Validation of Myocardial Acceleration During Isovolumic Contraction as a Novel Noninvasive Index of Right Ventricular Contractility

Vogel, Michael; Schmidt, Michael; Kristiansen, Steen Buus; Cheung, Michael; White, Paul A.; Sørensen, Keld E.; Redington, Andrew N.

doi:10.1161/01.cir.0000013773.67850.ba

Cited by 423 publications

(401 citation statements)

References 36 publications

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“…[2][3][4] We have recently shown that myocardial acceleration during isovolumic contraction (IVA) derived from TDE is a robust measurement of right ventricular contractile function. 5 In our experiments, we found that IVA was sensitive to small changes in inotropy but unaffected by large changes in right ventricular preload and afterload. 5 We hypothesized that, in a similar way, myocardial acceleration during isovolumic contraction (IVA) may reflect LV myocardial contractile function.…”

supporting

confidence: 51%

“…5 In our experiments, we found that IVA was sensitive to small changes in inotropy but unaffected by large changes in right ventricular preload and afterload. 5 We hypothesized that, in a similar way, myocardial acceleration during isovolumic contraction (IVA) may reflect LV myocardial contractile function. Furthermore, although we were able to show that myocardial acceleration could describe the force-frequency relationship in the right ventricle, no noninvasive index has been used previously in the LV in either an experimental or clinical setting.…”

supporting

confidence: 51%

“…Our protocol has been described in detail previously. 5 After premedication with azaperone (4 mg/kg IV), midazolam (0.1 mg/kg IV), and etomidate (0.5 mg/kg IV), the animals were endotracheally intubated and ventilated with a Servo 900 (Siemens) ventilator. Arterial blood gases were taken to confirm adequate ventilation during the study.…”

Section: Study 1: Validation Of Ivamentioning

confidence: 99%

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Noninvasive Assessment of Left Ventricular Force-Frequency Relationships Using Tissue Doppler–Derived Isovolumic Acceleration

et al. 2003

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Background-We have demonstrated that myocardial acceleration during isovolumic contraction (IVA) is a sensitive index of right ventricular contractile function. In this study, we assessed the usefulness of IVA to measure left ventricular (LV) contractile function and force-frequency relationships in an experimental preparation. Methods and Results-In study 1, we examined 6 pigs by use of tissue Doppler imaging of LV free wall and simultaneous measurements of intraventricular pressure, volume, maximal elastance (E max ), and dP/dt max by conductance catheterization. Animals were paced via the right atrium at a rate of 130 bpm. IVA was compared with elastance during contractility modulation by esmolol and dobutamine and assessed during preload reduction and afterload increase. In study 2, in 6 more pigs, force-frequency data were obtained during incremental atrial pacing from 120 to 180 bpm. Study 1: Esmolol led to a decrease in IVA and E max (PϽ0.03 and Ͻ0.02, respectively), both of which increased during dobutamine infusion (PϽ0.02 and Ͻ0.03, respectively). IVA was unaffected by significant (PϽ0.001) acute reduction of LV volume and a significantly increased LV afterload (systolic pressure increase, PϽ0.001). Study 2: There was a positive correlation between IVA and dP/dt max (r 2 ϭ0.92, PϽ0.05). As heart rate was increased from 120 to 160 bpm, there were significant increases in both IVA and dP/dt max (PϽ0. 0004 and Pϭ0.02, respectively). Over the same range of heart rates, there was no significant change in E max (Pϭ0.22). Conclusions-IVA is a measurement of LV contractile function that is unaffected by preload and afterload changes within a physiological range and can be used noninvasively to measure LV force-frequency relationships.

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confidence: 51%

supporting

confidence: 51%

Section: Study 1: Validation Of Ivamentioning

confidence: 99%

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Noninvasive Assessment of Left Ventricular Force-Frequency Relationships Using Tissue Doppler–Derived Isovolumic Acceleration

et al. 2003

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“…The S' velocity has been shown to be load and inotropic dependent in an animal model. 22 In humans, S' velocity has been found to be stable under load alterations in Table 1 Demographics Group E (n = 24) Group V (n = 26) All (n = 50) Age (yr)…”

Section: Discussionmentioning

confidence: 99%

Evaluation of TAPSE as a measure of right ventricular output

Tousignant

Kim

Papa

et al. 2012

Can J Anesth/J Can Anesth

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Purpose This study was designed to show the relationship between tricuspid annular plane systolic excursion (TAPSE) and stroke volume (SV) by thermodilution using three different methods and also to assess whether TAPSE can track hemodynamic changes associated with volume loading and ephedrine administration. Methods This was an observational study in 61 elective patients with a pulmonary artery catheter who were undergoing coronary artery bypass graft surgery in a cardiac surgical centre. We measured TAPSE by three methods using transesophageal echocardiography: M mode, speckle tracking at the lateral wall, and tissue tracking at the inferior wall. There were two interventions: leg raising (volume recruitment) or administration of ephedrine 5 mg iv. Echo and hemodynamic measurements were performed before and after each intervention.Results Eleven patients were excluded due to poor imaging. There were 26 patients in the leg raising group and 24 patients in the ephedrine group. The correlation coefficient between stroke volume (SV) and TAPSE by M mode, speckle tracking, and tissue tracking was 0.48, 0.44, and 0.09, respectively. There was a significant increase in SV following each intervention; however, the changes in TAPSE by any method and velocity were not large enough to reach statistical significance. Conclusion Tricuspid annular plane systolic excursion by M mode and by speckle tracking correlates modestly with SV. There was no correlation between TAPSE and SV by tissue tracking at the inferior wall of the right ventricle. Tricuspid annular plane systolic excursion by M mode and by speckle tracking does not track changes in SV following either volume loading or ephedrine administration. RésuméObjectif Cette e´tude a e´te´conçue pour montrer le rapport entre le de´placement systolique du plan de l'anneau tricuspidien (TAPSE) avec le volume d'e´jection systolique (SV) par thermodilution en utilisant trois me´thodes diffe´rentes et aussi pour de´terminer si le TAPSE peut suivre les modifications he´modynamiques associe´es a`une charge volumique et a`une administration d'e´phe´drine. Méthodes Il s'agit d'une e´tude observationnelle mene´e chez 61 patients se´lectionne´s porteurs d'un cathe´ter de l'arte`re pulmonaire qui devaient subir un pontage coronarien dans un centre de chirurgie cardiaque. Nous avons mesure´le TAPSE par trois me´thodes diffe´rentes al 'aide d'une e´chocardiographie transoesophagienne: mode M;suivi de granularite´s (speckle tracking) sur la paroi late´rale; et suivi de tissu (tissue tracking) sur la paroi infe´rieure. Il y a eu deux interventions: jambes releve´es

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“…Myocardial acceleration during isovolumic contraction is another measure of load-independent RV function in healthy animals, but validation in PAH is required. 47 In patients with PAH, a reduced longitudinal strain has been demonstrated, with the most severe impairments in patients with RV failure. [48][49][50][51][52][53][54] Regional heterogeneity was an important feature of a dysfunctional RV in which the apical region is the most affected.…”

Section: Regional Rv Function and Strainmentioning

confidence: 99%

State of the Art: Advanced Imaging of the Right Ventricle and Pulmonary Circulation in Humans (2013 Grover Conference Series)

et al. 2014

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Pulmonary arterial hypertension (PAH) is a progressive disease characterized by remodeling and vasoconstriction of the pulmonary vasculature, ultimately leading to right ventricular (RV) failure and death. Recent developments in echocardiography, cardiovascular magnetic resonance imaging, computed tomography, and positron emission tomography allow advanced, noninvasive, in vivo assessment of the RV and have contributed to the identification of risk factors, prognostic factors, and monitoring of therapeutic responses in patients with PAH. Although far from reaching its future potential, these techniques have not only provided global RV assessment but also allowed evaluation of changes in cellular and molecular tissue processes, such as metabolism, oxygen balance and ischemia, angiogenesis, and apoptosis. Integrated application of these techniques could provide full insights into the different pathophysiological aspects of a failing RV in the setting of PAH. Recent advances in hybrid imaging have implemented simultaneous measurements of myocardial and vascular interactions and will be one of the most important potential future developments.

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Validation of Myocardial Acceleration During Isovolumic Contraction as a Novel Noninvasive Index of Right Ventricular Contractility

Cited by 423 publications

References 36 publications

Noninvasive Assessment of Left Ventricular Force-Frequency Relationships Using Tissue Doppler–Derived Isovolumic Acceleration

Noninvasive Assessment of Left Ventricular Force-Frequency Relationships Using Tissue Doppler–Derived Isovolumic Acceleration

Evaluation of TAPSE as a measure of right ventricular output

State of the Art: Advanced Imaging of the Right Ventricle and Pulmonary Circulation in Humans (2013 Grover Conference Series)

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