Afterload induced changes in myocardial relaxation A mechanism for diastolic dysfunction

Leite‐Moreira, Adelino F.; Correia‐Pinto, Jorge; Gillebert, Thierry C.

doi:10.1016/s0008-6363(99)00099-1

Cited by 235 publications

(194 citation statements)

References 40 publications

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“…30 An impaired cardiac relaxation may cause elevation of LV DBP, which increase extravascular compression forces on the coronary arterioles resulting in increased coronary microcirculatory resistance and consequently to the reduction of coronary flow in the subendocardial layers. 31 Thus, enhanced wave reflections exert a negative impact on LV myocardial relaxation 32,33 and may cause subendocardial ischaemia. 11,32,34,35 Chronic subendocardial ischaemia has been associated with myocardial fibrosis and LV diastolic dysfunction.…”

Section: Association Of Cai and Aos With LV Diastolic Dysfunctionmentioning

confidence: 99%

Incremental value of arterial wave reflections in the determination of left ventricular diastolic dysfunction in untreated patients with essential hypertension

et al. 2008

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Systemic arterial stiffness is an indicator of cardiovascular disease and an independent marker of morbidity and cardiovascular mortality. We investigated the association of arterial wave reflections with left ventricular (LV) diastolic dysfunction and their incremental value to other determinants of LV diastolic dysfunction in patients with essential hypertension. In total 143 patients and 20 controls with similar atherosclerotic risk factors were examined by applanation tonometry of the radial artery (Sphygmocor) and echocardiography. Central augmentation index (CAI%) of reflected arterial waves as well as aortic strain (AoS) assessed by echocardiography were estimated. Doppler diastolic abnormalities were defined as proposed by the European Study Group on diastolic heart failure by measurement of E/A ratio (the ratio of the mitral inflow velocities), isovolumic relaxation time, deceleration time and flow propagation velocity. AoS and CAI were impaired in patients compared with controls (4.67 ± 2.94 vs 6.06 ± 4.91% and 145.8 ± 22.7 vs 135.7 ± 20.3%, Po0.01) as well as in patients with LV diastolic dysfunction compared to patients without, (5.52 ± 4.29 vs 10.73 ± 5.77% and 139.5 ± 21.7 vs 124.5 ± 17.0%, Po0.05). The odds ratio (OR) of AoS and CAI for diastolic dysfunction was OR:0.918, 95% confidence interval (CI):0.837-0.99, P ¼ 0.04 and OR:1.023, 95%CI: 1.023-1.040 P ¼ 0.010, respectively. The addition of CAI to the multivariable model including age, LV mass index, AoS and mean arterial pressure increased the power of the model for determination of LV diastolic dysfunction (À2 log likelihood ¼ 139.368, change of v 2 ¼ 4.2, P-value for change ¼ 0.04). In untreated patients with newly diagnosed essential hypertension, wave reflections are independent and additive determinants of LV diastolic dysfunction.

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Section: Association Of Cai and Aos With LV Diastolic Dysfunctionmentioning

confidence: 99%

Incremental value of arterial wave reflections in the determination of left ventricular diastolic dysfunction in untreated patients with essential hypertension

et al. 2008

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“…[30][31][32] It is possible that the contribution of afterload is underestimated in our study. Many studies, including our own, utilize compliance of the aorta or large proximal arteries as measures of afterload.…”

Section: Discussionmentioning

confidence: 99%

Proximal aortic compliance and diastolic function assessed by speckle tracking imaging

Gregory

Dobson

2013

Can J Anesth/J Can Anesth

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Purpose Speckle tracking imaging (STI) is a recent technique that evaluates an echocardiographic image throughout the cardiac cycle and provides dynamic variables such as tissue velocities and strain rates. The objective of our study was to determine 1) if STI can be used to quantify proximal aortic compliance and 2) if decreased aortic compliance determined by STI will reproduce the previously reported correlation with diastolic function. Methods This was a retrospective observational case series using previously obtained intraoperative transesophageal images. Diastolic performance was quantified by STI-based longitudinal velocities of the basal-septal and basal-lateral walls of the left ventricle in early diastole (LV E 0 ). Change in proximal aortic volume was calculated using STI to measure peak longitudinal and radial velocities in early diastole. After normalizing for mean arterial pressure, compliance was calculated and then compared with basal-septal and basal-lateral LV E 0 using single regression analysis.Results Twenty patients were included in our analysis. Linear regression of basal-septal LV E 0 and basal-lateral LV E 0 vs proximal aortic compliance during diastole each resulted in an R 2 value of 0.26 (P \ 0.05). Conclusion Speckle tracking can be used to describe the physical motion of the aortic wall and to calculate its compliance. We confirm that variation in diastolic function can be attributed, in part, to aortic compliance. Our novel approach of measuring compliance throughout the cardiac cycle, isolating radial and longitudinal contributions, and evaluating previously obtained images retrospectively provides advantages over previously reported measures of aortic compliance. Speckle tracking promises new insights into ventricular function, aortic mechanics, and the interaction between these structures. RésuméObjectif L'imagerie de suivi de pixel, ou speckle tracking imaging (STI) en anglais, est une technique re´cente qui permet d'e´valuer une image e´chocardiographique tout au long du cycle cardiaque et d'obtenir des variables dynamiques telles que les ve´locite´s tissulaires et les vitesses de de´formation. L'objectif de notre e´tude e´tait de de´terminer si 1) la STI pouvait eˆtre utilise´e pour quantifier la compliance de l'aorte proximale, et si 2) une compliance aortique re´duite telle que de´termine´e par la STI reproduisait la corre´lation avec la fonction diastolique rapporte´e pre´ce´demment. Méthode Cette e´tude est une se´rie de cas observationnelle re´trospective se fondant sur des images transoesophagiennes perope´ratoires obtenues par le passe´. La performance diastolique a e´te´quantifie´e par les ve´locite´s longitudinales fonde´es sur la STI des parois basales septales et basales late´rales du ventricule gauche en de´but de diastole (LV E 0 ). Les changements de volume de l'aorte proximale ont e´teć alcule´s à l'aide de la STI afin de mesurer les ve´locite´s

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“…15,16 These changes are also reflected by elevation in the end-systolic pressurevolume ratio accompanied by a rise in Ees and a reduction in stroke volume and further progression of the diastolic dysfunction via impaired and raised diastolic pressure. 17 Additionally, high Ees accompanied by diastolic dysfunction can increase myocardial oxygen consumption, thus limiting myocardial perfusion reserve. 15 Of interest, the results of this study showing no significant change in Ees in MHT vs. essential hypertension, which accords with the previous observation of preserved myocardial perfusion reserve in MHT despite impairment of endothelial dysfunction.…”

Section: Vascular Ventricular Coupling In Malignant Hypertensionmentioning

confidence: 99%

Vascular ventricular coupling in patients with malignant phase hypertension: the West Birmingham malignant hypertension project

et al. 2012

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Patients with malignant hypertension (MHT) have persistent vascular dysfunction and a much worse clinical prognosis than non-MHT hypertensive patients, despite good long-term blood pressure (BP) control. We hypothesized that abnormal arterial (arterial elastance (Ea); arterial elastance index (EaI)) and ventricular (End-systolic elastance (Ees) and End-diastolic elastance (Eed)) elastances are present in treated MHT patients, compared with non-MHT hypertensive controls. Echocardiographic parameters of cardiac and vascular stiffness (EaI, Ees and Eed) were quantified in patients with stable MHT and treated 'high-risk' hypertension patients (HHT, but non-MHT). All patients had well-controlled BP, with a median follow-up time for MHT of 144 months. Ea was calculated from stroke volume and systolic BP and adjusted by body area (EaI). Ees was calculated using systolic and diastolic BP, stroke volume, ejection fraction, time intervals and estimated normalized ventricular elastance at arterial end diastole. Eed was calculated from Doppler parameters and the diastolic filling volume. Both study groups had preserved left ventricular contractility, with no significant differences on 3D-echocardiography (P ¼ 0.10) There were no significant differences in EaI (P ¼ 0.83), Ees (P ¼ 0.32), Eed (P ¼ 0.23) and arterial-ventricular interaction (Ees/Ea, P ¼ 0.69). In the MHT group, Eed positively correlated with age (r ¼ 0.56, P ¼ 0.38) and systolic BP (r ¼ 0.68, P ¼ 0.008). On multivariable regression analysis, MHT status was not predictive of the ventricular and Ea. Despite documented vascular dysfunction in patients with previously diagnosed stable MHT, the arterial and systolic elastances were similar to HHT patients, suggesting that adequate BP control in MHT patients allows preservation or restoration of normal arterial-ventricular coupling.

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Afterload induced changes in myocardial relaxation A mechanism for diastolic dysfunction

Cited by 235 publications

References 40 publications

Incremental value of arterial wave reflections in the determination of left ventricular diastolic dysfunction in untreated patients with essential hypertension

Incremental value of arterial wave reflections in the determination of left ventricular diastolic dysfunction in untreated patients with essential hypertension

Proximal aortic compliance and diastolic function assessed by speckle tracking imaging

Vascular ventricular coupling in patients with malignant phase hypertension: the West Birmingham malignant hypertension project

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