Clinical InvestigationPresence and Implication of Temporal Nonuniformity of Early Diastolic Left Ventricular Wall Expansion in Patients With Heart Failure
Section snippets
Study Population
The study protocol was approved by the Institutional Review Boards of University of Mississippi Medical Center (#2013-0254). From November 2013 to April 2014, we prospectively and consecutively enrolled patients who underwent clinically indicated transthoracic echocardiography and had a documented history of congestive HF based on the Framingham criteria.9 Exclusion criteria were nonsinus rhythm, left bundle branch block, fusion of early and late diastolic mitral inflow, significant left-sided
Patient Characteristics
The clinical characteristics of the study subjects are presented in Table 1. Among the 143 HF patients, 50 patients had a preserved LVEF (≥0.50) and 93 patients had a reduced LVEF (<0.50). The HF patients were older and had a higher systolic blood pressure than the normal control subjects. Female sex was more frequent in HFpEF than in HFrEF. The patients with HFrHF had a higher heart rate than the control subjects. All patients had some HF symptoms, which tended to progress with a decrease in
Discussion
In this study, we showed that in early diastole, the LV expands asymmetrically in subjects with HF whereas it expands symmetrically in normal control subjects. This temporal nonuniformity of early diastolic expansion was due to a delay of longitudinal relative to circumferential expansion. Furthermore, the longitudinal delay was observed regardless of EF; ie, it occurred both in HFpEF and HFrEF. We also found that the temporal nonuniformity of wall expansion was associated with reduced LV
Study Limitations
First, because we selected HF patients based on their history of worsening HF, this study did not include the HF patients who have symptoms only during exertion, which is a frequent symptom among HF patients. In addition, we did not analyze patients without HF who have evidence of diastolic dysfunction. Therefore, we can not clearly determine that temporal nonuniformity of the wall expansion is characteristic of all HF patients. Second, in this study, the normal control subjects were younger
Conclusion
An abnormal temporal nonuniformity of early diastolic expansion is present in HF regardless of EF, with a delay of longitudinal relative to circumferential expansion. This delay was associated with reduced longitudinal LV wall expansion and could influence the reduced LV suction.
Disclosures
None.
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A Wavelet Approach to the Estimation of Left Ventricular Early Filling Wave Propagation Velocity from Color M-Mode Echocardiograms
2021, Ultrasound in Medicine and BiologyCitation Excerpt :Emerging techniques of speckle tracking echocardiography measuring global strain and strain rate (SR) of the left ventricle provide incremental improvement in the diagnostic capability of patients with normal ejection fraction but with myocardial infarction (Wang et al. 2007; Kasner et al. 2010). In the presence of diastolic dysfunction, circumferential SR was influenced by changes in IVPD, but longitudinal SR remained unaffected by IVPD variations with an abnormal temporal non-uniformity causing a delay of longitudinal relative to circumferential expansion (Iwano et al. 2014, 2016). Left atrium strain has recently been observed to have superior diagnostic capability in differentiating between all stages of diastolic dysfunction (Singh et al. 2017; Fernandes et al. 2019; Thomas et al. 2019).
Assessment of cardiac function using the modified ejection fraction as an indicator of myocardial circumferential strain
2022, Journal of Biomechanical Science and Engineering
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Passed away July 9, 2015.