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Stępniewski J, Kopeć G, Magoń W, Podolec P. Diastolic dyssynchrony and its exercise-induced changes affect exercise capacity in patients with heart failure with reduced ejection fraction. Cardiol J 2019; 28:932-940. [PMID: 30994185 PMCID: PMC8747811 DOI: 10.5603/cj.a2019.0032] [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: 01/02/2019] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Left ventricular diastolic dyssynchrony is common in patients with heart failure with reduced ejection fraction (HFREF). Little is known however, about its pathophysiology and clinical effects. Herein is hypothesized that presence of diastolic dyssynchrony at rest or at exercise may importantly contribute to HF symptoms. The aim was to investigate the influence of diastolic dyssynchrony and its exercise-induced changes on exercise capacity in HFREF patients. METHODS Patients with stable, chronic HF, left ventricular ejection fraction < 35%, sinus rhythm and QRS ≥ 120 ms were eligible for the study. Rest and cyclo-ergometer exercise echocardiography were performed. Diastolic dyssynchrony was defined as opposing-wall-diastolic-delay ≥ 55 ms measured in tissue-Doppler imaging. Exercise capacity was assessed by peak oxygen consumption (VO2peak). Association between diastolic dyssynchrony and VO2peak was assessed in univariate regression analysis and further adjusted for possible confounders. RESULTS Fourty eight patients were included (aged 63.7 ± 12.2). Twenty-seven (56.25%) had diastolic dyssynchrony at rest and 13 (27%) at exercise. Twenty-two (46%) experienced a change in diastolic dyssynchrony status during exercise. In univariate models diastolic dyssynchrony at rest or at exercise were associated with lower VO2peak (beta coefficient = -3.8, p = 0.004; beta coefficient = -3.6, p = 0.02, respectively). However, the ability to restore diastolic synchronicity during exercise was associated with higher VO2peak (beta coefficient = 3.4, p = 0.04) and remained an important predictor of exercise capacity after adjustment for age and HF etiology. CONCLUSIONS The ability to restore diastolic synchronicity at exercise predicts exercise capacity in patients with HFREF.
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Affiliation(s)
- Jakub Stępniewski
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
| | - Grzegorz Kopeć
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Wojciech Magoń
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
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Melka J, Rienzo M, Bizé A, Jozwiak M, Sambin L, Hittinger L, Su JB, Berdeaux A, Ghaleh B. Improvement of left ventricular filling by ivabradine during chronic hypertension: involvement of contraction-relaxation coupling. Basic Res Cardiol 2016; 111:30. [PMID: 27040115 DOI: 10.1007/s00395-016-0550-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/24/2016] [Indexed: 11/30/2022]
Abstract
Chronic hypertension is associated with left ventricular (LV) hypertrophy and LV diastolic dysfunction with impaired isovolumic relaxation and abnormal LV filling. Increased heart rate (HR) worsens these alterations. We investigated whether the I f channel blocker ivabradine exerts beneficial effects on LV filling dynamic. In this setting, we also evaluated the relationship between LV filling and isovolumic contraction as a consequence of contraction-relaxation coupling. Therefore, hypertension was induced by a continuous infusion of angiotensin II during 28 days in 10 chronically instrumented pigs. LV function was investigated after stopping angiotensin II infusion to offset the changes in loading conditions. In the normal heart, LV relaxation filling, LV early filling, LV peak early filling rate were positively correlated to HR. In contrast, these parameters were significantly reduced at day 28 vs. day 0 (18, 42, and 26 %, respectively) despite the increase in HR (108 ± 6 beats/min vs. 73 ± 2 beats/min, respectively). These abnormalities were corrected by acute administration of ivabradine (1 mg/kg, iv). Ivabradine still exerted these effects when HR was controlled at 150 beats/min by atrial pacing. Interestingly, LV relaxation filling, LV early filling and LV peak early filling were strongly correlated with both isovolumic contraction and relaxation. In conclusion, ivabradine improves LV filling during chronic hypertension. The mechanism involves LV contraction-relaxation coupling through normalization of isovolumic contraction and relaxation as well as HR-independent mechanisms.
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Affiliation(s)
- Jonathan Melka
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
| | - Mario Rienzo
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
- AP-HP, Hôpital Européen Georges Pompidou, Service d'Anesthésie-Réanimation Chirurgicale, 75015, Paris, France
| | - Alain Bizé
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
| | - Mathieu Jozwiak
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
| | - Lucien Sambin
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
| | - Luc Hittinger
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
- AP-HP, Groupe Hospitalier Henri Mondor, Fédération de Cardiologie, 94000, Créteil, France
| | - Jin Bo Su
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
| | - Alain Berdeaux
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
- AP-HP, Groupe Hospitalier Henri Mondor, Fédération de Cardiologie, 94000, Créteil, France
| | - Bijan Ghaleh
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France.
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France.
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France.
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Sugihara H, Yonekura Y, Matsumoto T, Sasaki Y. Relationship Between Asynchronous Myocardial Contraction and Left Ventricular Systolic and Diastolic Function-Assessment Using the ECG-Gated Polar Map With 99mTc-Methoxy-Isobutyl Isonitrile-. Circ J 2005; 69:183-7. [PMID: 15671610 DOI: 10.1253/circj.69.183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To quantitate the degree of 3-dimensional asynchronous myocardial contraction, an ECG-gated polar map method was developed with (99m)Tc-methoxy-isobutyl isonitrile, and used to investigate the relationship between asynchrony and left ventricular (LV) function. METHODS AND RESULTS Twelve normal subjects and 38 patients with an old myocardial infarction were studied with ECG-gated single-photon emission computed tomography (SPECT). In each frame, a myocardial perfusion polar map was reconstructed and the peak contraction phase in each pixel was displayed (phase map). The degree of asynchronous contraction was assessed from the standard deviations of the peak contraction phase (SDP) on the phase map. Ejection fraction (EF), peak ejection rate (PER), 1/3EF, peak filling rate (PFR) and 1/3 filling fraction (1/3FF) were calculated by the quantitative gated SPECT software, and E/A from Doppler echocardiography. The SDP was compared with these parameters. Correlation coefficients and p values between the SDP and parameters of cardiac function were as follows: EF, r=-0.69 (p<0.001); PER, r=-0.54 (p<0.001); 1/3EF, r=-0.57 (p<0.001); PFR, r=-0.29 (p<0.05); 1/3FF, r=-0.63 (p<0.001); E/A, r=-0.11 (p=0.51). CONCLUSIONS There was a negative correlation between the SDP and LV systolic and diastolic function, which confirmed the functional significance of asynchrony on cardiac function.
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Affiliation(s)
- Hideki Sugihara
- Department of Cardiology, Takashima General Hospital, Shiga, Japan
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Funabashi N, Yoshida K, Tadokoro H, Nakagawa K, Komiyama N, Odaka K, Tsunoo T, Mori S, Tanada S, Endo M, Komuro I. Cardiovascular Circulation and Hepatic Perfusion of Pigs in 4-Dimensional Films Evaluated by 256-Slice Cone-Beam Computed Tomography. Circ J 2005; 69:585-9. [PMID: 15849446 DOI: 10.1253/circj.69.585] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In both cardiac and hepatic disorders it is desirable to accurately visualize the direction and scale of blood flow in the whole organ in pulsating 3-dimensional (D) images, which are known as 4-D images. METHODS AND RESULTS The present study used 256-slice cone-beam computed tomography (CT) (Athena, Sony-Toshiba) at one rotation per second and a section thickness of 0.5 mm to show the dynamics of cardiovascular circulation and hepatic perfusion by contrast injection in 4-D films of pigs. Four pigs (20 kg each) were anesthetized with isoflurane. The distal tips of the catheters were positioned in the inferior vena cava (IVC) (pigs 1-3) and in the proper hepatic artery (pig 4). Volumetric scanning and injection of contrast material were started simultaneously and continued for 25 s with image reconstruction at 1-s intervals. In pigs 1-3, 4-D filming revealed the dynamics of cardiovascular circulation, first in the IVC, followed by the right ventricle and pulmonary artery, then the left ventricle, left atrium, pulmonary vein, and finally, the right heart disappeared and only the left heart and aorta remained visible. In pig 4, the hepatic arterial trees, followed by the venous trees, could be easily visualized in turn on the 4-D images. CONCLUSIONS This technology successfully demonstrated cardiovascular circulation and hepatic perfusion in 4-D and will have clinical applicability.
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Affiliation(s)
- Nobusada Funabashi
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Japan.
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Ito T, Suwa M, Imai M, Hozumi T, Tonari S, Kitaura Y. Acute Effects of Diltiazem on Regional Left Ventricular Diastolic Filling Dynamics in Patients With Hypertrophic Cardiomyopathy as Assessed by Color Kinesis. Circ J 2004; 68:1035-40. [PMID: 15502385 DOI: 10.1253/circj.68.1035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of calcium antagonists on regional left ventricular (LV) filling dynamics in patients with hypertrophic cardiomyopathy (HCM) is not well known, so the present study evaluated the results of echocardiography with color kinesis (CK) analysis during diltiazem infusion. METHODS AND RESULTS Nineteen patients (16 men, 3 women; mean age 55+/-15 years) underwent echocardiography with CK analysis during intravenous diltiazem (10 mg/2 min). Using the quantitative CK software the LV short-axis image was divided into 6 segments and the percent endocardial expansion at the early, mid- and late-diastolic filling time was averaged for all segments, with the standard deviation of the mean used as an index of diastolic asynchrony (asynchrony index). The regional mean filling time was also measured for the corresponding segments. As global diastolic parameters, the global filling time, peak filling rate, and the time-to-peak filling were calculated. After the administration of diltiazem, the asynchrony index was decreased for all three diastolic filling times. Diltiazem shortened the mean filling time overall, especially in the posterior and lateral wall segments. These findings were associated with significant improvement in the CK-derived global diastolic parameters. CONCLUSIONS Diltiazam has a favorable effect on LV diastolic asynchrony, which may account for the acute changes in global LV relaxation.
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Affiliation(s)
- Takahide Ito
- The Third Division, Department of Internal Medicine, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki 569-8686, Japan.
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