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Kerstens TP, Donker SC, Kleinnibbelink G, van Dijk AP, Oxborough D, Thijssen DHJ. Left and right ventricular strain-volume/area loops: a narrative review of current physiological understanding and potential clinical value. Echo Res Pract 2024; 11:12. [PMID: 38769555 PMCID: PMC11106969 DOI: 10.1186/s44156-024-00046-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
Traditionally, echocardiography is used for volumetric measurements to aid in assessment of cardiac function. Multiple echocardiographic-based assessment techniques have been developed, such as Doppler ultrasound and deformation imaging (e.g., peak global longitudinal strain (GLS)), which have shown to be clinically relevant. Volumetric changes across the cardiac cycle can be related to deformation, resulting in the Ventricular Strain-Volume/Area Loop. These Loops allow assessment of the dynamic relationship between longitudinal strain change and volumetric change across both systole and diastole. This integrated approach to both systolic and diastolic function assessment may offer additional information in conjunction with traditional, static, measures of cardiac function or structure. The aim of this review is to summarize our current understanding of the Ventricular Strain-Volume/Area Loop, describe how acute and chronic exposure to hemodynamic stimuli alter Loop characteristics, and, finally, to outline the potential clinical value of these Loops in patients with cardiovascular disease. In summary, several studies observed Loop changes in different hemodynamic loading conditions and various (patho)physiological conditions. The diagnostic and prognostic value, and physiological interpretation remain largely unclear and have been addressed only to a limited extent.
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Affiliation(s)
- Thijs P Kerstens
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Stijn Cm Donker
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Medicine, Liverpool John Moores University, L3 5UX, Liverpool, United Kingdom
| | - Geert Kleinnibbelink
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands
| | - Arie Pj van Dijk
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands
| | - David Oxborough
- Research Institute for Sport and Exercise Medicine, Liverpool John Moores University, L3 5UX, Liverpool, United Kingdom
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Research Institute for Sport and Exercise Medicine, Liverpool John Moores University, L3 5UX, Liverpool, United Kingdom.
- Department of Medical BioSciences (928), Radboud University Medical Center, 6500HB, Nijmegen, P.O. Box 9101, The Netherlands.
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Scarlatescu AI, Micheu MM, Petre IG, Oprescu N, Mihail AM, Cojocaru ID, Vatasescu RG. Left Ventricular-Arterial Coupling as an Independent Predictor of Adverse Events in Young Patients with ST Elevation Myocardial Infarction-A 3D Echocardiographic Study. Biomedicines 2024; 12:105. [PMID: 38255210 PMCID: PMC10812951 DOI: 10.3390/biomedicines12010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
Left ventricular-arterial coupling (VAC) is a key determinant of global cardiovascular performance, calculated as the ratio between arterial elastance (EA) and left ventricular end-systolic elastance (EES). Over the years, acute myocardial infarction (STEMI) has remained an important cause of morbidity and mortality worldwide. Although, until recently, it was considered a disease occurring mostly in older patients, its prevalence in the young population is continuously rising. In this study, we aimed to investigate the role of 3D VAC and its derived indices in predicting adverse outcomes in young patients with STEMI. We prospectively enrolled 84 young patients (18-51 years) with STEMI who underwent primary PCI and 28 healthy age and sex-matched controls. A 3D echocardiography was used for non-invasive measurements of end-systolic elastance (EES), arterial elastance (EA), and VAC (EA/EES). The occurrence of major adverse cardiac events (MACE) was assessed one year after the index STEMI. Out of 84 patients, 15.4% had adverse events at 12 months follow-up. Patients were divided into two groups according to the presence or absence of MACE. There were no significant differences in arterial elastance between the two groups. EA was higher in the MACE group but without statistical significance (2.65 vs. 2.33; p = 0.09). EES was significantly lower in the MACE group (1.25 ± 0.34 vs. 1.91 ± 0.56. p < 0.0001) and VAC was higher (2.2 ± 0.62 vs. 1.24 ± 0.29, p < 0.0001). ROC analysis showed that VAC has a better predictive value for MACE (AUC 0.927) compared with EA or EEA but also compared with a classical determinant of LV function (LVEF and LVGLS). A VAC value over 1.71 predicts unfavourable outcome with 83.3% sensitivity and 97.1% specificity. In both univariate and multivariate COX regression analysis, VAC remained an independent predictor for MACE and demonstrated incremental prognostic value over LVEF and LVGLS in the proposed statistical models. In conclusion, 3D VAC is an independent predictor of adverse events in young patients with STEMI at a 12 month follow-ups and could be used for a more accurate risk stratification in the acute phase.
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Affiliation(s)
- Alina Ioana Scarlatescu
- Department of Cardiology, Clinic Emergency Hospital of Bucharest, Calea Floreasca 8, 014461 Bucharest, Romania; (A.I.S.); (I.G.P.); (N.O.); (A.M.M.); (I.D.C.); (R.G.V.)
| | - Miruna Mihaela Micheu
- Department of Cardiology, Clinic Emergency Hospital of Bucharest, Calea Floreasca 8, 014461 Bucharest, Romania; (A.I.S.); (I.G.P.); (N.O.); (A.M.M.); (I.D.C.); (R.G.V.)
| | - Ioana Gabriela Petre
- Department of Cardiology, Clinic Emergency Hospital of Bucharest, Calea Floreasca 8, 014461 Bucharest, Romania; (A.I.S.); (I.G.P.); (N.O.); (A.M.M.); (I.D.C.); (R.G.V.)
- Department IV—Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania
| | - Nicoleta Oprescu
- Department of Cardiology, Clinic Emergency Hospital of Bucharest, Calea Floreasca 8, 014461 Bucharest, Romania; (A.I.S.); (I.G.P.); (N.O.); (A.M.M.); (I.D.C.); (R.G.V.)
| | - Ana Maria Mihail
- Department of Cardiology, Clinic Emergency Hospital of Bucharest, Calea Floreasca 8, 014461 Bucharest, Romania; (A.I.S.); (I.G.P.); (N.O.); (A.M.M.); (I.D.C.); (R.G.V.)
| | - Ioana Denise Cojocaru
- Department of Cardiology, Clinic Emergency Hospital of Bucharest, Calea Floreasca 8, 014461 Bucharest, Romania; (A.I.S.); (I.G.P.); (N.O.); (A.M.M.); (I.D.C.); (R.G.V.)
| | - Radu Gabriel Vatasescu
- Department of Cardiology, Clinic Emergency Hospital of Bucharest, Calea Floreasca 8, 014461 Bucharest, Romania; (A.I.S.); (I.G.P.); (N.O.); (A.M.M.); (I.D.C.); (R.G.V.)
- Department IV—Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania
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Kleinnibbelink G, van Dijk AP, Fornasiero A, Speretta GF, Johnson C, Hopman MT, Sculthorpe N, George KP, Somauroo JD, Thijssen DH, Oxborough DL. Exercise-Induced Cardiac Fatigue after a 45-Minute Bout of High-Intensity Running Exercise Is Not Altered under Hypoxia. J Am Soc Echocardiogr 2021; 34:511-521. [DOI: 10.1016/j.echo.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
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Tadic M, Cuspidi C, Pencic B, Vukomanovic V, Taddei S, Grassi G, Celic V. Association between myocardial work and functional capacity in patients with arterial hypertension: an echocardiographic study. Blood Press 2021; 30:188-195. [PMID: 33769171 DOI: 10.1080/08037051.2021.1902267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to examine myocardial performance using pressure-strain loops in hypertensive patients with different level of blood pressure control. MATERIAL AND METHODS This cross-sectional study included 204 subjects (45 controls, 70 patients with well-controlled hypertension, 58 patients with uncontrolled hypertension and 31 patients with resistant hypertension) who underwent complete two-dimensional echocardiographic examination including two-dimensional speckle-tracking echocardiography. Pressure-strain curve was used to determine global myocardial work, constructive work, wasted work and work efficiency in all study participants. RESULTS Left ventricular (LV) longitudinal strain gradually reduced from controls throughout well-controlled hypertensive patients, to patients with uncontrolled and resistant hypertension. Global myocardial work was higher in patients with uncontrolled and resistant hypertension than in controls and well-controlled hypertension. Constructive work was also higher in all hypertensive patients than in controls. Global wasted work and work efficiency were similar between different groups. Global myocardial work index was associated with peak oxygen consumption independently of sex, age, body mass index (BMI), LV structural and functional parameters in all hypertensive participants. CONCLUSIONS Myocardial work was significantly deteriorated in patients with uncontrolled and resistant arterial hypertension compared to controls and well-controlled hypertensive patients. Global myocardial work was associated with functional capacity independent of clinical and echocardiographic parameters.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Hospital 'Dr. Dragisa Misovic - Dedinje', Belgrade, Serbia
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University Milano-Bicocca, Milano, Italy.,Istituto Auxologico Italiano IRCCS, Clinical Research Unit, Meda, Italy
| | - Biljana Pencic
- Department of Cardiology, University Hospital 'Dr. Dragisa Misovic - Dedinje', Belgrade, Serbia
| | - Vladan Vukomanovic
- Department of Cardiology, University Hospital 'Dr. Dragisa Misovic - Dedinje', Belgrade, Serbia
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University Milano-Bicocca, Milano, Italy
| | - Vera Celic
- Department of Cardiology, University Hospital 'Dr. Dragisa Misovic - Dedinje', Belgrade, Serbia
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Tadic M, Cuspidi C, Pencic B, Grassi G, Celic V. Myocardial work in hypertensive patients with and without diabetes: An echocardiographic study. J Clin Hypertens (Greenwich) 2020; 22:2121-2127. [DOI: 10.1111/jch.14053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/19/2020] [Accepted: 08/29/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Marijana Tadic
- Department of Cardiology University Hospital “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
| | - Cesare Cuspidi
- Department of Medicine and Surgery University Milano‐Bicocca Milano Italy
- Clinical Research Unit Istituto Auxologico Italiano IRCCS Meda Italy
| | - Biljana Pencic
- Department of Cardiology University Hospital “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
| | - Guido Grassi
- Department of Medicine and Surgery University Milano‐Bicocca Milano Italy
| | - Vera Celic
- Department of Cardiology University Hospital “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
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