Left ventricular ejection fraction is determined by both global myocardial strain and wall thickness

MacIver, David H.; Adeniran, Ismail; Zhang, Henggui

doi:10.1016/j.ijcha.2015.03.007

Cited by 46 publications

(51 citation statements)

References 55 publications

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“…Consequently, in a hypertrophied LV with elevated end-diastolic wall thickness, less endocardial displacement (the output from myocardial strain) may be required to achieve the same stroke volume. 23 Concentric remodelling and LVH: a spectrum or distinct entities?…”

Section: Left Ventricular Hypertrophymentioning

confidence: 99%

Comprehensive characterisation of hypertensive heart disease left ventricular phenotypes

Rodrigues

Amadu

Dastidar

et al. 2016

Heart

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ObjectiveMyocardial intracellular/extracellular structure and aortic function were assessed among hypertensive left ventricular (LV) phenotypes using cardiovascular magnetic resonance (CMR).MethodsAn observational study from consecutive tertiary hypertension clinic patients referred for CMR (1.5 T) was performed. Four LV phenotypes were defined: (1) normal with normal indexed LV mass (LVM) and LVM to volume ratio (M/V), (2) concentric remodelling with normal LVM but elevated M/V, (3) concentric LV hypertrophy (LVH) with elevated LVM but normal indexed end-diastolic volume (EDV) or (4) eccentric LVH with elevated LVM and EDV. Extracellular volume fraction was measured using T1-mapping. Circumferential strain was calculated by voxel-tracking. Aortic distensibility was derived from high-resolution aortic cines and contemporaneous blood pressure measurements.Results88 hypertensive patients (49±14 years, 57% men, systolic blood pressure (SBP): 167±30 mm Hg, diastolic blood pressure (DBP): 96±14 mm Hg) were compared with 29 age-matched/sex-matched controls (47±14 years, 59% men, SBP: 128±12 mm Hg, DBP: 79±10 mm Hg). LVH resulted from increased myocardial cell volume (eccentric LVH: 78±19 mL/m2 vs concentric LVH: 73±15 mL/m2 vs concentric remodelling: 55±9 mL/m2, p<0.05, respectively) and interstitial fibrosis (eccentric LVH: 33±10 mL/m2 vs concentric LVH: 30±10 mL/m2 vs concentricremodelling: 19±2 mL/m2, p<0.05, respectively). LVH had worst circumferential impairment (eccentric LVH: −12.8±4.6% vs concentric LVH: −15.5±3.1% vs concentric remodelling: –17.1±3.2%, p<0.05, respectively). Concentric remodelling was associated with reduced aortic distensibility, but not with large intracellular/interstitial expansion or myocardial dysfunction versus controls.ConclusionsMyocardial interstitial fibrosis varies across hypertensive LV phenotypes with functional consequences. Eccentric LVH has the most fibrosis and systolic impairment. Concentric remodelling is only associated with abnormal aortic function. Understanding these differences may help tailor future antihypertensive treatments.

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Section: Left Ventricular Hypertrophymentioning

confidence: 99%

Comprehensive characterisation of hypertensive heart disease left ventricular phenotypes

Rodrigues

Amadu

Dastidar

et al. 2016

Heart

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“…In light of the limitations, our calculations should be considered only as improved approximations and, in our view, the trends observed and concepts described are likely to be valid and concordant with recent modeling studies. 42…”

Section: Limitationsmentioning

confidence: 99%

The Relationship Between Left Ventricular Wall Thickness, Myocardial Shortening, and Ejection Fraction in Hypertensive Heart Disease: Insights From Cardiac Magnetic Resonance Imaging

Rodrigues

Rohan

Trickey

et al. 2016

J of Clinical Hypertension

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Hypertensive heart disease is often associated with a preserved left ventricular ejection fraction despite impaired myocardial shortening. The authors investigated this paradox in 55 hypertensive patients (52±13 years, 58% male) and 32 age‐ and sex‐matched normotensive control patients (49±11 years, 56% male) who underwent cardiac magnetic resonance imaging at 1.5T. Long‐axis shortening (R=0.62), midwall fractional shortening (R=0.68), and radial strain (R=0.48) all decreased (P<.001) as end‐diastolic wall thickness increased. However, absolute wall thickening (defined as end‐systolic minus end‐diastolic wall thickness) was maintained, despite the reduced myocardial shortening. Absolute wall thickening correlated with ejection fraction (R=0.70, P<.0001). In multiple linear regression analysis, increasing wall thickness by 1 mm independently increased ejection fraction by 3.43 percentage points (adjusted β‐coefficient: 3.43 [2.60–4.26], P<.0001). Increasing end‐diastolic wall thickness augments ejection fraction through preservation of absolute wall thickening. Left ventricular ejection fraction should not be used in patients with hypertensive heart disease without correction for degree of hypertrophy.

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“…Left ventricular ejection fraction is determined by both myocardial strain and wall thickness, which can increase with the increased strain and wall thickness, and even if the strain decreases, it could keep constant because of increased wall thickness [28][29][30]. Wall thickness is determined by enddiastolic wall thickness and radial thickening (ie radial strain), it has a substantial influence on ejection fraction: a 1 centimeter increase in thickness increased ejection fraction by approximately 13 percentage points [29,30].…”

Section: Discussionmentioning

confidence: 99%

Effect of pericardial incision on left ventricular morphology and systolic function in patients during coronary artery bypass grafting

Liu

Meng

Wang

et al. 2020

Preprint

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Background: Accurate assessment of left ventricular (LV) systolic function is important after coronary artery bypass grafting (CABG). LV ejection fraction (LVEF) is conventionally used to evaluate LV systolic function; deformation parameters can be used to detect subtle LV systolic dysfunction. It is unclear whether an incised pericardium without sutures during CABG could affect LV morphology and function. We investigated the effect of pericardial incision on LV morphology and systolic function during CABG. Methods: Intraoperative transesophageal echocardiography was performed in 27 patients during elective CABG 5 minutes before and after pericardial incision. LV longitudinal and mid-cavity transversal diameters, sphericity index, volumes, and LVEF were measured. LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and twist obtained by two-dimensional speckle tracking echocardiography were measured simultaneously. Results: LV mid-cavity transversal diameter increased, while the LV sphericity index decreased (P<0.001) immediately after pericardial incision. The GLS, GCS, and twist significantly decreased, while the GRS notably increased (P<0.001). The LV volumes and LVEF remained unchanged. The SYNTAX score was an independent predictor of reduction of GLS by >15% immediately after pericardial incision (P<0.001). Conclusions: Pericardial incision immediately transformed LV morphology from an ellipsoid to sphere, with decreased longitudinal and circumferential strain and twist, and increased radial strain, while LVEF remained unchanged. This should be considered when evaluating LV systolic function in patients after CABG, especially in those with a lower SYNTAX score.

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Left ventricular ejection fraction is determined by both global myocardial strain and wall thickness

Cited by 46 publications

References 55 publications

Comprehensive characterisation of hypertensive heart disease left ventricular phenotypes

Comprehensive characterisation of hypertensive heart disease left ventricular phenotypes

The Relationship Between Left Ventricular Wall Thickness, Myocardial Shortening, and Ejection Fraction in Hypertensive Heart Disease: Insights From Cardiac Magnetic Resonance Imaging

Effect of pericardial incision on left ventricular morphology and systolic function in patients during coronary artery bypass grafting

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