Elsevier

Journal of Cardiac Failure

Volume 22, Issue 12, December 2016, Pages 945-953
Journal of Cardiac Failure

Clinical Investigation
Presence and Implication of Temporal Nonuniformity of Early Diastolic Left Ventricular Wall Expansion in Patients With Heart Failure

https://doi.org/10.1016/j.cardfail.2016.04.007Get rights and content

Highlights

  • Early diastolic LV longitudinal expansion is delayed with diastolic dysfunction.

  • Diastolic temporal nonuniformity could exist in patients with heart failure.

  • Temporal uniformity and LV suction were evaluated in heart failure patients.

  • We found a clear temporal nonuniformity in heart failure patients.

  • The temporal nonuniformity was associated with reduced LV suction.

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.

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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