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Hodzic A, Gendron P, Baron E, Éthier A, Bonnefous O, Saloux E, Milliez P, Normand H, Tournoux F. Inter-season training effects on cardiovascular health in American-style football players. BMC Sports Sci Med Rehabil 2024; 16:108. [PMID: 38741116 DOI: 10.1186/s13102-024-00888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Recent studies on American-style football (ASF) athletes raised questions about the impact of training on the cardiovascular phenotype, particularly among linemen players who engage mostly in static exercise during competition and who exhibit concentric cardiac remodeling, often considered maladaptive. We aimed to examine the cardiovascular adaptation to the inter-season mixed-team training program among ASF players. METHODS A prospective, longitudinal, cohort study was conducted among competitive male ASF players from the University of Montreal before and after an inter-season training, which lasted 7 months. This program includes, for all players, combined dynamic and static exercises. Clinical and echocardiographic examinations were performed at both steps. Left atrial (LA) and ventricular (LV) morphological and functional changes were assessed using a multiparametric echocardiographic approach (2D and 3D-echo, Doppler, and speckle tracking). Two-way ANOVA was performed to analyze the impacts of time and field position (linemen versus non-linemen). RESULTS Fifty-nine players (20 linemen and 39 non-linemen) were included. At baseline, linemen had higher blood pressure (65% were prehypertensive and 10% were hypertensive), thicker LV walls, lower LV systolic and diastolic functions, lower LA-reservoir and conduit functions than non-linemen. After training, linemen significantly reduced weight (Δ-3.4%, P < 0.001) and systolic blood pressure (Δ-4.5%, P < 0.001), whereas non-linemen maintained their weight and significantly increased their systolic (Δ+4.2%, P = 0.037) and diastolic (Δ+16%, P < 0.001) blood pressure ). Mixed training was associated with significant increases in 2D-LA volume (P < 0.001), 3D-LV end-diastolic volume (P < 0.001), 3D-LV mass (P < 0.001), and an improvement in LV systolic function, independently of the field position. Non-linemen remodeled their LV in a more concentric fashion and showed reductions in LV diastolic and LA reservoir functions. CONCLUSIONS Our study underscored the influence of field position on cardiovascular adaptation among university-level ASF players, and emphasized the potential of inter-season training to modulate cardiovascular risk factors, particularly among linemen.
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Affiliation(s)
- Amir Hodzic
- Department of Clinical Physiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Inserm Comete, GIP Cyceron, Caen, 14000, France.
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, 14000, France.
- Université Caen Normandie, UMR 1075 COMETE UNICAEN/INSERM, 2 Rue Des Rochambelles, Caen, 14032, France.
| | - Patrick Gendron
- Clinique de Médecine du Sport, University of Montreal, Montreal, Canada
| | - Emmanuelle Baron
- Clinique de Médecine du Sport, University of Montreal, Montreal, Canada
| | - Amélie Éthier
- Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de L'Université de Montréal), Montreal, Canada
| | - Odile Bonnefous
- Philips Research, Medical Imaging (Medisys), Suresnes, France
| | - Eric Saloux
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, 14000, France
| | - Paul Milliez
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, 14000, France
- Université Caen Normandie, UMR 1075 COMETE UNICAEN/INSERM, 2 Rue Des Rochambelles, Caen, 14032, France
| | - Hervé Normand
- Department of Clinical Physiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Inserm Comete, GIP Cyceron, Caen, 14000, France
- Université Caen Normandie, UMR 1075 COMETE UNICAEN/INSERM, 2 Rue Des Rochambelles, Caen, 14032, France
| | - François Tournoux
- Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de L'Université de Montréal), Montreal, Canada
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Watanabe K, Koch Esteves N, Gibson OR, Akiyama K, Watanabe S, González-Alonso J. Heat-related changes in the velocity and kinetic energy of flowing blood influence the human heart's output during hyperthermia. J Physiol 2024; 602:2227-2251. [PMID: 38690610 DOI: 10.1113/jp285760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
Passive whole-body hyperthermia increases limb blood flow and cardiac output (Q ̇ $\dot Q$ ), but the interplay between peripheral and central thermo-haemodynamic mechanisms remains unclear. Here we tested the hypothesis that local hyperthermia-induced alterations in peripheral blood flow and blood kinetic energy modulate flow to the heart andQ ̇ $\dot Q$ . Body temperatures, regional (leg, arm, head) and systemic haemodynamics, and left ventricular (LV) volumes and functions were assessed in eight healthy males during: (1) 3 h control (normothermic condition); (2) 3 h of single-leg heating; (3) 3 h of two-leg heating; and (4) 2.5 h of whole-body heating. Leg, forearm, and extracranial blood flow increased in close association with local rises in temperature while brain perfusion remained unchanged. Increases in blood velocity with small to no changes in the conduit artery diameter underpinned the augmented limb and extracranial perfusion. In all heating conditions,Q ̇ $\dot Q$ increased in association with proportional elevations in systemic vascular conductance, related to enhanced blood flow, blood velocity, vascular conductance and kinetic energy in the limbs and head (all R2 ≥ 0.803; P < 0.001), but not in the brain. LV systolic (end-systolic elastance and twist) and diastolic functional profiles (untwisting rate), pulmonary ventilation and systemic aerobic metabolism were only altered in whole-body heating. These findings substantiate the idea that local hyperthermia-induced selective alterations in peripheral blood flow modulate the magnitude of flow to the heart andQ ̇ $\dot Q$ through changes in blood velocity and kinetic energy. Localised heat-activated events in the peripheral circulation therefore affect the human heart's output. KEY POINTS: Local and whole-body hyperthermia increases limb and systemic perfusion, but the underlying peripheral and central heat-sensitive mechanisms are not fully established. Here we investigated the regional (leg, arm and head) and systemic haemodynamics (cardiac output:Q ̇ $\dot Q$ ) during passive single-leg, two-leg and whole-body hyperthermia to determine the contribution of peripheral and central thermosensitive factors in the control of human circulation. Single-leg, two-leg, and whole-body hyperthermia induced graded increases in leg blood flow andQ ̇ $\dot Q$ . Brain blood flow, however, remained unchanged in all conditions. Ventilation, extracranial blood flow and cardiac systolic and diastolic functions only increased during whole-body hyperthermia. The augmentedQ ̇ $\dot Q$ with hyperthermia was tightly related to increased limb and head blood velocity, flow and kinetic energy. The findings indicate that local thermosensitive mechanisms modulate regional blood velocity, flow and kinetic energy, thereby controlling the magnitude of flow to the heart and thus the coupling of peripheral and central circulation during hyperthermia.
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Affiliation(s)
- Kazuhito Watanabe
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Uxbridge, UK
- Faculty of Education and Human Studies, Akita University, Akita, Japan
| | - Nuno Koch Esteves
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Uxbridge, UK
- Research Centre, University College of Osteopathy, London, UK
| | - Oliver R Gibson
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Uxbridge, UK
- Centre for Physical Activity in Health and Disease, Brunel University London, Uxbridge, UK
| | - Koichi Akiyama
- Department of Anesthesiology, Kindai University Hospital, Osaka, Japan
| | - Sumie Watanabe
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Uxbridge, UK
- Faculty of Education and Human Studies, Akita University, Akita, Japan
| | - José González-Alonso
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Uxbridge, UK
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Hosono Y, Takahashi K, Shigemitsu S, Akimoto S, Ifuku M, Yazaki K, Wakatsuki H, Yaguchi A, Tomita O, Fujimura J, Saito M, Yoneoka D, Shimizu T. Assessment of anthracycline-induced cardiotoxicity in childhood cancer survivors during long-term follow-up using strain analysis and intraventricular pressure gradient measurements. Heart Vessels 2024; 39:105-116. [PMID: 37973710 DOI: 10.1007/s00380-023-02312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Cardiac dysfunction due to cardiotoxicity from anthracycline chemotherapy is a leading cause of morbidity and mortality in childhood cancer survivors (CCS), and the cumulative incidence of cardiac events has continued to increase. This study identifies an adequate indicator of cardiac dysfunction during long-term follow-up. PROCEDURE In total, 116 patients (median age: 15.5 [range: 4.7-40.2] years) with childhood cancer who were treated with anthracycline were divided into three age groups for analysis (C1: 4-12 years of age, C2: 13-18 years of age, C3: 19-40 years of age), and 116 control patients of similar ages were divided into three corresponding groups (N1, N2, and N3). Layer-specific strains were assessed for longitudinal strain (LS) and circumferential strain (CS). The total and segmental intraventricular pressure gradients (IVPG) were also calculated based on Doppler imaging of the mitral inflow using Euler's equation. RESULTS Conventional echocardiographic parameters were not significantly different between the patients and controls. All layers of the LS and inner and middle layers of the basal and papillary CS in all ages and all IVPGs in C2 and C3 decreased compared to those of corresponding age groups. Interestingly, basal CS and basal IVPG in CCS showed moderate correlation and both tended to rapidly decrease with aging. Furthermore, basal IVPG and anthracycline dose showed significant correlations. CONCLUSIONS Basal CS and total and basal IVPGs may be particularly useful indicators of cardiotoxicity in long-term follow-up.
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Affiliation(s)
- Yu Hosono
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Ken Takahashi
- Department of Pediatrics, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-Shi, Chiba-Ken, 279-0021, Japan.
| | - Sachie Shigemitsu
- Faculty of Medicine, Department of Pediatrics, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Satoshi Akimoto
- Department of Pediatrics, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-Ku, Tokyo, 177-8521, Japan
| | - Mayumi Ifuku
- Faculty of Medicine, Department of Pediatrics, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Kana Yazaki
- Faculty of Medicine, Department of Pediatrics, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Hisako Wakatsuki
- Faculty of Medicine, Department of Pediatrics, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Akinori Yaguchi
- Faculty of Medicine, Department of Pediatrics, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Osamu Tomita
- Faculty of Medicine, Department of Pediatrics, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Junya Fujimura
- Faculty of Medicine, Department of Pediatrics, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Masahiro Saito
- Faculty of Medicine, Department of Pediatrics, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Daisuke Yoneoka
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 102-0071, Japan
| | - Toshiaki Shimizu
- Faculty of Medicine, Department of Pediatrics, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
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Mandour AS, Farag A, Helal MAY, El-Masry G, Al-Rejaie S, Takahashi K, Yoshida T, Hamabe L, Tanaka R. Non-Invasive Assessment of the Intraventricular Pressure Using Novel Color M-Mode Echocardiography in Animal Studies: Current Status and Future Perspectives in Veterinary Medicine. Animals (Basel) 2023; 13:2452. [PMID: 37570261 PMCID: PMC10417806 DOI: 10.3390/ani13152452] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/06/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
The assessment of diastolic function has received great interest in order to comprehend its crucial role in the pathophysiology of heart failure and for the early identification of cardiac events. Silent changes in the intraventricular flow (IVF) dynamics occur before the deterioration of the cardiac wall, although they cannot be detected using conventional echocardiography. Collective information on left ventricular (LV) pressures throughout the cardiac cycle has great value when dealing with patients with altered hemodynamics. Accurate pressure measurement inside the ventricle can be obtained by invasive methods to determine the LV diastolic pressures, which reflect the myocardial relaxation and compliance. However, catheterization is only feasible in the laboratory setting and is not suitable for clinical use due to its disadvantages. In contrast, echocardiography is simple, safe, and accessible. Color M-mode echocardiography (CMME) is an advanced cardiac evaluation technique that can measure the intraventricular pressure differences (IVPDs) and intraventricular pressure gradients (IVPGs) based on the Doppler shift of the IVF. Recently, the assessment of IVPD and IVPG has gained growing interest in the cardiovascular literature in both animal and human studies as a non-invasive method for the early diagnosis of cardiac dysfunctions, especially diastolic ones. The usability of IVPD and IVPG has been reported in various surgically induced heart failure or pharmacologically altered cardiac functions in rats, dogs, cats, and goats. This report aims to give an overview of the current studies of CMME-derived IVPD and IVPG in animal studies and its feasibility for clinical application in veterinary practice and to provide the prospects of the technique's ability to improve our understanding.
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Affiliation(s)
- Ahmed S. Mandour
- Department of Animal Medicine (Internal Medicine), Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan
| | - Ahmed Farag
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan
- Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Mahmoud A. Y. Helal
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan
- Animal Medicine Department, Faculty of Veterinary Medicine, Benha University, Moshtohor, Benha 13736, Egypt
| | - Gamal El-Masry
- Agricultural Engineering Department, Faculty of Agriculture, Suez Canal University, Ismailia 41522, Egypt
| | - Salim Al-Rejaie
- Department of Pharmacology & Toxicology, College of Pharmacy, King Saud University, Riyadh 11564, Saudi Arabia
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo 113-8421, Japan
| | - Tomohiko Yoshida
- Department of Veterinary Surgery, Division of Veterinary Research, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido 080-8555, Japan
| | - Lina Hamabe
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan
| | - Ryou Tanaka
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan
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Yamamoto Y, Takahashi K, Takamizu A, Ogawa T, Yoshida K, Itakura A. Normative change with gestation in fetal intraventricular pressure difference with color M-mode Doppler echocardiography. J Obstet Gynaecol Res 2023. [PMID: 37190899 DOI: 10.1111/jog.15672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Abstract
AIM The intraventricular pressure difference (IVPD) is the pressure difference in early diastole from the base to the apex of the ventricle. It is a useful marker for evaluating diastolic function because of its role as a suction force. This study investigated the changes in total and segmental IVPDs in normal fetuses throughout gestation to obtain normative data equations. METHODS One hundred thirty-seven healthy pregnant women at 12-40 weeks of gestation were prospectively enrolled to evaluate IVPD. The color M mode was performed, and the image was evaluated using our own code to calculate the IVPD. Segmental IVPD was divided into mid to apex and base. Pearson's correlation coefficient was used to evaluate this relationship. RESULTS There was a significant, positive relationship between IVPD and gestational age in both ventricles (right ventricle [RV]: r = 0.800, left ventricle [LV]: r = 0.818). As for segmental IVPD, basal and mid-apical IVPD also increased with gestation in both ventricles (RV: basal, r = 0.627; mid-apical, r = 0.705; LV: basal r = 0.758; mid-apical, r = 0.756). IVPG, which was calculated as IVPD/ventricular length, also showed a weak, positive relationship with gestation in both ventricles (RV r = 0.351, p < 0.001; LV r = 0.373, p < 0.001). CONCLUSION The total and segmental IVPDs significantly increased linearly through time.
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Affiliation(s)
- Yuka Yamamoto
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ken Takahashi
- Department of Pediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Ai Takamizu
- Department Obstetrics and Gynecology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Takahisa Ogawa
- Department of Global Health Promotion, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Koyo Yoshida
- Department Obstetrics and Gynecology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Validating MRI-Derived Myocardial Stiffness Estimates Using In Vitro Synthetic Heart Models. Ann Biomed Eng 2023:10.1007/s10439-023-03164-7. [PMID: 36914919 DOI: 10.1007/s10439-023-03164-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/07/2023] [Indexed: 03/16/2023]
Abstract
Impaired cardiac filling in response to increased passive myocardial stiffness contributes to the pathophysiology of heart failure. By leveraging cardiac MRI data and ventricular pressure measurements, we can estimate in vivo passive myocardial stiffness using personalized inverse finite element models. While it is well-known that this approach is subject to uncertainties, only few studies quantify the accuracy of these stiffness estimates. This lack of validation is, at least in part, due to the absence of ground truth in vivo passive myocardial stiffness values. Here, using 3D printing, we created soft, homogenous, isotropic, hyperelastic heart phantoms of varying geometry and stiffness and simulate diastolic filling by incorporating the phantoms into an MRI-compatible left ventricular inflation system. We estimate phantom stiffness from MRI and pressure data using inverse finite element analyses based on a Neo-Hookean model. We demonstrate that our identified softest and stiffest values of 215.7 and 512.3 kPa agree well with the ground truth of 226.2 and 526.4 kPa. Overall, our estimated stiffnesses revealed a good agreement with the ground truth ([Formula: see text] error) across all models. Our results suggest that MRI-driven computational constitutive modeling can accurately estimate synthetic heart material stiffnesses in the range of 200-500 kPa.
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Sørensen K, Fadnes S, Mertens L, Henry M, Segers P, Løvstakken L, Nyrnes SA. Assessment of Early Diastolic Intraventricular Pressure Difference in Children by Blood Speckle-Tracking Echocardiography. J Am Soc Echocardiogr 2023; 36:523-532.e3. [PMID: 36632939 DOI: 10.1016/j.echo.2022.12.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/24/2022] [Accepted: 12/30/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The lack of reliable echocardiographic techniques to assess diastolic function in children is a major clinical limitation. Our aim was to develop and validate the intraventricular pressure difference (IVPD) calculation using blood speckle-tracking (BST) and investigate the method's potential role in the assessment of diastolic function in children. METHODS Blood speckle-tracking allows two-dimensional angle-independent blood flow velocity estimation. Blood speckle-tracking images of left ventricular (LV) inflow from the apical 4-chamber view in 138 controls, 10 patients with dilated cardiomyopathies (DCMs), and 21 patients with hypertrophic cardiomyopathies (HCMs) <18 years of age were analyzed to study LV IVPD during early diastole. Reproducibility of the IVPD analysis was assessed, IVPD estimates from BST and color M mode were compared, and the validity of the BST-based IVPD calculations was tested in a computer flow model. RESULTS Mean IVPD was significantly higher in controls (-2.28 ± 0.62 mm Hg) compared with in DCM (-1.21 ± 0.39 mm Hg, P < .001) and HCM (-1.57 ± 0.47 mm Hg, P < .001) patients. Feasibility was 88.3% in controls, 80% in DCM patients, and 90.4% in HCM patients. The peak relative negative pressure occurred earlier at the apex than at the base and preceded the peak E-wave LV filling velocity, indicating that it represents diastolic suction. Intraclass correlation coefficients for intra- and interobserver variability were 0.908 and 0.702, respectively. There was a nonsignificant mean difference of 0.15 mm Hg between IVPD from BST and color M mode. Estimation from two-dimensional velocities revealed a difference in peak IVPD of 0.12 mm Hg (6.6%) when simulated in a three-dimensional fluid mechanics model. CONCLUSIONS Intraventricular pressure difference calculation from BST is highly feasible and provides information on diastolic suction and early filling in children with heart disease. Intraventricular pressure difference was significantly reduced in children with DCM and HCM compared with controls, indicating reduced early diastolic suction in these patient groups.
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Affiliation(s)
- Kristian Sørensen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Division of Ålesund Hospital, Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund, Norway.
| | - Solveig Fadnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Division of Ålesund Hospital, Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Luc Mertens
- Department of Cardiology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Henry
- Department of Cardiology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Segers
- Department of Electronics and Information Systems, IBiTech-bioMMeda, Ghent University, Ghent, Belgium
| | - Lasse Løvstakken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siri Ann Nyrnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Children's Clinic, St. Olav`s Hospital, Trondheim University Hospital, Trondheim, Norway
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Determinants of exercise capacity in patients with heart failure without left ventricular hypertrophy. J Cardiol 2023; 81:33-41. [PMID: 36122643 DOI: 10.1016/j.jjcc.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Determinants of exercise intolerance in a phenotype of heart failure with preserved ejection fraction (HFpEF) with normal left ventricular (LV) structure have not been fully elucidated. METHODS Cardiopulmonary exercise testing and exercise-stress echocardiography were performed in 44 HFpEF patients without LV hypertrophy. Exercise capacity was determined by peak oxygen consumption (peak VO2). Doppler-derived cardiac output (CO), transmitral E velocity, systolic (LV-s') and early diastolic mitral annular velocities (e'), systolic pulmonary artery (PA) pressure (SPAP), tricuspid annular plane systolic excursion (TAPSE), and peak systolic right ventricular (RV) free wall velocity (RV-s') were measured at rest and exercise. E/e' and TAPSE/SPAP were used as an LV filling pressure parameter and RV-PA coupling, respectively. RESULTS During exercise, CO, LV-s', RV-s', e', and SPAP were significantly increased (p < 0.05 for all), whereas E/e' remained unchanged and TAPSE/SPAP was significantly reduced (p < 0.001). SPAP was higher and TAPSE/SPAP was lower at peak exercise in patients showing lower-half peak VO2. In univariable analyses, LV-s' (R = 0.35, p = 0.022), SPAP (R = -0.40, p = 0.008), RV-s' (R = 0.47, p = 0.002), and TAPSE/SPAP (R = 0.42, p = 0.005) were significantly correlated with peak VO2. In multivariable analyses, not only SPAP, but also TAPSE/SPAP independently determined peak VO2 even after the adjustment for clinically relevant parameters. CONCLUSIONS In HFpEF patients without LV hypertrophy, altered RV-PA coupling by exercise could be associated with exercise intolerance, which might not be caused by elevated LV filling pressure.
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Demirkiran A, van der Geest RJ, Hopman LHGA, Robbers LFHJ, Handoko ML, Nijveldt R, Greenwood JP, Plein S, Garg P. Association of left ventricular flow energetics with remodeling after myocardial infarction: New hemodynamic insights for left ventricular remodeling. Int J Cardiol 2022; 367:105-114. [PMID: 36007668 DOI: 10.1016/j.ijcard.2022.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/08/2022] [Accepted: 08/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Myocardial infarction leads to complex changes in left ventricular (LV) hemodynamics. It remains unknown how four-dimensional acute changes in LV-cavity blood flow kinetic energy affects LV-remodeling. METHODS AND RESULTS In total, 69 revascularised ST-segment elevation myocardial infarction (STEMI) patients were enrolled. All patients underwent cardiovascular magnetic resonance (CMR) examination within 2 days of the index event and at 3-month. CMR examination included cine, late gadolinium enhancement, and whole-heart four-dimensional flow acquisitions. LV volume-function, infarct size (indexed to body surface area), microvascular obstruction, mitral inflow, and blood flow KEi (kinetic energy indexed to end-diastolic volume) characteristics were obtained. Adverse LV-remodeling was defined and categorized according to increase in LV end-diastolic volume of at least 10%, 15%, and 20%. Twenty-four patients (35%) developed at least 10%, 17 patients (25%) at least 15%, 11 patients (16%) at least 20% LV-remodeling. Demographics and clinical history were comparable between patients with/without LV-remodeling. In univariable regression-analysis, A-wave KEi was associated with at least 10%, 15%, and 20% LV-remodeling (p = 0.03, p = 0.02, p = 0.02, respectively), whereas infarct size only with at least 10% LV-remodeling (p = 0.02). In multivariable regression-analysis, A-wave KEi was identified as an independent marker for at least 10%, 15%, and 20% LV-remodeling (p = 0.09, p < 0.01, p < 0.01, respectively), yet infarct size only for at least 10% LV-remodeling (p = 0.03). CONCLUSION In patients with STEMI, LV hemodynamic assessment by LV blood flow kinetic energetics demonstrates a significant inverse association with adverse LV-remodeling. Late-diastolic LV blood flow kinetic energetics early after acute MI was independently associated with adverse LV-remodeling.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Rob J van der Geest
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Lourens F H J Robbers
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Pankaj Garg
- Department of Cardiology, Norfolk Medical School, University of East Anglia, Norwich, United Kingdom.
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10
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Yanase Y, Iwashima S, Takahashi K. Echocardiographic Reference Ranges of Non-Invasive Myocardial Work Indices in Newborns. Circ Rep 2022; 4:429-438. [PMID: 36120485 PMCID: PMC9437471 DOI: 10.1253/circrep.cr-22-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Myocardial work (MCW), estimated using non-invasive pressure-strain loops, is a novel approach for assessing left ventricular function. MCW offers potential advantages over left ventricular ejection fraction and global longitudinal strain (GLS). This study aimed to establish a reference range for MCW in newborns. Methods and Results: Overall, 113 healthy newborns (mean [±SD] birth weight 3,120±378 g) were included in the study. After entering peripheral systolic and diastolic blood pressure (BP) values, global constructive work (GCW), global work index (GWI), global work efficiency (GWE), and global wasted work (GWW) were calculated using EchoPAC software (version 204). Considering a mean [±SD] GLS of −16.3±2.8%, the mean [±SD] GWI, GCW, GWW, and GWE was 698.7±147.9 mmHg%, 1,008.5±200.1 mmHg%, 58.1±28.1 mmHg%, and 93.1±2.9%, respectively. All MCW parameters in newborns were lower than those previously reported in children and adults. However, GWI and GCW were more closely correlated with BP and GLS, as in adulthood and children. Estimation of the correlation between MCW and the frame rate index revealed no significant correlations among MCW parameters. Conclusions: Cardiac function in newborns was evaluated by assessing MCW. With the establishment of reference ranges and normative MCW data for newborns, routine clinical use and rotational mechanics are likely to become increasingly common. Future studies are needed to determine whether MCW is useful in screening for cardiac illness among newborns.
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Affiliation(s)
- Yuma Yanase
- Department of Pediatric Cardiology, Hamamatsu Medical College of School
| | - Satoru Iwashima
- Department of Pediatric Cardiology, Chutoen General Medical Center
| | - Ken Takahashi
- Department of Pediatrics, Juntendo University Urayasu Hospital
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11
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El-Husseiny HM, Mady EA, Ma D, Hamabe L, Takahashi K, Tanaka R. Intraventricular pressure gradient: A novel tool to assess the post-infarction chronic congestive heart failure. Front Cardiovasc Med 2022; 9:944171. [PMID: 36051280 PMCID: PMC9425054 DOI: 10.3389/fcvm.2022.944171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Congestive heart failure (CHF), the leading cause of death, is deemed a grave sequel of myocardial infarction (MI). The employment of left ventricular end-diastolic pressure (LVEDP), as a primary indication of CHF, becomes restricted owing to the potential impairment of heart function and caused injury to the aortic valve during its measurement. Echocardiography is the standard technique to detect cardiac dysfunction. However, it exhibits a low capacity to predict the progression of CHF post chronic MI. Being extremely sensitive, noninvasive, and preload-independent, intraventricular pressure gradient (IVPG) was lately introduced to evaluate cardiac function, specifically during cardiomyopathy. Yet, the utility of its use to assess the CHF progression after chronic MI was not investigated. Herein, in the current research, we aimed to study the efficacy of a novel echocardiographic-derived index as IVPG in the assessment of cardiac function in a chronic MI rat model with CHF. Fifty healthy male rats were involved, and MI was surgically induced in 35 of them. Six months post-surgery, all animals were examined using transthoracic conventional and color M-mode echocardiography (CMME) for IVPG. Animals were euthanized the following day after hemodynamics recording. Gross pathological and histological evaluations were performed. J-tree cluster analysis was conducted relying on ten echocardiographic parameters suggestive of CHF. Animals were merged into two main clusters: CHF+ (MI/HF + group, n = 22) and CHF– (n = 28) that was joined from Sham (n = 15), and MI/HF– (n = 13) groups. MI/HF+ group showed the most severe echocardiographic, hemodynamic, anatomic, and histologic alterations. There was no significant change in the total IVPG among various groups. However, the basal IVPG was significantly increased in MI/HF+ group compared to the other groups. The remaining IVPG measures were considerably increased in the MI/HF+ group than in the Sham one. The segmental IVPG measures were significantly correlated with the anatomical, histological, echocardiographic, and hemodynamic findings except for the heart rate. Moreover, they were significant predictors of CHF following a long-standing MI. Conclusively, IVPG obtained from CMME is a substantially promising noninvasive tool with a high ability to detect and predict the progression of CHF following chronic MI compared to conventional echocardiography.
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Affiliation(s)
- Hussein M. El-Husseiny
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi, Japan
- Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Benha University, Toukh, Egypt
- *Correspondence: Hussein M. El-Husseiny
| | - Eman A. Mady
- Laboratory of Veterinary Physiology, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi, Japan
- Department of Animal Hygiene, Behavior and Management, Faculty of Veterinary Medicine, Benha University, Toukh, Egypt
| | - Danfu Ma
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi, Japan
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Lina Hamabe
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi, Japan
- Lina Hamabe
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo, Japan
| | - Ryou Tanaka
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi, Japan
- Ryou Tanaka
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12
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Hirose M, Mandour AS, Goya S, Hamabe L, Matsuura K, Yoshida T, Watanabe M, Shimada K, Uemura A, Takahashi K, Tanaka R. Color M-Mode Echocardiography for Non-Invasive Assessment of the Intraventricular Pressure in Dogs Before and After Ductus Arteriosus Occlusion: A Retrospective Study. Front Vet Sci 2022; 9:908829. [PMID: 35903130 PMCID: PMC9315367 DOI: 10.3389/fvets.2022.908829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background Novel non-invasive evaluation of the intraventricular pressure differences and gradients (IVPD and IVPG) by color M-mode echocardiography (CMME) is a promising method in diastolic function evaluation. Patent ductus arteriosus (PDA) is a congenital heart defect which is associated with increased preload. The present work provides a clinical trial for the assessment of IVPD and IVPG changes in dogs before and after surgical occlusion of PDA. Materials and Methods A total of 12 client-owned dogs were enrolled in this study. PDA was confirmed using echocardiography, and all dogs underwent PDA occlusion. Conventional echocardiography and CMME were conducted on each patient on the operation day (Pre-PDA) and 48 h after its occlusion (Post-PDA). The total IVPD and total IVPG, as well as segmental intraventricular pressure (basal, mid-to-apical, mid, and apical) were measured from Euler's equation using specific software (MATLAB). Data were analyzed for variability and for the difference between pre- and post-PDA. The effect of PDA occlusion on the measured variables was calculated using biserial ranked correlation (rc). Results There was a significant reduction in end-diastolic volume, fraction shortening, stroke volume, and mitral inflow velocities (early and late) after PDA closure. CMME was feasible in all dogs, and the CMME indices showed moderate variability, except for the apical segment of IVPD and IVPG. After PDA closure, in comparison with the pre-PDA occlusion, there was a significant reduction in total IVPD (2.285 ± 0.374 vs. 1.748 ± 0.436 mmHg; P = 0.014), basal IVPD (1.177 ± 0.538 vs. 0.696 ± 0.144 mmHg; P = 0.012), total IVPG (1.141 ± 0.246 vs. 0.933 ± 0.208 mmHg; P = 0.032), and basal IVPG (0.578 ± 0.199 vs. 0.377 ± 0.113 mmHg; P = 0.001); meanwhile, mid, mid-to-apical, and apical segments of both IVPD and IVPG showed non-significant difference. The magnitude of PDA occlusion on the measured variables was clinically relevant and associated with a large effect size on total and basal IVPD and IVPG (rc > 0.6). Conclusion The current clinical study revealed matched response of IVPD and IVPG to the reduced preload rather than left ventricular relaxation. This result is an initial step in the clinical utility of CMME-derived IVPD and IVPG measurements in the diastolic function evaluation in dogs with PDA that warrants further clinical studies.
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Affiliation(s)
- Miki Hirose
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Ahmed S. Mandour
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
- Department of Animal Medicine (Internal Medicine), Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Seijirow Goya
- Department of Bioresource Sciences, Nihon University, Fujisawa, Japan
| | - Lina Hamabe
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Katsuhiro Matsuura
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Tomohiko Yoshida
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Momoko Watanabe
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Kazumi Shimada
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Akiko Uemura
- Division of Veterinary Research, Department of Veterinary Surgery, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo, Japan
| | - Ryou Tanaka
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
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13
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Matsuura K, Bach MB, Takahashi K, Willesen JL, Koch J, Tanaka R. Non-invasive assessment of left ventricular relaxation property using color M-mode-derived intraventricular pressure gradients in cats. J Vet Cardiol 2022; 41:236-248. [DOI: 10.1016/j.jvc.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
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14
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Chiba Y, Iwano H, Tsuneta S, Tsujinaga S, Meyers B, Vlachos P, Ishizaka S, Motoi K, Aoyagi H, Tamaki Y, Tanemura A, Murayama M, Yokoyama S, Nakabachi M, Nishino H, Kaga S, Kamiya K, Ohira H, Tsujino I, Anzai T. Determinants of altered left ventricular suction in pre-capillary pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2022; 23:1399-1406. [PMID: 35019957 DOI: 10.1093/ehjci/jeab285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Although the left ventricular (LV) dysfunction in pre-capillary pulmonary hypertension (PH) has been recently recognized, the mechanism of LV dysfunction in this entity is not completely understood. We thus aimed to elucidate the determinants of intraventricular pressure difference (IVPD), a measure of LV suction, in pre-capillary PH. METHODS AND RESULTS Right heart catheterization and echocardiography were performed in 86 consecutive patients with pre-capillary PH (57 ± 18 years, 85% female). IVPD was determined using colour M-mode Doppler to integrate the Euler equation. In overall, IVPD was reduced compared to previously reported value in normal subjects. In univariable analyses, QRS duration (P = 0.028), LV ejection fraction (P = 0.006), right ventricular (RV) end-diastolic area (P < 0.001), tricuspid annular plane systolic excursion (P = 0.004), and LV early-diastolic eccentricity index (P = 0.009) were associated with IVPD. In the multivariable analyses, RV end-diastolic area and LV eccentricity index independently determined the IVPD. CONCLUSION Aberrant ventricular interdependence caused by RV enlargement could impair the LV suction. This study first applied echocardiographic IVPD, a reliable marker of LV diastolic suction, to investigate the mechanism of LV diastolic dysfunction in pre-capillary PH.
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Affiliation(s)
- Yasuyuki Chiba
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.,Division of Cardiology, Hakodate Municipal Hospital, 1-10-1, Minato-cho, Hakodate 041-8680, Japan
| | - Satonori Tsuneta
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan
| | - Shingo Tsujinaga
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Brett Meyers
- School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN 47907-2088, USA
| | - Pavlos Vlachos
- School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN 47907-2088, USA
| | - Suguru Ishizaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Ko Motoi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Hiroyuki Aoyagi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Yoji Tamaki
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Asuka Tanemura
- Diagnostic Center for Sonography, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan
| | - Michito Murayama
- Diagnostic Center for Sonography, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan
| | - Shinobu Yokoyama
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan
| | - Masahiro Nakabachi
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan
| | - Hisao Nishino
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan
| | - Sanae Kaga
- Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo 060-0812, Japan
| | - Kiwamu Kamiya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Hiroshi Ohira
- Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.,Division of Cardiology, KKR Sapporo Medical Center, 3-40, Hiragishi 1-6, Toyohira-ku, Sapporo 062-0931, Japan
| | - Ichizo Tsujino
- Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
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15
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Reference Ranges of Left Ventricular Hemodynamic Forces in Healthy Adults: A Speckle-Tracking Echocardiographic Study. J Clin Med 2021; 10:jcm10245937. [PMID: 34945231 PMCID: PMC8707005 DOI: 10.3390/jcm10245937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 01/28/2023] Open
Abstract
Background: The normal limits of left ventricular (LV) hemodynamic forces (HDFs) are not exactly known. The aim of this study was to explore the full spectrum of HDF parameters in healthy subjects and determine their physiologic correlates. Methods: 269 healthy subjects were enrolled (mean age: 43 ± 14 years; 123 (45.7%) men). All participants underwent an echo-Doppler examination. Tri-plane tissue tracking from apical views was used to measure 2D global endocardial longitudinal strain (GLS), circumferential strain (GCS), and LV HDFs. HDFs were normalized with LV volume and divided by specific weight. Results: LV systolic longitudinal HDFs (%) were higher in men (20.8 ± 6.5 vs. 18.9 ± 5.6, p = 0.009; 22.0 ± 6.7 vs. 19.8 ± 5.6, p = 0.004, respectively). There was a significant correlation between GCS (increased) (r = −0.240, p < 0.001) and LV longitudinal HDFs (reduced) (r = −0.155, p = 0.01) with age. In a multivariable analysis age, BSA, pulse pressure, heart rate and GCS were the only independent variables associated with LV HDFs (β coefficient = −0.232, p < 0.001; 0.149, p = 0.003; 0.186, p < 0.001; 0.396, p < 0.001; −0.328, p < 0.001; respectively). Conclusion: We report on the physiologic range of LV HDFs. Knowledge of reference values of HDFs may prompt their implementation into clinical routine and allow a more comprehensive assessment of the LV function.
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16
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Ma D, Mandour AS, Yoshida T, Matsuura K, Shimada K, Kitpipatkun P, Uemura A, Ifuku M, Takahashi K, Tanaka R. Intraventricular pressure gradients change during the development of left ventricular hypertrophy: Effect of salvianolic acid B and beta-blocker. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2021; 29:229-240. [PMID: 34777543 DOI: 10.1177/1742271x20987584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022]
Abstract
Introduction Intraventricular pressure gradient is regarded as a non-invasive indicator of diastolic function. Salvianolic acid B (Sal-B), a traditional Asian medicine, revealed its usefulness in myocardial infarction models; however, the hemodynamic effect of salvianolic acid B is still unknown. The present study aimed to investigate the intraventricular pressure gradient changes during the development of left ventricular hypertrophy with or without salvianolic acid B and a beta-blocker. Methods In total, 48 rats were divided into four groups; Sham, Non-treatment, salvianolic acid B, and Carvedilol. Aortic coarctation-induced left ventricular hypertrophy was done in three groups and the treatment was started from the third to the sixth week. Blood pressure, conventional echocardiography, and color M-mode echocardiography for measurement of intraventricular pressure gradient were carried out for six consecutive weeks. Results At 4.5 weeks, the LV mass was elevated in the coarctation groups but the blood pressure was significantly lower in salvianolic acid B and Carvedilol groups (P < 0.05). In the Non-treatment group, the total intraventricular pressure gradient was increased at 4.5 and 6 weeks (2.60 and 2.65, respectively). Meanwhile, the basal intraventricular pressure gradient was elevated at 3 and 6 weeks (1.67 and 1.75) compared with the Sham group. Salvianolic acid B and Carvedilol significantly reduced the basal intraventricular pressure gradient at six weeks compared with the Non-treatment group (1.52 and 1.51 vs 1.75, respectively). Conclusions Salvianolic acid B and Carvedilol promote cardiac function by decreasing the elevated basal intraventricular pressure gradient. The current preclinical results revealed the efficacy of salvianolic acid B as a potential therapy for left ventricular hypertrophy because of the non-blood pressure lowering effect.
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Affiliation(s)
- Danfu Ma
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Ahmed S Mandour
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan.,Department of Animal Medicine (Internal Medicine), Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Tomohiko Yoshida
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Katsuhiro Matsuura
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Kazumi Shimada
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Pitipat Kitpipatkun
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Akiko Uemura
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Mayumi Ifuku
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryou Tanaka
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
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17
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Yairo A, Mandour AS, Matsuura K, Yoshida T, Ma D, Kitpipatkun P, Kato K, Cheng CJ, El-Husseiny HM, Tanaka T, Shimada K, Hamabe L, Uemura A, Takahashi K, Tanaka R. Effect of Loading Changes on the Intraventricular Pressure Measured by Color M-Mode Echocardiography in Rats. Diagnostics (Basel) 2021; 11:1403. [PMID: 34441337 PMCID: PMC8391789 DOI: 10.3390/diagnostics11081403] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 02/06/2023] Open
Abstract
Evaluation of diastolic function is a pivotal challenge due to limitations of the conventional echocardiography, especially when the heart rate is rapid as in rats. Currently, by using color M-mode echocardiography (CMME), intraventricular pressure difference (IVPD) and intraventricular pressure gradient (IVPG) in early diastole can be generated and are available as echocardiographic indices. These indices are expected to be useful for the early diagnosis of heart failure (HF), especially diastolic dysfunction. There have not been any studies demonstrating changes in IVPD and IVPG in response to changes in loading conditions in rats. Therefore, the present study aims to evaluate CMME-derived IVPD and IVPG changes in rats under various loading conditions. Twenty rats were included, divided into two groups for two different experiments, and underwent jugular vein catheterization under inhalational anesthetics. Conventional echocardiography, CMME, and 2D speckle tracking echocardiography were measured at the baseline (BL), after intravenous infusion of milrinone (MIL, n = 10), and after the infusion of hydroxyethyl starch (HES, n = 10). Left ventricular IVPD and IVPG were calculated from color M-mode images and categorized into total, basal, mid-to-apical, mid, and apical parts, and the percentage of the corresponding part was calculated. In comparison to the BL, the ejection fraction, mid-to-apical IVPG, mid IVPG, and apical IVPD were significantly increased after MIL administration (p < 0.05); meanwhile, the end-diastolic volume, E-wave velocity, total IVPD, and basal IVPD were significantly increased with the administration of HES (p < 0.05). The increase in mid-to-apical IVPD, mid IVPD, and apical IVPD indicated increased relaxation. A significant increase in basal IVPD reflected volume overloading by HES. CMME-derived IVPD and IVPG are useful tools for the evaluation of various loading conditions in rats. The approach used in this study provides a model for continuous data acquisition in chronic cardiac disease models without drug testing.
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Affiliation(s)
- Akira Yairo
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (A.Y.); (K.M.); (T.Y.); (D.M.); (P.K.); (K.K.); (C.-J.C.); (H.M.E.-H.); (T.T.); (K.S.); (L.H.)
| | - Ahmed S. Mandour
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (A.Y.); (K.M.); (T.Y.); (D.M.); (P.K.); (K.K.); (C.-J.C.); (H.M.E.-H.); (T.T.); (K.S.); (L.H.)
- Department of Animal Medicine (Internal Medicine), Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Katsuhiro Matsuura
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (A.Y.); (K.M.); (T.Y.); (D.M.); (P.K.); (K.K.); (C.-J.C.); (H.M.E.-H.); (T.T.); (K.S.); (L.H.)
| | - Tomohiko Yoshida
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (A.Y.); (K.M.); (T.Y.); (D.M.); (P.K.); (K.K.); (C.-J.C.); (H.M.E.-H.); (T.T.); (K.S.); (L.H.)
| | - Danfu Ma
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (A.Y.); (K.M.); (T.Y.); (D.M.); (P.K.); (K.K.); (C.-J.C.); (H.M.E.-H.); (T.T.); (K.S.); (L.H.)
| | - Pitipat Kitpipatkun
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (A.Y.); (K.M.); (T.Y.); (D.M.); (P.K.); (K.K.); (C.-J.C.); (H.M.E.-H.); (T.T.); (K.S.); (L.H.)
| | - Konosuke Kato
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (A.Y.); (K.M.); (T.Y.); (D.M.); (P.K.); (K.K.); (C.-J.C.); (H.M.E.-H.); (T.T.); (K.S.); (L.H.)
| | - Chieh-Jen Cheng
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (A.Y.); (K.M.); (T.Y.); (D.M.); (P.K.); (K.K.); (C.-J.C.); (H.M.E.-H.); (T.T.); (K.S.); (L.H.)
| | - Hussein M. El-Husseiny
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (A.Y.); (K.M.); (T.Y.); (D.M.); (P.K.); (K.K.); (C.-J.C.); (H.M.E.-H.); (T.T.); (K.S.); (L.H.)
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Benha University, Moshtohor, Toukh, Elqaliobiya 13736, Egypt
| | - Takashi Tanaka
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (A.Y.); (K.M.); (T.Y.); (D.M.); (P.K.); (K.K.); (C.-J.C.); (H.M.E.-H.); (T.T.); (K.S.); (L.H.)
| | - Kazumi Shimada
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (A.Y.); (K.M.); (T.Y.); (D.M.); (P.K.); (K.K.); (C.-J.C.); (H.M.E.-H.); (T.T.); (K.S.); (L.H.)
| | - Lina Hamabe
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (A.Y.); (K.M.); (T.Y.); (D.M.); (P.K.); (K.K.); (C.-J.C.); (H.M.E.-H.); (T.T.); (K.S.); (L.H.)
| | - Akiko Uemura
- Department of Veterinary Surgery, Division of Veterinary Research, Obihiro University of Agriculture and Veterinary Medicine, Obihiro 080-8555, Hokkaido, Japan;
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan;
| | - Ryou Tanaka
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (A.Y.); (K.M.); (T.Y.); (D.M.); (P.K.); (K.K.); (C.-J.C.); (H.M.E.-H.); (T.T.); (K.S.); (L.H.)
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18
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Chalikias GK, Tziakas DN. Echocardiography derived intra-ventricular pressure gradients: a window to the temporal and spatial components of diastolic dysfunction. Int J Cardiovasc Imaging 2021; 37:2675-2678. [PMID: 34286446 DOI: 10.1007/s10554-021-02351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Georgios K Chalikias
- Cardiology Department, Medical School, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece.
| | - Dimitrios N Tziakas
- Cardiology Department, Medical School, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
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19
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Maekawa M, Minami K, Yoshitani K, Watanabe K, Kanazawa H, Tadokoro N, Fukushima S, Fujita T, Ohnishi Y. Correlation Between Intraventricular Pressure Difference and Indexed Flow of a Left Ventricular Assist Device. J Cardiothorac Vasc Anesth 2021; 35:3626-3630. [PMID: 34130898 DOI: 10.1053/j.jvca.2021.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES There is no definitive parameter for left ventricular (LV) preload in patients with a continuous-flow left ventricular assist device (LVAD). The intraventricular pressure difference (IVPD) is the maximum pressure difference between the mitral valve and LV apex during diastole; and, in past studies, the IVPD was influenced by volume loading. The authors hypothesized that IVPD in LVAD patients correlates with indexed LVAD flow and that IVPD can serve as a novel parameter of LV preload in this population. DESIGN A single-center, retrospective, observational study. SETTING A tertiary-care hospital from August 2019 to July 2020. PARTICIPANTS Sixteen ramp tests for adjustment of LVAD pump speed in 14 adult patients undergoing continuous-flow LVAD implantation. INTERVENTIONS Measurement of IVPD during ramp tests. MEASUREMENTS AND MAIN RESULTS LVAD flow and IVPD were measured at each LVAD pump speed during the ramp test for the adjustment of LVAD pump speed after patients came off cardiopulmonary bypass during LVAD implantation. A straight, longitudinal view of the left atrium and left ventricle was obtained, and the pressure difference between the mitral valve and LV apex during diastole was measured by transesophageal echocardiography. The maximum pressure difference during diastole was recorded as IVPD. The relationship between indexed LVAD flow (LVAD flow/body surface area) and IVPD was assessed by a multivariate nonlinear regression analysis with the Huber-White sandwich estimator. IVPD correlated with indexed LVAD flow (p < 0.001). CONCLUSIONS IVPD is a useful indicator of LV preload during LVAD implantation.
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Affiliation(s)
- Masaki Maekawa
- Department of Anesthesiology, Toranomon Hospital, Tokyo, Japan
| | - Kimito Minami
- Department of Surgical Intensive Care, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Kenji Yoshitani
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenji Watanabe
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroko Kanazawa
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Naoki Tadokoro
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
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20
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Chakraborty S, Meyers BA, Iwano H, Hall ME, Vlachos PP. A Wavelet Approach to the Estimation of Left Ventricular Early Filling Wave Propagation Velocity from Color M-Mode Echocardiograms. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1397-1407. [PMID: 33546924 DOI: 10.1016/j.ultrasmedbio.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
A new approach to calculating left ventricular (LV) early filling propagation velocity (VP) from color M-mode echocardiograms using wavelet analysis is described. Current methods for measuring VP do not account for the spatiotemporal variation in VP. They are confined by empirical assumptions and user inputs that hinder the accuracy of VP, limiting its clinical utility. We evaluated three methods for measuring LV early filling: conventional VP, the strength of propagation (VS) and wavelet propagation velocity (VW) determined from the most energetically significant wave (peak VW). Group A comprised 125 patients (n = 50 normal filling, n = 25 impaired relaxation, n = 25 pseudonormal filling and n = 25 restrictive filling), and group B comprised 69 patients (n = 32 normal, n = 15 dilated and n = 22 hypertrophic). Peak VW most accurately distinguished normal from diseased patients. For group A, the area under the receiver operating characteristic curve was 0.92 for peak VW versus 0.62 for VP, 0.63 for VS and 0.58 for intraventricular pressure difference. These correspond to a 50%-70% improvement in classification ability. Similar improvements were measured in group B. Peak VW may provide a more accurate evaluation of diastolic function than standard methods and enable better diagnostic classification of patients with diastolic dysfunction.
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Affiliation(s)
- Sreyashi Chakraborty
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Brett A Meyers
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Hiroyuki Iwano
- Division of Cardiology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA; Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Michael E Hall
- Division of Cardiology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Pavlos P Vlachos
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, USA.
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21
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Matsuura K, Shiraishi K, Mandour AS, Sato K, Shimada K, Goya S, Yoshida T, Kitpipatkun P, Hamabe L, Uemura A, Yilmaz Z, Ifuku M, Iso T, Takahashi K, Tanaka R. The Utility of Intraventricular Pressure Gradient for Early Detection of Chemotherapy-Induced Subclinical Cardiac Dysfunction in Dogs. Animals (Basel) 2021; 11:1122. [PMID: 33919889 PMCID: PMC8070943 DOI: 10.3390/ani11041122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 01/04/2023] Open
Abstract
Early detection of doxorubicin (DXR)-induced cardiomyopathy (DXR-ICM) is crucial to improve cancer patient outcomes and survival. In recent years, the intraventricular pressure gradient (IVPG) has been a breakthrough as a sensitive index to assess cardiac function. This study aimed to evaluate the usefulness of IVPG for the early detection of chemotherapy-related cardiac dysfunction. For this purpose, six dogs underwent conventional, speckle tracking, and color M-mode echocardiography concomitantly with pressure-and-volume analysis by conductance catheter. The cardiac function measurements were assessed before DXR administration (baseline, Pre), at the end of treatment protocol (Post), and at 1.5 years follow-up (Post2). The result showed a significant reduction in the left ventricular end-systolic pressure-volume (Emax: 4.4 ± 0.7, 6.1 ± 1.6 vs. 8.4 ± 0.8 mmHg/mL), total-IVPG (0.59 ± 0.12, 0.62 ± 0.15 vs. 0.86 ± 0.12 mmHg), and mid-IVPG (0.28 ± 0.12, 0.31 ± 0.11 vs. 0.48 ± 0.08 mmHg), respectively in Post2 and Post compared with the baseline (p < 0.05). Mid-to-apical IVPG was also reduced in Post2 compared with the baseline (0.29 ± 0.13 vs. 0.51 ± 0.11). Meanwhile, the fraction shortening, ejection fraction, and longitudinal strain revealed no change between groups. Total and mid-IVPG were significantly correlated with Emax (R = 0.49; p < 0.05, both) but only mid-IVPG was a predictor for Emax (R2 = 0.238, p = 0.040). In conclusion, this study revealed that impairment of contractility was the initial changes observed with DXR-ICM in dogs and only IVPG could noninvasively detect subclinical alterations in cardiac function. Color M-mode echocardiography-derived IVPG could be a potential marker for the early detection of doxorubicin cardiomyopathy.
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Affiliation(s)
- Katsuhiro Matsuura
- VCA Japan Shiraishi Animal Hospital, Saitama 350-1304, Japan;
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Kenjirou Shiraishi
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Ahmed S. Mandour
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
- Department of Animal Medicine (Internal Medicine), Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Kotomi Sato
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Kazumi Shimada
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Seijirow Goya
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Tomohiko Yoshida
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Pitipat Kitpipatkun
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Lina Hamabe
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Akiko Uemura
- Department of Veterinary Surgery, Division of Veterinary Research, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido 080-8555, Japan;
| | - Zeki Yilmaz
- Department of Internal Medicine, Faculty of Veterinary Medicine, Uludag University, Bursa 16120, Turkey;
| | - Mayumi Ifuku
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.I.); (T.I.); (K.T.)
| | - Takeshi Iso
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.I.); (T.I.); (K.T.)
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.I.); (T.I.); (K.T.)
| | - Ryou Tanaka
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
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22
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Noninvasive estimation of impaired left ventricular untwisting velocity by peak early diastolic intra-ventricular pressure gradients using vector flow mapping. J Echocardiogr 2021; 19:166-172. [PMID: 33682077 DOI: 10.1007/s12574-021-00520-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/06/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Introduction of vector flow mapping (VFM) based on the combination of color Doppler and speckle-tracking echocardiography provides noninvasive assessment of early diastolic intra-ventricular pressure gradient (ED-IVPG). The purpose of this study was to evaluate the value of peak ED-IVPG measurement just after aortic valve closure using VFM for noninvasive estimation of impaired LV untwisting velocity as the index of LV relaxation in the clinical setting. METHODS AND RESULTS The study included 65 consecutive patients in whom echocardiography was performed for the assessment of LV function. We assessed peak ED-IVPG between LV apex and base by VFM analysis software. We also measured peak LV untwisting velocity and LV twisting by speckle-tracking strain analysis. Peak ED-IVPG was successfully and quickly assessed in all the study patients. Peak ED-IVPG was significantly reduced in patients with impaired peak LV untwisting velocity (< 70 degrees/s) compared with patients without impaired peak LV untwisting velocity. The receiver operating characteristic analysis showed the best cut-off value of peak ED-IVPG for determining impaired peak LV untwisting velocity was 0.40 mmHg (sensitivity 81%, specificity 74%, and area under the curve 0.81). There was a well correlation between peak ED-IVPG and peak LV untwisting velocity (r = 0.64, p < 0.0001). CONCLUSIONS The present results suggest that peak ED-IVPG just after aortic valve closure measured by VFM may be used as noninvasive index for estimation of impaired LV untwisting velocity in the clinical setting.
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23
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Progression of left ventricular diastolic function in the neonate and early childhood from transmitral color M-mode filling analysis. Pediatr Res 2021; 89:987-995. [PMID: 32570271 DOI: 10.1038/s41390-020-1011-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND We implemented sophisticated color M-mode analysis to assess age-dependent progression of left ventricular (LV) diastolic function. METHODS Normal infants were prospectively enrolled for serial echocardiograms at 1 week, 1 month, 6 months, 1 year, and 2 years. From color M-mode scans, propagation velocity (VP), strength of filling (VS), and intraventricular pressure difference (IVPD) in 3 segments along apex-to-mitral valve scan line were measured. RESULTS Age-wise comparisons of diastolic filling from 121 echocardiograms in 31 infants showed VP (cm/s), VS (cm2/s), and E-wave IVPD (mmHg) at 1 week to be 66.2 ± 11.9, 75.3 ± 19.9, and 1.5 ± 0.4, respectively, while VP, VS, and E-wave IVPD at 1 month were 80.3 ± 14.4, 101.2 ± 28.3, and 2.42 ± 1.1, respectively. There were significant differences in VP and segmental IVPD between first week and first month (p < 0.005) and IVPD between the age groups (p < 0.001). CONCLUSIONS Comprehensive analysis of transmitral color M-mode data is feasible in infants, enabling calculation of pressure drop between the LV base and apex and strength of propagation from two distinct slopes. Profound changes very early followed by relatively constant filling mechanics in later infancy indicate significant LV maturation occurring during the first month of life. IMPACT We implemented sophisticated analytic methods for color M-mode echocardiography in infants to assess age- and dimension-dependent changes in left ventricular diastolic function. Comprehensive characterization of transmitral color M-mode flow was feasible, enabling calculation of pressure drop between left ventricular base and apex and strength of propagation. Left ventricular diastolic filling function has predictable maturational progression, with significant differences in the intraventricular pressure between infants from birth to 2 years. This study forms the basis for future studies to examine alteration of early diastolic filling in congenital heart disease.
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24
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Kitpipatkun P, Yairo A, Kato K, Matsuura K, Ma D, Goya S, Uemura A, Takahashi K, Tanaka R. Effects of Individual and Coexisting Diabetes and Cardiomyopathy on Diastolic Function in Rats ( Rattus norvegicus domestica). Comp Med 2020; 70:499-509. [PMID: 33138891 DOI: 10.30802/aalas-cm-20-000042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The goal of this study was to evaluate diastolic intraventricular pressure gradients (IVPG) and 2-dimensional tissue tracking (2DTT) patterns during diabetes and cardiomyopathy. Rats (n = 60) were induced to become diabetic (DM group, n = 15) by using streptozotocin, to become cardiomyopathic (CM group, n = 15) by using isoproterenol, and to become both diabetic and cardiomyopathic (DMCM group, n = 15); control rats (CT group, n = 15) were injected with saline. Two months after induction, all rats underwent conventional echocardiography, IVPG, and 2DTT and then were euthanized for microscopic examination of cardiac fibrosis. Compared with the controls, all 3 treated groups showed diastolic dysfunction and delayed cardiac relaxation. DMCM rats showed the most pronounced cardiac abnormalities. In addition, CM and DMCM groups had showed decreased middle IVPG, whereas DMCM rats had decreased midapical IVPG. Although the overall IVPG of the CM group was normal, the middle segment was significantly decreased. 2DTT results showed that the DMCM group had a delay in relaxation compared with other groups. IVPG and 2DTT can be used to overcome the limitation of conventional echocardiographic methods and reveal diastolic dysfunction. DM worsened diastolic function during cardiac disease.
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Affiliation(s)
- Pitipat Kitpipatkun
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Akira Yairo
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Konosuke Kato
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Katsuhiro Matsuura
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Danfu Ma
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Seijirow Goya
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Akiko Uemura
- Department of Clinical Veterinary Medicine, Division of Veterinary Research, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryou Tanaka
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan;,
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25
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Takigami M, Itatani K, Nakanishi N, Morichi H, Nishino T, Miyazaki S, Nakaji K, Yamano M, Kajiyama Y, Maeda Y, Matoba S, Yaku H, Yamagishi M. Reconstruction of right ventricular outflow tract stenosis and right ventricular failure after Ross procedure - comprehensive assessment of adult congenital heart disease with four-dimensional imaging: a case report. J Med Case Rep 2020; 14:113. [PMID: 32698864 PMCID: PMC7376682 DOI: 10.1186/s13256-020-02414-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Re-intervention after Ross procedure into the right ventricular outflow tract might be needed in patients in the long term. However, right ventricular outflow tract re-intervention indications are still unclear. Comprehensive assessment of total hemodynamics is needed. A 42-year-old Japanese woman was referred to our hospital for moderately severe pulmonary regurgitation and severe tricuspid regurgitation after a Ross-Konno procedure. Thirteen years after surgery, she developed atrial fibrillation and atrial flutter and complained of dyspnea. Electrophysiological studies showed re-entry circuit around the low voltage area of the lateral wall on the right atrium. Four-dimensional flow magnetic resonance imaging revealed moderate pulmonary regurgitation, severe tricuspid regurgitation, and a dilated right ventricle. Flow energy loss in right ventricle calculated from four-dimensional flow magnetic resonance imaging was five times higher than in normal controls, suggesting an overload of the right-sided heart system. Her left ventricular ejection fraction was almost preserved. Moreover, the total left interventricular pressure difference, which shows diastolic function, revealed that her sucking force in left ventricle was preserved. After the comprehensive assessments, we performed right ventricular outflow tract reconstruction, tricuspid valve annuloplasty, and right-side Maze procedure. A permanent pacemaker with a single atrial lead was implanted 14 days postoperatively. She was discharged 27 days postoperatively. Echocardiography performed 3 months later showed that the size of the dilated right ventricle had significantly reduced. DISCUSSION A four-dimensional imaging tool can be useful in the decision of re-operation in patients with complex adult congenital heart disease. The optimal timing of surgery should be considered comprehensively.
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Affiliation(s)
- Masao Takigami
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Naohiko Nakanishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroko Morichi
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | - Kosuke Nakaji
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yo Kajiyama
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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26
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Watanabe K, Stöhr EJ, Akiyama K, Watanabe S, González‐Alonso J. Dehydration reduces stroke volume and cardiac output during exercise because of impaired cardiac filling and venous return, not left ventricular function. Physiol Rep 2020; 8:e14433. [PMID: 32538549 PMCID: PMC7294577 DOI: 10.14814/phy2.14433] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/12/2020] [Indexed: 12/17/2022] Open
Abstract
Dehydration accrued during intense prolonged whole-body exercise in the heat compromises peripheral blood flow and cardiac output ( Q ˙ ). A markedly reduced stroke volume (SV) is a key feature of the dehydration-induced cardiovascular strain, but whether the lower output of the heart is mediated by peripheral or cardiac factors remains unknown. Therefore, we repeatedly quantified left ventricular (LV) volumes, LV mechanics (LV twist, a marker of systolic muscle function, and LV untwisting rate, an independent marker of LV muscle relaxation), left intra-ventricular pressure gradients, blood volume and peripheral blood flow during 2 hr of cycling in the heat with and without dehydration (DEH: 4.0 ± 0.2% body mass loss and EUH: euhydration control, respectively) in eight participants (three females and five males). While brachial and carotid blood flow, blood volume, SV, LV end-diastolic volume (LVEDV), cardiac filling time, systemic vascular conductance and Q ˙ were reduced in DEH compared to EUH after 2 hr, LV twist and untwisting rate tended to be higher (p = .09 and .06, respectively) and intra-ventricular pressure gradients were not different between the two conditions (p = .22). Furthermore, LVEDV in DEH correlated strongly with blood volume (r = .995, p < .01), head and forearms beat volume (r = .98, p < .05), and diastolic LV filling time (r = .98, p < .05). These findings suggest that the decline in SV underpinning the blunted Q ˙ with exercise-induced dehydration is caused by compromised LV filling and venous return, but not intrinsic systolic or diastolic LV function.
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Affiliation(s)
- Kazuhito Watanabe
- Centre for Human Performance, Exercise and RehabilitationBrunel University LondonUxbridgeUK
- Faculty of Education and Human StudiesAkita UniversityAkitaJapan
| | - Eric J. Stöhr
- Cardiff School of Sport and Health SciencesCardiff Metropolitan UniversityCardiffUK
- Department of MedicineDivision of CardiologyColumbia University Irving Medical CenterNew York CityNYUSA
| | - Koichi Akiyama
- Department of AnesthesiologyYodogawa Christian HospitalOsakaJapan
| | - Sumie Watanabe
- Centre for Human Performance, Exercise and RehabilitationBrunel University LondonUxbridgeUK
| | - José González‐Alonso
- Centre for Human Performance, Exercise and RehabilitationBrunel University LondonUxbridgeUK
- Division of Sport, Health and Exercise SciencesDepartment of Life SciencesBrunel University LondonUxbridgeUK
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27
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Analysis of inter-system variability of systolic and diastolic intraventricular pressure gradients derived from color Doppler M-mode echocardiography. Sci Rep 2020; 10:7180. [PMID: 32346030 PMCID: PMC7188811 DOI: 10.1038/s41598-020-64059-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/09/2020] [Indexed: 11/11/2022] Open
Abstract
Assessment of intraventricular pressure gradients (IVPG) using color Doppler M-mode echocardiography has gained increasing interest in the evaluation of cardiac function. However, standardized analysis tools for IVPG quantification are missing. We aimed to evaluate the feasibility, the test-retest observer reproducibility, and the inter-system variability of a semi-automated IVPG quantification algorithm. The study included forty healthy volunteers (50% were men). All volunteers were examined using two ultrasound systems, the Philips Epiq 7 and the General Electric Vivid 6. Left ventricular diastolic (DIVPG) and systolic (SIVPG) intraventricular pressure gradients were measured from the spatiotemporal distribution of intraventricular propagation flow velocities using color Doppler M-mode in standard apical views. There was good feasibility for both systolic and diastolic IVPG measurements (82.5% and 85%, respectively). Intra and inter-observer test-retest variability measured with the intraclass correlation coefficient were 0.98 and 0.93 for DIVPG respectively, and 0.95 and 0.89 for SIVPG respectively. The inter-system concordance was weak to moderate with Lin’s concordance correlation coefficient of 0.59 for DIVPG and 0.25 for SIVPG. In conclusion, it is feasible and reproducible to assess systolic and diastolic IVPG using color Doppler M-mode in healthy volunteers. However, the inter-system variability in IVPG analysis needs to be taken into account, especially when using displayed data.
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Kitpipatkun P, Matsuura K, Shimada K, Uemura A, Goya S, Yoshida T, Ma D, Takahashi K, Tanaka R. Key factors of diastolic dysfunction and abnormal left ventricular relaxation in diabetic rats. J Med Ultrason (2001) 2020; 47:347-356. [PMID: 32306191 DOI: 10.1007/s10396-020-01021-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/08/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To study the diastolic functions using color Doppler M-mode (CDMM) for noninvasive analysis of the intraventricular pressure difference (IVPD) in diabetic rats. METHODS Two equal groups of rats were included: control and streptozotocin-induced DM (n = 15). The cardiac functions were examined monthly using conventional echocardiography and CDMM with a specific MATLAB software. Echocardiography was performed under 2% isoflurane mask inhalation. Five months thereafter, all rats were killed for macroscopic and microscopic examinations of the cardiac fibrosis. RESULTS DM rats showed higher systolic blood pressure and diastolic dysfunction, i.e., decreases in several parameters such as E, E/A, TDIs, and IVPDs, compared to the controls. Moreover, obvious cardiac fibrosis was seen in perivascular and interstitial tissues, but there were no notable differences in terms of gross lesions. CONCLUSIONS Because of the noninvasive nature of CDMM, IVPD and other conventional echocardiographic parameters can be used as reliable indicators generally for evaluating cardiac function and particularly the change in intraventricular pressure.
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Affiliation(s)
- Pitipat Kitpipatkun
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Katsuhiro Matsuura
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Kazumi Shimada
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Akiko Uemura
- Animal Medical Centor, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Seijirow Goya
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Tomohiko Yoshida
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Danfu Ma
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryou Tanaka
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan.
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Hodzic A, Garcia D, Saloux E, Ribeiro PAB, Ethier A, Thomas JD, Milliez P, Normand H, Tournoux F. Echocardiographic evidence of left ventricular untwisting-filling interplay. Cardiovasc Ultrasound 2020; 18:8. [PMID: 32075637 PMCID: PMC7029574 DOI: 10.1186/s12947-020-00190-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/07/2020] [Indexed: 11/11/2022] Open
Abstract
Background Left ventricular untwisting generates an early diastolic intraventricular pressure gradient (DIVPG) than can be quantified by echocardiography. We sought to confirm the quantitative relationship between peak untwisting rate and peak DIVPG in a large adult population. Methods From our echocardiographic database, we retrieved all the echocardiograms with a normal left ventricular ejection fraction, for whom color Doppler M-Mode interrogation of mitral inflow was available, and left ventricular untwisting rate was measurable using speckle tracking. Standard indices of left ventricular early diastolic function were assessed by Doppler (peaks E, e’ and Vp) and speckle tracking (peak strain rate Esr). Load dependency of DIVPG and untwisting rate was evaluated using a passive leg raising maneuver. Results We included 154 subjects, aged between 18 to 77 years old, 63% were male. Test-retest reliability for color Doppler-derived DIVPG measurements was good, the intraclass correlation coefficients were 0.97 [0.91–0.99] and 0.97 [0.67–0.99] for intra- and inter-observer reproducibility, respectively. Peak DIVPG was positively correlated with peak untwisting rate (r = 0.73, P < 0.001). On multivariate analysis, peak DIVPG was the only diastolic parameter that was independently associated with untwisting rate. Age and gender were the clinical predictive factors for peak untwisting rate, whereas only age was independently associated with peak DIVPG. Untwisting rate and DIVPG were both load-dependent, without affecting their relationship. Conclusions Color Doppler-derived peak DIVPG was quantitatively and independently associated with peak untwisting rate. It thus provides a reliable flow-based index of early left ventricular diastolic function.
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Affiliation(s)
- Amir Hodzic
- Department of Clinical Physiology, INSERM COMETE, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France. .,Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France. .,Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Montreal, Canada.
| | - Damien Garcia
- CREATIS, CNRS UMR 5220, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France
| | - Eric Saloux
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Paula A B Ribeiro
- Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Montreal, Canada
| | - Amélie Ethier
- Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Montreal, Canada
| | - James D Thomas
- Department of Cardiology, Bluhm Cardiovascular Institute, Northwestern University, Chicago, USA
| | - Paul Milliez
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Hervé Normand
- Department of Clinical Physiology, INSERM COMETE, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Francois Tournoux
- Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Montreal, Canada
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30
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Matsuura K, Sato K, Shimada K, Goya S, Uemura A, Iso T, Yazaki K, Yilmaz Z, Takahashi K, Tanaka R. Changes in left ventricular blood flow during diastole due to differences in chamber size in healthy dogs. Sci Rep 2020; 10:1106. [PMID: 31980646 PMCID: PMC6981119 DOI: 10.1038/s41598-019-57180-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/03/2019] [Indexed: 11/09/2022] Open
Abstract
Vorticity is a novel index that reflects diastolic function of left ventricle. The size of the ventricle can influence the ventricular diastolic blood flow. We evaluated effect of ventricular size on diastolic function and diastolic intracardiac blood flow using a particular species of dogs, which has a wide range of body size. Vector flow mapping was used for evaluation of intracardiac blood flow, and intraventricular pressure gradient (IVPG) was used for evaluation of diastolic function. 58 dogs weighing 1.3-42.3 kg were included in this study. Vorticity was found to be inversely proportional to the length of the ventricular chamber. Intraventricular pressure difference was positively correlated with the length of the left ventricle, whereas IVPG was not. This study showed that the vorticity is influenced by the size of the left ventricle independently of other factors. To evaluate the hemodynamic state of each individual appropriately by using vorticity and IVPD, ventricular size should be taken into account especially in the field of veterinary medicine and human pediatric and adolescent cardiology.
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Affiliation(s)
- Katsuhiro Matsuura
- Tokyo University of Agriculture and Technology, Department of Veterinary Surgery, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo, 183-0052, Japan
| | - Kotomi Sato
- Tokyo University of Agriculture and Technology, Department of Veterinary Surgery, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo, 183-0052, Japan
| | - Kazumi Shimada
- Tokyo University of Agriculture and Technology, Department of Veterinary Surgery, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo, 183-0052, Japan
| | - Seijirow Goya
- Tokyo University of Agriculture and Technology, Department of Veterinary Surgery, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo, 183-0052, Japan
| | - Akiko Uemura
- Teikyo University of Science, Department of Animal Science, 2-2-1, Senjyusakuragi, Adachi-ku, Tokyo, 120-0045, Japan
| | - Takeshi Iso
- Juntendo University Graduate School of Medicine, Department of Pediatrics and Adolescent Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kana Yazaki
- Juntendo University Graduate School of Medicine, Department of Pediatrics and Adolescent Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Zeki Yilmaz
- Uludag University, Department of Internal Medicine, Özlüce Mahallesi, Veterinerlik Fak. Hayvan Hst., 16120, Nilüfer, Bursa, Turkey
| | - Ken Takahashi
- Juntendo University Graduate School of Medicine, Department of Pediatrics and Adolescent Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ryou Tanaka
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Animal Medical Center, 3-5-8 Saiwaicho, 183-8509, Fuchu-shi, Tokyo, Japan.
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31
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Londono-Hoyos F, Segers P, Hashmath Z, Oldland G, Koppula MR, Javaid K, Miller R, Bhuva R, Vasim I, Tariq A, Witschey W, Akers S, Chirinos JA. Non-invasive intraventricular pressure differences estimated with cardiac MRI in subjects without heart failure and with heart failure with reduced and preserved ejection fraction. Open Heart 2019; 6:e001088. [PMID: 31673389 PMCID: PMC6802988 DOI: 10.1136/openhrt-2019-001088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/24/2019] [Accepted: 09/11/2019] [Indexed: 12/29/2022] Open
Abstract
Objective Non-invasive assessment of left ventricular (LV) diastolic and systolic function is important to better understand physiological abnormalities in heart failure (HF). The spatiotemporal pattern of LV blood flow velocities during systole and diastole can be used to estimate intraventricular pressure differences (IVPDs). We aimed to demonstrate the feasibility of an MRI-based method to calculate systolic and diastolic IVPDs in subjects without heart failure (No-HF), and with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Methods We studied 159 subjects without HF, 47 subjects with HFrEF and 32 subjects with HFpEF. Diastolic and systolic intraventricular flow was measured using two-dimensional in-plane phase-contrast MRI. The Euler equation was solved to compute IVPDs in diastole (mitral base to apex) and systole (apex to LV outflow tract). Results Subjects with HFpEF demonstrated a higher magnitude of the early diastolic reversal of IVPDs (−1.30 mm Hg) compared with the No-HF group (−0.78 mm Hg) and the HFrEF group (−0.75 mm Hg; analysis of variance p=0.01). These differences persisted after adjustment for clinical variables, Doppler-echocardiographic parameters of diastolic filling and measures of LV structure (No-HF=−0.72; HFrEF=−0.87; HFpEF=−1.52 mm Hg; p=0.006). No significant differences in systolic IVPDs were found in adjusted models. IVPD parameters demonstrated only weak correlations with standard Doppler-echocardiographic parameters. Conclusions Our findings suggest distinct patterns of systolic and diastolic IVPDs in HFpEF and HFrEF, implying differences in the nature of diastolic dysfunction between the HF subtypes.
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Affiliation(s)
- Francisco Londono-Hoyos
- Hospital of the University of Pennsylvania and University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Institute Biomedical Technology (IBiTech) - bioMMeda Research Group, Ghent University, Gent, Belgium
| | - Patrick Segers
- Institute Biomedical Technology (IBiTech) - bioMMeda Research Group, Ghent University, Gent, Belgium
| | - Zeba Hashmath
- Hospital of the University of Pennsylvania and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Garrett Oldland
- Hospital of the University of Pennsylvania and University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Maheshwara Reddy Koppula
- Hospital of the University of Pennsylvania and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Khuzaima Javaid
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Rachana Miller
- Hospital of the University of Pennsylvania and University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Rushikkumar Bhuva
- Hospital of the University of Pennsylvania and University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Izzah Vasim
- Hospital of the University of Pennsylvania and University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Ali Tariq
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Walter Witschey
- Hospital of the University of Pennsylvania and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott Akers
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Julio Alonso Chirinos
- Hospital of the University of Pennsylvania and University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Institute Biomedical Technology (IBiTech) - bioMMeda Research Group, Ghent University, Gent, Belgium.,Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
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32
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Iwashima S, Hayano S, Murakami Y, Tanaka A, Joko Y, Morikawa S, Ifuku M, Iso T, Takahashi K. Cardiac Function in Infants Born to Mothers With Gestational Diabetes - Estimation of Early Diastolic Intraventricular Pressure Differences. Circ Rep 2019; 1:378-388. [PMID: 33693166 PMCID: PMC7892812 DOI: 10.1253/circrep.cr-19-0062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background:
This study compared the myocardial performance of infants born to mothers with gestational diabetes mellitus (IGDM) and without GDM (controls) under the new GDM definitions. Methods and Results:
The subjects consisted of 36 IGDM and 39 control infants. GDM diagnosis was based on oral glucose tolerance test during pregnancy or the presence of diabetes prior to the current pregnancy. Between-group infant cardiac function was determined and compared using 2-D speckle tracking analysis, intraventricular pressure difference (IVPD) and IVP gradient (IVPG), using color M-mode Doppler imaging. IVPD and IVPG were higher in IGDM than in the controls, particularly the mid–apical IVPG. The global circumferential strain (GCS) and endocardial GCS were higher in IGDM than in controls. Increased maternal glycated hemoglobin was correlated with reduced transmural and epicardial GCS in the IGDM. Maternal maximum fasting blood sugar had a mild, positive correlation with IVPD and IVPG. Conclusions:
Ventricular sucking force, measured as the IVPD, IVPG, and endocardial GCS, were higher in IGDM than in the controls. A hyperglycemic environment during pregnancy leads to impaired cardiac performance in IGDM, compared with control infants. IGDM might have favorable systolic and diastolic cardiac performance due to cardiac metabolic adaptations occurring before poor glucose control causes impaired cardiac performance.
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Affiliation(s)
- Satoru Iwashima
- Department of Pediatric Cardiology, Chutoen General Medical Center Kakegawa Japan
| | - Satoshi Hayano
- Department of Pediatric Cardiology, Chutoen General Medical Center Kakegawa Japan
| | - Yusuke Murakami
- Department of Obstetrics and Gynecology, Chutoen General Medical Center Kakegawa Japan
| | - Aki Tanaka
- Department of Obstetrics and Gynecology, Chutoen General Medical Center Kakegawa Japan
| | - Yumiko Joko
- Department of Cardiology, Chutoen General Medical Center Kakegawa Japan
| | - Shuji Morikawa
- Department of Cardiology, Chutoen General Medical Center Kakegawa Japan
| | - Mayumi Ifuku
- Department of Pediatrics, Juntendo University Faculty of Medicine Tokyo Japan
| | - Takeshi Iso
- Department of Pediatrics, Juntendo University Faculty of Medicine Tokyo Japan
| | - Ken Takahashi
- Department of Pediatrics, Juntendo University Faculty of Medicine Tokyo Japan
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33
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Matsuura K, Shiraishi K, Sato K, Shimada K, Goya S, Uemura A, Ifuku M, Iso T, Takahashi K, Tanaka R. Left ventricular vortex and intraventricular pressure difference in dogs under various loading conditions. Am J Physiol Heart Circ Physiol 2019; 316:H882-H888. [PMID: 30735074 PMCID: PMC7002869 DOI: 10.1152/ajpheart.00686.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/15/2019] [Accepted: 01/30/2019] [Indexed: 01/28/2023]
Abstract
Restrictions on the conventional evaluation of diastolic function have been recognized, especially under various loading conditions. Recently, new noninvasive ventricular vortex indexes have been introduced and are expected to reflect the cardiac function. Physiologically, there is a hypothesis that the intraventricular pressure difference (IVPD) is related to the formation of vortexes. IVPD and vortex indexes were simultaneously measured, and the relationship between the two was investigated. To verify the possibility of diastolic vorticity as an index of diastolic relaxation, a correlation between diastolic vorticity and the load dependency of vorticity [time constant (τ)] was examined. Six healthy dogs were studied using transthoracic echocardiography, pressure, and a conductance catheter. Vorticity was analyzed using vector flow mapping (VFM). IVPD was determined using Euler's equation with color M-mode Doppler images. Data were obtained at baseline, at balloon dilatation in the thoracic aorta to alter afterload, at hydroxyethyl starch infusion to alter preload, and at milrinone administration to alter ventricular relaxation. Peak vorticity at early diastole (E-Vor) and IVPD of the midventricle (MIVPD) decreased under pressure loading, were unchanged under volume loading, and increased during milrinone administration. In multivariate analysis, the independent predictors of τ were global longitudinal strain, strain rate at early diastole, and E-Vor. MIVPD was strongly correlated with E-Vor ( r = 0.84). VFM-derived peak E vorticity was strongly related to IVPD, especially MIVPD, under various loading conditions. Both of these novel indexes are promising as reliable indexes of ventricular relaxation, independent from preload. NEW & NOTEWORTHY We showed the close relationship of vortex and intraventricular pressure difference and showed that both of them can become new markers of the left ventricular relaxation property. Our present study creates a paradigm for future studies in the field of intraventircular flow physiology and clinical diastology.
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Affiliation(s)
- Katsuhiro Matsuura
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology , Tokyo , Japan
| | - Kenjirou Shiraishi
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology , Tokyo , Japan
| | - Kotomi Sato
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology , Tokyo , Japan
| | - Kazumi Shimada
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology , Tokyo , Japan
| | - Seijirow Goya
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology , Tokyo , Japan
| | - Akiko Uemura
- Department of Animal Science, Faculty of Life and Environmental Science, TEIKYO University of Science , Tokyo , Japan
| | - Mayumi Ifuku
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Takeshi Iso
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Ryou Tanaka
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology , Tokyo , Japan
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Tsujinaga S, Iwano H, Sarashina M, Hayashi T, Murayama M, Ichikawa A, Nakabachi M, Nishino H, Yokoyama S, Fukushima A, Yokota T, Okada K, Kaga S, Vlachos PP, Anzai T. Diastolic Intra-Left Ventricular Pressure Difference During Exercise: Strong Determinant and Predictor of Exercise Capacity in Patients With Heart Failure. J Card Fail 2019; 25:268-277. [PMID: 30753935 DOI: 10.1016/j.cardfail.2019.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/21/2019] [Accepted: 02/05/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the enhancement of early-diastolic intra-left ventricular pressure difference (IVPD) during exercise is considered to maintain exercise capacity, little is known about their relationship in heart failure (HF). METHODS AND RESULTS Cardiopulmonary exercise testing and exercise-stress echocardiography were performed in 50 HF patients (left ventricular [LV] ejection fraction 39 ± 15%). Echocardiographic images were obtained at rest and submaximal and peak exercise. Color M-mode Doppler images of LV inflow were used to determine IVPD. Thirty-five patients had preserved exercise capacity (peak oxygen consumption [VO2] ≥14 mL·kg-1·min-1; group 1) and 15 patients had reduced exercise capacity (group 2). During exercise, IVPD increased only in group 1 (group 1: 1.9 ± 0.9 mm Hg at rest, 4.1 ± 2.0 mm Hg at submaximum, 4.7 ± 2.1 mm Hg at peak; group 2: 1.9 ± 0.8 mm Hg at rest, 2.1 ± 0.9 mm Hg at submaximum, 2.1 ± 0.9 mm Hg at peak). Submaximal IVPD (r = 0.54) and peak IVPD (r = 0.69) were significantly correlated with peak VO2. Peak IVPD determined peak VO2 independently of LV ejection fraction. Moreover, submaximal IVPD could well predict the reduced exercise capacity. CONCLUSION Early-diastolic IVPD during exercise was closely associated with exercise capacity in HF. In addition, submaximal IVPD could be a useful predictor of exercise capacity without peak exercise in HF patients.
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Affiliation(s)
- Shingo Tsujinaga
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Miwa Sarashina
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Taichi Hayashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Michito Murayama
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Ayako Ichikawa
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Masahiro Nakabachi
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Hisao Nishino
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Shinobu Yokoyama
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Arata Fukushima
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Yokota
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazunori Okada
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Sanae Kaga
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Pavlos P Vlachos
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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35
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Shigemitsu S, Takahashi K, Yazaki K, Kobayashi M, Yamada M, Akimoto K, Tamaichi H, Fujimura J, Saito M, Nii M, Itatani K, Shimizu T. New insight into the intraventricular pressure gradient as a sensitive indicator of diastolic cardiac dysfunction in patients with childhood cancer after anthracycline therapy. Heart Vessels 2019; 34:992-1001. [PMID: 30673819 DOI: 10.1007/s00380-018-01332-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 12/28/2018] [Indexed: 02/01/2023]
Abstract
Cardiac dysfunction due to cardiotoxicity from anthracycline chemotherapy is a leading cause of morbidity and mortality in survivors of childhood cancer. The intraventricular pressure gradient (IVPG) of the left ventricle (LV) is the suction force of blood from the left atrium to the LV apex during early diastole and is a sensitive indicator of diastolic function. We assessed IVPG as a new indicator of the cardiac dysfunction in survivors of childhood cancer after anthracycline therapy. We performed a prospective echocardiographic study on 40 survivors of childhood cancer aged 6-26 years who received anthracycline therapy (group A) and 53 similar-age normal controls (group N). The subjects were divided into the younger groups, N1 and A1 (age < 16 years); older groups, N2 and A2 (age ≥ 16 years). IVPG was calculated using color M-mode Doppler imaging of the mitral inflow using Euler's equation. Total IVPG was divided into the basal and mid-to-apical IVPG to demonstrate more clearly the mechanisms of the LV diastolic suction force. The total anthracycline dose was 16.2-600.0 mg/m2 (median 143.5 mg/m2). Total IVPG significantly decreased in group A2 compared with that in group N2 (0.39 ± 0.07 vs. 0.29 ± 0.11 mmHg/cm; p = 0.010). The mid-to-apical IVPG significantly decreased in groups A1 and A2 compared with that in groups N1 and N2, respectively (N1 vs. A1: 0.20 ± 0.05 vs. 0.16 ± 0.05 mmHg/cm, p = 0.036; N2 vs. A2: 0.21 ± 0.06 vs. 0.14 ± 0.06 mmHg/cm, p = 0.001). Basal IVPG, E wave, and E/e' were not significantly different between patients and normal controls. The total and mid-to-apical IVPG, especially mid-to-apical IVPG, could be sensitive new indicators in survivors of childhood cancer after anthracycline therapy.
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Affiliation(s)
- Sachie Shigemitsu
- Department of Pediatrics, Faculty of Medicine, Juntendo University, 3-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatrics, Kawasaki Kyodo Hospital, 2-1-5 Sakuramoto, Kawasaki-ku, Kawasaki-city, Kanagawa, 210-0833, Japan
| | - Ken Takahashi
- Department of Pediatrics, Faculty of Medicine, Juntendo University, 3-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Kana Yazaki
- Department of Pediatrics, Faculty of Medicine, Juntendo University, 3-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Maki Kobayashi
- Department of Pediatrics, Faculty of Medicine, Juntendo University, 3-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mariko Yamada
- Department of Pediatrics, Faculty of Medicine, Juntendo University, 3-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Katsumi Akimoto
- Department of Pediatrics, Faculty of Medicine, Juntendo University, 3-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroyuki Tamaichi
- Department of Pediatrics, Faculty of Medicine, Juntendo University, 3-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Junya Fujimura
- Department of Pediatrics, Faculty of Medicine, Juntendo University, 3-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masahiro Saito
- Department of Pediatrics, Faculty of Medicine, Juntendo University, 3-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital, 860 Urushiyama Aoi-ku, Shizuoka-city, Shizuoka, 420-8660, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto-city, Kyoto, 602-8566, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Faculty of Medicine, Juntendo University, 3-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Garg P, Crandon S, Swoboda PP, Fent GJ, Foley JRJ, Chew PG, Brown LAE, Vijayan S, Hassell MECJ, Nijveldt R, Bissell M, Elbaz MSM, Al-Mohammad A, Westenberg JJM, Greenwood JP, van der Geest RJ, Plein S, Dall’Armellina E. Left ventricular blood flow kinetic energy after myocardial infarction - insights from 4D flow cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2018; 20:61. [PMID: 30165869 PMCID: PMC6117925 DOI: 10.1186/s12968-018-0483-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/20/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Myocardial infarction (MI) leads to complex changes in left ventricular (LV) haemodynamics that are linked to clinical outcomes. We hypothesize that LV blood flow kinetic energy (KE) is altered in MI and is associated with LV function and infarct characteristics. This study aimed to investigate the intra-cavity LV blood flow KE in controls and MI patients, using cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow assessment. METHODS Forty-eight patients with MI (acute-22; chronic-26) and 20 age/gender-matched healthy controls underwent CMR which included cines and whole-heart 4D flow. Patients also received late gadolinium enhancement imaging for infarct assessment. LV blood flow KE parameters were indexed to LV end-diastolic volume and include: averaged LV, minimal, systolic, diastolic, peak E-wave and peak A-wave KEiEDV. In addition, we investigated the in-plane proportion of LV KE (%) and the time difference (TD) to peak E-wave KE propagation from base to mid-ventricle was computed. Association of LV blood flow KE parameters to LV function and infarct size were investigated in all groups. RESULTS LV KEiEDV was higher in controls than in MI patients (8.5 ± 3 μJ/ml versus 6.5 ± 3 μJ/ml, P = 0.02). Additionally, systolic, minimal and diastolic peak E-wave KEiEDV were lower in MI (P < 0.05). In logistic-regression analysis, systolic KEiEDV (Beta = - 0.24, P < 0.01) demonstrated the strongest association with the presence of MI. In multiple-regression analysis, infarct size was most strongly associated with in-plane KE (r = 0.5, Beta = 1.1, P < 0.01). In patients with preserved LV ejection fraction (EF), minimal and in-plane KEiEDV were reduced (P < 0.05) and time difference to peak E-wave KE propagation during diastole increased (P < 0.05) when compared to controls with normal EF. CONCLUSIONS Reduction in LV systolic function results in reduction in systolic flow KEiEDV. Infarct size is independently associated with the proportion of in-plane LV KE. Degree of LV impairment is associated with TD of peak E-wave KE. In patient with preserved EF post MI, LV blood flow KE mapping demonstrated significant changes in the in-plane KE, the minimal KEiEDV and the TD. These three blood flow KE parameters may offer novel methods to identify and describe this patient population.
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Affiliation(s)
- Pankaj Garg
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Saul Crandon
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Peter P. Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Graham J. Fent
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - James R. J. Foley
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Pei G. Chew
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Louise A. E. Brown
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Sethumadhavan Vijayan
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Mariëlla E. C. J. Hassell
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Malenka Bissell
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Mohammed S. M. Elbaz
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jos J. M. Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - John P. Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Rob J. van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
| | - Erica Dall’Armellina
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT UK
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Development of suction force during early diastole from the left atrium to the left ventricle in infants, children, and adolescents. Heart Vessels 2018; 34:296-306. [DOI: 10.1007/s00380-018-1239-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
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38
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Olesen JB, Villagomez-Hoyos CA, Moller ND, Ewertsen C, Hansen KL, Nielsen MB, Bech B, Lonn L, Traberg MS, Jensen JA. Noninvasive Estimation of Pressure Changes Using 2-D Vector Velocity Ultrasound: An Experimental Study With In Vivo Examples. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:709-719. [PMID: 29733275 DOI: 10.1109/tuffc.2018.2808328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A noninvasive method for estimating intravascular pressure changes using 2-D vector velocity is presented. The method was first validated on computational fluid dynamic (CFD) data and with catheter measurements on phantoms. Hereafter, the method was tested in vivo at the carotid bifurcation and at the aortic valve of two healthy volunteers. Ultrasound measurements were performed using the experimental scanner SARUS, in combination with an 8 MHz linear array transducer for experimental scans and a carotid scan, whereas a 3.5-MHz phased array probe was employed for a scan of an aortic valve. Measured 2-D fields of angle-independent vector velocities were obtained using synthetic aperture imaging. Pressure drops from simulated steady flow through six vessel geometries spanning different degrees of diameter narrowing, running from 20%-70%, showed relative biases from 0.35% to 12.06%, depending on the degree of constriction. Phantom measurements were performed on a vessel with the same geometry as the 70% constricted CFD model. The derived pressure drops were compared to pressure drops measured by a clinically used 4F catheter and to a finite-element model. The proposed method showed peak systolic pressure drops of -3 kPa ± 57 Pa, while the catheter and the simulation model showed -5.4 kPa ± 52 Pa and -2.9 kPa, respectively. An in vivo acquisition of 10 s was made at the carotid bifurcation. This produced eight cardiac cycles from where pressure gradients of -227 ± 15 Pa were found. Finally, the aortic valve measurement showed a peak pressure drop of -2.1 kPa over one cardiac cycle. In conclusion, pressure gradients from convective flow changes are detectable using 2-D vector velocity ultrasound.
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Abstract
Cardiac function is about creating and sustaining blood in motion. This is achieved through a proper sequence of myocardial deformation whose final goal is that of creating flow. Deformation imaging provided valuable contributions to understanding cardiac mechanics; more recently, several studies evidenced the existence of an intimate relationship between cardiac function and intra-ventricular fluid dynamics. This paper summarizes the recent advances in cardiac flow evaluations, highlighting its relationship with heart wall mechanics assessed through the newest techniques of deformation imaging and finally providing an opinion of the most promising clinical perspectives of this emerging field. It will be shown how fluid dynamics can integrate volumetric and deformation assessments to provide a further level of knowledge of cardiac mechanics.
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40
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Evaluation of Myocardial Function According to Early Diastolic Intraventricular Pressure Difference in Fetuses. J Am Soc Echocardiogr 2017; 30:1130-1137.e1. [DOI: 10.1016/j.echo.2017.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Indexed: 11/24/2022]
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41
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Londono-Hoyos FJ, Swillens A, Van Cauwenberge J, Meyers B, Koppula MR, Vlachos P, Chirinos JA, Segers P. Assessment of methodologies to calculate intraventricular pressure differences in computational models and patients. Med Biol Eng Comput 2017; 56:469-481. [PMID: 28812203 DOI: 10.1007/s11517-017-1704-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/03/2017] [Indexed: 12/29/2022]
Abstract
Intraventricular pressure differences (IVPDs) govern left ventricular (LV) efficient filling and are a significant determinant of LV diastolic function. Our primary aim is to assess the performance of available methods (color M-mode (CMM) and 1D/2D MRI-based methods) to determine IVPDs from intracardiac flow measurements. Performance of three methods to calculate IVPDs was first investigated via an LV computational fluid dynamics (CFD) model. CFD velocity data were derived along a modifiable scan line, mimicking ultrasound/MRI acquisition of 1D (IVPDCMM/IVPD1D MRI) and 2D (IVPD2D MRI) velocity-based IVPD information. CFD pressure data (IVPDCFD) was used as a ground truth. Methods were also compared in a small cohort (n = 13) of patients with heart failure with preserved ejection fraction (HFpEF). In silico data showed a better performance of the IVPD2D MRI approach: RMSE values for a well-aligned scan line were 0.2550 mmHg (IVPD1D MRI), 0.0798 mmHg (IVPD2D MRI), and 0.2633 mmHg (IVPDCMM). In vivo data exhibited moderate correlation between techniques. Considerable differences found may be attributable to different timing of measurements and/or integration path. CFD modeling demonstrated an advantage using 2D velocity information to compute IVPDs, and therefore, a 2D MRI-based method should be favored. However, further studies are needed to support the clinical significance of MRI-based computation of IVPDs over CMM.
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Affiliation(s)
- Francisco J Londono-Hoyos
- bioMMeda Research Group, Institute of Biomedical Technology (IBiTech), iMinds Ghent University, Ghent, Belgium. .,Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Abigail Swillens
- bioMMeda Research Group, Institute of Biomedical Technology (IBiTech), iMinds Ghent University, Ghent, Belgium
| | - Joris Van Cauwenberge
- bioMMeda Research Group, Institute of Biomedical Technology (IBiTech), iMinds Ghent University, Ghent, Belgium
| | - Brett Meyers
- Department of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Maheswara Reddy Koppula
- Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Pavlos Vlachos
- Department of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Julio A Chirinos
- Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Patrick Segers
- bioMMeda Research Group, Institute of Biomedical Technology (IBiTech), iMinds Ghent University, Ghent, Belgium
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42
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Pedrizzetti G, Arvidsson PM, Töger J, Borgquist R, Domenichini F, Arheden H, Heiberg E. On estimating intraventricular hemodynamic forces from endocardial dynamics: A comparative study with 4D flow MRI. J Biomech 2017; 60:203-210. [PMID: 28711164 DOI: 10.1016/j.jbiomech.2017.06.046] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 05/26/2017] [Accepted: 06/25/2017] [Indexed: 10/19/2022]
Abstract
Intraventricular pressure gradients or hemodynamic forces, which are their global measure integrated over the left ventricular volume, have a fundamental importance in ventricular function. They may help revealing a sub-optimal cardiac function that is not evident in terms of tissue motion, which is naturally heterogeneous and variable, and can influence cardiac adaptation. However, hemodynamic forces are not utilized in clinical cardiology due to the unavailability of simple non-invasive measurement tools. Hemodynamic forces depend on the intraventricular flow; nevertheless, most of them are imputable to the dynamics of the endocardial flow boundary and to the exchange of momentum across the mitral and aortic orifices. In this study, we introduce a simplified model based on first principles of fluid dynamics that allows estimating hemodynamic forces without knowing the velocity field inside the LV. The model is validated with 3D phase-contrast MRI (known as 4D flow MRI) in 15 subjects, (5 healthy and 10 patients) using the endocardial surface reconstructed from the three standard long-axis projections. Results demonstrate that the model provides consistent estimates for the base-apex component (mean correlation coefficient r=0.77 for instantaneous values and r=0.88 for root mean square) and good estimates of the inferolateral-anteroseptal component (r=0.50 and 0.84, respectively). The present method represents a potential integration to the existing ones quantifying endocardial deformation in MRI and echocardiography to add a physics-based estimation of the corresponding hemodynamic forces. These could help the clinician to early detect sub-clinical diseases and differentiate between different cardiac dysfunctional states.
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Affiliation(s)
- Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy.
| | - Per M Arvidsson
- Lund University, Skane University Hospital, Department of Clinical Sciences, Clinical Physiology, Lund, Sweden
| | - Johannes Töger
- Lund University, Skane University Hospital, Department of Clinical Sciences, Clinical Physiology, Lund, Sweden
| | - Rasmus Borgquist
- Lund University, Skane University Hospital, Department of Arrhythmias, Lund, Sweden
| | - Federico Domenichini
- Department of Civil and Environmental Engineering, University of Firenze, Firenze, Italy
| | - Håkan Arheden
- Lund University, Skane University Hospital, Department of Clinical Sciences, Clinical Physiology, Lund, Sweden
| | - Einar Heiberg
- Lund University, Skane University Hospital, Department of Arrhythmias, Lund, Sweden; Department of Biomedical Engineering, Lund University, Lund, Sweden
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43
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Kobayashi M, Takahashi K, Yamada M, Yazaki K, Matsui K, Tanaka N, Shigemitsu S, Akimoto K, Kishiro M, Nakanishi K, Kawasaki S, Nii M, Itatani K, Shimizu T. Assessment of early diastolic intraventricular pressure gradient in the left ventricle among patients with repaired tetralogy of Fallot. Heart Vessels 2017. [DOI: 10.1007/s00380-017-1011-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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44
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Hernandez-Suarez DF, Palm D, Lopez-Menendez F, Mesa Pabon M, Lopez-Candales A. Left Ventricular Velocity of Propagation: A Useful Non-Invasive Measurement When Assessing Hemodynamic Alterations in Pulmonary Arterial Hypertension. Cardiol Res 2017; 8:44-51. [PMID: 28515821 PMCID: PMC5421485 DOI: 10.14740/cr541w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 11/25/2022] Open
Abstract
Background Left ventricular (LV) velocity of propagation (Vp) has been shown to be inversely related to the LV relaxation time constant. We sought to examine Vp from a group of chronic pulmonary hypertension (cPH) patients and compare these values to Vp obtained in normal individuals and patients with known LV diastolic dysfunction (LVDD). Methods Echo-Doppler data and Vp measurements were retrospectively collected from all patients. The studied population was divided into four groups. Group I comprised of 15 patients with normal LV diastole, group II included 27 patients with stage 1 LVDD, group III was made up of 27 patients with stage 2 LVDD, and group IV included 66 patients with cPH. Results In the cPH population studied, patients had smaller end-diastolic LV cavities with the highest Vp values but their early mitral inflow to Vp ratios were not different from healthy controls. In addition, Vp values and pulmonary wedge capillary pressures were significantly associated in patients with LV dysfunction or pulmonary hypertension (P < 0.01). Conclusions LVVp might be a useful non-invasive measurement to be routinely obtained in cPH patients as it probably not only reflects the compressive forces being exerted on the LV, known to increase Vp, but also might be quite useful for the non-invasive assessment of pulmonary capillary wedge pressures in these patients.
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Affiliation(s)
| | - Denada Palm
- Division of Cardiovascular Health and Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Francisco Lopez-Menendez
- Division of Cardiovascular Health and Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marcel Mesa Pabon
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Angel Lopez-Candales
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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45
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von Lueder TG, Hodt A, Gjerdalen GF, Steine K. Left ventricular biomechanics in professional football players. Scand J Med Sci Sports 2017; 28:187-195. [PMID: 28378431 DOI: 10.1111/sms.12893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
Chronic exercise induces adaptive changes of left ventricular (LV) ejection and filling capacities which may be detected by novel speckle-tracking echocardiography (STE) and tissue Doppler imaging (TDI)-based techniques. A total of 103 consecutive male elite Norwegian soccer players and 46 age-matched healthy controls underwent echocardiography at rest. STE was used to assess LV torsional mechanics and LV systolic longitudinal strain (LS). Diastolic function was evaluated by trans-mitral blood flow, mitral annular velocities by TDI, and LV inflow propagation velocity by color M-mode. Despite similar global LS, players displayed lower basal wall and higher apical wall LS values vs controls, resulting in an incremental base-to-apex gradient of LS. Color M-mode and TDI-derived data were similar in both groups. Peak systolic twist rate (TWR) was significantly lower in players (86.4±2.8 vs controls 101.9±5.2 deg/s, P<.01). Diastolic untwisting rate (UTWR) was higher in players (-124.5±4.2 vs -106.9±6.7 deg/s) and peaked earlier during the cardiac cycle (112.7±0.8 vs 117.4±2.4% of systole duration, both P<.05). Untwisting/twisting ratio (-1.48±0.05 vs -1.11±0.08; P<.001) and untwisting performance (=UTR/TW; -9.25±0.34 vs -7.38±0.40 s-1 , P<.01) were increased in players. Augmented diastolic wall strain (DWS), a novel measure of LV compliance in players, was associated with improved myocardial mechanical efficiency. The described myocardial biomechanics may underlie augmented exertional cardiac function in athletes and may have a potential role to characterize athlete's heart by itself or to distinguish it from hypertensive or hypertrophic cardiomyopathy.
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Affiliation(s)
- T G von Lueder
- Department of Cardiology, Akershus University Hospital, Lørenskog/Oslo, Norway.,Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - A Hodt
- Center for Heart Failure Research, University of Oslo, Oslo, Norway.,Section of Vascular Investigations, Oslo University Hospital Aker, Oslo, Norway
| | - G F Gjerdalen
- Section of Vascular Investigations, Oslo University Hospital Aker, Oslo, Norway
| | - K Steine
- Department of Cardiology, Akershus University Hospital, Lørenskog/Oslo, Norway.,Center for Heart Failure Research, University of Oslo, Oslo, Norway
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46
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Bavo AM, Pouch AM, Degroote J, Vierendeels J, Gorman JH, Gorman RC, Segers P. Patient-specific CFD models for intraventricular flow analysis from 3D ultrasound imaging: Comparison of three clinical cases. J Biomech 2016; 50:144-150. [PMID: 27866678 DOI: 10.1016/j.jbiomech.2016.11.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND As the intracardiac flow field is affected by changes in shape and motility of the heart, intraventricular flow features can provide diagnostic indications. Ventricular flow patterns differ depending on the cardiac condition and the exploration of different clinical cases can provide insights into how flow fields alter in different pathologies. METHODS In this study, we applied a patient-specific computational fluid dynamics model of the left ventricle and mitral valve, with prescribed moving boundaries based on transesophageal ultrasound images for three cardiac pathologies, to verify the abnormal flow patterns in impaired hearts. One case (P1) had normal ejection fraction but low stroke volume and cardiac output, P2 showed low stroke volume and reduced ejection fraction, P3 had a dilated ventricle and reduced ejection fraction. RESULTS The shape of the ventricle and mitral valve, together with the pathology influence the flow field in the left ventricle, leading to distinct flow features. Of particular interest is the pattern of the vortex formation and evolution, influenced by the valvular orifice and the ventricular shape. The base-to-apex pressure difference of maximum 2mmHg is consistent with reported data. CONCLUSION We used a CFD model with prescribed boundary motion to describe the intraventricular flow field in three patients with impaired diastolic function. The calculated intraventricular flow dynamics are consistent with the diagnostic patient records and highlight the differences between the different cases. The integration of clinical images and computational techniques, therefore, allows for a deeper investigation intraventricular hemodynamics in patho-physiology.
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Affiliation(s)
- A M Bavo
- IBiTech-bioMMeda, ELIS Department, Ghent University, Ghent, Belgium.
| | - A M Pouch
- Gorman Cardiovascular Research Group, University of Pennsylvania, PA, United States
| | - J Degroote
- Department of Flow, Heat and Combustion Mechanics, Ghent University, Belgium
| | - J Vierendeels
- Department of Flow, Heat and Combustion Mechanics, Ghent University, Belgium
| | - J H Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, PA, United States
| | - R C Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, PA, United States
| | - P Segers
- IBiTech-bioMMeda, ELIS Department, Ghent University, Ghent, Belgium
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47
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Jensen JA, Nikolov SI, Yu ACH, Garcia D. Ultrasound Vector Flow Imaging-Part I: Sequential Systems. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2016; 63:1704-1721. [PMID: 27824555 DOI: 10.1109/tuffc.2016.2600763] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This paper gives a review of the most important methods for blood velocity vector flow imaging (VFI) for conventional sequential data acquisition. This includes multibeam methods, speckle tracking, transverse oscillation, color flow mapping derived VFI, directional beamforming, and variants of these. The review covers both 2-D and 3-D velocity estimation and gives a historical perspective on the development along with a summary of various vector flow visualization algorithms. The current state of the art is explained along with an overview of clinical studies conducted and methods for presenting and using VFI. A number of examples of VFI images are presented, and the current limitations and potential solutions are discussed.
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48
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Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Alexandru Popescu B, Waggoner AD. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 17:1321-1360. [PMID: 27422899 DOI: 10.1093/ehjci/jew082] [Citation(s) in RCA: 1522] [Impact Index Per Article: 190.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | | | | | - Benjamin F Byrd
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | | | | | | | | | - Jae K Oh
- Mayo Clinic, Rochester, Minnesota
| | - Bogdan Alexandru Popescu
- The University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Alan D Waggoner
- Washington University School of Medicine, St. Louis, Missouri
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49
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Iwano H, Kamimura D, Fox ER, Hall ME, Vlachos P, Little WC. Presence and Implication of Temporal Nonuniformity of Early Diastolic Left Ventricular Wall Expansion in Patients With Heart Failure. J Card Fail 2016; 22:945-953. [PMID: 27095528 DOI: 10.1016/j.cardfail.2016.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/08/2016] [Accepted: 04/12/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Early-diastolic left ventricular (LV) longitudinal expansion is delayed with diastolic dysfunction. We hypothesized that, in patients with heart failure (HF), regardless of LV ejection fraction (EF), there is diastolic temporal nonuniformity with a delay of longitudinal relative to circumferential expansion. METHODS AND RESULTS Echocardiography was performed in 143 HF patients-50 with preserved EF (HFpEF) and 93 with reduced EF (HFrEF)-as well as 31 normal control subjects. The delay of early-diastolic mitral annular velocity from the mitral Doppler E (TE-e') was measured as a parameter of the longitudinal expansion delay. The delay of the longitudinal early-diastolic global strain rate (SRE) relative to circumferential SRE (DelayC-L) was calculated as a parameter of temporal nonuniformity. Intra-LV pressure difference (IVPD) was estimated with the use of color M-mode Doppler data as a parameter of LV diastolic suction. Although normal control subjects had symmetric LV expansion in early diastole, TE-e' and DelayC-L were significantly prolonged in HF regardless of EF (P < .01 vs control for all). Multivariate analysis revealed that DelayC-L was the independent determinant of IVPD among the parameters of LV geometry and contraction (β = -0.21; P < .05). CONCLUSION An abnormal temporal nonuniformity of early-diastolic expansion is present in HF regardless of EF, which was associated with reduced LV suction.
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Affiliation(s)
- Hiroyuki Iwano
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi.
| | - Daisuke Kamimura
- Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ervin R Fox
- Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael E Hall
- Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Pavlos Vlachos
- School of Mechanical Engineering, Purdue University, Indiana
| | - William C Little
- Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi
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de Vecchi A, Gomez A, Pushparajah K, Schaeffter T, Simpson JM, Razavi R, Penney GP, Smith NP, Nordsletten DA. A novel methodology for personalized simulations of ventricular hemodynamics from noninvasive imaging data. Comput Med Imaging Graph 2016; 51:20-31. [PMID: 27108088 PMCID: PMC4907311 DOI: 10.1016/j.compmedimag.2016.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 01/18/2016] [Accepted: 03/29/2016] [Indexed: 11/17/2022]
Abstract
Current state-of-the-art imaging techniques can provide quantitative information to characterize ventricular function within the limits of the spatiotemporal resolution achievable in a realistic acquisition time. These imaging data can be used to personalize computer models, which in turn can help treatment planning by quantifying biomarkers that cannot be directly imaged, such as flow energy, shear stress and pressure gradients. To date, computer models have typically relied on invasive pressure measurements to be made patient-specific. When these data are not available, the scope and validity of the models are limited. To address this problem, we propose a new methodology for modeling patient-specific hemodynamics based exclusively on noninvasive velocity and anatomical data from 3D+t echocardiography or Magnetic Resonance Imaging (MRI). Numerical simulations of the cardiac cycle are driven by the image-derived velocities prescribed at the model boundaries using a penalty method that recovers a physical solution by minimizing the energy imparted to the system. This numerical approach circumvents the mathematical challenges due to the poor conditioning that arises from the imposition of boundary conditions on velocity only. We demonstrate that through this technique we are able to reconstruct given flow fields using Dirichlet only conditions. We also perform a sensitivity analysis to investigate the accuracy of this approach for different images with varying spatiotemporal resolution. Finally, we examine the influence of noise on the computed result, showing robustness to unbiased noise with an average error in the simulated velocity approximately 7% for a typical voxel size of 2mm(3) and temporal resolution of 30ms. The methodology is eventually applied to a patient case to highlight the potential for a direct clinical translation.
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Affiliation(s)
- A de Vecchi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK.
| | - A Gomez
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - K Pushparajah
- Evelina London Children's Hospital, London SE1 7EH, UK
| | - T Schaeffter
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - J M Simpson
- Evelina London Children's Hospital, London SE1 7EH, UK
| | - R Razavi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK; Evelina London Children's Hospital, London SE1 7EH, UK
| | - G P Penney
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - N P Smith
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - D A Nordsletten
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
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