Systolic and Diastolic Myocardial Mechanics in Patients with Cardiac Disease and Preserved Ejection Fraction: Impact of Left Ventricular Filling Pressure

Nguyen, John; Lakkis, Nasser; Bobek, Jaromir; Goswami, Rajiv; Dokainish, Hisham

doi:10.1016/j.echo.2010.09.008

Cited by 41 publications

(34 citation statements)

References 37 publications

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“…Unexpectedly, as cited above, we found a seemingly increasing dynamic heart with a tendency towards increasing S’ (LV) and GLS (LV) with increasing severity of COPD (Table 2). We see two possible explanations: Firstly, left ventricular filling pressure has an impact on left ventricular longitudinal systolic strain rate in preserved LVEF: lower filling pressures (usually considered normal filling pressures) are associated with higher peak systolic strain rate [22]. Secondly, these findings may also be explained by a hypoxia or baroreflex mediated increase in cardiac sympathetic nerve activity which will increase cardiac inotropy and chronotropy [23], which is supported by our findings of a significant.…”

Section: Discussionsupporting

confidence: 62%

Echocardiographic predictors of exercise capacity and mortality in chronic obstructive pulmonary disease

Schoos

Dalsgaard²,

Kjærgaard

et al. 2013

BMC Cardiovasc Disord

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BackgroundChronic obstructive pulmonary disease (COPD) reduces exercise capacity, but lung function parameters do not fully explain functional class and lung-heart interaction could be the explanation. We evaluated echocardiographic predictors of mortality and six minutes walking distance (6MWD), a marker for quality of life and mortality in COPD.MethodsNinety COPD patients (GOLD criteria) were evaluated by body plethysmography, 6MWD and advanced echocardiography parameters (pulsed wave tissue Doppler and speckle tracking).ResultsMean 6MWD was 403 (± 113) meters. All 90 subjects had preserved left ventricular (LV) ejection fraction 64.3% ± 8.6%. Stroke volume decreased while heart rate increased with COPD severity and hyperinflation. In 66% of patients, some degree of diastolic dysfunction was present. Mitral tissue Doppler data in COPD could be interpreted as a sign of low LV preload and not necessarily an intrinsic impairment in LV relaxation/compliance. Tricuspid regurgitation (TR) increased with COPD severity and hyperinflation. Age (p < 0.001), BMI (p < 0.001), DLCO SB (p < 0.001) and TR (p 0.005) were independent predictors of 6MWD and a multivariable model incorporating heart function parameters (adjusted r2 = .511) compared well to a model with lung function parameters alone (adjusted r2 = .475). LV global longitudinal strain (p = 0.034) was the only independent predictor of mortality among all baseline, body plethysmographic and echocardiographic variables.ConclusionsAmong subjects with moderate to severe COPD and normal LVEF, GLS independently predicted all-cause mortality. Exercise tolerance correlated with standard lung function parameters only in univariate models; in subsequent models including echocardiographic parameters, longer 6MWD correlated independently with milder TR, better DLCO SB, younger age and lower BMI. We extended the evidence on COPD affecting cardiac chamber volumes, LV preload, heart rate, as well as systolic and diastolic function. Our results highlight lung-heart interaction and the necessity of cardiac evaluation in COPD.

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Section: Discussionsupporting

confidence: 62%

Echocardiographic predictors of exercise capacity and mortality in chronic obstructive pulmonary disease

Schoos

Dalsgaard²,

Kjærgaard

et al. 2013

BMC Cardiovasc Disord

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“…Myocardial strain data derived from 2D STE have been validated against hemodynamics, tissue Doppler methods, tagged MRI studies, and sonomicrometry studies . The STE‐derived strain data correlate well with TDI‐derived strain data, but the overall reproducibility of the data is better with STE (Table ) …”

Section: Normal Values and Validation Of 2d Stementioning

confidence: 99%

Two‐ and Three‐Dimensional Speckle Tracking Echocardiography: Clinical Applications and Future Directions

et al. 2013

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Two-dimensional speckle tracking echocardiography (2D STE) is a novel technique of cardiac imaging for quantifying complex cardiac motion based on frame-to-frame tracking of ultrasonic speckles in gray scale 2D images. Two-dimensional STE is a relatively angle independent technology that can measure global and regional strain, strain rate, displacement, and velocity in longitudinal, radial, and circumferential directions. It can also quantify rotational movements such as rotation, twist, and torsion of the myocardium. Two-dimensional STE has been validated against hemodynamics, tissue Doppler, tagged magnetic resonance imaging, and sonomicrometry studies. Two-dimensional STE has been found clinically useful in the assessment of cardiac systolic and diastolic function as well as providing new insights in deciphering cardiac physiology and mechanics in cardiomyopathies, and identifying early subclinical changes in various pathologies. A large number of studies have evaluated the role of 2D STE in predicting response to cardiac resynchronization therapy in patients with severe heart failure. However, the clinical utility of 2D STE in the above mentioned conditions remains controversial because of conflicting reports from different studies. Emerging areas of application include prediction of rejection in heart transplant patients, early detection of cardiotoxicity in patients receiving chemotherapy for cancer, and effect of intracoronary injection of bone marrow stem cells on left ventricular function in patients with acute myocardial infarction. The emerging technique of three-dimensional STE may further extend its clinical usefulness.

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“…31,32 Although elevated LV filling pressures have been implicated as one of the major mechanisms of the symptoms of HFNEF, 33,34 other researches have recently shown that additional physiopathological processes, such as impaired CO reserve, could be involved in the pathogenesis of the symptoms of patients with HFNEF. 24,29 In this regard, Borlaug et al 24 and more recently Haykowsky et al 29 demonstrated that a diminished response of CO to exercise is strongly associated with reduced functional capacity during exercise in subjects with HFNEF.…”

Section: Association Of a Low Systolic And Diastolic LV Myocardial Pementioning

confidence: 99%

Myocardial Systolic and Diastolic Performance Derived by 2-Dimensional Speckle Tracking Echocardiography in Heart Failure With Normal Left Ventricular Ejection Fraction

Morris

Boldt

Eichstädt

et al. 2012

Circ: Heart Failure

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U nlike systolic heart failure (HF), HF with normal left ventricular (LV) ejection fraction (HFNEF) is characterized by a normal LV systolic function often evaluated by the biplane Simpson method.1 However, recent studies have shown that, despite a normal LV ejection fraction (LVEF), patients with HFNEF have a significant impairment of the longitudinal systolic function of the LV, suggesting that in these patients the myocardial systolic function of the LV is not preserved.2-5 Furthermore, several investigations have highlighted the key role of the longitudinal diastolic dysfunction of the LV in the pathophysiology of HFNEF.6-8 Nonetheless, despite these studies, 2-8 whether a longitudinal systolic and diastolic LV dysfunction is associated with an impairment of the global function or myocardial performance of the LV in patients with HFNEF remains poorly understood. In addition, echocardiographic indices that evaluate the systolic and diastolic myocardial performance of the LV (ie, the average value of the longitudinal, radial, and circumferential function of the LV) have not been investigated in these patients. Clinical Perspective on p 620We hypothesized that in patients with HFNEF a significant alteration in the longitudinal function of the LV, and to a lesser extent in the circumferential and radial LV func tion, could lead © 2012 American Heart Association, Inc. Background-The aim of this study was to investigate the myocardial systolic and diastolic performance of the left ventricle (LV) in patients with heart failure with normal LV ejection fraction (HFNEF) through novel LV myocardial indices, which assess the systolic and diastolic function of the whole myocardium of the LV. Methods and Results-LV myocardial systolic and diastolic performance were assessed as the average value of peak systolic strain and peak early-diastolic strain rate, respectively, in longitudinal, circumferential, and radial directions from all LV segments using 2-dimensional speckle-tracking echocardiography. We studied patients with HFNEF and a control group consisting of asymptomatic subjects with LV diastolic dysfunction of similar age, sex, and LV ejection fraction. A total of 322 patients were included (92 with HFNEF and 230 with asymptomatic LV diastolic dysfunction). Myocardial systolic and diastolic LV performance were significantly lower in HFNEF (20.13±6.02% and 1.14±0.27 s −1 Circ Heart Fail) than in patients with asymptomatic LV diastolic dysfunction (25.33±6.06% and 1.37±0.33 s −1 , respectively; all P<0.0001). In addition, patients with HFNEF with low systolic and diastolic LV myocardial performance had significantly higher LV filling pressures (17.1±6.6 and 17.6±6.3 versus 12.0±5.1 and 11.7±4.7, respectively; all P<0.001) and lower cardiac output (4.8±1.0 L/min and 4.9±1.1 L/min versus 5.7±1.2 L/min and 5.8±1.1 L/min, respectively; all P<0.001) than patients with normal LV myocardial performance. In relation to these findings, the symptomatic status (ie, New York Heart Association functional class) was significantly a...

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Systolic and Diastolic Myocardial Mechanics in Patients with Cardiac Disease and Preserved Ejection Fraction: Impact of Left Ventricular Filling Pressure

Cited by 41 publications

References 37 publications

Echocardiographic predictors of exercise capacity and mortality in chronic obstructive pulmonary disease

Echocardiographic predictors of exercise capacity and mortality in chronic obstructive pulmonary disease

Two‐ and Three‐Dimensional Speckle Tracking Echocardiography: Clinical Applications and Future Directions

Myocardial Systolic and Diastolic Performance Derived by 2-Dimensional Speckle Tracking Echocardiography in Heart Failure With Normal Left Ventricular Ejection Fraction

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