Midwall ejection fraction for assessing systolic performance of the hypertrophic left ventricle

Yoshikawa, Hisao; Suzuki, Michitaka; Hashimoto, Go; Kusunose, Yukiko; Otsuka, Takenori; Nakamura, Masato; Sugi, Kaoru

doi:10.1186/1476-7120-10-45

Cited by 13 publications

(11 citation statements)

References 22 publications

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“…Systolic performance of the heart was assessed by EF and fractional shortening (FS) (MacIver et al, 2015 ). Patients with ventricular hypertrophy or hypertrophic cardiomyopathy showed decreased EF and FS (Yoshikawa et al, 2012 ). Results from the current study showed that decreased cardiac function (EF and FS) coupled with impaired ventricular end diastolic volume in both WT and Nrf2 −/− in response to CEE, suggest that CEE stress impairs cardiac function.…”

Section: Discussionmentioning

confidence: 99%

Chronic Endurance Exercise Impairs Cardiac Structure and Function in Middle-Aged Mice with Impaired Nrf2 Signaling

et al. 2017

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Nuclear factor erythroid 2 related factor 2 (Nrf2) signaling maintains the redox homeostasis and its activation is shown to suppress cardiac maladaptation. Earlier we reported that acute endurance exercise (2 days) evoked antioxidant cytoprotection in young WT animals but not in aged WT animals. However, the effect of repeated endurance exercise during biologic aging (WT) characterized by an inherent deterioration in Nrf2 signaling and pathological aging (pronounced oxidative susceptibility—Nrf2 absence) in the myocardium remains elusive. Thus, the purpose of our study was to determine the effect of chronic endurance exercise-induced cardiac adaptation in aged mice with and without Nrf2. Age-matched WT and Nrf2-null mice (Nrf2−/−) (>22 months) were subjected to 6 weeks chronic endurance exercise (25 meter/min, 12% grade). The myocardial redox status was assessed by expression of antioxidant defense genes and proteins along with immunochemical detection of DMPO-radical adduct, GSH-NEM, and total ubiquitination. Cardiac functions were assessed by echocardiography and electrocardiogram. At sedentary state, loss of Nrf2 resulted in significant downregulation of antioxidant gene expression (Nqo1, Ho1, Gclm, Cat, and Gst-α) with decreased GSH-NEM immuno-fluorescence signals. While Nrf2−/− mice subjected to CEE showed an either similar or more pronounced reduction in the transcript levels of Gclc, Nqo1, Gsr, and Gst-α in relation to WT littermates. In addition, the hearts of Nrf2−/− on CEE showed a substantial reduction in specific antioxidant proteins, G6PD and CAT along with decreased GSH, a pronounced increase in DMPO-adduct and the total ubiquitination levels. Further, CEE resulted in a significant upregulation of hypertrophy genes (Anf, Bnf, and β-Mhc) (p < 0.05) in the Nrf2−/− hearts in relation to WT mice. Moreover, the aged Nrf2−/− mice exhibited a higher degree of cardiac remodeling in association with a significant decrease in fractional shortening, pronounced ST segment, and J wave elevation upon CEE compared to age-matched WT littermates. In conclusion, our findings indicate that while the aged WT and Nrf2 knockout animals both exhibit hypertrophy after CEE, the older Nrf2 knockouts showed ventricular remodeling coupled with profound cardiac functional abnormalities and diastolic dysfunction.

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Section: Discussionmentioning

confidence: 99%

Chronic Endurance Exercise Impairs Cardiac Structure and Function in Middle-Aged Mice with Impaired Nrf2 Signaling

et al. 2017

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“…However, new indices and calculations partly overcome these limitations through the analysis of 2D and 3D midwall mechanics, introducing the concepts of 2D and 3D midwall EF. 125,126 Finally, advanced echocardiographic techniques are modifying the understanding of the hypertensive heart. Disturbances of longitudinal strain of the endocardial layer precedes the alteration of circumferential strain, which is attributed to the midwall layer.…”

Section: Midwall Functionmentioning

confidence: 99%

Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)†

Marwick

Gillebert

Aurigemma

et al. 2015

Journal of the American Society of Echocardiography

411

345

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Hypertension remains a major contributor to the global burden of disease. The measurement of blood pressure continues to have pitfalls related to both physiological aspects and acute variation. As the left ventricle (LV) remains one of the main target organs of hypertension, and echocardiographic measures of structure and function carry prognostic information in this setting, the development of a consensus position on the use of echocardiography in this setting is important. Recent developments in the assessment of LV hypertrophy and LV systolic and diastolic function have prompted the preparation of this document. The focus of this work is on the cardiovascular responses to hypertension rather than the diagnosis of secondary hypertension. Sections address the pathophysiology of the cardiac and vascular responses to hypertension, measurement of LV mass, geometry, and function, as well as effects of treatment.

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“…However, paradoxically, this hypertrophic remodeling is associated with worse outcome, even accounting for other risk factors (11)(12)(13)(14). Accordingly, data from several groups have proven that, in adults, subtle systolic dysfunction might be present in patients with LV hypertrophy before impairment is identified through the analysis of LV ejection fraction (15,16). The ability to identify early markers of LV dysfunction in CKD represents one of the main applications of echocardiography in preventing overt cardiac diseases of this high-risk pediatric population.…”

Section: Introductionmentioning

confidence: 99%

Advanced Parameters of Cardiac Mechanics in Children with CKD

Chinali

Matteucci²,

Franceschini

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Newer parameters of cardiac mechanics provide additional insights on cardiac dysfunction in adult patients with CKD. The aim of this study was to identify prevalence of subclinical abnormalities in cardiac function through the analysis of novel indices of cardiac mechanics in a large population of children with CKD.Design, setting, participants, & measurements Between 2009 and 2011, the prospective observational Cardiovascular Comorbidity in Children with CKD Study enrolled patients with CKD ages 6-17 years old with eGFR=10-45 ml/min per 1.73 m 2 in 14 European countries. Cardiac morphology and function were assessed through echocardiography. The analysis presented encompasses global radial, longitudinal, and circumferential strains as well as time to peak analysis. Data were compared with 61 healthy children with comparable age and sex.Results Data on 272 patients with CKD with complete echocardiographic assessment are reported (age =12.863.5 years old; 65% boys). Patients with CKD showed mildly higher office BP values and higher prevalence of left ventricular hypertrophy, but no differences were observed among groups in left ventricular ejection fraction. Strain analysis showed significantly lower global radial strain (29.6%613.3% versus 35.5%68.9%) and circumferential strain components (221.8%64.8% versus 228.2%65.0%; both P,0.05) in patients with CKD without significant differences observed in longitudinal strain (215.9%63.4% versus 216.2%63.7%). Lower values of global radial strain were associated with lower circumferential endocardial-to-epicardial gradient (r=0.51; P,0.01). This association remained significant after adjusting for BP, eGFR, and presence of left ventricular hypertrophy. Eventually, patients with CKD also showed higher delay in time to peak cardiac contraction (58628 versus 37618 milliseconds; P,0.05).Conclusions A significant proportion of children with CKD show impaired systolic mechanics. Impaired systolic function is characterized by lower radial strain, transmural circumferential gradient, and mild cardiac dyssynchrony. This study suggests that analysis of cardiac strain is feasible in a large multicenter study in children with CKD and provides additional information on cardiac pathophysiology of this high-risk population.

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Midwall ejection fraction for assessing systolic performance of the hypertrophic left ventricle

Cited by 13 publications

References 22 publications

Chronic Endurance Exercise Impairs Cardiac Structure and Function in Middle-Aged Mice with Impaired Nrf2 Signaling

Chronic Endurance Exercise Impairs Cardiac Structure and Function in Middle-Aged Mice with Impaired Nrf2 Signaling

Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)†

Advanced Parameters of Cardiac Mechanics in Children with CKD

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