The mechanism of emergence and clinical significance of apically directed intraventricular flow during isovolumic relaxation

Ohte, Nobuyuki; Narita, Hitomi; Akita, Sachie; Kurokawa, Kazuyuki; Hayano, Junichiro; Sugawara, Motoaki; Kimura, Genjiro

doi:10.1067/mje.2002.119113

Cited by 23 publications

(34 citation statements)

References 21 publications

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“…The loss of IFLAF is highly associated with the impairment of LV relaxation because of a lack of elastic recoil at the very early phase of diastole 7, 17, 20. We also demonstrated previously that LVEF < 58% could significantly predict the loss of inertia force in patients with preserved LVEF 8.…”

Section: Discussionsupporting

confidence: 74%

“…Furthermore, we found that there was a tendency for event‐free survival to be better in patients with HFrhEF compared with those with HFrlEF among patients with HFpEF; however, this trend did not reach statistical significance ( P = 0.067). Good systolic function of LV is observed in patients with high LVEF and should speed LV relaxation, which overcomes a substantial risk of development of HF associated with LV diastolic dysfunction 6, 7, 20. This result suggests that maintaining higher LVEF in HF might improve prognosis 23…”

Section: Discussionmentioning

confidence: 98%

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The prognostic value of brain natriuretic peptide in patients with heart failure and left ventricular ejection fraction higher than 60%: a sub‐analysis of the J‐MELODIC study

et al. 2017

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AimsCardiac function varies in the population of patients with heart failure (HF) with preserved left ventricular ejection fraction (LVEF; HFpEF). This study investigated the heterogeneity of clinical features associated with HF and the prognostic value of BNP levels in patients with HFpEF.Methods and resultsThe study enrolled 288 patients with stable HF and serum creatinine <1.5 mg/dL who were part of the original J‐MELODIC study cohort. They were categorized as having HF with reduced LVEF (HFrEF; EF ≤ 40%, n = 83) or as having HFpEF (EF > 40%, n = 205). Patients with HFpEF were further categorized as having relatively low LVEF (HFrlEF; EF 40–60%, n = 107) or as having relatively high LVEF (HFrhEF; EF ≥ 60%, n = 98). We defined cardiovascular death and hospitalization for HF as adverse events and evaluated the prognostic value of the BNP levels in each group. There was no significant difference in event‐free survival between HFpEF and HFrEF patients or between HFrhEF and HFrlEF patients. A multivariate Cox proportional hazards model revealed that the BNP level was an independent predictor of adverse events in HFrEF patients (hazard ratio: 4.088, 95% confidence interval: 1.178–14.179, P = 0.027) and in HFrlEF patients (hazard ratio: 14.888, 95% confidence interval: 4.969–44.608, P < 0.001) but not in HFrhEF patients (P = 0.767).ConclusionsThe BNP level has prognostic value in HFrlEF but not in HFrhEF. This indicates that HFrhEF and HFrlEF are distinct entities that may require different approaches for the management of HF.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 98%

The prognostic value of brain natriuretic peptide in patients with heart failure and left ventricular ejection fraction higher than 60%: a sub‐analysis of the J‐MELODIC study

et al. 2017

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“…Modern ultrasonic technology has increased sensitivity for the detection of intraventricular flow, which can be assessed with relatively high frame rates. Ohte et al (21) found that the greater magnitude of LV elastic recoil and the faster LV relaxation in patients without LV apical asynchrony produce apically directed flow during IVR. Nonuniform contraction and filling are associated with ineffective shifting of blood volume within the left ventricle.…”

Section: Discussionmentioning

confidence: 99%

Interaction between left ventricular wall motion and intraventricular flow propagation in acute and chronic ischemia

Edvardsen

Rødevand

Endresen

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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The combination of tissue Doppler imaging and high framerate acquisition of two-dimensional color flow makes it possible to study the interaction between LV wall motion and intraventricular flow propagation. The aim of this study was to examine in a clinical model the impact that acute myocardial ischemia and prior myocardial infarct might have on LV flow patterns and to explain the underlying mechanisms from the tissue Doppler data. LV flow propagation and tissue velocities during early diastole were studied in 18 healthy individuals, 17 patients with prior anterior myocardial infarct, and 16 patients before and during percutaneous coronary intervention (PCI) of the left anterior descending artery. Normal individuals had intraventricular flow propagation toward the apex during isovolumic relaxation. During this early diastolic time phase, myocardial velocities measured at mid-and apical septal segment were directed away from the apex. Before PCI, patients without myocardial infarction had similar findings as in normal individuals. In contrast, each patient with either prior myocardial infarction or PCI-induced acute ischemia had flow propagation opposite to normal individuals, and tissue velocities reversed toward the apex during early diastole. Reversal of early diastolic LV flow propagation in acute and chronic anterior myocardial ischemia reflects postsystolic shortening in the dyskinetic apical and septal myocardial segments.

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“…By assessing intraventricular flow dynamics, Ohte et al demonstrated a mechanism whereby the LV actively stops blood flow ejection [25]. During isovolumic relaxation apically directed intraventricular flow was observed by using high-frame-rate, two-dimensional, color-Doppler imaging.…”

Section: The Meaning Of the Second Peakmentioning

confidence: 99%

Clinical usefulness of wave intensity analysis

Sugawara

Niki

Ohte

et al. 2008

Med Biol Eng Comput

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105

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Wave intensity (WI) is a hemodynamic index, which can evaluate the working condition of the heart interacting with the arterial system. It can be defined at any site in the circulatory system and provides a great deal of information. However, we need simultaneous measurements of blood pressure and velocity to obtain wave intensity, which has limited the clinical application of wave intensity, in spite of its potential. To expand the application of wave intensity in the clinical setting, we developed a real-time non-invasive measurement system for wave intensity based on a combined color Doppler and echo-tracking system. We measured carotid arterial WI in normal subjects and patients with various cardiovascular diseases. In the coronary artery disease group, the magnitude of the first peak of carotid arterial WI (W 1 ) increased with LV max. dP/dt (r = 0.74, P \ 0.001), and the amplitude of the second peak (W 2 ) decreased with an increase in the time constant of LV pressure decay (r = -0.77, P \ 0.001). In the dilated cardiomyopathy group, the values of W 1 were much lower than those in the normal group (P \ 0.0001). In the hypertrophic cardiomyopathy group, the values of W 2 were much smaller than those in the normal group (P \ 0.0001). In mitral regurgitation before surgery, W 2 decreased or disappeared, but after surgery W 2 appeared clearly. In the hypertension group, the magnitude of reflection from the head was considerably greater than that in the normal group (P \ 0.0001). We also evaluated hemodynamic effects of sublingual nitroglycerin in normal subjects. Nitroglycerin increased W 1 significantly (P \ 0.001). WI can be obtained non-invasively using an echo-Doppler system in the clinical setting. This method will increase the clinical usefulness of wave intensity.

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The mechanism of emergence and clinical significance of apically directed intraventricular flow during isovolumic relaxation

Cited by 23 publications

References 21 publications

The prognostic value of brain natriuretic peptide in patients with heart failure and left ventricular ejection fraction higher than 60%: a sub‐analysis of the J‐MELODIC study

The prognostic value of brain natriuretic peptide in patients with heart failure and left ventricular ejection fraction higher than 60%: a sub‐analysis of the J‐MELODIC study

Interaction between left ventricular wall motion and intraventricular flow propagation in acute and chronic ischemia

Clinical usefulness of wave intensity analysis

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