Effects of the reduction of preload on left and right ventricular myocardial velocities analyzed by Doppler tissue echocardiography in healthy subjects

Pelà, Giovanna; Regolisti, Giuseppe; Coghi, Pietro; Cabassi, Aderville; Basile, Alberico; Cavatorta, A; Manca, C; Borghetti, A

doi:10.1016/j.euje.2003.10.001

Cited by 88 publications

(87 citation statements)

References 30 publications

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“…6 On the other hand, S' velocity was reduced following preload reduction in healthy subjects. 23 It is likely that the S' velocity is an indicator of performance in relation to the speed at which a certain amount of work is performed, which is dependent on both load and inotropy. In our study, the S' velocity was measured using speckle tracking.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of TAPSE as a measure of right ventricular output

Tousignant

Kim

Papa

et al. 2012

Can J Anesth/J Can Anesth

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Purpose This study was designed to show the relationship between tricuspid annular plane systolic excursion (TAPSE) and stroke volume (SV) by thermodilution using three different methods and also to assess whether TAPSE can track hemodynamic changes associated with volume loading and ephedrine administration. Methods This was an observational study in 61 elective patients with a pulmonary artery catheter who were undergoing coronary artery bypass graft surgery in a cardiac surgical centre. We measured TAPSE by three methods using transesophageal echocardiography: M mode, speckle tracking at the lateral wall, and tissue tracking at the inferior wall. There were two interventions: leg raising (volume recruitment) or administration of ephedrine 5 mg iv. Echo and hemodynamic measurements were performed before and after each intervention.Results Eleven patients were excluded due to poor imaging. There were 26 patients in the leg raising group and 24 patients in the ephedrine group. The correlation coefficient between stroke volume (SV) and TAPSE by M mode, speckle tracking, and tissue tracking was 0.48, 0.44, and 0.09, respectively. There was a significant increase in SV following each intervention; however, the changes in TAPSE by any method and velocity were not large enough to reach statistical significance. Conclusion Tricuspid annular plane systolic excursion by M mode and by speckle tracking correlates modestly with SV. There was no correlation between TAPSE and SV by tissue tracking at the inferior wall of the right ventricle. Tricuspid annular plane systolic excursion by M mode and by speckle tracking does not track changes in SV following either volume loading or ephedrine administration. RésuméObjectif Cette e´tude a e´te´conçue pour montrer le rapport entre le de´placement systolique du plan de l'anneau tricuspidien (TAPSE) avec le volume d'e´jection systolique (SV) par thermodilution en utilisant trois me´thodes diffe´rentes et aussi pour de´terminer si le TAPSE peut suivre les modifications he´modynamiques associe´es a`une charge volumique et a`une administration d'e´phe´drine. Méthodes Il s'agit d'une e´tude observationnelle mene´e chez 61 patients se´lectionne´s porteurs d'un cathe´ter de l'arte`re pulmonaire qui devaient subir un pontage coronarien dans un centre de chirurgie cardiaque. Nous avons mesure´le TAPSE par trois me´thodes diffe´rentes al 'aide d'une e´chocardiographie transoesophagienne: mode M;suivi de granularite´s (speckle tracking) sur la paroi late´rale; et suivi de tissu (tissue tracking) sur la paroi infe´rieure. Il y a eu deux interventions: jambes releve´es

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Section: Discussionmentioning

confidence: 99%

Evaluation of TAPSE as a measure of right ventricular output

Tousignant

Kim

Papa

et al. 2012

Can J Anesth/J Can Anesth

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“…Early mitral inflow velocity and early annular tissue velocity are preload dependent, with significant decreases in early mitral inflow velocity (4, 30) and early annular tissue velocity (7,16,22) accompanying reductions in preload. In the present study, HUT and HUT heat stress reduced early inflow and annular tissue velocities.…”

Section: Diastolic Functionmentioning

confidence: 99%

Left ventricular systolic and diastolic function during tilt-table positioning and passive heat stress in humans

Nelson

Altamirano-Diaz

Petersen

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

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The ventricular response to passive heat stress has predominantly been studied in the supine position. It is presently unclear how acute changes in venous return influence ventricular function during heat stress. To address this question, left ventricular (LV) systolic and diastolic function were studied in 17 healthy men (24.3 Ϯ 4.0 yr; mean Ϯ SD), using two-dimensional transthoracic echocardiography with Doppler ultrasound, during tilt-table positioning (supine, 30°h ead-up tilt, and 30°head-down tilt), under normothermic and passive heat stress (core temperature 0.8 Ϯ 0.1°C above baseline) conditions. The supine heat stress LV volumetric and functional response was consistent with previous reports. Combining head-up tilt with heat stress reduced end-diastolic (25.2 Ϯ 4.1%) and end-systolic (65.4 Ϯ 10.5%) volume from baseline, whereas heart rate (37.7 Ϯ 2.0%), ejection fraction (9.4 Ϯ 2.4%), and LV elastance (37.7 Ϯ 3.6%) increased, and stroke volume (Ϫ28.6 Ϯ 9.4%) and early diastolic inflow (Ϫ17.5 Ϯ 6.5%) and annular tissue (Ϫ35.6 Ϯ 7.0%) velocities were reduced. Combining head-down tilt with heat stress restored end-diastolic volume, whereas LV elastance (16.8 Ϯ 3.2%), ejection fraction (7.2 Ϯ 2.1%), and systolic annular tissue velocities (22.4 Ϯ 5.0%) remained elevated above baseline, and end-systolic volume was reduced (Ϫ15.3 Ϯ 3.9%). Stroke volume and the early and late diastolic inflow and annular tissue velocities were unchanged from baseline. This investigation extends previous work by demonstrating increased LV systolic function with heat stress, under varied levels of venous return, and highlights the preload dependency of early diastolic function during passive heat stress. tilt table; systolic function; left ventricle WHOLE BODY PASSIVE HEAT STRESS results in multiple cardiovascular and neural adjustments, including increases in cardiac output (14,17,29), cutaneous vascular conductance (2, 5), splanchnic and renal sympathetic vasoconstriction (15,26,28), and muscle sympathetic nerve activity (6,19). These responses occur in a coordinated effort to redistribute cardiac output to the cutaneous circulation, limit the reduction in blood pressure, and protect against syncope.In the supine heat-stressed individual, left ventricular (LV) end-diastolic volume is significantly reduced compared with normothermic conditions (17,18,34), along with reductions in central blood volume (5) and cardiac filling pressures (3,27,34,37). Despite this significant reduction in preload, stroke volume (SV) is maintained during passive heating (14,15,17,18,23,37), secondary to increased ventricular contractility (2,5,17,18) and ventricular diastolic suction (17, 18). While supine measures are helpful, an important and understudied issue is what happens when blood pressure control mechanisms are challenged during orthostasis. Likewise, because supine heat stress significantly reduces cardiac preload, an equally important issue is what happens to cardiac function when preload is restored.Passive postural changes by tilt-table...

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“…It is well known that reductions in venous return and thus filling pressures will significantly reduce both early mitral inflow velocity and mitral annular velocities (11,20,26,29). Mild unloading (Ϫ30 mmHg of lower body negative pressure) has been shown to reduce E wave velocities from 77 to 53 cm/s and E= in the lateral wall from 15.0 to 10.1 cm/s (11).…”

Section: Diastolic Function During Passive Hsmentioning

confidence: 99%

Increased left ventricular twist, untwisting rates, and suction maintain global diastolic function during passive heat stress in humans

Nelson¹,

Haykowsky

Petersen³

et al. 2010

American Journal of Physiology-Heart and Circulatory Physiology

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Nelson MD, Haykowsky MJ, Petersen SR, DeLorey DS, ChengBaron J, Thompson RB. Increased left ventricular twist, untwisting rates, and suction maintain global diastolic function during passive heat stress in humans. Am J Physiol Heart Circ Physiol 298: H930-H937, 2010. First published January 8, 2010 doi:10.1152/ajpheart.00987.2009 systolic function increases with passive heat stress (HS); however, less is known about diastolic function. Eight healthy subjects (24.0 Ϯ 2.0 yr of age) underwent whole body passive heating ϳ1°C above baseline (BL). Cardiac magnetic resonance imaging was used to measure biventricular volumes, function, filling velocities, volumetric flow rates, and LV twist and strain at BL and after 45 min of HS. Passive heating reduced left atrial volume (Ϫ17.6 Ϯ 11.7 ml, P Ͻ 0.05), right and LV end-diastolic volumes (Ϫ22.7 Ϯ 11.0 and Ϫ25.7 Ϯ 24.9 ml, respectively; P Ͻ 0.05), and LV stroke volume (Ϫ6.7 Ϯ 6.8 ml, P Ͻ 0.05) from BL. LV ejection fraction (EF), end-systolic elastance, septal and lateral mitral annular systolic velocities, circumferential strain, and peak LV twist increased with HS (P Ͻ 0.05). Right ventricular stroke volume, EF, and systolic tissue velocities were unchanged with HS (P Ͼ 0.05). Early LV diastolic tissue and blood velocities and strain rates were maintained with HS, whereas untwisting rate increased significantly from 166.4 Ϯ 46.9 to 268.7 Ϯ 76.8°/s (P Ͻ 0.05). The major novel finding of this study was that, secondary to an increase in peak LV twist and untwisting rate, early diastolic blood and tissue velocities and strain rates are maintained despite a reduction in filling pressure.hyperthermia; cardiac magnetic resonance imaging; biventricular function DURING PASSIVE HEAT STRESS (HS), cutaneous vascular conductance increases to augment skin blood flow to facilitate heat loss (3, 34). To maintain blood pressure and tissue oxygen delivery, cardiac output rises (17,18,33,34,41,42), and efferent sympathetic nerve activity increases to noncutaneous vascular beds (32), redistributing blood flow away from skeletal muscle (21) and splanchnic vascular beds (7,18,34,35) toward the skin. Secondary to this redistribution of blood flow, thoracic blood volume and central venous pressure is also reduced significantly (17,28,34,41,42).The effects of reduced cardiac filling pressure on ventricular function remain unclear. A recent study reported that early diastolic filling and mitral tissue velocities are maintained during HS (3), suggesting that early diastolic function is maintained despite reduced cardiac filling pressures. However, the effect on left ventricular (LV) end-diastolic volume remains equivocal, since previous studies have shown it decreases (41) or remains unchanged (7) during passive HS.The development of minimum LV pressure is a function of active relaxation and elastic recoil of the LV (13,22). During systole, basal-to-apical rotation of the LV (twisting) serves to augment stroke volume, whereas, in addition, systolic torsional deformation produces potential energy ...

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Effects of the reduction of preload on left and right ventricular myocardial velocities analyzed by Doppler tissue echocardiography in healthy subjects

Abstract: In this study, myocardial E', A' and S' velocities, in both the left and the right ventricle, were significantly affected by preload in healthy subjects. Our results support the usefulness of the E'/A' ratio as a relatively load-independent index of diastolic function.

Cited by 88 publications

References 30 publications

Evaluation of TAPSE as a measure of right ventricular output

Evaluation of TAPSE as a measure of right ventricular output

Left ventricular systolic and diastolic function during tilt-table positioning and passive heat stress in humans

Increased left ventricular twist, untwisting rates, and suction maintain global diastolic function during passive heat stress in humans

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