Influence of wall stress and left ventricular geometry on the accuracy of dobutamine stress echocardiography

Yuda, Satoshi; Khoury, Vincent; Marwick, Thomas H.

doi:10.1016/s0735-1097(02)02105-8

Cited by 74 publications

(36 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regional ejection fraction showed a significant inverse correlation with regional loading, suggesting that regional mechanical performance decreases as regional wall stress increases (135). Inverse correlations between regional parameters of systolic function and wall stress were similarly reported in patients with first-reperfused MI (with use of 3-dimensional MRI) (38), in patients with known or suspected CAD (with use of echocardiography) (172), and in hypertensive patients with concentric remodeling (with use of echocardiography) (139). The explanation for such observations is unclear, and further studies are necessary to correctly interpret these correlations in patients presenting ischemic or hypertrophic territories, in which systolic function is also influenced by factors other than wall stress.…”

Section: Myocardial Wall Stressmentioning

confidence: 64%

“…The balance between the distinct patterns of myocardial response to these agents will modulate phenotypic outcome, for instance, mechanical performance and myocardial hypertrophy, which shows a varied geometric pattern in severe CAD (172). It may be speculated that the time course of these processes could be longer than for the other pathophysiological mechanisms that are thought to lead to mechanical dysfunction in severe CAD, such as wall stress and the tethering effect.…”

Section: Myocardial Expression and Release Of Auto-and Paracrine Agentsmentioning

confidence: 99%

See 1 more Smart Citation

Mechanisms leading to reversible mechanical dysfunction in severe CAD: alternatives to myocardial stunning

Mazzadi

André‐Fouët²,

Costes³

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

Croisille, Didier Revel, and Marc F. Janier. Mechanisms leading to reversible mechanical dysfunction in severe CAD: alternatives to myocardial stunning. Am J Physiol Heart Circ Physiol 291: H2570 -H2582, 2006. First published July 21, 2006 doi:10.1152/ajpheart.01249.2005.-Patients with severe chronic coronary artery disease (CAD) exhibit a highly altered myocardial pattern of perfusion, metabolism, and mechanical performance. In this context, the diagnosis of stunning remains elusive not only because of methodological and logistic considerations, but also because of the pathophysiological characteristics of the myocardium of these patients. In addition, a number of alternative pathophysiological mechanisms may act by mimicking the functional manifestations usually attributed to stunning. The present review describes three mechanisms that could theoretically lead to reversible mechanical dysfunction in these patients: myocardial wall stress, the tethering effect, and myocardial expression and release of auto-and paracrine agents. Attention is focused on the role of these mechanisms in scintigraphically "normal" regions (i.e., regions usually showing normal perfusion, glucose metabolism, and cellular integrity as assessed by nuclear imaging techniques), in which stunning is usually considered, but these mechanisms could also operate throughout the viable myocardium. We hypothesize that reversion of these three mechanisms could partially explain the unexpected functional benefit after reperfusion recently highlighted by high-spatial-resolution imaging techniques. stunned myocardium; hibernating myocardium; inotropic reserve; cardiac imaging; myocardial wall stress; ventricular remodeling SUMMARY OF CLINICAL PROBLEMIN RECENT YEARS, WIDESPREAD utilization of noninvasive cardiac imaging methods has greatly improved the synergy between clinical and basic investigation of cardiac ischemic pathophysiology. Thus imaging methods have shown that the reversible left ventricular (LV) dysfunction arising from brief coronary occlusion and reflow (myocardial stunning), first described in animal models (80), occurs in humans. Two major hypotheses explain this phenomenon: 1) the oxyradical hypothesis, which proposes that oxidant stress impairs LV function (18), and 2) the calcium hypothesis, which postulates that stunning results from disturbed myocyte calcium homeostasis (98). On the other hand, the hibernating myocardium (136, 137) was first discovered by imaging methods in humans, and it was originally defined as "resting LV dysfunction due to reduced coronary blood flow that can be partially or completely reversed by myocardial revascularization and/or by reducing myocardial oxygen demand" (136). The concept was refined when ultrastructural investigations showed a distinctive morphology for hibernating myocardium, generally without necrosis, but with loss of sarcomeres and myofibrils (suggesting a "dedifferentiation" process toward an embryonic phenotype), with loss of mitochondria and increased glycogen storage (9,19,27,162)...

show abstract

Section: Myocardial Wall Stressmentioning

confidence: 64%

Section: Myocardial Expression and Release Of Auto-and Paracrine Agentsmentioning

confidence: 99%

Mechanisms leading to reversible mechanical dysfunction in severe CAD: alternatives to myocardial stunning

Mazzadi

André‐Fouët²,

Costes³

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

show abstract

“…[6][7][8] Lower end-systolic wall stress has been implicated as a primary cause for reducing the sensitivity of DSE for detection of CAD. 9 One safe adjunct that has been used to increase the sensitivity of DSE for the detection of functionally significant CAD is the addition of isometric exercise in the form of sustained submaximal handgrip (HG) at peak DSE. 2 Several mechanisms have been implicated as causing the physiologic effects of handgrip.…”

Section: Introductionmentioning

confidence: 99%

Adjunctive handgrip during dobutamine stress echocardiography: Invasive assessment of myocardial oxygen consumption in humans

Khan

Otero

Font-Cordoba

et al. 2005

Clinical Cardiology

View full text Add to dashboard Cite

SummaryBackground: Adjunctive isometric exercise in the form of sustained submaximal handgrip (HG) is considered to increase the sensitivity of dobutamine stress echo (DSE) for detection of functionally significant coronary artery disease.Hypothesis: The study was undertaken to quantify invasively the impact of HG in humans on hemodynamics and myocardial oxygen consumption (MVO2) during DSE.Methods: An invasive hemodynamic evaluation was performed during DSE and with addition of adjunctive HG in 11 subjects. Coronary sinus (CS) blood flow, right-sided and systemic pressures, oxygen saturations, and transthoracic two-dimensional echocardiography were obtained at each 3-min stage and after adding HG at peak DSE. Myocardial oxygen consumption was calculated by the Fick method and circumferential end-systolic wall stress (ESWS) by Mirsky's formula.Results: At peak DSE, heart rate, left ventricular ejection fraction, CS flow, and MVO2 increased, whereas pulmonary capillary wedge pressure (PCWP) and circumferential endsystolic wall stress (ESWS) decreased from baseline. Com-

show abstract

“…Table II ), and the proportion of patients presenting with left ventricular hypertrophy (> 131 g/m 2 for males and > 100 g/m 2 for females) 8) decreased from baseline (61.0%; 47 patients) compared to week 16 (45.5%; 35 patients). LVMI significantly decreased (P = 0.001) in patients whose Hb levels reached 11.0 g/dL or higher, with significant correlation (P = 0.011) between the Hb levels and changes in the LVMI ( Figure 4A).…”

Section: Resultsmentioning

confidence: 99%

Effects of Anemia Correction by Erythropoiesis-Stimulating Agents on Cardiovascular Function in Non-Dialysis Patients With Chronic Kidney Disease

et al. 2012

View full text Add to dashboard Cite

SummaryAnemia is a significant risk factor for patients with chronic kidney disease (CKD). Here, we investigated the effects of anemia correction on cardiac functions in CKD patients. Pre-dialysis CKD patients (n = 171) without known risk factors for cardiovascular disease (CVD) other than CKD with hemoglobin (Hb) concentrations < 10.0 g/dL were enrolled for evaluation of cardiac functions and biomarkers before and after the 16-week treatment of erythropoiesis-stimulating agents. The treatment significantly increased Hb concentrations in all patients who completed the study (n = 143, 8.91 ± 0.87 versus 11.27 ± 1.31 g/dL; P < 0.001) and among patients whose echocardiograms were available for evaluation (n = 77, 8.92 ± 0.94 versus 11.24 ± 1.13 g/dL; P < 0.001). The left ventricular mass index (LVMI) was decreased (121.3 ± 25.8 versus 114.7 ± 25.1 g/m 2 , n = 77, P = 0.012) and significant correlation between the change in the LVMI and Hb concentration was noted (P = 0.011). The levels of B-type natriuretic peptide and human atrial natriuretic peptide, and the cardio-thoracic ratio were significantly increased among subjects with Hb concentrations < 11.0 g/dL at completion of the study. The changes in these parameters were significantly correlated with the Hb concentrations (P = 0.033, P = 0.011, and P < 0.001, respectively). No significant differences were observed in the electrocardiographic parameters. Correcting Hb levels higher than those conventionally recommended reduced left ventricular hypertrophy and myocardial stress, lowering risks for CVD in pre-dialysis CKD patients. (Int Heart J 2012; 53: 238-243)

show abstract

Influence of wall stress and left ventricular geometry on the accuracy of dobutamine stress echocardiography

Abstract: The accuracy of DSE is influenced by the LV geometric pattern and peak wall stress.

Cited by 74 publications

References 20 publications

Mechanisms leading to reversible mechanical dysfunction in severe CAD: alternatives to myocardial stunning

Mechanisms leading to reversible mechanical dysfunction in severe CAD: alternatives to myocardial stunning

Adjunctive handgrip during dobutamine stress echocardiography: Invasive assessment of myocardial oxygen consumption in humans

Effects of Anemia Correction by Erythropoiesis-Stimulating Agents on Cardiovascular Function in Non-Dialysis Patients With Chronic Kidney Disease

Contact Info

Product

Resources

About