Noninvasive Assessment of Wall Distensibility With the Evaluation of Diastolic Epicardial Movement

Takeda, Yasuharu; Sakata, Yasushi; Higashimori, Mitsuru; Mano, Toshiaki; Nishio, Makoto; Ohtani, Tomohito; Hori, Masatsugu; Masuyama, Tohru; Kaneko, Makoto; Yamamoto, Keiji

doi:10.1016/j.cardfail.2008.09.004

Cited by 66 publications

(132 citation statements)

References 21 publications

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“…DWS is reflective of resistance to myocardial deformation during diastole and thus myocardial diastolic stiffness 16, 17. Impairment in diastolic function has been suggested in the pediatric Fontan population as well2 and may be related to the impact of the pre‐Fontan arterial hypoxia and volume overload, surgical procedures, renin‐angiotensin‐aldosterone system activation, inflammation, and other end‐organ dysfunction 1, 2, 35, 36.…”

Section: Discussionmentioning

confidence: 99%

Ventricular‐Arterial Function and Coupling in the Adult Fontan Circulation

Saiki

Eidem

Ohtani

et al. 2016

JAHA

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BackgroundIn adult Fontan patients, ventricular or arterial dysfunction may impact homeostasis of the Fontan circulation and predispose to heart failure. We sought to characterize ventricular‐arterial (VA) properties in adult Fontan patients.Methods and ResultsAdult Fontan patients (n=170), including those with right (SRV, n=57) and left (SLV, n=113) dominant ventricular morphology, were compared to age, sex, and body size matched controls (n=170). Arterial function, load‐insensitive measures of contractility, VA coupling, diastolic function, and ventricular efficiency were assessed. Compared to controls, Fontan patients had similar arterial (Ea), but lower end‐systolic ventricular (Ees), elastance, preload recruitable stroke work and peak power index, impaired VA coupling, eccentric remodeling, reduced ventricular efficiency and increased diastolic stiffness (P<0.05 for all). Ventricular efficiency declined steeply with higher heart rate in Fontan, but not control, patients. Among Fontan patients (n=123) and controls (n=162) with preserved cardiac index (CI; ≥2.5 L/min per m2), Fontan patients had worse contractility than controls, but CI was preserved owing to relative tachycardia, lower afterload, and eccentric remodeling. However, 25% of Fontan patients had reduced CI and were distinguished from those with preserved CI by less‐eccentric remodeling and worse diastolic function, rather than more‐impaired contractility.ConclusionsAdult Fontan patients have contractile and diastolic dysfunction with normal afterload, impaired VA coupling, and reduced ventricular efficiency with heightened sensitivity to heart rate. Maintenance of CI is dependent on lower afterload, eccentric remodeling, and relative preservation of diastolic function. These data contribute to our understanding of circulatory physiology in adult Fontan patients.

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Section: Discussionmentioning

confidence: 99%

Ventricular‐Arterial Function and Coupling in the Adult Fontan Circulation

Saiki

Eidem

Ohtani

et al. 2016

JAHA

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“…8) DWS, an extension of linear elastic theory, uses the difference between PWs and PWd to approximate LV stiffness, where decreased wall thinning during diastole reflects reduced LV compliance and distensibility, and thus, increased LV stiffness. 7) DWS is a feasible and simple calculation that does not require complex analysis. DWS correlated well with the diastolic stiffness constant measured invasively in an animal model.…”

Section: Discussionmentioning

confidence: 99%

“…14) As previously illustrated, DWS was calculated using the formula: DWS = (PWs -PWd)/PWs, where PWs is the PW thickness at endsystole and PWd is the PW thickness at end-diastole using Mmode echocardiography. 7,8) The peak velocities of early (E) and late (A) filling waves, the E/A ratio of peak velocities, and the deceleration time of the E-wave were measured from transmitral flow velocities. The early diastolic mitral annular velocity of the septal and lateral mitral annulus (e' velocity) was obtained by tissue Doppler imaging and the E/e' ratio was calculated.…”

Section: Stiffness In Patients At Risk For Hfmentioning

confidence: 99%

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Prognostic Impact of Diastolic Wall Strain in Patients at Risk for Heart Failure

et al. 2017

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SummaryDiastolic wall strain (DWS) is based on the linear elastic theory, according to which decreased wall thinning during diastole reflects reduced left ventricular compliance and thus increased diastolic stiffness. Increased diastolic stiffness as assessed by DWS is associated with a worse prognosis in patients who have heart failure (HF) with preserved ejection fraction. However, there are no data about the prognostic value of DWS derived by M-mode echocardiography in patients at risk for HF. We retrospectively enrolled 1829 consecutive patients without prior HF who were hospitalized for cardiovascular (CV) diseases in our hospital between 2005 and 2012. Patients were divided into two groups stratified by DWS (median value 0.34). The study endpoint was the composite of major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, and hospitalization for HF. Over a 4.2-year median follow-up, adverse events were observed in 322 patients (17.6%). In Kaplan-Meier analysis, patients with low DWS (≤ 0.34, n = 915) showed worse prognoses than those with high DWS (> 0.34, n = 914) (MACE incidence 39.4% versus 31.9%, P = 0.011). In multivariate Cox proportional hazards analysis after the adjustment for age, sex, and echocardiographic parameters, low DWS (≤ 0.34) was significantly associated with the incidence of MACE (hazard ratio: 1.26, 95% confidence interval: 1.01-1.59; P = 0 .045). In patients without prior HF, DWS is an independent predictor of MACE. Simple assessment of DWS might improve risk stratification for CV events in those patients. (Int Heart J 2017; 58: 250-256)

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“…16,17 The pulsed Doppler transmitral flow velocity curve was recorded to measure E/A, DT and IRT. 20 Mean carotid intima-media thickness (mean IMT) and plaque score were calculated as previously described. 21,22 These recordings and measurements were performed by sonographers from Advanced Harmonic Information Technology , Osaka, Japan, who were unaware of the study group assignment.…”

Section: Data Collectionmentioning

confidence: 99%

The Effect of Losartan and Amlodipine on Left Ventricular Diastolic Function and Atherosclerosis in Japanese Patients with Mild-to-Moderate Hypertension (J-ELAN) study

Yamamoto

Ozaki²,

Takayasu

et al. 2010

Hypertens Res

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This study was a prospective, randomized, open, blinded endpoint study to assess the effects of angiotensin II type 1 receptor blocker, losartan, compared with calcium channel blocker, amlodipine, on left ventricular (LV) diastolic function and atherosclerosis of the carotid artery in Japanese patients with mild-to-moderate hypertension, LV hypertrophy, diastolic dysfunction and preserved systolic function. Fifty-seven patients were randomly assigned to losartan-or amlodipine-based treatment groups and were followed up for 18 months. Blood pressure was similarly reduced by both regimens. Losartan shortened the transmitral E-wave deceleration time, and amlodipine reduced LV mass index; however, there was no significant difference in the percent changes of these indices between the two groups. Mean carotid intima-media thickness (mean IMT) as well as plaque score significantly increased in the amlodipine-based regimen (pre: 1.05 ± 0.26 mm, follow-up: 1.23 ± 0.33 mm, P¼0.0015), but not in the losartan-based regimen (pre: 1.08 ± 0.35 mm, follow-up: 1.16 ± 0.52 mm, P¼non-significant). The percent increase in mean IMT in the amlodipine-based regimen tended to be large compared with the losartan-based regimen (amlodipine: 19.8 ± 23.7%, losartan: 6.9 ± 23.3%, P¼0.06). Under similar reduction of blood pressure, losartan is likely effective in protecting the progression of atherosclerosis of the carotid artery compared with amlodipine. Losartan may improve LV diastolic function, and amlodipine may attenuate LV hypertrophy; however, this study cannot make consecutive remarks about the superiority of either treatment regimen in the effects on cardiac function and geometry. This study has been registered at

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Noninvasive Assessment of Wall Distensibility With the Evaluation of Diastolic Epicardial Movement

Cited by 66 publications

References 21 publications

Ventricular‐Arterial Function and Coupling in the Adult Fontan Circulation

Ventricular‐Arterial Function and Coupling in the Adult Fontan Circulation

Prognostic Impact of Diastolic Wall Strain in Patients at Risk for Heart Failure

The Effect of Losartan and Amlodipine on Left Ventricular Diastolic Function and Atherosclerosis in Japanese Patients with Mild-to-Moderate Hypertension (J-ELAN) study

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