Acute right ventricular pressure overload compromises left ventricular function by altering septal strain and rotation

While right ventricular (RV) dysfunction has long been known to affect the performance of left ventricle (LV), the mechanisms remain poorly defined. Recently, speckle-tracking echocardiography has demonstrated that preservation of strain and rotational dynamics is crucial to both LV systolic and diastolic function. We hypothesized that alteration in septal strain and rotational dynamics of the LV occurs during acute RV pressure overload (RVPO) and leads to decreased cardiac performance. Seven anesthetized pigs underwent median sternotomy and placement of intraventricular pressure-volume conductance catheters. Two-dimensional echocardiographic images and LV pressure-volume loops were acquired for offline analysis at baseline and after banding of the pulmonary artery to achieve RVPO (>50 mmHg) induced RV dysfunction. RVPO resulted in a significant decrease ( P < 0.05) in LV end-systolic elastance (50%), systolic change in pressure over change in time (19%), end-diastolic volume (22%), and cardiac output (37%) that correlated with decrease in LV global circumferential strain (58%), LV apical rotation (28%), peak untwisting (reverse rotation) rate (27%), and prolonged time to peak rotation (17%), while basal rotation was not significantly altered. RVPO reduced septal radial and circumferential strain, while no other segment of the LV midpapillary wall was affected. RVPO decreased septal radial strain on LV side by 27% and induced a negative radial strain from 28 ± 5 to −16 ± 2% on the RV side of the septum. The septal circumferential strain on both LV and RV side decreased by 46 and 50%, respectively, following RVPO ( P < 0.05). Our results suggest that acute RVPO impairs LV performance by primarily altering septal strain and apical rotation.

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The influence of acute unloading on left ventricular strain and strain rate by speckle tracking echocardiography in a porcine model

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00947.2015 ◽

2016 ◽

Vol 310 (10) ◽

pp. H1330-H1339 ◽

Cited By ~ 23

Author(s):

Geir Olav Dahle ◽

Lodve Stangeland ◽

Christian Arvei Moen ◽

Pirjo-Riitta Salminen ◽

Rune Haaverstad ◽

...

Keyword(s):

Strain Rate ◽

Speckle Tracking ◽

Circumferential Strain ◽

Speckle Tracking Echocardiography ◽

Radial Strain ◽

Left Ventricular ◽

Conductance Catheter ◽

Left Ventricular Strain ◽

End Diastolic Volume ◽

Strain And Strain Rate

Noninvasive measurements of myocardial strain and strain rate by speckle tracking echocardiography correlate to cardiac contractile state but also to load, which may weaken their value as indices of inotropy. In a porcine model, we investigated the influence of acute dynamic preload reductions on left ventricular strain and strain rate and their relation to the pressure-conductance catheter-derived preload recruitable stroke work (PRSW) and peak positive first derivative of left ventricular pressure (LV-dP/d tmax). Speckle tracking strain and strain rate in the longitudinal, circumferential, and radial directions were measured during acute dynamic reductions of end-diastolic volume during three different myocardial inotropic states. Both strain and strain rate were sensitive to unloading of the left ventricle ( P < 0.001), but the load dependency for strain rate was modest compared with strain. Changes in longitudinal and circumferential strain correlated more strongly to changes in end-diastolic volume ( r = −0.86 and r = −0.72) than did radial strain ( r = 0.35). Longitudinal, circumferential, and radial strain significantly correlated with LV-dP/d tmax ( r = −0.53, r = −0.46, and r = 0.86), whereas only radial strain correlated with PRSW ( r = 0.55). Strain rate in the longitudinal, circumferential and radial direction significantly correlated with both PRSW ( r = −0.64, r = −0.58, and r = 0.74) and LV-dP/d tmax ( r = −0.95, r = −0.70, and r = 0.85). In conclusion, the speckle tracking echocardiography-derived strain rate is more robust to dynamic ventricular unloading than strain. Longitudinal and circumferential strain could not predict load-independent contractility. Strain rates, and especially in the radial direction, are good predictors of preload-independent inotropic markers derived from conductance catheter.

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Structural and Biomechanical Adaptations of Right Ventricular Remodeling—In Pulmonary Arterial Hypertension—Reduces Left Ventricular Rotation During Contraction: A Computational Study

Journal of Biomechanical Engineering ◽

10.1115/1.4042682 ◽

2019 ◽

Vol 141 (5) ◽

Cited By ~ 2

Author(s):

Vitaly O. Kheyfets ◽

Uyen Truong ◽

Dunbar Ivy ◽

Robin Shandas

Keyword(s):

Right Ventricular ◽

Structural Changes ◽

Ventricular Remodeling ◽

Computational Study ◽

Functional Decline ◽

Pressure Overload ◽

Left Ventricular ◽

Apical Rotation ◽

Gene And Protein Expression ◽

Myocardial Fibers

Pulmonary hypertension (PH) is a degenerative disease characterized by progressively increased right ventricular (RV) afterload that leads to ultimate functional decline. Recent observational studies have documented a decrease in left ventricular (LV) torsion during ejection, with preserved LV ejection fraction (EF) in pediatric and adult PH patients. The objective of this study was to develop a computational model of the biventricular heart and use it to evaluate changes in LV torsion mechanics in response to mechanical, structural, and hemodynamic changes in the RV free wall. The heart model revealed that LV torsion and apical rotation were decreased when increasing RV mechanical rigidity and during re-orientation of RV myocardial fibers, both of which have been demonstrated in PH. Furthermore, structural changes to the RV appear to have a notable impact on RV EF, but little influence on LV EF. Finally, RV pressure overload exponentially increased LV myocardial stress. The computational results found in this study are consistent with clinical observations in adult and pediatric PH patients, which reveal a decrease in LV torsion with preserved LV EF. Furthermore, discovered causes of decreased LV torsion are consistent with RV structural adaptations seen in PH rodent studies, which might also explain suspected stress-induced changes in LV myocardial gene and protein expression.

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Abstract 2823: Right Ventricular Septal Versus Apical Pacing: Long Term Impact On Left Ventricular Synchrony And Function

Circulation ◽

10.1161/circ.118.suppl_18.s_781-d ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Arnold Ng ◽

Christine Allman ◽

Jane Vidaic ◽

Hui Tei ◽

Andrew P Hopkins ◽

...

Keyword(s):

Right Ventricular ◽

Circumferential Strain ◽

Radial Strain ◽

Left Ventricular ◽

Volume Index ◽

Lv Function ◽

Systolic Volume ◽

Septal Pacing ◽

Normal Controls

Background: Right ventricular (RV) septal pacing has been advocated as an alternative to RV apical pacing to avoid long term detrimental effects. There is conflicting evidence on the benefits of RV septal pacing. No studies have previously compared left ventricular (LV) strain and dyssynchrony between different pacing sites and utilized echocardiography to determine pacing sites. Methods: 55 patients (22 normal controls, 17 RV septal and 17 RV apical pacing) were recruited. LV circumferential and radial strain were determined in the midventricular short axis views. Circumferential and radial strain synchrony, and longitudinal systolic (SDTs) and diastolic (SDTe) dyssynchrony indices were determined. Echocardiographic determination of pacing sites were compared with ECG and chest x-ray (CXR). Results: The median pacing durations were 436 days for RV septal and 2398 days for RV apical pacing. Mean QRS duration were significantly shorter for septal than apical pacing and normal controls (139.8 ± 22.6 vs. 162.4 ± 22.9 vs. 85.9 ± 15.2 msec respectively, p < 0.001). LV mass index, end-systolic volume index and ejection fraction were more impaired in RV septal than apical pacing (108.2 ± 27.2 vs. 91.5 ± 15.4 g/m 2 , 21.3 ± 3.7 vs. 19.4 ± 9.3mL/m 2 , 47.6 ± 8.5 vs. 54.2 ± 7.8% respectively, all p < 0.05). RV septal pacing was associated with more impaired circumferential strain (p < 0.001) and worse circumferential strain dyssynchrony (p = 0.02) than apical pacing and normal controls. There were no significant differences in radial strain, radial strain dyssynchrony or SDTs. RV septal pacing consisted of a heterogeneous group of different pacing sites on echocardiography, and there was only modest agreement between echocardiographic, ECG and CXR determinations of pacing sites. Conclusions: RV septal pacing was associated with poorer long term LV function and greater dyssynchrony than RV apical pacing and normal controls.

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Abstract 2477: Ventricular Synchrony can be Preserved by Right Ventricular Septal Pacing Compared with Right Ventricular Apical Pacing: Evaluation by Ultrasound Speckle-Tracking Imaging and Tissue Doppler Imaging

Circulation ◽

10.1161/circ.116.suppl_16.ii_545-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Chisato Izumi ◽

Shuichi Takahashi ◽

Sumiyo Hashiwada ◽

Hidetaka Hayashi ◽

Jiro Sakamoto ◽

...

Keyword(s):

Right Ventricular ◽

Speckle Tracking ◽

Circumferential Strain ◽

Radial Strain ◽

Lateral Wall ◽

Tissue Doppler ◽

Doppler Imaging ◽

Speckle Tracking Imaging ◽

Myocardial Velocity ◽

Time To Peak

Objectives: Traditional right ventricular apical (RVA) pacing may induce ventricular dyssynchrony in patients with normal left ventricular (LV) function. The purpose of this study is to elucidate the influence of pacing sites on the ventricular dyssynchrony, using ultrasound speckle-tracking imaging and tissue Doppler imaging. Methods: We investigated 24 patients with normal LV function who underwent DDD pacemaker implantation. Right ventricular lead position was apex in 18 patients and septum in 6 patients. Radial strain and circumferential strain were measured using ultrasound speckle-tracking imaging (Vivid 7, GE) from short axis view at papillary muscle level. Myocardial velocity was measured by tissue Doppler imaging in mid-segments from apical 4-chamber view. The difference of time to peak radial strain, circumferential strain, and systolic myocardial velocity between septal and lateral wall were compared between during patients’ intrinsic rhythm and pacing rhythm, and between patients with RVA pacing and right ventricular septal (RVS) pacing. Results: In 18 patients with RVA pacing, difference of time to peak circumferential strain and systolic myocardial velocity between septal and lateral wall were larger during pacing rhythm than during patients’ intrinsic rhythm (circumferential strain: 118±57 vs 59±48msec, p<0.01, myocardial velocity: 75±47 vs 52±40msec, p<0.05). On the other hand, in 6 patients with RVS pacing, difference of time to peak radial strain, circumferential strain and systolic myocardial velocity during pacing rhythm were the same as those during patients’ intrinsic rhythm. Difference of time to peak circumferential strain between septal and lateral wall was smaller in patients with RVS pacing than patients with RVA pacing (37±50 vs 118±57msec, p<0.005). Conclusions: Ventricular synchrony can be preserved by RVS pacing compared with RVA pacing.

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The Role of Speckle Tracking Echocardiography in the Evaluation of Common Inherited Cardiomyopathies in Children and Adolescents: A Systematic Review

Diagnostics ◽

10.3390/diagnostics11040635 ◽

2021 ◽

Vol 11 (4) ◽

pp. 635

Author(s):

Dan M. Dorobantu ◽

Curtis A. Wadey ◽

Nurul H. Amir ◽

A. Graham Stuart ◽

Craig A. Williams ◽

...

Keyword(s):

Systematic Review ◽

Speckle Tracking ◽

Circumferential Strain ◽

Speckle Tracking Echocardiography ◽

Radial Strain ◽

Left Ventricular ◽

Arrhythmogenic Cardiomyopathy ◽

Apical Rotation ◽

Inherited Cardiomyopathies

Speckle tracking echocardiography (STE) has gained importance in the evaluation of adult inherited cardiomyopathies, but its utility in children is not well characterized. We conducted a systematic review to evaluate the role of STE in pediatric inherited cardiomyopathies. PubMed, EMBASE, Web of Science, Scopus, CENTRAL and CINAHL databases were searched up to May 2020, for terms related to inherited cardiomyopathies and STE. Included were dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), left ventricular non-compaction (LVNC) and arrhythmogenic cardiomyopathy (ACM). A total of 14 cohorts were identified, of which six were in DCM, four in HCM, three in LVNC and one in ACM. The most commonly reported STE measurements were left ventricular longitudinal strain (Sl), circumferential strain (Sc), radial strain (Sr) and rotation/torsion/twist. Sl, Sc and were abnormal in all DCM and LVNC cohorts, but not in all HCM. Apical rotation and twist/torsion were increased in HCM, and decreased in LVNC. Abnormal STE parameters were reported even in cohorts with normal non-STE systolic/diastolic measurements. STE in childhood cardiomyopathies can detect early changes which may not be associated with changes in cardiac function detectable by non-STE methods. Longitudinal and circumferential strain should be introduced in the cardiomyopathy echocardiography protocol, reflecting current practice in adults.

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Impact of Right Ventricular Function on Left Ventricular Torsion and Ventricular Deformations in Pulmonary Artery Hypertension Patients

Cardiovascular & Haematological Disorders - Drug Targets ◽

10.2174/1871529x21666210401150404 ◽

2021 ◽

Vol 21 ◽

Author(s):

Krishnananda Nayak ◽

Abdul Razak ◽

Megha A. ◽

Padmakumar R. ◽

Jyothi Samanth ◽

...

Keyword(s):

Right Ventricular ◽

Strain Rate ◽

Radial Strain ◽

Left Ventricular ◽

Controlled Study ◽

Routine Practice ◽

Systolic Strain ◽

Current Case ◽

Strain And Strain Rate ◽

Apical Rotation

Introduction: Ventricular interdependence in pulmonary arterial hypertension (PAH) by the use of most recent echocardiographic techniques are still rare. The current case-controlled study aims to assess left ventricular (LV) torsion in patients with PAH. Methods: The study included 42 cases of moderate to severe PAH and 42 age and gender-matched healthy controls between March 2016 and January 2018. All the patients and controls undergo routine practice echocardiography using the Vivid 7-echocardiography (2.5MHz transducer) system. Results: The LV twisting parameters, peak basal rotation, peak apical rotation, and twist were similar among both cases and controls, however, LV torsion was significantly (p=0.04) impacted. Right ventricular (RV) longitudinal deformation was clinically significant in the cases compared to controls: RV systolic strain imaging (p=0.001, 95%CI-9.75 to -2.65), RV systolic strain rate (p=0.01, 95%CI-0.99 to -0.09), and RV late diastolic strain rate (p=0.01, 95%CI-0.64 to -0.85). Although PAH did not impact longitudinal LV deformations significantly. At basal level circumferential strain and strain rate were significantly impacted (p=0.005, 95%CI-4.38 to -0.70; p=0.004, 95%CI-0.35 to -0.07) in the PAH group, while the radial strain was preserved. All RV echocardiographic parameters and LV end-diastolic dimension, LV end-systolic volume in the PAH were affected significantly (p=0.002, 95%CI-19.91 to -4.46; p=0.01, 95%CI-8.44 to -2.77). However, only a weak correlation (p=0.05, r =-0.20) was found between tricuspid annular plane systolic excursion and LV Tei index. Conclusion: RV pressure overload directly affects RV longitudinal systolic deformation further influences the interventricular septal and LV geometry, which impaired LV torsion.

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Myocardial Function in Offspring Aged 5 to 8 Years of Pregnancy Complicated by Severe Preeclampsia Measured by Two-Dimensional Speckle-Tracking Echocardiography

Frontiers in Physiology ◽

10.3389/fphys.2021.643926 ◽

2022 ◽

Vol 12 ◽

Author(s):

Huiyun Chen ◽

Yu Gong ◽

Fangcan Sun ◽

Bing Han ◽

Bingyuan Zhou ◽

...

Keyword(s):

Right Ventricular ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Circumferential Strain ◽

Speckle Tracking Echocardiography ◽

Radial Strain ◽

Left Ventricular ◽

Two Dimensional ◽

Preterm Children ◽

2D Speckle Tracking

Objective: This study aimed to quantitatively assess myocardial strain in preterm children aged 5 to 8 years of pregnancy complicated by severe preeclampsia (PE) by two-dimensional (2D) speckle tracking echocardiography.Method: A cohort study of 23 preterm children delivered by severe PE pregnant women from 2010 to 2012 in the First Affiliated Hospital of Soochow University was carried out. 23 preterm children from uneventful pregnancies in the same period served as controls. Myocardial functions including left ventricular longitudinal strain, radial strain, circumferential strain, and right ventricular longitudinal strain were evaluated by conventional Doppler, tissue Doppler imaging, and 2D speckle-tracking echocardiography (2D STE). All examinations were performed by an experienced ultrasonographer using the VIVID E9 (GE Healthcare) machine, according to standard techniques.Results: Children aged 5–8 years delivered from severe PE presented less weight (24.41 vs. 20.89 kg, P < 0.05), shorter height (124.1 vs 115.6 cm, P < 0.05) and faster heart rates (84 vs. 93 bpm, P < 0.05) compared to offspring of normotensive women. There were no significant differences in global left ventricular longitudinal strain, radial strain, circumferential strain, and right ventricular longitudinal strain between the children in the experimental group and the control group (P > 0.05).Conclusion: Exposure to the intrauterine environment of severe PE during the fetal period did not have a significant impact on cardiac structure in premature children at 5–8 years old, but they had a higher resting heart rate which may be associated with cardiovascular disease in the long run.

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Morphological and functional cardiac consequences of rapid hypertension treatment: a cohort study

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-021-00805-5 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Andrew N. Jordan ◽

Jon Fulford ◽

Kim Gooding ◽

Christine Anning ◽

Lindsay Wilkes ◽

...

Keyword(s):

Feature Tracking ◽

Circumferential Strain ◽

Radial Strain ◽

Treatment Protocol ◽

Left Ventricular ◽

Hypertension Treatment ◽

Functional Changes ◽

Apical Rotation ◽

Grade Ii ◽

And Function

Abstract Background Left ventricular (LV) hypertrophy (LVH) in uncontrolled hypertension is an independent predictor of mortality, though its regression with treatment improves outcomes. Retrospective data suggest that early control of hypertension provides a prognostic advantage and this strategy is included in the 2018 European guidelines, which recommend treating grade II/III hypertension to target blood pressure (BP) within 3 months. The earliest LVH regression to date was demonstrated by echocardiography at 24 weeks. The effect of a rapid guideline-based treatment protocol on LV remodelling, with very early BP control by 18 weeks remains controversial and previously unreported. We aimed to determine whether such rapid hypertension treatment is associated with improvements in LV structure and function through paired cardiovascular magnetic resonance (CMR) scanning at baseline and 18 weeks, utilising CMR mass and feature tracking analysis. Methods We recruited participants with never-treated grade II/III hypertension, initiating a guideline-based treatment protocol which aimed to achieve BP control within 18 weeks. CMR and feature tracking were used to assess myocardial morphology and function immediately before and after treatment. Results We acquired complete pre- and 18-week post-treatment data for 41 participants. During the interval, LV mass index reduced significantly (43.5 ± 9.8 to 37.6 ± 8.3 g/m2, p < 0.001) following treatment, accompanied by reductions in LV ejection fraction (65.6 ± 6.8 to 63.4 ± 7.1%, p = 0.03), global radial strain (46.1 ± 9.7 to 39.1 ± 10.9, p < 0.001), mid-circumferential strain (− 20.8 ± 4.9 to − 19.1 ± 3.7, p = 0.02), apical circumferential strain (− 26.0 ± 5.3 to − 23.4 ± 4.2, p = 0.003) and apical rotation (9.8 ± 5.0 to 7.5 ± 4.5, p = 0.003). Conclusions LVH regresses following just 18 weeks of intensive antihypertensive treatment in subjects with newly-diagnosed grade II/III hypertension. This is accompanied by potentially advantageous functional changes within the myocardium and supports the hypothesis that rapid treatment of hypertension could improve clinical outcomes. Trial registration: ISRCTN registry number: 57475376 (assigned 25/06/2015).

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