The Influence of Changes in Loading Patterns on Left Ventricular Relaxation in Humans

Iketani, Toshiro; Takazawa, Kenji; Ibukiyama, Chiharu

doi:10.1253/jcj.62.581

Cited by 15 publications

(12 citation statements)

References 21 publications

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“…11,12 Specifically, Iketani et al examined the effects of changes in LV afterload on LV relaxation using iv injection of angiotensin and sublingual administration of nitroglycerin in patients undergoing cardiac catheterization for CAD. 11 They found that an increase in AI, but not peak aortic pressure, significantly increased Tau. Yano et al examined the effects of timing of arterial wave reflection on LV relaxation using the compression of bilateral femoral arteries in patients undergoing cardiac catheterization.…”

Section: Discussionmentioning

confidence: 97%

“…Although animal and small human studies have shown that an acute increase in LV afterload, particularly in late-systolic load, adversely impacts on LV early diastolic relaxation, [8][9][10][11][12] little is known about its chronic effect on LV diastolic function. We hypothesized that enhanced late-systolic load may be associated with altered LV diastolic function at steady state.…”

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confidence: 99%

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Impact of Arterial Load on Left Ventricular Diastolic Function in Patients Undergoing Cardiac Catheterization for Coronary Artery Disease

Fukuta

Ohte

Wakami

et al. 2010

Circ J

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Background:Although left ventricular (LV) diastolic dysfunction is associated with increased risk for incident heart failure in patients with coronary artery disease (CAD), no specific treatment for diastolic abnormalities has been established. Animal and small human studies have shown that an acute increase in LV afterload adversely impacts on LV early diastolic relaxation, but little is known about its chronic effect on diastolic function. Methods and Results:The relationships of various components of arterial load (arterial compliance, total vascular resistance index, and augmentation index [AI] in the ascending aorta) with LV diastolic function indices determined on cardiac catheterization (relaxation time constant [Tau] and end-diastolic pressure [EDP]) and those on tissue Doppler echocardiography (early diastolic mitral annular velocity [E'] and the ratio of early diastolic mitral inflow to annular velocities [E/E']) were investigated in 303 consecutive patients undergoing cardiac catheterization for CAD. All components of arterial load correlated with diastolic function indices, with AI, an index reflecting late-systolic load, having the strongest correlations with diastolic function indices. After adjustment for potential confounders, AI correlated with Tau (standardized β=0.25, P<0.001), EDP (β=0.25, P<0.001), E' (β= -0.21, P<0.001), and E/E' (β=0.23, P<0.001). Conclusions:Increased AI is independently associated with LV diastolic function in patients with known or suspected CAD. Late-systolic load may be a therapeutic target to improve LV diastolic abnormalities in this population. (Circ J 2010; 74: 1900 - 1905

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

Impact of Arterial Load on Left Ventricular Diastolic Function in Patients Undergoing Cardiac Catheterization for Coronary Artery Disease

Fukuta

Ohte

Wakami

et al. 2010

Circ J

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“…42,43 Myocardial ischaemia has been described, even in the absence of coronary artery narrowing, when this ratio drops below 0.7-1.0. 43 LV hypertrophy anatomically, 6 and loading sequence physiologically 9,23,41 can decrease the diastolic period through prolonging systolic contraction and delaying relaxation. The relation of the systolic period to the diastolic period is as important as coronary narrowing in the induction of myocardial ischaemia: indeed, a decrease in the diastolic period from 55% to 45% of the cardiac cycle can have the same effect as an increase in coronary narrowing from 40% to 90%.…”

Section: 40mentioning

confidence: 99%

The Cardiovascular Continuum extended: Aging effects on the aorta and microvasculature

2010

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The 'Cardiovascular Continuum' was described by Dzau and colleagues in 2006 to explain the development over many years of coronary disease with its complications, then end-stage heart failure. The Continuum identified different points along the way where the process could be interrupted by drug therapies or interventions, then described the trials that have been undertaken over the last three decades to establish their value. The approach summarized the major steps in cardiology through modern times, but it had an emphasis on coronary atherosclerosis in prosperous nations, and did not account fully for the problems of aging, which occur in all societies. Aging of the aorta and elastic arteries causes arterial stiffening and leads to development of cardiac failure and microvascular disease in highly perfused organs such as the brain and kidneys. The 'Vascular Aging Continuum' which we introduce, dovetails with the late phases of the Cardiovascular Continuum and provides a more comprehensive explanation, especially for vascular diseases in nations with little atherosclerosis. It will become more common in the Western World where attention to risk factors and widespread use of statins are responsible for a decrease in atherosclerotic disease, prolongation of life, and dominance of macrovascular and microvascular arterial disease, as well as of cardiac failure.

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“…The increase in the afterload at systole causes (a) prolongation of ejection time and delayed onset of isovolumic myocardial relaxation period, 28 (b) impairment of the cross-bridge dissociation between the thin-thick myofilaments during isovolumic relaxation contributing to the significant impairment in myocardial relaxation 29 and (c) direct reduction of the rate of isovolumic LV pressure decline in humans. 30 An impaired cardiac relaxation may cause elevation of LV DBP, which increase extravascular compression forces on the coronary arterioles resulting in increased coronary microcirculatory resistance and consequently to the reduction of coronary flow in the subendocardial layers. 31 Thus, enhanced wave reflections exert a negative impact on LV myocardial relaxation 32,33 and may cause subendocardial ischaemia.…”

Section: Association Of Cai and Aos With LV Diastolic Dysfunctionmentioning

confidence: 99%

Incremental value of arterial wave reflections in the determination of left ventricular diastolic dysfunction in untreated patients with essential hypertension

et al. 2008

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Systemic arterial stiffness is an indicator of cardiovascular disease and an independent marker of morbidity and cardiovascular mortality. We investigated the association of arterial wave reflections with left ventricular (LV) diastolic dysfunction and their incremental value to other determinants of LV diastolic dysfunction in patients with essential hypertension. In total 143 patients and 20 controls with similar atherosclerotic risk factors were examined by applanation tonometry of the radial artery (Sphygmocor) and echocardiography. Central augmentation index (CAI%) of reflected arterial waves as well as aortic strain (AoS) assessed by echocardiography were estimated. Doppler diastolic abnormalities were defined as proposed by the European Study Group on diastolic heart failure by measurement of E/A ratio (the ratio of the mitral inflow velocities), isovolumic relaxation time, deceleration time and flow propagation velocity. AoS and CAI were impaired in patients compared with controls (4.67 ± 2.94 vs 6.06 ± 4.91% and 145.8 ± 22.7 vs 135.7 ± 20.3%, Po0.01) as well as in patients with LV diastolic dysfunction compared to patients without, (5.52 ± 4.29 vs 10.73 ± 5.77% and 139.5 ± 21.7 vs 124.5 ± 17.0%, Po0.05). The odds ratio (OR) of AoS and CAI for diastolic dysfunction was OR:0.918, 95% confidence interval (CI):0.837-0.99, P ¼ 0.04 and OR:1.023, 95%CI: 1.023-1.040 P ¼ 0.010, respectively. The addition of CAI to the multivariable model including age, LV mass index, AoS and mean arterial pressure increased the power of the model for determination of LV diastolic dysfunction (À2 log likelihood ¼ 139.368, change of v 2 ¼ 4.2, P-value for change ¼ 0.04). In untreated patients with newly diagnosed essential hypertension, wave reflections are independent and additive determinants of LV diastolic dysfunction.

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The Influence of Changes in Loading Patterns on Left Ventricular Relaxation in Humans

Cited by 15 publications

References 21 publications

Impact of Arterial Load on Left Ventricular Diastolic Function in Patients Undergoing Cardiac Catheterization for Coronary Artery Disease

Impact of Arterial Load on Left Ventricular Diastolic Function in Patients Undergoing Cardiac Catheterization for Coronary Artery Disease

The Cardiovascular Continuum extended: Aging effects on the aorta and microvasculature

Incremental value of arterial wave reflections in the determination of left ventricular diastolic dysfunction in untreated patients with essential hypertension

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