load alteration and analyzed for change in peak systolic velocities and strain during same contractile status with a controlled load alteration. Two pharmacological inotropic interventions were also included to generate several myocardial contractile conditions in each animal. RESULTS Peak systolic velocities reflected the drug-induced changes in contractility in both radial and longitudinal axis. During the acute load change, the peak systolic velocities remain stable when derived from signal in the longitudinal axis and from the radial axis. The peak systolic velocity parameter demonstrated no strong relation to either load or inotropic intervention, that is, it remained unchanged when load was systematically and progressively varied (peak systolic velocity, longitudinal axis, control group beat 1-5.72 ± 1.36 with beat 8-6.49 ± 1.28 cm/sec, 95% confidence interval), with the single exception of the negative inotropic intervention group where peak systolic velocity decreased a small amount during load reduction (beat 1-3.98 ± 0.92 with beat 8-2.72 ± 0.89 cm/sec). Systolic strain, however, showed a clear degree of load-dependence. CONCLUSIONS Peak systolic velocity appears to be load-independent as tested by beat-to-beat load reduction, while peak systolic strain appears to be load-dependent in this model. Peak systolic velocity, in a controlled experimental model where successive beats during load alteration are assessed, has a strong relation to contractility. Peak systolic velocity, but not peak strain rate, is largely independent of load, in this model. More study is needed to confirm this finding in the clinical setting.
Collapse
Affiliation(s)
- Roman A’roch
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, University Hospital of Umeå, Umeå, Sweden
| | - Ulf Gustafsson
- Department of Clinical Physiology, Heart Centre, University Hospital of Umeå, Umeå, Sweden
| | - Göran Johansson
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, University Hospital of Umeå, Umeå, Sweden
| | - Jan Poelaert
- Department of Anaesthesiology and Perioperative Medicine, University Hospital of Brussels, Brussels, Belgium
| | - Michael Haney
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, University Hospital of Umeå, Umeå, Sweden
| |
Collapse
|
32
|
Naqvi TZ, Elkayam U. Serial Echocardiographic Assessment of the Human Heart in Normal Pregnancy. Circ Cardiovasc Imaging 2012; 5:283-5. [DOI: 10.1161/circimaging.112.974808] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tasneem Z. Naqvi
- From the Cardiac Non-Invasive Laboratory and Department of Medicine, Division of Cardiovascular Disease and the Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Uri Elkayam
- From the Cardiac Non-Invasive Laboratory and Department of Medicine, Division of Cardiovascular Disease and the Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles
| |
Collapse
|
33
|
López-Candales A, Edelman K. Chronic Pulmonary Hypertension Causes Significant Interventricular Spatiotemporal Dyssynchrony When Onset of Diastolic Flow Signals Are Assessed by Color M-Mode. Echocardiography 2012; 29:653-60. [DOI: 10.1111/j.1540-8175.2011.01660.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
34
|
Vitiello D, Boissière J, Doucende G, Gayrard S, Polge A, Faure P, Goux A, Tanguy S, Obert P, Reboul C, Nottin S. β-Adrenergic receptors desensitization is not involved in exercise-induced cardiac fatigue: NADPH oxidase-induced oxidative stress as a new trigger. J Appl Physiol (1985) 2011; 111:1242-8. [DOI: 10.1152/japplphysiol.00449.2011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Prolonged strenuous exercise (PSE) induces transient left ventricular (LV) dysfunction. Previous studies suggest that β-adrenergic pathway desensitization could be involved in this phenomenon, but it remains to be confirmed. Moreover, other underlying mechanisms involving oxidative stress have been recently proposed. The present study aimed to evaluate the involvement of both the β-adrenergic pathway and NADPH oxidase (Nox) enzyme-induced oxidative stress in myocardial dysfunction in rats following PSE. Rats were divided into 4 groups: controls (Ctrl), 4-h exercised on treadmill (PSE), and 2 groups in which Nox enzyme was inhibited with apocynin treatment (Ctrl APO and PSE APO, respectively). We evaluated cardiac function in vivo and ex vivo during basal conditions and isoproterenol stress. GSH/GSSG ratio, cardiac troponin I (cTnI) release, and lipid peroxidation (MDA) were evaluated. PSE induced a decrease in LV developed pressure, intrinsic myocardial contractility, and relaxation associated with an increase in plasma cTnI release. Our in vivo and ex vivo results demonstrated no differences in myocardial response to isoproterenol and of effective dose 50 between control and PSE rats. Interestingly, the LV dysfunction was reversed by apocynin treatment. Moreover, apocynin prevented cellular oxidation [GSH/GSSG ratio: PSE APO rats vs. PSE rats in arbitrary units (au): 1.98 ± 0.07 vs. 1.35 ± 0.10; P < 0.001]. However, no differences in MDA were observed between groups. These data suggest that myocardial dysfunction observed after PSE was not due to β-adrenergic receptor desensitization but could be due to a signaling oxidative stress from the Nox enzyme.
Collapse
Affiliation(s)
- Damien Vitiello
- Research Laboratory, Laboratory of Cardiovascular Adjustments to Exercise, Faculty of Sciences, University of Avignon
| | - Julien Boissière
- Research Laboratory, Physical Activity, Muscle, Health, Faculty of Sport Sciences and Physical Education, Lille-2 University, Ronchin
| | - Grégory Doucende
- Research Laboratory, Laboratory of Cardiovascular Adjustments to Exercise, Faculty of Sciences, University of Avignon
| | - Sandrine Gayrard
- Research Laboratory, Laboratory of Cardiovascular Adjustments to Exercise, Faculty of Sciences, University of Avignon
| | - Anne Polge
- Biochemistry Laboratory, Hospital of Nîmes, Nîmes
| | - Patrice Faure
- Nutritional and Hormonal Biochemistry Laboratory, Hospital of Grenoble, Grenoble
- Research Laboratory, INSERM U 1040, Faculty of Medicine and Pharmacy, Grenoble University, Grenoble; and
| | - Aurélie Goux
- Research Laboratory, Human Nutrition and Atherogenesis, University Institute of Clinical Research, Montpellier, France
| | - Stéphane Tanguy
- Research Laboratory, Laboratory of Cardiovascular Adjustments to Exercise, Faculty of Sciences, University of Avignon
| | - Philippe Obert
- Research Laboratory, Laboratory of Cardiovascular Adjustments to Exercise, Faculty of Sciences, University of Avignon
| | - Cyril Reboul
- Research Laboratory, Laboratory of Cardiovascular Adjustments to Exercise, Faculty of Sciences, University of Avignon
| | - Stéphane Nottin
- Research Laboratory, Laboratory of Cardiovascular Adjustments to Exercise, Faculty of Sciences, University of Avignon
| |
Collapse
|
35
|
Popović ZB, Desai MY, Buakhamsri A, Puntawagkoon C, Borowski A, Levine BD, Tang WWH, Thomas JD. Predictors of mitral annulus early diastolic velocity: impact of long-axis function, ventricular filling pattern, and relaxation. ACTA ACUST UNITED AC 2011; 12:818-25. [PMID: 21865226 DOI: 10.1093/ejechocard/jer146] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIMS Although left ventricular (LV) relaxation is well recognized as a predictor of mitral annulus (MA) early diastolic (E') velocity, its significance relative to other predictors of E' is less well understood. METHODS AND RESULTS We assessed 40 healthy volunteers, 43 patients with acutely decompensated chronic systolic heart failure (HF), and 36 patients with hypertrophic obstructive cardiomyopathy (HOCM) using echocardiography and right or left heart catheterization. Data were obtained at baseline. In addition, in healthy volunteers haemodynamics were varied by graded saline infusion and low body negative pressure, while in HF patients it was varied by vasoactive drug treatment. E- and A-wave velocity (E/A) ratio of the mitral valve inflow, systolic MA velocity integral (s' integral) and E' and late velocity (A') of lateral and septal MA pulsed wave velocities were assessed by echocardiography. Time constant of isovolumic pressure decay τ(0)) was calculated from isovolumic relaxation time/[ln(aortic dicrotic notch pressure) - ln(LV filling pressure)]. In all three groups, s' integral was the strongest predictor of E' (partial r= 0.53-0.79; 0.81 for three groups combined), followed by E/A ratio (partial r= 0.10-0.78; 0.26 for all groups combined) and τ(0) (partial r= -0.1 to 0.023; -0.21 for all groups combined). CONCLUSION In healthy adults, patients with systolic HF, or patients with HOCM, E' is related to LV long-axis function and E/A ratio, a global marker of LV filling. E' appears less sensitive to LV relaxation.
Collapse
Affiliation(s)
- Zoran B Popović
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Fernhall B, Fahs CA, Horn G, Rowland T, Smith D. Acute effects of firefighting on cardiac performance. Eur J Appl Physiol 2011; 112:735-41. [DOI: 10.1007/s00421-011-2033-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 05/28/2011] [Indexed: 10/18/2022]
|
37
|
Yotti R, Bermejo J, Benito Y, Antoranz JC, Desco MM, Rodríguez-Pérez D, Cortina C, Mombiela T, Barrio A, Elízaga J, Fernández-Avilés F. Noninvasive Estimation of the Rate of Relaxation by the Analysis of Intraventricular Pressure Gradients. Circ Cardiovasc Imaging 2011; 4:94-104. [PMID: 21245360 DOI: 10.1161/circimaging.110.960369] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background—
During late ejection, myocardial relaxation causes systolic flow to decelerate and stop, and this phenomenon is coupled with the generation of a pressure gradient inside the left ventricle (LV). We hypothesized that the peak reverse ejection intraventricular pressure difference (REIVPD) between the LV apex and the outflow tract could be a useful method to improve the assessment of LV relaxation using Doppler echocardiography.
Methods and Results—
Three sets of animal experiments and 1 clinical study were designed. In 6 pigs, a close relationship between REIVPD and the intensity of the relaxation wave (
R
rm
=0.89) was demonstrated using wave intensity analysis of high-fidelity pressure-volume-velocity data. In 19 animals, REIVPD sensitively detected modifications of the lusotropic state and closely correlated with the time constant of LV relaxation (τ) within animals (
R
rm
=−0.93). Load-dependence analysis in 5 pigs showed that REIVPD remained stable up to values of 35% to 40% acute preload reduction. Clinical validation was tested in 50 patients (23 with normal systolic function) undergoing simultaneous Doppler echocardiography and high-fidelity LV pressure measurements on the same beat. REIVPD and tissue Doppler mitral annulus velocity (e′) were independently related to τ, but the REIVPD · e′ product correlated better with τ than either variable separately (bootstrap-corrected correlation coefficients:
R
=−0.84 versus −0.71, and −0.70, respectively,
P
<0.05). Area under the receiver operating characteristic curve to predict impaired relaxation (τ>50 ms) for e′ · REIVPD was 0.96 (95% confidence interval, 0.85 to 0.99).
Conclusions—
The Doppler-derived REIVPD provides a sensitive, reliable, reproducible, and relatively load-independent index of the rate of LV relaxation. Combined with tissue Doppler measurements of longitudinal function, this method improves noninvasive assessment of LV relaxation in the clinical setting.
Collapse
Affiliation(s)
- Raquel Yotti
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Javier Bermejo
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Yolanda Benito
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - J. Carlos Antoranz
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - M. Mar Desco
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Daniel Rodríguez-Pérez
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Cristina Cortina
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Teresa Mombiela
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Alicia Barrio
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Jaime Elízaga
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Francisco Fernández-Avilés
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| |
Collapse
|
38
|
Popescu WM, Bell R, Duffy AJ, Katz KH, Perrino AC. A pilot study of patients with clinically severe obesity undergoing laparoscopic surgery: evidence for impaired cardiac performance. J Cardiothorac Vasc Anesth 2011; 25:943-9. [PMID: 21232976 DOI: 10.1053/j.jvca.2010.11.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Given the propensity for heart disease in obese patients, the authors investigated the effects of pneumoperitoneum on cardiac performance. DESIGN A pilot observational intraoperative study. SETTING A single-center university hospital. PARTICIPANTS Patients undergoing laparoscopic gastric bypass surgery. INTERVENTIONS Abdominal insufflation. MEASUREMENTS AND RESULTS Hemodynamic, respiratory, and echocardiographic data were collected at 4 epochs: (1) baseline after the induction of anesthesia, (2) after abdominal insufflation in supine position, (3) after abdominal insufflation in the reverse Trendelenburg (RT) position, and (4) after desufflation in RT position. At epoch 1, 3 of 13 patients manifested systolic dysfunction (SD), 5 of 13 patients exhibited diastolic dysfunction (DD) according to transmitral flow (TMF) Doppler criteria, and 4 of 8 patients according to Doppler tissue imaging (DTI) criteria. With pneumoperitoneum, the total systemic resistance increased to values of 142% from baseline (p < 0.05). Compared with baseline, stroke volume decreased by 25%, cardiac output by 35%, and fractional area change by 13% (p < 0.05). Mean arterial blood pressure and heart rate remained stable. Additionally, new-onset DD manifested in 1 of 8 patients according to TMF criteria and in 3 of 4 patients according to DTI criteria. Desufflation of the abdomen reverted the diastolic function to baseline in all but 1 patient. CONCLUSION The study data revealed that surgical pneumoperitoneum used in patients with clinically severe obesity resulted in the deterioration of cardiac performance including the development of new-onset DD. These patients, despite their relative young age and without a history of heart failure or coronary artery disease, displayed a cardiovascular profile during laparoscopic surgery similar to that seen in patients with significant heart disease.
Collapse
Affiliation(s)
- Wanda M Popescu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520-8051, USA.
| | | | | | | | | |
Collapse
|
39
|
Impact of concomitant diabetes and chronic kidney disease on preload-induced changes in left ventricular diastolic filling in hypertensive patients. J Hypertens 2011; 29:144-53. [DOI: 10.1097/hjh.0b013e32833f387c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Dragulescu A, Mertens LL. Developments in echocardiographic techniques for the evaluation of ventricular function in children. Arch Cardiovasc Dis 2010; 103:603-14. [PMID: 21147445 DOI: 10.1016/j.acvd.2010.09.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 09/07/2010] [Accepted: 09/09/2010] [Indexed: 11/15/2022]
Abstract
Echocardiography is a very important tool for the diagnosis and follow-up of children with congenital and acquired heart disease. One of the challenges that remains in paediatric heart disease is the assessment of systolic and diastolic function in children, as this is influenced by growth, morphology and loading conditions. New echocardiographic techniques, such as tissue Doppler, deformation imaging and three-dimensional echocardiography, have great potential application in this field. They may provide new insights into the influence of growth, morphology and loading on cardiac mechanics, and could become useful clinical tools. In this review, we discuss the potential use and limitations of these new echocardiographic techniques in paediatric and congenital heart disease.
Collapse
Affiliation(s)
- Andreea Dragulescu
- Department of Cardiology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8 Canada
| | | |
Collapse
|
41
|
Tomczak CR, Thompson RB, Paterson I, Schulte F, Cheng-Baron J, Haennel RG, Haykowsky MJ. Effect of acute high-intensity interval exercise on postexercise biventricular function in mild heart failure. J Appl Physiol (1985) 2010; 110:398-406. [PMID: 21088202 DOI: 10.1152/japplphysiol.01114.2010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We studied the acute effect of high-intensity interval exercise on biventricular function using cardiac magnetic resonance imaging in nine patients [age: 49 ± 16 yr; left ventricular (LV) ejection fraction (EF): 35.8 ± 7.2%] with nonischemic mild heart failure (HF). We hypothesized that a significant impairment in the immediate postexercise end-systolic volume (ESV) and end-diastolic volume (EDV) would contribute to a reduction in EF. We found that immediately following acute high-intensity interval exercise, LV ESV decreased by 6% and LV systolic annular velocity increased by 21% (both P < 0.05). Thirty minutes following exercise (+30 min), there was an absolute increase in LV EF of 2.4% (P < 0.05). Measures of preload, left atrial volume and LV EDV, were reduced immediately following exercise. Similar responses were observed for right ventricular volumes. Early filling velocity, filling rate, and diastolic annular velocity remained unchanged, while LV untwisting rate increased 24% immediately following exercise (P < 0.05) and remained 18% above baseline at +30 min (P < 0.05). The major novel findings of this investigation are 1) that acute high-intensity interval exercise decreases the immediate postexercise LV ESV and increases LV EF at +30 min in patients with mild HF, and this is associated with a reduction in LV afterload and maintenance of contractility, and 2) that despite a reduction in left atrial volume and LV EDV immediately postexercise, diastolic function is preserved and may be modulated by enhanced LV peak untwisting rate. Acute high-intensity interval exercise does not impair postexercise biventricular function in patients with nonischemic mild HF.
Collapse
Affiliation(s)
- Corey R Tomczak
- Faculty of Rehabilitation Medicinem, 3-48 Corbett Hall, Univ. of Alberta, Edmonton, AB, Canada, T6G 2G4.
| | | | | | | | | | | | | |
Collapse
|
42
|
Enhanced systolic myocardial function in elite endurance athletes during combined arm-and-leg exercise. Eur J Appl Physiol 2010; 111:905-13. [DOI: 10.1007/s00421-010-1712-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2010] [Indexed: 11/25/2022]
|
43
|
Moore CL, Tham ET, Samuels KJ, McNamara RL, Galante NJ, Stachenfeld N, Shelley K, Dziura J, Silverman DG. Tissue Doppler of early mitral filling correlates with simulated volume loss in healthy subjects. Acad Emerg Med 2010; 17:1162-8. [PMID: 21175513 DOI: 10.1111/j.1553-2712.2010.00906.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The accurate noninvasive assessment of preload in emergency department (ED) patients remains elusive. Point-of-care ultrasound (US) imaging, particularly evaluation of the inferior vena cava (IVC), has been shown to be qualitatively helpful. Doppler and tissue Doppler are now routinely available on ED US equipment, but few studies have looked at the correlation of dynamic changes in these parameters in a controlled model of hypovolemia. Our objective was to examine the correlation of Doppler parameters to simulated volume loss in healthy subjects using a lower-body negative pressure (LBNP) model and to compare these measurements to commonly used IVC measurements of preload. METHODS Twelve paid volunteers with no known cardiovascular disease between the ages of 23 and 31 years old (mean ± SD = 25.5 ± 2.5 years old) were recruited. Hypovolemia was simulated using graduated LBNP levels with measurements taken at 0, -30, and -60 mm Hg and lower pressures as tolerated. Vital signs were monitored in all patients. US measurements recorded at each negative pressure level included IVC maximum (IVC(max)) and minimum (IVC(min)) dimensions; early (E) and late (A) transmitral filling velocities using pulsed-wave spectral Doppler; and early (E') and late (A') tissue Doppler velocities at the septal ((sep)) and lateral ((lat)) mitral annulus, using pulsed-wave tissue Doppler. RESULTS Lower-body negative pressure correlated significantly and positively within subjects for all US parameters except for the A filling wave. E'(lat) and E'(sep) showed the strongest correlation with R² values of 0.749 (95% confidence interval [CI] = 0.577 to 0.854) and 0.738 (95% CI = 0.579 to 0.875) respectively, followed by A'(sep) 0.674 (95% CI = 0.416 to 0.845), IVC(max) 0.638 (95% CI = 0.425 to 0.806), A'(lat) 0.547 (95% CI = 0.280 to 0.802), IVC(min) 0.512 (95% CI = 0.192 to 0.777), and E 0.478 (95% CI = 0.187 to 0.762). Ratios correlated only moderately with LBNP level, including E/ E'(lat) R² of 0.430 (95% CI = 0.131 to 0.706), E/ E'(sep) 0.416 (95% CI = 0.183 to 0.686), and IVC collapsibility index (IVC(CI)) 0.201 (95% CI = 0.003 to 0.681). Vital signs, including heart rate and blood pressure, did not vary significantly with LBNP levels. CONCLUSIONS In this pilot study of healthy subjects, tissue Doppler assessment of early diastolic filling correlated most strongly with simulated hypovolemia.
Collapse
Affiliation(s)
- Christopher L Moore
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Groban L, Sanders DM, Houle TT, Antonio BL, Ntuen EC, Zvara DA, Kon ND, Kincaid EH. Prognostic value of tissue Doppler-Derived E/e' on early morbid events after cardiac surgery. Echocardiography 2010; 27:131-8. [PMID: 20380676 DOI: 10.1111/j.1540-8175.2009.01076.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The tissue Doppler-derived surrogate for left ventricular diastolic pressure, E/e', has been used to prognosticate outcome in a variety of cardiovascular conditions. In this study, we determined the relationship of intraoperative E/e' to the use of inotropic support, duration of mechanical ventilation (MV), length of intensive care unit stay (ICU-LOS), and total hospital stay (H-LOS) in patients requiring cardiac surgery. The records of 245 consecutive patients were retrospectively reviewed to obtain 205 patients who had intraoperative transesophageal echocardiography examinations prior to coronary artery bypass grafting and/or valvular surgery. Cox proportional hazards and logistic regression models were used to analyze the relation between intraoperative E/e' or LVEF and early postoperative morbidity (H-LOS, ICU-LOS, and MV) and the probability that a patient would require inotropic support. With adjustments for other predictors (female gender, hypertension, diabetes, history of myocardial infarction, emergency surgery, renal failure, procedure type, and length of aortic cross-clamp time), an elevated E/e' ratio (>or=8) was significantly associated with an increased ICU-LOS (49 versus 41 median h, P = 0.037) and need for inotropic support (P = 0.002) while baseline LVEF was associated with inotropic support alone (P < 0.0001). These data suggest that the tissue Doppler-derived index of left ventricular diastolic filling pressure may be a useful indicator for predicting early morbid events after cardiac surgery, and may even provide additional information from that of baseline LVEF. Further, patients with elevated preoperative E/e' may need more careful peri- and postoperative management than those patients with E/e' <8.
Collapse
Affiliation(s)
- Leanne Groban
- Departments of Anesthesiology and Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Mousavi N, Czarnecki A, Ahmadie R, Tielan Fang, Kumar K, Lytwyn M, Kumar A, Jassal DS. The Utility of Tissue Doppler Imaging for the Noninvasive Determination of Left Ventricular Filling Pressures in Patients With Septic Shock. J Intensive Care Med 2010; 25:163-7. [DOI: 10.1177/0885066609359903] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Pulmonary artery wedge pressure (PAWP) is an important indicator of volume status in septic patients. Although it requires invasive pulmonary artery catheterization (PAC), a noninvasive method to assess PAWP would be clinically useful in this select patient population. Diastolic indices using transthoracic echocardiography (TTE) may provide an accurate estimate of PAWP. Objective: To determine whether echocardiographic Doppler assessment is accurate in estimating PAWP in patients with septic shock. Methods: A retrospective chart review was performed of 320 patients admitted with a diagnosis of septic shock from 2007-2008. Of the total patient population, 40 patients fulfilled the inclusion criteria, having undergone both TTE and PAC within 4 hours. Spectral Doppler indices including peak early (E) and late (A) transmitral velocities, E/A ratio, and E-wave deceleration time were measured. Tissue Doppler indices including S’, E’ and A’ velocities were determined. Pulmonary artery wedge pressure values measured invasively were compared to the dimensionless index of E/E’ in each patient. Results: The mean age was 68 ± 12 years with 28 males (70%). On echo assessment, 28% of patients had evidence of mild left ventricular diastolic dysfunction while 17% of patients had moderate diastolic dysfunction. Pulmonary artery wedge pressures ranged from 7 to 31 mm Hg with a mean of 18 ± 5 mm Hg. The mean E/E’ was 11 ± 8. Linear regression analysis between PAWP and E/E7apos; demonstrated a strong correlation (r = .84, P < .05). Conclusion: Tissue Doppler indices using TTE is a feasible and strong predictor of PAWP in patients with septic shock.
Collapse
Affiliation(s)
- Negareh Mousavi
- Section of Cardiology, Department of Cardiac Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew Czarnecki
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roien Ahmadie
- Institute of Cardiovascular Sciences, St. Boniface Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tielan Fang
- Institute of Cardiovascular Sciences, St. Boniface Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kanwal Kumar
- Institute of Cardiovascular Sciences, St. Boniface Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew Lytwyn
- Institute of Cardiovascular Sciences, St. Boniface Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anand Kumar
- Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Davinder S. Jassal
- Section of Cardiology, Department of Cardiac Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, Institute of Cardiovascular Sciences, St. Boniface Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada, Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada,
| |
Collapse
|
46
|
The role of exercise echocardiography in the diagnosis of heart failure with preserved left ventricular ejection fraction (primary diastolic heart failure). COR ET VASA 2010. [DOI: 10.33678/cor.2010.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
47
|
Borg AN, Harrison JL, Argyle RA, Pearce KA, Beynon R, Ray SG. Left ventricular filling and diastolic myocardial deformation in chronic primary mitral regurgitation. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:523-9. [PMID: 20185526 DOI: 10.1093/ejechocard/jeq012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Chronic primary mitral regurgitation (MR) results in enhanced filling of the left ventricle (LV) during early diastole. Filling is impaired with the onset of LV systolic dysfunction, due to increased myocardial stiffness and reduced restoring forces. We investigated echocardiographic parameters of early diastolic function in relation to LV systolic function. METHODS AND RESULTS Early diastolic transmitral flow and tissue Doppler velocities, propagation velocity of early filling (V(p)), and early diastolic strain rates (SR-E) were measured in 30 patients with chronic degenerative MR and 30 age-matched controls. MR subjects were further subdivided into group 1 (14 subjects) if they had well compensated LV, and group 2 (16 subjects) if they had one or more of the following: functional limitation (> NYHA class I), LV end-systolic diameter >or=4.0 cm, and LV ejection fraction <or=60%. Group 1 had increased early diastolic transmitral flow and tissue velocities, V(p) and SR-E, compared with controls. V(p) and SR-E in group 2 (46.5 +/- 9.92 cm/s and 1.44 +/- 0.36 s(-1), respectively) decreased significantly compared with group 1 (74.4 +/- 19.9 cm/s and 1.96 +/- 0.53 s(-1), P <or= 0.002). Onset and peak of early long-axis expansion and myocardial lengthening were significantly delayed in MR, and this delay was directly correlated with preload parameters. CONCLUSION In chronic MR, novel echocardiographic measurements of early diastolic function exhibit a biphasic pattern depending on the state of LV systolic function, and may prove useful in the timing of surgery.
Collapse
Affiliation(s)
- Alexander N Borg
- Department of Cardiology, Wythenshawe HospitalSouthmoor Road, Wythenshawe, Manchester M23 9LT, UK.
| | | | | | | | | | | |
Collapse
|
48
|
Sanders D, Dudley M, Groban L. Diastolic dysfunction, cardiovascular aging, and the anesthesiologist. Anesthesiol Clin 2009; 27:497-517. [PMID: 19825489 DOI: 10.1016/j.anclin.2009.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
As the number of persons aged 65 years and older continues to increase, the anesthesiologist will more frequently encounter this demographic. Cardiovascular changes that occur in this patient population present difficult anesthetic challenges and place these patients at high risk of perioperative morbidity and mortality. The anesthesiologist should be knowledgeable about these age-related cardiovascular changes, the pathophysiology underlying them, and the appropriate perioperative management. Whether presenting for cardiac or general surgery, the anesthesiologist must identify patients with altered physiology as a result of aging or diastolic dysfunction and be prepared to modify the care plan accordingly. With a directed preoperative assessment that focuses on certain aspects of the cardiovascular system, and the assistance of powerful echocardiographic tools such as tissue Doppler, this can be achieved.
Collapse
Affiliation(s)
- David Sanders
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA
| | | | | |
Collapse
|
49
|
Pauliks LB, Undar A, Clark JB, Myers JL. Segmental differences of impaired diastolic relaxation following cardiopulmonary bypass surgery in children: a tissue Doppler study. Artif Organs 2009; 33:904-8. [PMID: 19821817 DOI: 10.1111/j.1525-1594.2009.00923.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Impaired myocardial relaxation is an important aftereffect of cardiopulmonary bypass (CPB). Infants with their immature calcium metabolism may be particularly vulnerable. However, it has been difficult to quantitate diastolic dysfunction clinically. This study used tissue Doppler to measure regional diastolic myocardial velocities in 31 pediatric patients undergoing open heart surgery. Color tissue Doppler images were acquired in the operating room before and 8 and 24 h post CPB surgery. Early (E) and atrial (A) diastolic velocities were determined. Long axis motion was assessed from apical views near the mitral and tricuspid rings and radial wall motion from the parasternal view. The study included 31 children aged 3.6 +/- 4.4 years (6 days to 16 years), with a mean weight of 14.7 +/- 13.7 kg and body surface area of 0.59 +/- 0.35 m(2). Tissue Doppler analysis of regional wall motion revealed abnormal left ventricle (LV) and right ventricle (RV) diastolic relaxation in the early postoperative phase after CPB. Initially, all segments were significantly altered, but by 24 h, regional differences became apparent: LV radial wall motion was recovered, while longitudinal fibers in LV and RV appeared to be less resilient. RV myocardial mechanics were most abnormal. Tissue Doppler analysis may deepen our understanding of myocardial recovery and offers a sensitive tool to compare different cardioprotective strategies.
Collapse
Affiliation(s)
- Linda B Pauliks
- Department of Pediatrics, Penn State College of Medicine, Penn State Children's Hospital, Hershey, PA 17033, USA.
| | | | | | | |
Collapse
|
50
|
Tschöpe C, Paulus WJ. Is echocardiographic evaluation of diastolic function useful in determining clinical care? Doppler echocardiography yields dubious estimates of left ventricular diastolic pressures. Circulation 2009; 120:810-20; discussion 820. [PMID: 19720947 DOI: 10.1161/circulationaha.109.869628] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Carsten Tschöpe
- Institute for Cardiovascular Research VU, VU University Medical Center Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | | |
Collapse
|