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Mandry D, Girerd N, Lamiral Z, Huttin O, Filippetti L, Micard E, Beaumont M, Ncho Mottoh MPB, Pace N, Zannad F, Rossignol P, Marie PY. Relationship Between Left Ventricular Ejection Fraction Variation and Systemic Vascular Resistance: A Prospective Cardiovascular Magnetic Resonance Study. Front Cardiovasc Med 2022; 8:803567. [PMID: 35004914 PMCID: PMC8739894 DOI: 10.3389/fcvm.2021.803567] [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] [Received: 10/28/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: This cardiovascular magnetic resonance (CMR) study aims to determine whether changes in systemic vascular resistance (SVR), obtained from CMR flow sequences, might explain the significant long-term changes in left ventricular (LV) ejection fraction (EF) observed in subjects with no cardiac disease history. Methods: Cohort subjects without any known cardiac disease but with high rates of hypertension and obesity, underwent CMR with phase-contrast sequences both at baseline and at a median follow-up of 5.2 years. Longitudinal changes in EF were analyzed for any concomitant changes in blood pressure and vascular function, notably the indexed SVR given by the formula: mean brachial blood pressure / cardiac output x body surface area. Results: A total of 118 subjects (53 ± 12 years, 52% women) were included, 26% had hypertension, and 52% were obese. Eighteen (15%) had significant EF variations between baseline and follow-up (7 increased EF and 11 decreased EF). Longitudinal changes in EF were inversely related to concomitant changes in mean and diastolic blood pressures (p = 0.030 and p = 0.027, respectively) and much more significantly to SVR (p < 0.001). On average, these SVR changes were -8.08 ± 9.21 and +8.14 ± 8.28 mmHg.min.m2.L-1, respectively, in subjects with significant increases and decreases in EF, and 3.32 ± 7.53 mmHg.min.m2.L-1 in subjects with a stable EF (overall p < 0.001). Conclusions: Significant EF variations are not uncommon during the long-term CMR follow-up of populations with no evident health issues except for uncomplicated hypertension and obesity. However, most of these variations are linked to SVR changes and may therefore be unrelated to any intrinsic change in LV contractility. This underscores the benefits of specifically assessing LV afterload when EF is monitored in populations at risk of vascular dysfunction. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT01716819 and NCT02430805.
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Affiliation(s)
- Damien Mandry
- CHRU-Nancy, Université de Lorraine, Department of Radiology, Nancy, France.,Université de Lorraine, INSERM, UMR-1254, Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, INSERM, UMR-1116, Nancy, France.,CHRU-Nancy, Université de Lorraine, Department of Cardiology, Nancy, France.,Université de Lorraine, CHRU-Nancy, INSERM, CIC 1433, Nancy, France
| | - Zohra Lamiral
- Université de Lorraine, CHRU-Nancy, INSERM, CIC 1433, Nancy, France
| | - Olivier Huttin
- Université de Lorraine, INSERM, UMR-1116, Nancy, France.,CHRU-Nancy, Université de Lorraine, Department of Cardiology, Nancy, France
| | - Laura Filippetti
- CHRU-Nancy, Université de Lorraine, Department of Cardiology, Nancy, France
| | - Emilien Micard
- Université de Lorraine, CHRU-Nancy, INSERM, CIC 1433, Nancy, France
| | - Marine Beaumont
- Université de Lorraine, INSERM, UMR-1254, Nancy, France.,Université de Lorraine, CHRU-Nancy, INSERM, CIC 1433, Nancy, France
| | | | - Nathalie Pace
- CHRU-Nancy, Université de Lorraine, Department of Cardiology, Nancy, France
| | - Faïez Zannad
- Université de Lorraine, INSERM, UMR-1116, Nancy, France.,CHRU-Nancy, Université de Lorraine, Department of Cardiology, Nancy, France.,Université de Lorraine, CHRU-Nancy, INSERM, CIC 1433, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, INSERM, UMR-1116, Nancy, France.,Université de Lorraine, CHRU-Nancy, INSERM, CIC 1433, Nancy, France.,FCRIN INI-CRCT, Nancy, France
| | - Pierre-Yves Marie
- Université de Lorraine, INSERM, UMR-1116, Nancy, France.,CHRU-Nancy, Université de Lorraine, Department of Nuclear Medicine and Nancyclotep, Nancy, France
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Richards DA, Bao W, Rambo MV, Burgert M, Jucker BM, Lenhard SC. Examining the relationship between exercise tolerance and isoproterenol-based cardiac reserve in murine models of heart failure. J Appl Physiol (1985) 2013; 114:1202-10. [DOI: 10.1152/japplphysiol.00556.2012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The loss of cardiac reserve is, in part, responsible for exercise intolerance in late-stage heart failure (HF). Exercise tolerance testing (ETT) has been performed in mouse models of HF; however, treadmill performance and at-rest cardiac indexes determined by magnetic resonance imaging (MRI) rarely correlate. The present study adopted a stress-MRI technique for comparison with ETT in HF models, using isoproterenol (ISO) to evoke cardiac reserve responses. Male C57BL/6J mice were randomly subjected to myocardial infarction (MI), transverse aortic constriction (TAC), or sham surgery under general anesthesia. Mice underwent serial ETT on a graded treadmill with follow-up ISO stress-MRI. TAC mice showed consistent exercise intolerance, with a 16.2% reduction in peak oxygen consumption vs. sham at 15-wk postsurgery (WPS). MI and sham mice had similar peak oxygen consumption from 7 WPS onward. Time to a respiratory exchange ratio of 1.0 correlated with ETT distance ( r = 0.64; P < 0.001). The change in ejection fraction under ISO stress was reduced in HF mice at 4 WPS [10.1 ± 3.9% change (Δ) and 8.9 ± 3.5%Δ in MI and TAC, respectively, compared with 32.0 ± 3.5%Δ in sham; P < 0.001]. However, cardiac reserve differences between surgery groups were not observed at 16 WPS in terms of ejection fraction or cardiac output. In addition, ETT did not correlate with cardiac indexes under ISO stress. In conclusion, ISO stress was unable to reflect consistent differences in ETT between HF and healthy mice, suggesting cardiac-specific indexes are not the sole factors in defining exercise intolerance in mouse HF models.
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Affiliation(s)
- Daniel A. Richards
- Heart Failure Discovery Performance Unit, Metabolic Pathways and Cardiovascular Therapy Area Unit, GlaxoSmithKline, King of Prussia, Pennsylvania
- University of Bristol, Bristol, Avon, United Kingdom
| | - Weike Bao
- Heart Failure Discovery Performance Unit, Metabolic Pathways and Cardiovascular Therapy Area Unit, GlaxoSmithKline, King of Prussia, Pennsylvania
| | - Mary V. Rambo
- Laboratory Animal Sciences, GlaxoSmithKline, King of Prussia, Pennsylvania
| | - Mark Burgert
- Statistical Consulting Group, GlaxoSmithKline, King of Prussia, Pennsylvania
| | - Beat M. Jucker
- Heart Failure Discovery Performance Unit, Metabolic Pathways and Cardiovascular Therapy Area Unit, GlaxoSmithKline, King of Prussia, Pennsylvania
- Preclinical and Translational Imaging, GlaxoSmithKline, King of Prussia, Pennsylvania
| | - Stephen C. Lenhard
- Heart Failure Discovery Performance Unit, Metabolic Pathways and Cardiovascular Therapy Area Unit, GlaxoSmithKline, King of Prussia, Pennsylvania
- Preclinical and Translational Imaging, GlaxoSmithKline, King of Prussia, Pennsylvania
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