Diastolic Dysfunction and Myocardial Energetics

Pouleur, H.; Hayashida, Wataru

doi:10.1007/978-1-4615-2594-3_27

Cited by 14 publications

(16 citation statements)

References 32 publications

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“…34 However, although the LV ejection performance is relatively preserved, LV diastolic function can be significantly compromised at this stage. 35 As the period of early myocardial relaxation is the most energy-demanding phase of the cardiac cycle, 36 even mild impairment of subendocardial function may lead to progressive slowing of the LV relaxation. This process is further compounded by gradual fibrosis of LV myocardium with the progression of the disease, which results in progressive loss of cardiac muscle resilience and worsening of LV diastolic function.…”

Section: Hf With Predominant Longitudinal Dysfunctionmentioning

confidence: 99%

Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction

Omar

Bansal

Sengupta

2016

Circulation Research

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Echocardiography, given its safety, easy availability, and the ability to permit a comprehensive assessment of cardiac structure and function, is an indispensable tool in the evaluation and management of patients with heart failure (HF). From initial phenotyping and risk stratification to providing vital data for guiding therapeutic decision-making and monitoring, echocardiography plays a pivotal role in the care of HF patients. The recent advent of multiparametric approaches for myocardial deformation imaging has provided valuable insights in the pathogenesis of HF, elucidating distinct patterns of myocardial dysfunction and events that are associated with progression from subclinical stage to overt HF. At the same time, miniaturization of echocardiography has further expanded clinical application of echocardiography, with the use of pocket cardiac ultrasound as an adjunct to physical examination demonstrated to improve diagnostic accuracy and risk stratification. Furthermore, ongoing advances in the field of big data analytics promise to create an exciting opportunity to operationalize precision medicine as the new approach to healthcare delivery that aims to individualize patient care by integrating data extracted from clinical, laboratory, echocardiographic, and genetic assessments. evidence supporting the diagnosis of HF. Echocardiography is the most commonly used modality for this purpose because of its ease of application, noninvasive nature, safety, and ability to provide a vast amount of information about cardiac structure and function. Additionally, echocardiography also plays an important role in guiding therapeutic decision-making and in monitoring response to therapy. Over the past 3 decades, numerous advancements have occurred in the field of echocardiography that have helped improve our understanding of the morpho-functional aberrations occurring in HF. This review summarizes the recent advances in echocardiography as applicable to the evaluation and management of HF. Classification of Heart FailureTo facilitate clinical management, several attempts have been made to divide HF patients into categories that unify them according to their dominant clinical presentations. Thus, HF has often been described as low output failure or high output failure; forward failure or backward failure; systolic HF or diastolic HF; HFrEF or HF with preserved ejection fraction (HFpEF); and so on. More recently, HF has also been classified according to alterations in the mechanical function of the left ventricle (LV; Table 1). 6The classification of HF into systolic or diastolic HF appeared to be intuitive, categorizing patients based on the primary pathogenic abnormality, that is, impairment of cardiac contractility or impairment of filling. However, this description has now been abandoned with the recognition that these 2 entities are not mutually exclusive and have considerable overlap. Significant LV diastolic dysfunction is a ubiquitous occurrence in patients with systolic HF, whereas systolic dysfunction...

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Section: Hf With Predominant Longitudinal Dysfunctionmentioning

confidence: 99%

Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction

Omar

Bansal

Sengupta

2016

Circulation Research

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“…1 Flow-limiting coronary stenosis causes inadequate delivery of myocardial energy supplies. 2 A decreased rate of energetically demanding calcium uptake by sarcoendoplasmic reticulum slows the decay of a calcium transient, [3][4][5][6] prolongs myocardial contraction, 7 and consequently delays the onset of regional relaxation. We have previously shown, in both an experimental 8,9 and clinical 10 setting, that a delayed onset of regional myocardial lengthening or thinning suggests an acutely developing ischemia.…”

mentioning

confidence: 99%

Delayed Onset of Subendocardial Diastolic Thinning at Rest Identifies Hypoperfused Myocardium

et al. 2005

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Background-Onset of myocardial relaxation is highly energy dependent. Perfusion and therefore energy substrate delivery are predominantly reduced in the subendocardial myocardium in the early stages of progressive ischemia. We hypothesized that delayed onset of subendocardial diastolic thinning will functionally identify regionally hypoperfused resting myocardium. Methods and Results-Progressive left anterior descending coronary artery stenosis was induced by an ameroid occluder and maintained for 1 or 2 weeks (end point) in 12 dogs. M-mode tissue Doppler images of the anterior apical and middle segments (testing region) and middle inferior segment (control region) were acquired selectively in the subendocardium and subepicardium. The time to the onset of thinning was measured with the use of tissue Doppler velocity (TOTv) and a thickness function (TOTt). At the end point in the testing region, myocardial flow was significantly lower in the subendocardial layer (PϽ0.05) in all animals, whereas viability staining showed preserved transmural viability in 10 dogs and thin subendocardial necrosis in 2 dogs. Both TOTv and TOTt were significantly (PϽ0.01) prolonged in the testing region. The mean difference between subendocardial and subepicardial TOTv values versus that in the control region identified the ischemic region, even when only dogs with hypoperfused but transmurally viable myocardium were considered (PϽ0.05). Systolic and diastolic myocardial velocities did not identify subendocardial hypoperfusion. Conclusions-In resting myocardium subtended to progressive coronary stenosis, a delayed onset of subendocardial thinning suggests an early stage of hypoperfusion, before the development of local wall motion abnormalities.

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“…( Left ventricular diastolic function may be abnormal at rest in patients with ischaemic heart disease' 2 and the abnormalities may be more pronounced during acute ischaemia. 34 During ischaemia, subendocardial blood flow is compromised earlier and to a greater extent than other layers and this territory is also subjected to the highest wall stress.5 6 Subendocardial myocytes are oriented along the long axis of the heart7 and contribute to the descent of the base of the heart towards the apex during systole, thus playing an important part in systolic ejection. During systole, elastic energy is stored in the myocardial wall.…”

mentioning

confidence: 99%

Regional myocardial velocity imaged by magnetic resonance in patients with ischaemic heart disease.

Karwatowski¹,

Mohiaddin²,

Yang³

et al. 1994

Heart

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Objective-To assess the pattern of global and regional left ventricular long axis motion during early diastole in patients with ischaemic heart disease with and without myocardial infarction using magnetic resonance velocity mapping. Design-Prospective study of 26 patients with a history of myocardial infarction (age 29-78, mean 55 years) and 21 patients with coronary artery disease without infarction (age range 39-71, mean 58 years). Values were compared with a control group (19 controls, age 35-76, mean 52 years) with a low likelihood of cardiovascular disease. Results-Regional long axis velocity varied with time and position around the ventricle. All measurements were taken at the time of maximum early diastolic long axis velocity. Patients with coronary artery disease without infarction had lower values for maximum (mean (SD)) (99 (30) v 125 (33) mm/s, P < 0.05) and mean peak early diastolic wall motion (63 (13) v 82 (22) mm/s, P < 0.05) than controls. The coefficient of variation showed greater inhomogeneity of relaxation in patients than in controls (38 (18)% v 27 (10)%). All values were lower in patients with previous infarction than in patients with coronary artery disease without infarction and normal subjects. In patients with previous myocardial infarction the maximum (mean (SD)) early diastolic velocity was 80 (22) mm/s (P < 0-01 compared with controls and P < 0 05 compared with patients without infarction) and the mean (SD) velocity was 47 (18) mm/s (P < 0-01 compared with controls).

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Diastolic Dysfunction and Myocardial Energetics

Cited by 14 publications

References 32 publications

Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction

Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction

Delayed Onset of Subendocardial Diastolic Thinning at Rest Identifies Hypoperfused Myocardium

Regional myocardial velocity imaged by magnetic resonance in patients with ischaemic heart disease.

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