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Sun Z, Cai Y, Yang Y, Huang L, Xie Y, Zhu S, Wu C, Sun W, Zhang Z, Li Y, Wang J, Fang L, Yang Y, Lv Q, Dong N, Zhang L, Gu H, Xie M. Early left ventricular systolic function is a more sensitive predictor of adverse events after heart transplant. Int J Cardiol 2024; 398:131620. [PMID: 38036269 DOI: 10.1016/j.ijcard.2023.131620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/30/2023] [Accepted: 11/26/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND First-phase ejection fraction (EF1) is a novel measure of early changes in left ventricular systolic function. This study was to investigate the prognostic value of EF1 in heart transplant recipients. METHODS Heart transplant recipients were prospectively recruited at the Union Hospital, Wuhan, China between January 2015 and December 2019. All patients underwent clinical examination, biochemistry measures [brain natriuretic peptide (BNP) and creatinine] and transthoracic echocardiography. The primary endpoint was a combined event of all-cause mortality and graft rejection. RESULTS In 277 patients (aged 48.6 ± 12.5 years) followed for a median of 38.7 [26.8-45.0] months, there were 35 (12.6%) patients had adverse events including 20 deaths and 15 rejections. EF1 was negatively associated with BNP (β = -0.220, p < 0.001) and was significantly lower in patients with events compared to those without. EF1 had the largest area under the curve in ROC analysis compared to other measures. An optimal cut-off value of 25.8% for EF1 had a sensitivity of 96.3% and a specificity of 97.1% for prediction of events. EF1 was the most powerful predictor of events with hazard ratio per 1% change in EF1: 0.628 (95%CI: 0.555-0.710, p < 0.001) after adjustment for left ventricular ejection fraction and global longitudinal strain. CONCLUSIONS Early left ventricular systolic function as measured by EF1 is a powerful predictor of adverse outcomes after heart transplant. EF1 may be useful in risk stratification and management of heart transplant recipients.
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Affiliation(s)
- Zhenxing Sun
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yu Cai
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yujia Yang
- British Heart Foundation Centre of Research Excellence, King's College London, UK
| | - Lei Huang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yuji Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Shuangshuang Zhu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Chun Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wei Sun
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Ziming Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lingyun Fang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yali Yang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
| | - Haotian Gu
- British Heart Foundation Centre of Research Excellence, King's College London, UK.
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
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Kampourakis T, Irving M. The regulatory light chain mediates inactivation of myosin motors during active shortening of cardiac muscle. Nat Commun 2021; 12:5272. [PMID: 34489440 PMCID: PMC8421338 DOI: 10.1038/s41467-021-25601-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
The normal function of heart muscle depends on its ability to contract more strongly at longer length. Increased venous filling stretches relaxed heart muscle cells, triggering a stronger contraction in the next beat- the Frank-Starling relation. Conversely, heart muscle cells are inactivated when they shorten during ejection, accelerating relaxation to facilitate refilling before the next beat. Although both effects are essential for the efficient function of the heart, the underlying mechanisms were unknown. Using bifunctional fluorescent probes on the regulatory light chain of the myosin motor we show that its N-terminal domain may be captured in the folded OFF state of the myosin dimer at the end of the working-stroke of the actin-attached motor, whilst its C-terminal domain joins the OFF state only after motor detachment from actin. We propose that sequential folding of myosin motors onto the filament backbone may be responsible for shortening-induced de-activation in the heart.
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Affiliation(s)
- Thomas Kampourakis
- Randall Centre for Cell and Molecular Biophysics, King's College London, London, UK.
- British Heart Foundation Centre of Research Excellence, King's College London, London, UK.
| | - Malcolm Irving
- Randall Centre for Cell and Molecular Biophysics, King's College London, London, UK
- British Heart Foundation Centre of Research Excellence, King's College London, London, UK
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Magne J, Aboyans V. First-phase left ventricular ejection fraction: a small step for myocardial assessment, a big leap for aortic stenosis. Eur Heart J Cardiovasc Imaging 2021; 22:658-659. [PMID: 33106865 DOI: 10.1093/ehjci/jeaa238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Julien Magne
- Cardiology Department, CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042, France.,Cardiology Department, INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000, Limoges, France.,Center of Epidemiology, Biostatistics and Methodology of Research (CENTER), CHU de Limoges, 2 av Martin Luther King, 87042, Limoges, France
| | - Victor Aboyans
- Cardiology Department, CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042, France.,Cardiology Department, INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000, Limoges, France
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Habigt MA, Krieger M, Gesenhues J, Ketelhut M, Mechelinck M, Hein M. Non-linearity of end-systolic pressure-volume relation in afterload increases is caused by an overlay of shortening deactivation and the Frank-Starling mechanism. Sci Rep 2021; 11:3353. [PMID: 33558620 PMCID: PMC7870877 DOI: 10.1038/s41598-021-82791-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/19/2021] [Indexed: 11/09/2022] Open
Abstract
The linearity and load insensitivity of the end-systolic pressure-volume-relationship (ESPVR), a parameter that describes the ventricular contractile state, are controversial. We hypothesize that linearity is influenced by a variable overlay of the intrinsic mechanism of autoregulation to afterload (shortening deactivation) and preload (Frank-Starling mechanism). To study the effect of different short-term loading alterations on the shape of the ESPVR, experiments on twenty-four healthy pigs were executed. Preload reductions, afterload increases and preload reductions while the afterload level was increased were performed. The ESPVR was described either by a linear or a bilinear regression through the end-systolic pressure volume (ES-PV) points. Increases in afterload caused a biphasic course of the ES-PV points, which led to a better fit of the bilinear ESPVRs (r2 0.929 linear ESPVR vs. r2 0.96 and 0.943 bilinear ESPVR). ES-PV points of a preload reduction on a normal and augmented afterload level could be well described by a linear regression (r2 0.974 linear ESPVR vs. r2 0.976 and 0.975 bilinear ESPVR). The intercept of the second ESPVR (V0) but not the slope demonstrated a significant linear correlation with the reached afterload level (effective arterial elastance Ea). Thus, the early response to load could be described by the fixed slope of the ESPVR and variable V0, which was determined by the actual afterload. The ESPVR is only apparently nonlinear, as its course over several heartbeats was affected by an overlay of SDA and FSM. These findings could be easily transferred to cardiovascular simulation models to improve their accuracy.
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Affiliation(s)
- Moriz A Habigt
- Anaesthesiology Clinic, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Michelle Krieger
- Anaesthesiology Clinic, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Jonas Gesenhues
- Institute of Automatic Control, RWTH Aachen University, Steinbachstr. 54, 52074, Aachen, Germany
| | - Maike Ketelhut
- Institute of Automatic Control, RWTH Aachen University, Steinbachstr. 54, 52074, Aachen, Germany
| | - Mare Mechelinck
- Anaesthesiology Clinic, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Marc Hein
- Anaesthesiology Clinic, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
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Gu H, Li Y, Fok H, Simpson J, Kentish JC, Shah AM, Chowienczyk PJ. Reduced First-Phase Ejection Fraction and Sustained Myocardial Wall Stress in Hypertensive Patients With Diastolic Dysfunction: A Manifestation of Impaired Shortening Deactivation That Links Systolic to Diastolic Dysfunction and Preserves Systolic Ejection Fraction. Hypertension 2017; 69:633-640. [PMID: 28223475 PMCID: PMC5344180 DOI: 10.1161/hypertensionaha.116.08545] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 10/24/2016] [Accepted: 01/09/2017] [Indexed: 11/16/2022]
Abstract
Impaired shortening deactivation of cardiac myocytes could sustain myocardial contraction, preserving ejection fraction at the expense of diastolic dysfunction. We examined the relationship between first-phase ejection fraction (EF1), the fraction of left ventricular volume ejected from the start of systole to the time of the first peak in left ventricular pressure (corresponding to the time of maximal ventricular shortening) to the duration of myocardial contraction and diastolic function in patients with hypertension (n=163), and varying degrees of diastolic dysfunction. Left ventricular systolic pressure was estimated by carotid tonometry; time-resolved left ventricular cavity and wall volume were obtained by echocardiography with speckle wall tracking. Measurements were repeated after nitroglycerin, a drug known to influence ventricular dynamics, in a subsample (n=18) of patients. EF1 and time of onset of ventricular relaxation (as determined from the temporal pattern of myocardial wall stress) were independently correlated with diastolic relaxation as measured by tissue Doppler early diastolic mitral annular velocity (E', standardized regression coefficients 0.48 and -0.34 for EF1 and time of onset of ventricular relaxation, respectively, each P<0.001, irrespective of adjustment for age, sex, antihypertensive treatment, measures of afterload, and ventricular geometry) and with diastolic function measured by the ratio of transmitral Doppler early filling velocity (E) to E' (E/E', regression coefficients -0.34 and 0.34, respectively, each P<0.001). Nitroglycerin increased EF1, decreased time of onset of ventricular relaxation, and improved diastolic function (each P<0.05). Hypertensive patients with diastolic dysfunction exhibit reduced EF1 which may sustain myocardial contraction, preserving systolic ejection fraction at the expense of impaired diastolic function.
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Affiliation(s)
- Haotian Gu
- From the King's College London, British Heart Foundation Centre, London, United Kingdom (H.G., Y.L., H.F., J.C.K., A.M.S., P.J.C.); and Department of Congenital Heart Disease, Evelina London Children's Hospital, United Kingdom (J.S.)
| | - Ye Li
- From the King's College London, British Heart Foundation Centre, London, United Kingdom (H.G., Y.L., H.F., J.C.K., A.M.S., P.J.C.); and Department of Congenital Heart Disease, Evelina London Children's Hospital, United Kingdom (J.S.)
| | - Henry Fok
- From the King's College London, British Heart Foundation Centre, London, United Kingdom (H.G., Y.L., H.F., J.C.K., A.M.S., P.J.C.); and Department of Congenital Heart Disease, Evelina London Children's Hospital, United Kingdom (J.S.)
| | - John Simpson
- From the King's College London, British Heart Foundation Centre, London, United Kingdom (H.G., Y.L., H.F., J.C.K., A.M.S., P.J.C.); and Department of Congenital Heart Disease, Evelina London Children's Hospital, United Kingdom (J.S.)
| | - Jonathan C Kentish
- From the King's College London, British Heart Foundation Centre, London, United Kingdom (H.G., Y.L., H.F., J.C.K., A.M.S., P.J.C.); and Department of Congenital Heart Disease, Evelina London Children's Hospital, United Kingdom (J.S.)
| | - Ajay M Shah
- From the King's College London, British Heart Foundation Centre, London, United Kingdom (H.G., Y.L., H.F., J.C.K., A.M.S., P.J.C.); and Department of Congenital Heart Disease, Evelina London Children's Hospital, United Kingdom (J.S.)
| | - Philip J Chowienczyk
- From the King's College London, British Heart Foundation Centre, London, United Kingdom (H.G., Y.L., H.F., J.C.K., A.M.S., P.J.C.); and Department of Congenital Heart Disease, Evelina London Children's Hospital, United Kingdom (J.S.).
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