scholarly journals 311 A new color Doppler-based echocardiographic technique for evaluation of intraventricular flow dynamics: first application to normal subjects, athletes, and patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Andrea Fiorencis ◽  
Marco Pepe ◽  
Vittorio Smarrazzo ◽  
Marika Martini ◽  
Salvatore Severino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Healthy Subjects ◽  
Vortex Flow ◽  
Color Doppler ◽  
Normal Subjects ◽  
Flow Dynamics ◽  
Altman Analysis ◽  
Patients With Heart Failure ◽  
Repeatability And Reproducibility ◽  
Lv Ejection Fraction

Abstract Aims A new echocardiographic, color Doppler-based technique, named HyperDoppler, has been recently introduced for non-invasive evaluation of intracardiac flow dynamics. The aim of this study was to verify the feasibility and reproducibility of this technique and its capability to differentiate geometrical and energy measures of vortex flow within the left ventricle (LV) in normal subjects, athletes and patients with heart failure. Methods and results Two Italian cardiology centres enrolled each one 100 unselected, consecutive patients presenting at the echocardiography laboratory for a clinical examination, regardless of the indication to echocardiography. In these patients, the feasibility, repeatability, reproducibility, and inter-centre reproducibility of the HyperDoppler technique were tested using the intraclass correlation coefficient (ICC) and Bland–Altman analysis. In addition, 50 normal subjects, 30 professional athletes, and 50 patients with stabilized chronic heart failure and LV ejection fraction <40% were enrolled. Images were acquired using a MyLab X8 echo-scanner and analysed to provide the following vortex flow measures: vortex area, normalized with the LV area; vortex intensity (i.e. the integral of the vorticity inside the vortex), normalized with the total vorticity; vortex depth (the distance of its centre from the LV base) and length along the base-apex direction, both normalized with the LV length; and the total kinetic energy dissipation (KED). Feasibility of HyperDoppler was very high (94.5%). According to the ICC values, at Centre 1 repeatability and reproducibility of vortex flow measures in unselected patients were good for vortex area (0.82, 0.85), length (0.83, 0.82) and depth (0.87, 0.84) and excellent for vortex intensity (0.92, 0.90) and KED (0.98, 0.98). Results of the Bland–Altman analysis showed no bias nor consistent under/overestimations of flow measures, with 95% of points always lying within the limits of agreement for each flow measure. Centre 2 provided similar repeatability and reproducibility evaluations for all the vortex measures, thus supporting a good-to-excellent inter-centre reproducibility. Athletes had greater vortex area, intensity, and KED compared to healthy subjects while they had smaller vortex length and depth and greater KED compared to patients with heart failure and reduced LV ejection fraction. In comparison with healthy subjects, heart failure patients showed greater vortex area, length, depth, and intensity but smaller KED. Combining vortex flow measures, the LV flow profile of healthy individuals, athletes, and heart failure patients could be differentiated. Conclusions HyperDoppler is a new ultrasound technique which is feasible, reliable, and practical for assessment of LV flow dynamics. It can quantitate several measures of the LV vortex and may distinguish normal subjects and patients. Future studies are needed to clarify how to implement this technique in cardiology clinical practice.

scholarly journals Effects of continuous physical training on exercise tolerance and left ventricular myocardial function in patients with heart failure

2007 ◽  
Vol 135 (9-10) ◽  
pp. 516-520 ◽  
Author(s):  
Marina Deljanin-Ilic ◽  
Stevan Ilic ◽  
Viktor Stoickov
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Physical Training ◽  
Exercise Tolerance ◽  
Myocardial Function ◽  
Left Ventricular ◽  
Rehabilitation Programme ◽  
Patients With Heart Failure ◽  
Lv Ejection Fraction ◽  
Residential Rehabilitation

Introduction Physical training is an important method in the rehabilitation programme for cardiovascular patients. Nevertheless, some controversies about physical training in patients with heart failure still exist. Objective The aim of the study was to assess the effects of continuous physical training on exercise tolerance, ejection fraction and regional systolic and diastolic left ventricular (LV) myocardial function in patients with stable heart failure. Method The study involved 48 male patients with stable heart failure and LV ejection fraction ?35% determined by echocardiography. At the end of a two-week residential rehabilitation programme, the patients were divided in two groups. The group of 27 patients (T group) continued with regular physical training (4 to 5 times weekly) during 6 months, while 21 patients (K group) did not have regular physical training. In all patients, the exercise test and echocardiography studies were performed after residential rehabilitation and 6 months later. Regional myocardial function of LV was evaluated by the pulsed wave tissue Doppler imaging. Results After 6 months, an increase in exercise tolerance was more significant in T group. LV ejection fraction increased significantly (p<0.05) only in T group. After six months, in T group, regional systolic (p<0.01) and diastolic (p<0.005) myocardial function improved significantly, while in K group a significant improvement was seen only for regional diastolic function (p<0.05), and it was less than in T group. Conclusion The results of our study suggest that continuous physical training during the period of 6 months in patients with stable heart failure induced significant improvement of exercise tolerance, ejection fraction and regional systolic and diastolic LV myocardial function.

Peripheral muscle ergoreceptors and ventilatory response during exercise recovery in heart failure

1999 ◽  
Vol 276 (3) ◽  
pp. H913-H917 ◽  
Author(s):  
Noelle Francis ◽  
Alain Cohen-Solal ◽  
Damien Logeart
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ventilatory Response ◽  
Normal Subjects ◽  
Exercise Recovery ◽  
Cuff Inflation ◽  
Half Time ◽  
Peripheral Muscle ◽  
Patients With Heart Failure ◽  
Kinetics Of

Recent studies have suggested that the increased ventilatory response during exercise in patients with chronic heart failure was related to the activation of muscle metaboreceptors. To address this issue, 23 patients with heart failure and 7 normal subjects performed arm and leg bicycle exercises with and without cuff inflation around the arms or the thighs during recovery. Obstruction slightly reduced ventilation and gas exchange variables at recovery but did not change the kinetics of recovery of these parameters compared with nonobstructed recovery: half-time of ventilation recovery was 175 ± 54 to 176 ± 40 s in patients and 155 ± 66 to 127 ± 13 s in controls ( P < 0.05, patients vs. controls, not significant within each group from baseline to obstructed recovery). We conclude that muscle metaboreceptor activation does not seem to play a role in the exertion hyperventilation of patients with heart failure.

scholarly journals Time-Dependent Regional Myocardial Strains in Patients with Heart Failure with a Preserved Ejection Fraction

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Shane P. Smith ◽  
Timothy W. Secomb ◽  
Brian D. Hong ◽  
Michael J. Moulton
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Strain Rate ◽  
Speckle Tracking ◽  
Circumferential Strain ◽  
Normal Subjects ◽  
Peak Strain ◽  
Preserved Ejection Fraction ◽  
Diastolic Strain Rate ◽  
Patients With Heart Failure

Objectives. To better understand the etiology of HFpEF in a controlled human population, regional time-varying strains were computed using echocardiography speckle tracking in patients with heart failure with a preserved ejection fraction and normal subjects.Methods. Eleven normal volunteers and ten patients with echo-graded diastolic dysfunction and symptoms of heart failure were imaged with echocardiography and longitudinal, circumferential, and rotational strains were determined using speckle-tracking. Diastolic strain rate was also determined. Patient demographics and echo-derived flows, volumes, and pressures were recorded.Results. Peak longitudinal and circumferential strain was globally reduced in patients (p<0.001), when compared to controls. The patients attained peak longitudinal and circumferential strain at a consistently later point in systole than controls. Rotational strains were not different in most LV regions. Early diastolic strain rate was significantly reduced in the patients (p<0.001). LV mass and wall thickness were significantly increased in the patients; however ejection fraction was preserved and stroke volume was diminished (p<0.001).Conclusions. This study shows that patients with HFpEF have reduced early diastolic strain rate and reduced peak strain that is regionally homogeneous and that they also utilize a longer fraction of systole to achieve peak axial strains.

scholarly journals Acute Hyperglycemia Does Not Affect the Reactivity of Coronary Microcirculation in Humans

2005 ◽  
Vol 90 (7) ◽  
pp. 3871-3876 ◽  
Author(s):  
Brunella Capaldo ◽  
Maurizio Galderisi ◽  
Anna Amelia Turco ◽  
Arcangelo D’Errico ◽  
Salvatore Turco ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Healthy Subjects ◽  
Coronary Flow ◽  
Color Doppler ◽  
Normal Subjects ◽  
Coronary Microcirculation ◽  
Short Term ◽  
Acute Hyperglycemia ◽  
Diastolic Flow ◽  
Flow Reserve

Abstract Objective: There is some evidence that acute hyperglycemia (H) may cause vascular dysfunction in normal subjects. This study investigates whether acute, short-term H affects coronary vasodilatory function in healthy subjects. Design: Diastolic peak flow velocity in the left anterior descending coronary artery was measured at rest and after dipyridamole (0.56 mg/kg over 4 min) using transthoracic color Doppler echocardiography in 13 healthy men. Coronary flow reserve (CFR) was defined as the ratio of dipyridamole-induced coronary peak diastolic to resting peak diastolic flow velocity. CFR was measured both in euglycemia (E) and after 3 h H (∼14 mmol/liter) by a variable infusion of glucose and octreotide (0.4 mg/h) to prevent increase in insulin concentration. Results: Fasting plasma glucose increased to 14.3 ± 0.33 mmol/liter during the study and maintained variability within less than 10%. Plasma insulin remained nearly stable during H. Resting diastolic flow velocity was 18.5 ± 0.6 cm/sec in E and increased to 20.0 ± 0.7 cm/sec during H (P &lt; 0.005). Dipyridamole infusion produced a marked increase in coronary flow velocity, which reached values of 50.8 ± 2.9 cm/sec in E and 51.8 ± 2.1 cm/sec in H (P = not significant). CFR was 2.78 ± 0.16 in E and 2.59 ± 0.12 in H (P = not significant). Conclusion: Our study indicates that short-term hyperglycemia does not affect the vasodilatory response of coronary microcirculation in healthy subjects.

Sign in / Sign up

Export Citation Format

Share Document