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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.
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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
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Carrick-Ranson G, Howden EJ, Brazile TL, Levine BD, Reading SA. Effects of aging and endurance exercise training on cardiorespiratory fitness and cardiac structure and function in healthy midlife and older women. J Appl Physiol (1985) 2023; 135:1215-1235. [PMID: 37855034 DOI: 10.1152/japplphysiol.00798.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in women in developed societies. Unfavorable structural and functional adaptations within the heart and central blood vessels with sedentary aging in women can act as the substrate for the development of debilitating CVD conditions such as heart failure with preserved ejection fraction (HFpEF). The large decline in cardiorespiratory fitness, as indicated by maximal or peak oxygen uptake (V̇o2max and V̇o2peak, respectively), that occurs in women as they age significantly affects their health and chronic disease status, as well as the risk of cardiovascular and all-cause mortality. Midlife and older women who have performed structured endurance exercise training for several years or decades of their adult lives exhibit a V̇o2max and cardiac and vascular structure and function that are on par or even superior to much younger sedentary women. Therefore, regular endurance exercise training appears to be an effective preventative strategy for mitigating the adverse physiological cardiovascular adaptations associated with sedentary aging in women. Herein, we narratively describe the aging and short- and long-term endurance exercise training adaptations in V̇o2max, cardiac structure, and left ventricular systolic and diastolic function at rest and exercise in midlife and older women. The role of circulating estrogens on cardiac structure and function is described for consideration in the timing of exercise interventions to maximize beneficial adaptations. Current research gaps and potential areas for future investigation to advance our understanding in this critical knowledge area are highlighted.
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Affiliation(s)
- Graeme Carrick-Ranson
- Department of Surgery, the University of Auckland, Auckland, New Zealand
- Department of Exercise Sciences, the University of Auckland, Auckland, New Zealand
| | - Erin J Howden
- Human Integrative Physiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Tiffany L Brazile
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, United States
- University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, United States
- University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Stacey A Reading
- Department of Exercise Sciences, the University of Auckland, Auckland, New Zealand
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Williams AM, Levine BD, Stembridge M. A change of heart: mechanisms of cardiac adaptation to acute and chronic hypoxia. J Physiol 2022; 600:4089-4104. [PMID: 35930370 PMCID: PMC9544656 DOI: 10.1113/jp281724] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022] Open
Abstract
Over the last 100 years, high‐altitude researchers have amassed a comprehensive understanding of the global cardiac responses to acute, prolonged and lifelong hypoxia. When lowlanders are exposed to hypoxia, the drop in arterial oxygen content demands an increase in cardiac output, which is facilitated by an elevated heart rate at the same time as ventricular volumes are maintained. As exposure is prolonged, haemoconcentration restores arterial oxygen content, whereas left ventricular filling and stroke volume are lowered as a result of a combination of reduced blood volume and hypoxic pulmonary vasoconstriction. Populations native to high‐altitude, such as the Sherpa in Asia, exhibit unique lifelong or generational adaptations to hypoxia. For example, they have smaller left ventricular volumes compared to lowlanders despite having larger total blood volume. More recent investigations have begun to explore the mechanisms underlying such adaptive responses by combining novel imaging techniques with interventions that manipulate cardiac preload, afterload, and/or contractility. This work has revealed the contributions and interactions of (i) plasma volume constriction; (ii) sympathoexcitation; and (iii) hypoxic pulmonary vasoconstriction with respect to altering cardiac loading, or otherwise preserving or enhancing biventricular systolic and diastolic function even amongst high altitude natives with excessive erythrocytosis. Despite these advances, various areas of investigation remain understudied, including potential sex‐related differences in response to high altitude. Collectively, the available evidence supports the conclusion that the human heart successfully adapts to hypoxia over the short‐ and long‐term, without signs of myocardial dysfunction in healthy humans, except in very rare cases of maladaptation.
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Affiliation(s)
- Alexandra M Williams
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mike Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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Noninvasive estimation of impaired left ventricular untwisting velocity by peak early diastolic intra-ventricular pressure gradients using vector flow mapping. J Echocardiogr 2021; 19:166-172. [PMID: 33682077 DOI: 10.1007/s12574-021-00520-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/06/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Introduction of vector flow mapping (VFM) based on the combination of color Doppler and speckle-tracking echocardiography provides noninvasive assessment of early diastolic intra-ventricular pressure gradient (ED-IVPG). The purpose of this study was to evaluate the value of peak ED-IVPG measurement just after aortic valve closure using VFM for noninvasive estimation of impaired LV untwisting velocity as the index of LV relaxation in the clinical setting. METHODS AND RESULTS The study included 65 consecutive patients in whom echocardiography was performed for the assessment of LV function. We assessed peak ED-IVPG between LV apex and base by VFM analysis software. We also measured peak LV untwisting velocity and LV twisting by speckle-tracking strain analysis. Peak ED-IVPG was successfully and quickly assessed in all the study patients. Peak ED-IVPG was significantly reduced in patients with impaired peak LV untwisting velocity (< 70 degrees/s) compared with patients without impaired peak LV untwisting velocity. The receiver operating characteristic analysis showed the best cut-off value of peak ED-IVPG for determining impaired peak LV untwisting velocity was 0.40 mmHg (sensitivity 81%, specificity 74%, and area under the curve 0.81). There was a well correlation between peak ED-IVPG and peak LV untwisting velocity (r = 0.64, p < 0.0001). CONCLUSIONS The present results suggest that peak ED-IVPG just after aortic valve closure measured by VFM may be used as noninvasive index for estimation of impaired LV untwisting velocity in the clinical setting.
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Cellular, mitochondrial and molecular alterations associate with early left ventricular diastolic dysfunction in a porcine model of diabetic metabolic derangement. Sci Rep 2020; 10:13173. [PMID: 32764569 PMCID: PMC7413251 DOI: 10.1038/s41598-020-68637-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023] Open
Abstract
The prevalence of diabetic metabolic derangement (DMetD) has increased dramatically over the last decades. Although there is increasing evidence that DMetD is associated with cardiac dysfunction, the early DMetD-induced myocardial alterations remain incompletely understood. Here, we studied early DMetD-related cardiac changes in a clinically relevant large animal model. DMetD was established in adult male Göttingen miniswine by streptozotocin injections and a high-fat, high-sugar diet, while control animals remained on normal pig chow. Five months later left ventricular (LV) function was assessed by echocardiography and hemodynamic measurements, followed by comprehensive biochemical, molecular and histological analyses. Robust DMetD developed, evidenced by hyperglycemia, hypercholesterolemia and hypertriglyceridemia. DMetD resulted in altered LV nitroso-redox balance, increased superoxide production—principally due to endothelial nitric oxide synthase (eNOS) uncoupling—reduced nitric oxide (NO) production, alterations in myocardial gene-expression—particularly genes related to glucose and fatty acid metabolism—and mitochondrial dysfunction. These abnormalities were accompanied by increased passive force of isolated cardiomyocytes, and impaired LV diastolic function, evidenced by reduced LV peak untwist velocity and increased E/e′. However, LV weight, volume, collagen content, and cardiomyocyte cross-sectional area were unchanged at this stage of DMetD. In conclusion, DMetD, in a clinically relevant large-animal model results in myocardial oxidative stress, eNOS uncoupling and reduced NO production, together with an altered metabolic gene expression profile and mitochondrial dysfunction. These molecular alterations are associated with stiffening of the cardiomyocytes and early diastolic dysfunction before any structural cardiac remodeling occurs. Therapies should be directed to ameliorate these early DMetD-induced myocardial changes to prevent the development of overt cardiac failure.
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What Is the Heart? Anatomy, Function, Pathophysiology, and Misconceptions. J Cardiovasc Dev Dis 2018; 5:jcdd5020033. [PMID: 29867011 PMCID: PMC6023278 DOI: 10.3390/jcdd5020033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/10/2018] [Accepted: 05/23/2018] [Indexed: 01/08/2023] Open
Abstract
Cardiac dynamics are traditionally linked to a left ventricle, right ventricle, and septum morphology, a topography that differs from the heart's five-century-old anatomic description of containing a helix and circumferential wrap architectural configuration. Torrent Guasp's helical ventricular myocardial band (HVMB) defines this anatomy and its structure, and explains why the heart's six dynamic actions of narrowing, shortening, lengthening, widening, twisting, and uncoiling happen. The described structural findings will raise questions about deductions guiding "accepted cardiac mechanics", and their functional aspects will challenge and overturn them. These suppositions include the LV, RV, and septum description, timing of mitral valve opening, isovolumic relaxation period, reasons for torsion/twisting, untwisting, reasons for longitudinal and circumferential strain, echocardiographic sub segmentation, resynchronization, RV function dynamics, diastolic dysfunction's cause, and unrecognized septum impairment. Torrent Guasp's revolutionary contributions may alter future understanding of the diagnosis and treatment of cardiac disease.
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Stöhr EJ, Stembridge M, Shave R, Samuel TJ, Stone K, Esformes JI. Systolic and Diastolic Left Ventricular Mechanics during and after Resistance Exercise. Med Sci Sports Exerc 2018; 49:2025-2031. [PMID: 28915224 DOI: 10.1249/mss.0000000000001326] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To improve the current understanding of the impact of resistance exercise on the heart, by examining the acute responses of left ventricular (LV) strain, twist, and untwisting rate ("LV mechanics"). METHODS LV echocardiographic images were recorded in systole and diastole before, during and immediately after (7-12 s) double-leg press exercise at two intensities (30% and 60% of maximum strength, one-repetition maximum). Speckle tracking analysis generated LV strain, twist, and untwisting rate data. Additionally, beat-by-beat blood pressure was recorded and systemic vascular resistance (SVR) and LV wall stress were calculated. RESULTS Responses in both exercise trials were statistically similar (P > 0.05). During effort, stroke volume decreased, whereas SVR and LV wall stress increased (P < 0.05). Immediately after effort, stroke volume returned to baseline, whereas SVR and wall stress decreased (P < 0.05). Similarly, acute exercise was accompanied by a significant decrease in systolic parameters of LV muscle mechanics (P < 0.05). However, diastolic parameters, including LV untwisting rate, were statistically unaltered (P > 0.05). Immediately after exercise, systolic LV mechanics returned to baseline levels (P < 0.05) but LV untwisting rate increased significantly (P < 0.05). CONCLUSIONS A single, acute bout of double-leg press resistance exercise transiently reduces systolic LV mechanics, but increases diastolic mechanics after exercise, suggesting that resistance exercise has a differential impact on systolic and diastolic heart muscle function. The findings may explain why acute resistance exercise has been associated with reduced stroke volume but chronic exercise training may result in increased LV volumes.
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Affiliation(s)
- Eric J Stöhr
- Discipline of Physiology & Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UNITED KINGDOM
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9
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Williams AM, Shave RE, Cheyne WS, Eves ND. The influence of adrenergic stimulation on sex differences in left ventricular twist mechanics. J Physiol 2017; 595:3973-3985. [PMID: 28188951 DOI: 10.1113/jp273368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 02/05/2017] [Indexed: 12/20/2022] Open
Abstract
KEY POINTS Sex differences in left ventricular (LV) mechanics occur during acute physiological challenges; however, it is unknown whether sex differences in LV mechanics are fundamentally regulated by differences in adrenergic control. Using two-dimensional echocardiography and speckle tracking analysis, this study compared LV mechanics in males and females matched for LV length during post-exercise ischaemia (PEI) and β1 -adrenergic receptor blockade. Our data demonstrate that while basal rotation was increased in males, LV twist was not significantly different between the sexes during PEI. In contrast, during β1 -adrenergic receptor blockade, LV apical rotation, twist and untwisting velocity were reduced in males compared to females. Significant relationships were observed between LV twist and LV internal diameter and sphericity index in females, but not males. These findings suggest that LV twist mechanics may be more sensitive to alterations in adrenergic stimulation in males, but more highly influenced by ventricular structure and geometry in females. ABSTRACT Sex differences in left ventricular (LV) mechanics exist at rest and during acute physiological stress. Differences in cardiac autonomic and adrenergic control may contribute to sex differences in LV mechanics and LV haemodynamics. Accordingly, this study aimed to investigate sex differences in LV mechanics with altered adrenergic stimulation achieved through post-handgrip-exercise ischaemia (PEI) and β1 -adrenergic receptor (AR) blockade. Twenty males (23 ± 5 years) and 20 females (22 ± 3 years) were specifically matched for LV length (males: 8.5 ± 0.5 cm, females: 8.2 ± 0.6 cm, P = 0.163), and two-dimensional speckle-tracking echocardiography was used to assess LV structure and function at baseline, during PEI and following administration of 5 mg bisoprolol (β1 -AR antagonist). During PEI, LV end-diastolic volume and stroke volume were increased in both groups (P < 0.001), as was end-systolic wall stress (P < 0.001). LV twist and apical rotation were not altered from baseline or different between the sexes; however, basal rotation increased in males (P = 0.035). During β1 -AR blockade, LV volumes were unchanged but blood pressure and heart rate were reduced in both groups (P < 0.001). LV apical rotation (P = 0.036) and twist (P = 0.029) were reduced in males with β1 -AR blockade but not females, resulting in lower apical rotation (males: 6.8 ± 2.1 deg, females: 8.8 ± 2.3 deg, P = 0.007) and twist (males: 8.6 ± 1.9 deg, females: 10.7 ± 2.8 deg, P = 0.008), and slower untwisting velocity (males: 68.2 ± 22.1 deg s-1 , females: 82.0 ± 18.7 deg s-1 , P = 0.046) compared to females. LV twist mechanics are reduced in males compared to females during reductions to adrenergic stimulation, providing preliminary evidence that LV twist mechanics may be more sensitive to adrenergic control in males than in females.
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Affiliation(s)
- Alexandra M Williams
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada
| | - Rob E Shave
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK
| | - William S Cheyne
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada
| | - Neil D Eves
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada
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Williams AM, Shave RE, Stembridge M, Eves ND. Females have greater left ventricular twist mechanics than males during acute reductions to preload. Am J Physiol Heart Circ Physiol 2016; 311:H76-84. [PMID: 27199112 DOI: 10.1152/ajpheart.00057.2016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/09/2016] [Indexed: 11/22/2022]
Abstract
Compared to males, females have smaller left ventricular (LV) dimensions and volumes, higher ejection fractions (EF), and higher LV longitudinal and circumferential strain. LV twist mechanics determine ventricular function and are preload-dependent. Therefore, the sex differences in LV structure and myocardial function may result in different mechanics when preload is altered. This study investigated sex differences in LV mechanics during acute challenges to preload. With the use of conventional and speckle-tracking echocardiography, LV structure and function were assessed in 20 males (24 ± 6.2 yr) and 20 females (23 ± 3.1 yr) at baseline and during progressive levels of lower body negative pressure (LBNP). Fourteen participants (8 males, 6 females) were also assessed following a rapid infusion of saline. LV end-diastolic volume, end-systolic volume, stroke volume (SV), and EF were reduced in both groups during LBNP (P < 0.001). While males had greater absolute volumes (P < 0.001), there were no sex differences in allometrically scaled volumes at any stage. Sex differences were not detected at baseline in basal rotation, apical rotation, or twist. Apical rotation and twist increased in both groups (P < 0.001) with LBNP. At -60 mmHg, females had greater apical rotation (P = 0.009), twist (P = 0.008), and torsion (P = 0.002) and faster untwisting velocity (P = 0.02) than males. There were no differences in mechanics following saline infusion. Females have larger LV twist and a faster untwisting velocity than males during large reductions to preload, supporting that females have a greater reliance on LV twist mechanics to maintain SV during severe reductions to preload.
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Affiliation(s)
- Alexandra M Williams
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, The University of British Columbia, Kelowna, Canada; and
| | - Rob E Shave
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Mike Stembridge
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, The University of British Columbia, Kelowna, Canada; and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Neil D Eves
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, The University of British Columbia, Kelowna, Canada; and
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Kuwata S, Yoneyama K, Suzuki K, Izumo M, Mizukoshi K, Koyama K, Ishibashi Y, Mitarai T, Kamijima R, Kongoji K, Harada T, Akashi YJ. Aortic annulus displacement assessed by contrast left ventriculography during invasive coronary angiography as a predictor of adverse events. J Cardiol 2016; 69:442-448. [PMID: 26896307 DOI: 10.1016/j.jjcc.2015.12.012] [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: 08/15/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND We propose the use of aortic annulus displacement (AAD) detected on contrast left ventriculography (LVG) during invasive coronary angiography as a marker of left ventricular (LV) long-axis shortening. In the present study, we aimed to investigate whether AAD is associated with adverse events in patients who underwent coronary angiography because of suspected coronary artery disease. METHODS In this retrospective study, we evaluated the medical records of 998 consecutive patients who underwent invasive coronary angiography and LVG. LV lengths were measured from the apex to the aortic valve insertion by using LVG images. AAD (%) was calculated as [(LV end-diastolic length-LV end-systolic length)/LV end-diastolic length]×100. RESULTS The participants' median age was 67 years. Ninety-six adverse events (composite events; all-cause death, 39; congestive heart failure, 21; late revascularization, 34; and myocardial infarction, 2) were observed during a median follow-up period of 3.1 years. In multivariate Cox regression analysis, adverse events were associated with lower AAD (hazard ratio, 0.703; p=0.002), after adjusting for traditional risk factors and coronary artery stenosis. The area under the curve of AAD for predicting adverse events was greater than that of LV ejection fraction (0.656 vs. 0.541, p<0.05). CONCLUSIONS AAD was superior to LV ejection fraction as a predictor of adverse events in patients with and without coronary arterial stenosis. AAD may be the optimal method for assessing longitudinal LV systolic function in the catheter laboratory.
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Affiliation(s)
- Shingo Kuwata
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kihei Yoneyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kengo Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kei Mizukoshi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kohei Koyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuki Ishibashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takanobu Mitarai
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ryo Kamijima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ken Kongoji
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoo Harada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
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Stembridge M, Ainslie PN, Donnelly J, MacLeod NT, Joshi S, Hughes MG, Sherpa K, Shave R. Cardiac structure and function in adolescent Sherpa; effect of habitual altitude and developmental stage. Am J Physiol Heart Circ Physiol 2016; 310:H740-6. [PMID: 26801313 DOI: 10.1152/ajpheart.00938.2015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/16/2016] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to examine ventricular structure and function in Sherpa adolescents to determine whether age-specific differences in oxygen saturation (SpO2 ) and pulmonary artery systolic pressure (PASP) influence cardiac adaptation to chronic hypoxia early in life. Two-dimensional, Doppler, and speckle-tracking echocardiography were performed on adolescent (9-16 yr) highland Sherpa (HLS; 3,840 m; n = 26) and compared with age-matched lowland Sherpa (LLS; 1,400 m; n = 10) and lowland Caucasian controls (LLC; sea level; n = 30). The HLS were subdivided into pre- and postadolescence; SpO2 was also recorded. Only HLS exhibited a smaller relative left ventricular (LV) end-diastolic volume; however, both HLS and LLS demonstrated a lower peak LV untwisting velocity compared with LLC (92 ± 26 and 100 ± 45 vs. 130 ± 43°/s, P < 0.05). Although SpO2 was similar between groups, PASP was higher in post- vs. preadolescent HLS (30 ± 5 vs. 25 ± 5 mmHg, P < 0.05), which negatively correlated with right ventricular strain rate (r = 0.50, P < 0.01). Much like their adult counterparts, HLS and LLS adolescents exhibit slower LV diastolic relaxation, despite residing at different altitudes. These findings suggest fundamental differences exist in the diastolic function of Sherpa that are present at an early age and may be retained after migration to lower altitudes. The higher PASP in postadolescent Sherpa is in contrast to previous reports of lowland children at high altitude and, unlike that in lowlanders, was not explained by differences in SpO2 ; thus different regulatory mechanisms seem to exist between these two distinct populations.
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Affiliation(s)
- Mike Stembridge
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom;
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan Campus, Kelowna, British Columbia, Canada
| | - Joseph Donnelly
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | | | - Suchita Joshi
- Patan Academy of Health Sciences, Kathmandu, Nepal; and
| | - Michael G Hughes
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
| | | | - Rob Shave
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
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Affiliation(s)
- Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Diane E. Spicer
- Department of Pediatric Cardiology, University of Florida
- Johns Hopkins All Children’s Heart Institute
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Kauer F, Geleijnse ML, Dalen BMV. Role of left ventricular twist mechanics in cardiomyopathies, dance of the helices. World J Cardiol 2015; 7:476-482. [PMID: 26322187 PMCID: PMC4549781 DOI: 10.4330/wjc.v7.i8.476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 02/09/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023] Open
Abstract
Left ventricular twist is an essential part of left ventricular function. Nevertheless, knowledge is limited in “the cardiology community” as it comes to twist mechanics. Fortunately the development of speckle tracking echocardiography, allowing accurate, reproducible and rapid bedside assessment of left ventricular twist, has boosted the interest in this important mechanical aspect of left ventricular deformation. Although the fundamental physiological role of left ventricular twist is undisputable, the clinical relevance of assessment of left ventricular twist in cardiomyopathies still needs to be established. The fact remains; analysis of left ventricular twist mechanics has already provided substantial pathophysiological understanding on a comprehensive variety of cardiomyopathies. It has become clear that increased left ventricular twist in for example hypertrophic cardiomyopathy may be an early sign of subendocardial (microvascular) dysfunction. Furthermore, decreased left ventricular twist may be caused by left ventricular dilatation or an extensive myocardial scar. Finally, the detection of left ventricular rigid body rotation in noncompaction cardiomyopathy may provide an indispensible method to objectively confirm this difficult diagnosis. All this endorses the value of left ventricular twist in the field of cardiomyopathies and may further encourage the implementation of left ventricular twist parameters in the “diagnostic toolbox” for cardiomyopathies.
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Stembridge M, Ainslie PN, Shave R. Short-term adaptation and chronic cardiac remodelling to high altitude in lowlander natives and Himalayan Sherpa. Exp Physiol 2014; 100:1242-6. [PMID: 26575341 DOI: 10.1113/expphysiol.2014.082503] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/13/2014] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the topic of this review? At high altitude, the cardiovascular system must adapt in order to meet the metabolic demand for oxygen. This review summarizes recent findings relating to short-term and life-long cardiac adaptation to high altitude in the context of exercise capacity. What advances does it highlight? Both Sherpa and lowlanders exhibit smaller left ventricular volumes at high altitude; however, myocardial relaxation, as evidenced by diastolic untwist, is reduced only in Sherpa, indicating that short-term hypoxia does not impair diastolic relaxation. Potential remodelling of systolic function, as evidenced by lower left ventricular systolic twist in Sherpa, may facilitate the requisite sea-level mechanical reserve required during exercise, although this remains to be confirmed. Both short-term and life-long high-altitude exposure challenge the cardiovascular system to meet the metabolic demand for O2 in a hypoxic environment. As the demand for O2 delivery increases during exercise, the circulatory component of oxygen transport is placed under additional stress. Acute adaptation and chronic remodelling of cardiac structure and function may occur to facilitate O2 delivery in lowlanders during sojourn to high altitude and in permanent highland residents. However, our understanding of cardiac structural and functional adaption in Sherpa remains confined to a higher maximal heart rate, lower pulmonary vascular resistance and no differences in resting cardiac output. Ventricular form and function are intrinsically linked through the left ventricular (LV) mechanics that facilitate efficient ejection, minimize myofibre stress during contraction and aid diastolic recoil. Recent examination of LV mechanics has allowed detailed insight into fundamental cardiac adaptation in high-altitude Sherpa. In this symposium report, we review recent advances in our understanding of LV function in both lowlanders and Sherpa at rest and discuss the potential consequences for exercise capacity. Collectively, data indicate chronic structural ventricular adaptation, with adult Sherpa having smaller absolute and relative LV size. Consistent with structural remodelling, cardiac mechanics also differ in Sherpa when compared with lowlanders at high altitude. These differences are characterized by a reduction in resting systolic deformation and slower diastolic untwisting, a surrogate of relaxation. These changes may reflect a functional cardiac adaptation that affords Sherpa the same mechanical reserve seen in lowlanders at sea level, which is absent when they ascend to high altitude.
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Affiliation(s)
- Mike Stembridge
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Rob Shave
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK
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Crendal E, Dutheil F, Naughton G, McDonald T, Obert P. Increased myocardial dysfunction, dyssynchrony, and epicardial fat across the lifespan in healthy males. BMC Cardiovasc Disord 2014; 14:95. [PMID: 25086592 PMCID: PMC4125345 DOI: 10.1186/1471-2261-14-95] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/23/2014] [Indexed: 12/26/2022] Open
Abstract
Background Evaluation of sensitive myocardial mechanics with speckle tracking echocardiography (STE) across the lifespan may reveal early indicators of cardiovascular disease (CVD) risk. Epicardial adipose tissue (EAT) and left ventricular (LV) myocardial dyssynchrony; subclinical risk-factors of CVD, are of particular clinical interest. However, the evolution of EAT and LV-dyssynchrony across the lifespan, and their influence on myocardial dysfunction remains unclear. We aimed to establish a profile of the healthy aging-heart using conventional, tissue-Doppler imaging (TDI) and speckle-tracking echocardiography (STE), while also exploring underlying contributions from EAT and LV-dyssynchrony towards LV myocardial mechanics, independent of blood biology. Methods Healthy males aged 19–94 years were recruited through University-wide advertisements in Victoria and New-South Wales, Australia. Following strict exclusion criteria, basic clinical and comprehensive echocardiographic profiles (conventional, TDI and STE) were established. LV-dyssynchrony was calculated from the maximum-delay of time-to-peak velocity/strain in the four LV-annulus sites (TDI), and six LV-segments (STE longitudinal and circumferential axes). Epicardial fat diameter was obtained from two-dimensional grey-scale images in the parasternal long-axis. Blood biological measures included glycemia, hsCRP, triglycerides, total cholesterol, high-density and low-density lipoprotein levels. Results Three groups of 15 were assigned to young (<40 years), middle (40–65 years), and older (>65) aged categories. Five participants were excluded from STE analyses due to inadequate image quality. Decreased longitudinal strain, increased circumferential apical strain and LV twist were age-related. Moreover, independent of blood biology, significant increases were observed across age categories for EAT (young: 2.5 ± 0.9 mm, middle: 3.9 ± 1.0 mm, older 5.7 ± 2.4 mm; p < 0.01), longitudinal STE-dyssynchrony (young: 42 ± 7.7 ms, middle: 58.8 ± 18.9 ms, older 88.6 ± 18.2 ms; p < 0.05), and circumferential-basal STE-dyssynchrony (young: 50.2 ± 20.5 ms, middle: 75.9 ± 20.6 ms, older 97.9 ± 20.2 ms; p < 0.05). These variables collectively explained 37% and 31% (p < 0.01) of longitudinal strain and LV twist, respectively. Conclusions This study enabled comprehensive profiling of LV mechanics at different stages of aging using sensitive echocardiographic technology. Novel findings included increased epicardial fat, and both longitudinal and circumferential LV-dyssynchrony across the healthy age groups. These factors may be key underlying contributors to myocardial dysfunction during aging, and their recognition may promote an advanced understanding of early signs of cardiovascular disease.
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Affiliation(s)
- Edward Crendal
- School of Exercise Science, Australian Catholic University, Locked Bag 4115, Fitzroy, MDC Victoria 3065, Australia.
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Stembridge M, Ainslie PN, Hughes MG, Stöhr EJ, Cotter JD, Nio AQX, Shave R. Ventricular structure, function, and mechanics at high altitude: chronic remodeling in Sherpa vs. short-term lowlander adaptation. J Appl Physiol (1985) 2014; 117:334-43. [PMID: 24876358 DOI: 10.1152/japplphysiol.00233.2014] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Short-term, high-altitude (HA) exposure raises pulmonary artery systolic pressure (PASP) and decreases left-ventricular (LV) volumes. However, relatively little is known of the long-term cardiac consequences of prolonged exposure in Sherpa, a highly adapted HA population. To investigate short-term adaptation and potential long-term cardiac remodeling, we studied ventricular structure and function in Sherpa at 5,050 m (n = 11; 31 ± 13 yr; mass 68 ± 10 kg; height 169 ± 6 cm) and lowlanders at sea level (SL) and following 10 ± 3 days at 5,050 m (n = 9; 34 ± 7 yr; mass 82 ± 10 kg; height 177 ± 6 cm) using conventional and speckle-tracking echocardiography. At HA, PASP was higher in Sherpa and lowlanders compared with lowlanders at SL (both P < 0.05). Sherpa had smaller right-ventricular (RV) and LV stroke volumes than lowlanders at SL with lower RV systolic strain (P < 0.05) but similar LV systolic mechanics. In contrast to LV systolic mechanics, LV diastolic, untwisting velocity was significantly lower in Sherpa compared with lowlanders at both SL and HA. After partial acclimatization, lowlanders demonstrated no change in the RV end-diastolic area; however, both RV strain and LV end-diastolic volume were reduced. In conclusion, short-term hypoxia induced a reduction in RV systolic function that was also evident in Sherpa following chronic exposure. We propose that this was consequent to a persistently higher PASP. In contrast to the RV, remodeling of LV volumes and normalization of systolic mechanics indicate structural and functional adaptation to HA. However, altered LV diastolic relaxation after chronic hypoxic exposure may reflect differential remodeling of systolic and diastolic LV function.
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Affiliation(s)
- Mike Stembridge
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom;
| | - Philip N Ainslie
- School of Health and Exercise Sciences, University of British Columbia Okanagan Campus, Kelowna, Canada; and
| | - Michael G Hughes
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Eric J Stöhr
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - James D Cotter
- School of Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Amanda Q X Nio
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Rob Shave
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
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Effects of non-dipper blood pressure pattern on left ventricular rotational mechanics in hypertensive patients with type 2 diabetes mellitus: a speckle tracking study. Int J Cardiovasc Imaging 2013; 30:57-65. [DOI: 10.1007/s10554-013-0296-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/15/2013] [Indexed: 11/24/2022]
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Westrup U, McEvoy FJ. Speckle tracking echocardiography in mature Irish Wolfhound dogs: technical feasibility, measurement error and reference intervals. Acta Vet Scand 2013; 55:41. [PMID: 23680023 PMCID: PMC3672081 DOI: 10.1186/1751-0147-55-41] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/10/2013] [Indexed: 01/19/2023] Open
Abstract
Background Two-dimensional strain measurements obtained by speckle tracking echocardiography (STE) have been reported in both humans and dogs. Incorporation of this technique into canine clinical practice requires the availability of measurements from clinically normal dogs, ideally of the same breed, taken under normal clinical conditions. The aims of this prospective study were to assess if it is possible to obtain STE data during a routine echocardiographic examination in Irish Wolfhound dogs and that these data will provide reference values and an estimation of measurement error. Methods Fifty- four healthy mature Irish Wolfhounds were used. These were scanned under normal clinical conditions to obtain in one session both standard echocardiographic parameters and STE data. Measurement error was determined separately in 5 healthy mature Irish Wolfhounds. Results Eight dogs were rejected by the software algorithm for reasons of image quality, resulting in a total of 46 dogs (85.2%) being included in the statistical analysis. In 46 dogs it was possible to obtain STE data from three scanning planes, as well as to measure the rotation of the left ventricle at two levels and thus calculate the torsion of the heart. The mean peak radial strain at the cardiac apex (RS-apex) was 45.1 ± 10.4% (n = 44), and the mean peak radial strain at the base (RS-base) was 36.9 ± 14.7% (n = 46). The mean peak circumferential strain at the apex (CS-apex) was -24.8 ± 6.2% (n = 44), and the mean peak circumferential strain at the heart base (CS-base) was -15.9 ± 3.2% (n = 44). The mean peak longitudinal strain (LS) was -16.2 ± 3.0% (n = 46). The calculated mean peak torsion of the heart was 11.6 ± 5.1 degrees (n = 45). The measurement error was 24.8%, 26.4%, 11.5%, 6.7%, 9.0% and 10 degrees, for RS-apex, RS-base, CS-apex, CS-base, LS and torsion, respectively. Conclusions It is concluded that this technique can be included in a normal echocardiographic examination in large breed dogs under clinical conditions. The usefulness of the reference values reported here, given their wide normal range, will ultimately be determined by the values that are obtained from a large numbers of diseased dogs.
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Reyhan M, Ennis DB. Quantitative assessment of systolic and diastolic left ventricular twist using Fourier Analysis of Stimulated echoes (FAST) and CSPAMM. J Magn Reson Imaging 2013; 37:678-83. [PMID: 23371791 DOI: 10.1002/jmri.23849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 08/30/2012] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate Fourier Analysis of Stimulated echoes (FAST) and CSPAMM for the quantification of left ventricular (LV) systolic and diastolic function and compare it with the previously validated FAST+SPAMM technique. MATERIALS AND METHODS LV short-axis tagged images were acquired with CSPAMM and SPAMM in healthy volunteers (n = 13). The FAST method was used to automatically estimate LV systolic and diastolic twist parameters from rotation of the stimulated echo and stimulated anti-echo about the middle of k-space subsequent to ∼3 min of user interaction. RESULTS There was no significant difference between measures obtained for FAST+CSPAMM and FAST+SPAMM for mean peak twist (13.5 ± 2.7° versus 11.9 ± 4.0°), torsion (3.4 ± 0.8°/cm versus 2.9 ± 1.0°/cm), twisting rate (76.8 ± 22.2°/s versus 68.2 ± 23.4°/s), untwisting rate (-102.7 ± 24.6°/s versus -106.6 ± 32.4°/s), normalized untwisting rate (-7.9 ± 2.2/s versus -9.9 ± 4.4/s), and time of peak twist (279 ± 23 ms versus 293 ± 25 ms) (all P > 0.01). FAST+CSPAMM also provided measures of duration of untwisting (148 ± 21 ms) and the ratio of rapid untwist to peak twist (0.8 ± 0.3). Bland-Altman analysis of FAST+CSPAMM and FAST+SPAMM twist data demonstrates excellent agreement with a bias of 1.1° and 95% confidence intervals of [-3.3°, 5.2°]. CONCLUSION FAST+CSPAMM is a semi-automated method that provides a quick and quantitative assessment of LV systolic and diastolic twist and torsion.
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Affiliation(s)
- Meral Reyhan
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California 90095-7206, USA.
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Reyhan M, Li M, Gupta H, Llyod SG, Dell'Italia LJ, Kim HJ, Denney TS, Ennis D. Left ventricular twist, but not circumferential-longitudinal shear angle, increases with increasing age in normal subjects. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559952 DOI: 10.1186/1532-429x-15-s1-p7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Machida H, Nunoda S, Shitakura K, Okajima K, Kubo Y, Hirata M, Kojima S, Ueno E, Otsuka K. Usefulness of left ventricular diastolic function assessed by magnetic resonance imaging over invasive coronary flow reserve measurement for detecting cardiac allograft vasculopathy in heart transplant recipients. Int J Cardiovasc Imaging 2012; 29:151-7. [DOI: 10.1007/s10554-012-0070-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 05/08/2012] [Indexed: 10/27/2022]
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Lee LS, Mariani JA, Sasson Z, Goodman JM. Exercise with a Twist: Left Ventricular Twist and Recoil in Healthy Young and Middle-Aged Men, and Middle-Aged Endurance-Trained Men. J Am Soc Echocardiogr 2012; 25:986-93. [DOI: 10.1016/j.echo.2012.05.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Indexed: 01/11/2023]
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A'roch R, Gustafsson U, Poelaert J, Johansson G, Haney M. Left ventricular twist is load-dependent as shown in a large animal model with controlled cardiac load. Cardiovasc Ultrasound 2012; 10:26. [PMID: 22731666 PMCID: PMC3488500 DOI: 10.1186/1476-7120-10-26] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 06/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left ventricular rotation and twist can be assessed noninvasively by speckle tracking echocardiography. We sought to characterize the effects of acute load change and change in inotropic state on rotation parameters as a measure of left ventricular (LV) contractility. METHODS Seven anesthetised juvenile pigs were studied, using direct measurement of left ventricular pressure and volume and simultaneous transthoracic echocardiography. Transient inflation of an inferior vena cava balloon (IVCB) catheter produced controlled load reduction. First and last beats in the sequence of eight were analysed with speckle tracking (STE) during the load alteration and analysed for change in rotation/twist during controlled load alteration at same contractile status. Two pharmacological inotropic interventions were also included to examine the same hypothesis in additionally conditions of increased and decreased myocardial contractility in each animal. Paired comparisons were made for different load states using the Wilcoxon's Signed Rank test. RESULTS The inferior vena cava balloon occlusion (IVCBO) load change compared for first to last beat resulted in LV twist increase (11.67° ±2.65° vs. 16.17° ±3.56° respectively, p < 0.004) during the load alteration and under adrenaline stimulation LV twist increase 12.56° ±5.1° vs. 16.57° ±4.6° (p < 0.013), and though increased, didn't reach significance in negative inotropic condition. Untwisting rate increased significantly at baseline from -41.7°/s ±41.6°/s vs.-122.6°/s ±55.8°/s (P < 0.039) and under adrenaline stimulation untwisting rate increased (-55.3°/s ±3.8°/s vs.-111.4°/s ±24.0°/s (p < 0.05), but did not systematically changed in negative inotropic condition. CONCLUSIONS Peak systolic LV twist and peak early diastolic untwisting rate are load dependent. Differences in LV load should be included in the interpretation when serial measures of twist are compared.
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Affiliation(s)
- Roman A'roch
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, University Hospital of Umeå, 90185, Umeå, Sweden.
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KOSIUK JEDRZEJ, VAN BELLE YVES, BODE KERSTIN, KORNEJ JELENA, ARYA ARASH, ROLF SASCHA, HUSSER DANIELA, HINDRICKS GERHARD, BOLLMANN ANDREAS. Left Ventricular Diastolic Dysfunction in Atrial Fibrillation: Predictors and Relation with Symptom Severity. J Cardiovasc Electrophysiol 2012; 23:1073-7. [DOI: 10.1111/j.1540-8167.2012.02368.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yamane K, Hirose H, Youdelman BA, Bogar LJ, Diehl JT. Conventional aortic valve replacement for elderly patients in the current era. Circ J 2011; 75:2692-8. [PMID: 21857141 DOI: 10.1253/circj.cj-11-0541] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Because of the rising expectation of prolonged life in the general population and the recent recognition of undertreated aortic valve disease in the elderly, updating the available results of aortic valve surgery is imperative, especially considering the rapid evolution of the transcatheter valve implantation procedure. METHODS AND RESULTS Between 1997 and 2010, 308 patients aged 70 years or older underwent aortic valve replacement (AVR) for aortic stenosis (AS). Short- and long-term results were analyzed and risk factors for long-term mortality were determined. Mean age was 78.5 years and 124 patients were aged 80 or older. Concomitant coronary artery bypass grafting (CABG) was performed in 46% of the cases. Mean left ventricular ejection fraction (LVEF) was 52%. Overall observed and expected operative mortality using the Society of Thoracic Surgeons-Predicted Risk of Mortality score was 3.9% and 4.8%, respectively. Overall survival rates at 1, 5, and 10 years were 88.6%, 71.6%, and 31.8%, respectively. Predictors of long-term mortality included diabetes; preoperative shock; LVEF ≤ 40%; New York Heart Association functional class III or IV; and age. CONCLUSIONS Short- and long-term results of conventional AVR in the elderly prove it to be durable and, especially in relatively low-risk patients and patients who require concomitant CABG, operative mortality is reasonably low. Conventional AVR ± CABG remains the gold standard for elderly patients with AS.
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Affiliation(s)
- Kentaro Yamane
- Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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Yaniv Y, Juhaszova M, Wang S, Fishbein KW, Zorov DB, Sollott SJ. Analysis of mitochondrial 3D-deformation in cardiomyocytes during active contraction reveals passive structural anisotropy of orthogonal short axes. PLoS One 2011; 6:e21985. [PMID: 21779362 PMCID: PMC3136939 DOI: 10.1371/journal.pone.0021985] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 06/13/2011] [Indexed: 11/19/2022] Open
Abstract
The cardiomyocyte cytoskeleton, composed of rigid and elastic elements, maintains the isolated cell in an elongated cylindrical shape with an elliptical cross-section, even during contraction-relaxation cycles. Cardiomyocyte mitochondria are micron-sized, fluid-filled passive spheres distributed throughout the cell in a crystal-like lattice, arranged in pairs sandwiched between the sarcomere contractile machinery, both longitudinally and radially. Their shape represents the extant 3-dimensional (3D) force-balance. We developed a novel method to examine mitochondrial 3D-deformation in response to contraction and relaxation to understand how dynamic forces are balanced inside cardiomyocytes. The variation in transmitted light intensity induced by the periodic lattice of myofilaments alternating with mitochondrial rows can be analyzed by Fourier transformation along a given cardiomyocyte axis to measure mitochondrial deformation along that axis. This technique enables precise detection of changes in dimension of ∼1% in ∼1 µm (long-axis) structures with 8 ms time-resolution. During active contraction (1 Hz stimulation), mitochondria deform along the length- and width-axes of the cell with similar deformation kinetics in both sarcomere and mitochondrial structures. However, significant deformation anisotropy (without hysteresis) was observed between the orthogonal short-axes (i.e., width and depth) of mitochondria during electrical stimulation. The same degree of deformation anisotropy was also found between the myocyte orthogonal short-axes during electrical stimulation. Therefore, the deformation of the mitochondria reflects the overall deformation of the cell, and the apparent stiffness and stress/strain characteristics of the cytoskeleton differ appreciably between the two cardiomyocyte orthogonal short-axes. This method may be applied to obtaining a better understanding of the dynamic force-balance inside cardiomyocytes and of changes in the spatial stiffness characteristics of the cytoskeleton that may accompany aging or pathological conditions.
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Affiliation(s)
- Yael Yaniv
- Laboratory of Cardiovascular Science, Gerontology Research Center, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Magdalena Juhaszova
- Laboratory of Cardiovascular Science, Gerontology Research Center, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Su Wang
- Laboratory of Cardiovascular Science, Gerontology Research Center, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Kenneth W. Fishbein
- Laboratory of Clinical Investigation, Gerontology Research Center, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Dmitry B. Zorov
- Laboratory of Cardiovascular Science, Gerontology Research Center, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Steven J. Sollott
- Laboratory of Cardiovascular Science, Gerontology Research Center, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
- * E-mail:
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Machida H, Nunoda S, Okajima K, Shitakura K, Sekikawa A, Kubo Y, Otsuka K, Hirata M, Kojima S, Ueno E. Magnetic resonance assessment of left ventricular diastolic dysfunction for detecting cardiac allograft vasculopathy in recipients of heart transplants. Int J Cardiovasc Imaging 2011; 28:555-62. [DOI: 10.1007/s10554-011-9853-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Accepted: 03/16/2011] [Indexed: 10/18/2022]
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Di Bella G, Minutoli F, Pingitore A, Zito C, Mazzeo A, Aquaro GD, Di Leo R, Recupero A, Stancanelli C, Baldari S, Vita G, Carerj S. Endocardial and epicardial deformations in cardiac amyloidosis and hypertrophic cardiomyopathy. Circ J 2011; 75:1200-8. [PMID: 21427499 DOI: 10.1253/circj.cj-10-0844] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of the present study was to analyze epicardial (EPI) and endocardial (ENDO) strain (S) in patients with transthyretin-related cardiac amyloidosis (TTR-CA) and hypertrophic cardiomyopathy (HCM) using echocardiography (TTE) with 2-dimensional feature tracking imaging (FTI). METHODS AND RESULTS Thirty-three subjects (11 with HCM, 11 with TTR-CA, and 11 healthy subjects as controls) with a New York Heart Association functional class ≤ II underwent conventional TTE and FTI. TTE was used for the evaluation of left ventricle (LV) wall thickness, mass, systolic and diastolic function. FTI was used for the evaluation of EPI and ENDO longitudinal, and circumferential, and radial S. LV wall thickness and mass were higher in both TTR-CA and HCM in comparison with controls (P < 0.001), but ejection fraction (EF) was similar among patients with TTR-CA, HCM and controls (63 ± 6%, 64 ± 6%, 61 ± 5%, respectively). ENDO and EPI longitudinal and circumferential S and radial S were significantly lower in HCM and TTR-CA when compared with controls (P < 0.01). No differences in EPI and ENDO longitudinal S, ENDO circumferential S and radial S were found between TTR-CA and HCM groups, while EPI circumferential S was significantly lower in the TTRCA group (6 ± 3.3%) than in the HCM group (8.1 ± 4.3%; P < 0.0001). CONCLUSIONS Longitudinal, circumferential and radial LV deformations are impaired in patients with TTR-CA and HCM with a preserved EF. Impairment of EPI circumferential strain is greater in TTR-CA than in HCM.
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Affiliation(s)
- Gianluca Di Bella
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Italy.
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Thompson RB, Paterson I, Chow K, Cheng-Baron J, Scott JM, Esch BT, Ennis DB, Haykowsky MJ. Characterization of the relationship between systolic shear strain and early diastolic shear strain rates: insights into torsional recoil. Am J Physiol Heart Circ Physiol 2010; 299:H898-907. [PMID: 20562339 DOI: 10.1152/ajpheart.00353.2010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Early diastolic left ventricular (LV) untwisting has been evaluated as a manifestation of LV recoil, reflecting the release of elastic energy stored during systole. The primary goal of this study was to characterize the relationship between systolic strain (e.g., circumferential strain and the shear strains that comprise twist) with the resulting early diastolic shear strain rates, including the rate of untwisting. A further goal was to characterize these relationships regionally from apical to basal locations. Cardiac magnetic resonance imaging tissue tagging was used to measure circumferential strain, global and regional (apex, mid, basal) twist (theta), and circumferential-longitudinal (epsilon(CL)) and circumferential-radial (epsilon(CR)) shear strains along with the corresponding untwisting rates (dtheta/dt) and diastolic shear strain rates (depsilon/dt) in 32 healthy males (33 +/- 7 yr). LV untwisting rates and shear strain rates measured during early diastole varied significantly with the measurement location from apex to base (P < 0.001) but demonstrated significant linear correlation with their corresponding preceding systolic strains (P < 0.001). Untwisting rates and diastolic shear strain rates were not significantly correlated with circumferential systolic strain or end-systolic volume (P > 0.05). Normalization of the untwisting rates to the peak twist (dtheta/dt(Norm) = -13.6 +/- 2.1 s(-1)) or shear strain rates to peak systolic shear strain (depsilon(CL)/dt(Norm) = -15.0 +/- 5.4 s(-1), and depsilon(CR)/dt(Norm) = -14.2 +/- 7.7 s(-1)) yielded a uniform measure of early diastolic function that was similar for all shear strain and twist components and for all locations from apex to base. These findings support a linear model of torsional recoil in the healthy heart, where diastolic shear strain rates (e.g., untwisting rates) are linearly related to the corresponding preceding systolic shear stain component. Furthermore, these findings suggest that torsional recoil is uncoupled from end-systolic volumes or the associated strains, such as circumferential strain.
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Affiliation(s)
- Richard B Thompson
- Dept. of Biomedical Engineering, 1082 Research Transition Facility, Univ. of Alberta, Edmonton, AB, T6G 2V2, Canada.
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Di Bella G, Gaeta M, Pingitore A, Oreto G, Zito C, Minutoli F, Anfuso C, Dattilo G, Lamari A, Coglitore S, Carerj S. Myocardial deformation in acute myocarditis with normal left ventricular wall motion--a cardiac magnetic resonance and 2-dimensional strain echocardiographic study. Circ J 2010; 74:1205-13. [PMID: 20453384 DOI: 10.1253/circj.cj-10-0017] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of our study was to assess longitudinal (L), circumferential (C) and radial (R) strain (S) of the left ventricle (LV) in patients with acute myocarditis and preserved LV wall motion. METHODS AND RESULTS Of the 26 male patients that were enrolled, 13 patients (26+/-8 years) suffered from acute myocarditis and 13 (25+/-2 years) were healthy participants (controls). Both patients and controls underwent cardiac magnetic resonance (CMR) and 2-dimensional S imaging (2D-S) echocardiography on the same day. Myocardial strains (RS, LS and CS) were quantified by 2D-S. In patients with myocarditis, a delayed enhancement (DE) CMR study was performed to identify damaged myocardial segments. In the myocarditis group there was a significant LS reduction compared with controls (-25+/-7 vs -20+/-7, P<0.0001), whereas no difference was found between the 2 groups concerning CS and RS. Subepicardial DE areas were found in 12 of 13 patients. Segments with DE showed a significantly lower LS in comparison with segments without DE (-19+/-4 vs -23+/-6, P<0.0001). In contrast, no difference in CS and RS was found when comparing segments with DE vs segments without DE. CONCLUSIONS In patients with acute myocarditis, evidence of subepicardial damage and no wall motion abnormalities, longitudinal deformation is diffusely impaired, whereas circumferential impairment is regionally sited in the areas of subepicardial damage.
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Affiliation(s)
- Gianluca Di Bella
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
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