Differences in Left Ventricular Function at Rest and during Isometric Handgrip Exercise in Elite Swimmers, Water Polo Players, and Artistic Swimmers

Purpose: Elite swimmers (SW) have reduced diastolic function compared to elite runners, possibly as an adaptation to the aquatic training environment. Water polo players (WP) and artistic swimmers (AS) are exposed to the same hydrostatic pressures as SW, but are subject to different training intensities, postures, and hemodynamic stressors. Our purpose was to compare resting and exercising cardiac function in elite SW, WP, and AS, to characterize the influence of training for aquatic-sport on left ventricular (LV) adaptation.Methods: Ninety athletes (SW:20M/17F; WP:21M/9F; AS:23F) at the 2019 FINA World Championships volunteered for resting and stress (3min 30% maximal isometric handgrip) echocardiographic assessment of LV global function and mechanics. Results: Male SW displayed improved resting systolic and diastolic function compared to WP; however, both groups maintained stroke volume under high-pressure handgrip stress (SW:∆-4±12%; WP:∆-1±13%, P=0.11). There were no differences between female SW and WP resting LV function, but SW demonstrated improved function over AS. During isometric handgrip, all female sport athletes maintained stroke volume (SW:∆3±16%; WP:∆-10±11%; AS:∆-2±14%, P=0.46), but WP had improved apical rotation (∆1.7±4.5°), which was reduced in AS (∆-3.1±4.5°) and maintained in SW (∆-0.5±3.8°, P=0.04). Unlike SW and WP, AS displayed a unique maintenance of early filling velocity during handgrip exercise (SW:∆-3.5±14.7cm/s; WP:∆-15.1±10.8cm/s; AS:∆1.5±15.3cm/s, P=0.02).Conclusion: Among male athletes, SW display primarily volume-based functional adaptations distinct from the mixed volume-pressure adaptations of WP; however, both groups can maintain stroke volume with increased afterload. Female SW and WP do not demonstrate sport-specific differences like males, perhaps owing to sex-differences in adaptation, but have greater volume-based adaptations than AS. Lastly, AS display unique functional adaptations, that may be driven by elevated pressures under low-volume conditions.

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Effects of mechanical limitation of apical rotation on left ventricular relaxation and end-diastolic pressure

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00316.2011 ◽

2011 ◽

Vol 301 (4) ◽

pp. H1456-H1460 ◽

Cited By ~ 9

Author(s):

Mariko Iwasaki ◽

Kasumi Masuda ◽

Toshihiko Asanuma ◽

Satoshi Nakatani

Keyword(s):

Stroke Volume ◽

Diastolic Function ◽

Diastolic Pressure ◽

Radial Strain ◽

Systolic Pressure ◽

Left Ventricular ◽

Suction Device ◽

Relaxation Period ◽

Apical Rotation ◽

Pressure Peak

Left ventricular (LV) twist is thought to play an important role in cardiac function. However, how twist affects systolic or diastolic function is not understood in detail. We acquired apical and basal short-axis images of dogs undergoing open-chest procedures ( n = 15) using a GE Vivid 7 at baseline and during the use of an apical suction device (Starfish) to limit apical rotation. We measured LV pressure and stroke volume using a micromanometer-tipped catheter and an ultrasonic flow probe, respectively. Peak radial strain, peak rotation, peak twist, peak systolic twisting rate (TR), peak untwisting rate during isovolumic relaxation period (URIVR), and peak early diastolic untwisting rate after mitral valve opening (URE) were determined using speckle tracking echocardiography. Immobilizing the apex with gentle suction significantly decreased apical rotation (−50 ± 27%) and slightly increased basal rotation, resulting in a significant decrease in twist. The time constant of LV relaxation (τ) was prolonged, and LV end-diastolic pressure increased. TR and URIVR decreased. LV systolic pressure, peak positive and negative first derivative of LV pressure (±dP/d t), stroke volume, radial strain, and URE were not changed. The correlation between τ and URIVR ( r = 0.63, P = 0.0006) was stronger than that between peak +dP/d t and TR ( r = 0.46, P = 0.01). Diastolic function was impaired with reduced apical rotation and URIVR when the apex of the heart was immobilized using an apical suction device.

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Left Ventricular Systolic Function Has Strong Independent Genetic Background from Diastolic Function: A Classical Twin Study

Medicina ◽

10.3390/medicina57090935 ◽

2021 ◽

Vol 57 (9) ◽

pp. 935

Author(s):

Andrea Ágnes Molnár ◽

Márton Kolossváry ◽

Bálint Lakatos ◽

Márton Tokodi ◽

Ádám Domonkos Tárnoki ◽

...

Keyword(s):

Environmental Factors ◽

Diastolic Function ◽

Structural Equation ◽

Structural Equation Models ◽

Environmental Influence ◽

Systolic Function ◽

Left Ventricular ◽

Lv Function ◽

Apical Rotation ◽

Diastolic Velocity

Background and Objectives: No data are available on whether the heritability of left ventricle (LV) systolic and diastolic parameters are independent of each other. Therefore, our aim was to assess the magnitude of common and independent genetic and environmental factors defining LV systolic and diastolic function. Materials and Methods: We analyzed 184 asymptomatic twins (65% female, mean age: 56 ± 9 years). Transthoracic echocardiography was performed to measure LV systolic (global longitudinal and circumferential strain; basal and apical rotation) and diastolic (early diastolic velocity of mitral inflow and lateral mitral annulus tissue; deceleration time and early diastolic strain rate) parameters using conventional and speckle-tracking echocardiography. Genetic structural equation models were evaluated to quantify the proportion of common and specific genetic (Ac, As) and environmental factors (Ec, Es) contributing to the phenotypes. Results: LV systolic parameters had no common genetic or environmental heritability (Ac range: 0–0%; Ec range: 0–0%; As range: 57–77%; Es range: 24–43%). Diastolic LV parameters were mainly determined by common genetic and environmental effects (Ac range: 9–40%; Ec range: 11–49%; As range: 0–29%; Es range: 0–51%). Systolic parameters had no common genetic or environmental factors (Ac = 0%; Ec = 0%) with diastolic metrics. Conclusions: Systolic LV parameters have a strong genetic predisposition to any impact. They share no common genetic or environmental factors with each other or with diastolic parameters, indicating that they may deteriorate specifically to given effects. However, diastolic functional parameters are mainly affected by common environmental influences, suggesting that pathological conditions may deteriorate them equally. Estimation of the genetic and environmental influence and interdependence on systolic and diastolic LV function may help the understanding of the pathomechanism of different heart failure classification types.

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Application of the current HFA-ESC consensus guidelines on diagnosis of heart failure with preserved ejection fraction to a population referred for echocardiography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.038 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

K Liang ◽

R Hearse-Morgan ◽

S Fairbairn ◽

Y Ismail ◽

AK Nightingale

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Diastolic Function ◽

Global Longitudinal Strain ◽

Diagnostic Algorithm ◽

Left Ventricular ◽

Lv Function ◽

Preserved Ejection Fraction ◽

Consensus Guidelines

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The recent Heart Failure Association (HFA) of the European Society of Cardiology (ESC) consensus guidelines on diagnosis of heart failure with preserved ejection fraction (HFpEF) have developed a simple diagnostic algorithm for clinical use. PURPOSE To assess whether echocardiogram (echo) parameters needed to assess diastolic function are routinely collected in patients referred for assessment of heart failure symptoms. METHODS Retrospective analysis of echo referrals in January 2020 were assessed for parameters of diastolic function as per step 2 of the HF-PEFF diagnostic algorithm. Echo images and clinical reports were reviewed. Electronic records were utilised to obtain clinical history, blood results (NT-proBNP) and demographic data. RESULTS 1330 patients underwent an echo in our department during January 2020. 83 patients were referred with symptoms of heart failure without prior history of cardiac disease; 20 patients found to have impaired left ventricular (LV) function were excluded from analysis. Of the 63 patients with possible HFpEF, HF-PEFF score was low in 18, intermediate in 33 and high in 12. Median age was 68 years (range 32 to 97 years); 25% had a BMI >30. There was a high prevalence of hypertension (52%), diabetes (19%) and atrial fibrillation (40%) (cf. Table 1). Body surface area (BSA) was documented in 65% of echo reports. Most echo parameters were recorded with the exception of global longitudinal strain (GLS) and indexed LV mass (cf. image 1). NT-proBNP was recorded in only 20 patients (31.7%). 12 patients with an intermediate HF-PEFF score could have been re-categorised to a high score depending on GLS and NT-proBNP (which were not recorded). CONCLUSION More than three quarters of echoes acquired in our department obtained the relevant parameters to assess diastolic function. The addition of BSA, and inclusion of NT-proBNP, and GLS would have been additive to a third of ‘intermediate’ patients to determine definite HFpEF. Our study demonstrates that the current HFA-ESC diagnostic algorithm and HF-PEFF scoring system are easy to use, highly relevant and applicable to current clinical practice. Age >70 years 29 (46.0%) Obesity (BMI >30) 16 (25.4%) Diabetes 12 (19%) Hypertension 33 (52.4%) Atrial Fibrillation 25 (39.7%) ECG abnormalities 18 (28.5%) Table 1. Prevalence of Clinical Risk Factors Abstract Figure. Image 1. HFPEFF score & echo parameters

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Evaluation of diastolic LV function

The ESC Textbook of Cardiovascular Imaging ◽

10.1093/med/9780198703341.003.0024 ◽

2015 ◽

pp. 323-335

Author(s):

Johan De Sutter ◽

Jean-Louis J. Vanoverschelde

Keyword(s):

Diastolic Function ◽

Daily Practice ◽

Tissue Doppler ◽

Left Ventricular ◽

Doppler Imaging ◽

Lv Function ◽

Prognostic Information ◽

Heart Failure Patients ◽

Lv Mass ◽

Deformation Measurements

The evaluation of diastolic function in patients with reduced (HFREF) or preserved (HFPEF) left ventricular (LV) ejection fraction is important as it carries both diagnostic and prognostic information. In daily practice, this is most frequently done by standard echocardiographic techniques, including the evaluation of LV mass and LA volumes, as well as transmitral and pulmonary venous PW Doppler, CW Doppler for evaluation of the IVRT, and tissue Doppler imaging of the septal and lateral annular velocities. This permits grading the severity of diastolic dysfunction, which is related to outcome and may be used to estimate LV filling pressures. The latter needs further validation, especially in patients with HFPEF. Newer echocardiographic and cardiac magnetic resonance techniques, including myocardial deformation measurements during diastole, LV twist and untwisting, and parameters of left atrial function, are promising and will hopefully in the future help clinicians to make a more precise evaluation of diastolic function and filling pressures in heart failure patients.

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P901 Left ventricular diastolic and systolic functions are compromised in patients with hypothyroidism

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.539 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

R Tafarshiku ◽

M Y Henein ◽

V Berisha-Muharremi ◽

I Bytyci ◽

P Ibrahimi ◽

...

Keyword(s):

Diastolic Function ◽

Systolic Function ◽

White Blood Cells ◽

Left Ventricular ◽

Blood Analysis ◽

Lv Function ◽

Anthropometric Parameters ◽

Age And Gender ◽

And Gender ◽

Lv Diastolic Function

Abstract Background and Aim Long standing hypothyroidism may impair myocardial relaxation, but its effect on systolic myocardial function is still controversial. The aim of this study was to investigate left ventricular (LV) systolic and diastolic function in patients with hypothyroidism. Methods This study included 81 (age 42 ± 13 years, 92% female) patients with hypothyroidism, and 22 age and gender matched controls. All subjects underwent a detailed clinical examination followed by a complete biochemical blood analysis including thyroid function assessment and anthropometric parameters measurements. LV function was assessed by 2 dimensional, M-mode and Tissue-Doppler Doppler echocardiographic examination performed in the same day. Results Patients had lower waist/hip ratio (p < 0.001), higher urea level (p = 0.002) and lower white blood cells (p = 0.011), compared to controls. All other clinical, biochemical and anthropometric data did not differ between the two groups. Patients had impaired LV diastolic function (lower E wave [p < 0.001], higher A wave [p = 0.028], lower E/A ratio [p < 0.001], longer E wave deceleration time [p = 0.01], and higher E/e’ ratio [p < 0.001]), compared with controls. Although LV global systolic function did not differ between groups, LV longitudinal systolic function was compromised in patients (lateral mitral annular plane systolic excursion - MAPSE [p = 0.005], as were lateral and septal TDI s’ [p < 0.001 for both]). Conclusion In patients with hypothyroidism, in addition to compromised LV diastolic function, LV longitudinal systolic function is also impaired compared to healthy subjects of the same age and gender. These findings suggest significant subendocardial function impairment, reflecting potentially micro-circulation disease, that requires optimum management.

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P1273 Effects of surgical septal myectomy on left ventricular function in patients with hypertrophic obstructive cardiomyopathy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.723 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Furugen ◽

H D Doi ◽

M H Hashimoto ◽

R K Koshima ◽

K M Mitsube

Keyword(s):

Mitral Valve ◽

Diastolic Function ◽

Longitudinal Strain ◽

Function Analysis ◽

Left Ventricular ◽

Volume Index ◽

Lv Function ◽

Septal Myectomy ◽

Concomitant Procedure ◽

Lv Diastolic Function

Abstract Introduction and Purpose Surgical left ventricular (LV) septal myectomy in patients with obstructive hypertrophic cardiomyopathyhas been shown to reduce left ventricular outflow tract (LVOT) gradient and improve symptoms. We investigated changes in strain analysis, LA volume and LV systolic and diastolic function in patients with HOCM after surgical septal myectomy. Methods We enrolled consecutive 30 patients (age 63.7 ± 11.0 years, 47% Female), who underwent surgical LV septal myectomy for HOCM from 2012 to 2019. We evaluated LV dimension, LVOTG, LV-stroke volume, LV in flow pattern (E wave, A wave, Dct), e’(septal and lateral), LA volume, mitral regurgitation (MR), systolic anterior motion of mitral valve (SAM) and Global longitudinal strain. These parameters were evaluated at baseline and after LV myectomy at medium term (at least 6 months after surgery). Results They are followed for a mean of 3.4± 1.9 years after surgery. Eight patients underwent concomitant procedure; mitral valve repair and annuloplasty in 3 patients (10%), Maze surgery in 1 patient, LV aneurysmectomy in 2 patients and aortic valve replacement in 3 patients (10%). Patients with concomitant procedure were excluded from LV function analysis. Postoperative LVOTG were controlled in 10mmHg or less.Global longitudinal strain (GLS) improved but no significant change. Otherwise LA volume index decreased (from 52.5 ± 16.7 to 32.9 ± 14.6 ml/m2, p = 0.01) and LV diastolic function improved with an increase in lateral e" velocity (from 4.5 ± 2.8 to 9.2 ± 3.4 cm/sec, p = 0.001) and improved E/e’ (from 18.9 ± 5.6 to 10.6 ± 5.2, p <0.05). Symptoms of dyspnea, chest oppression and heart failure improved with reduction in the New York Heart Association functional class. Conclusion Excellent relief of LVOT obstruction in HOCM by surgical LV septal myectomy results in decreased LA volume and LV diastolic function with improved symptoms.

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Effect of isometric handgrip exercise on left ventricular function in the patient with artificial cardiac pacemaker.

Japanese Circulation Journal ◽

10.1253/jcj.41.855 ◽

1977 ◽

Vol 41 (8) ◽

pp. 855-861

Author(s):

YUICHIRO MATSUURA ◽

MUTSUO TAMURA ◽

HIDEKI YAMASHITA ◽

ITSUO TAKIZAWA ◽

YOSHITAKA SEKIGUCHI

Keyword(s):

Left Ventricular Function ◽

Ventricular Function ◽

Cardiac Pacemaker ◽

Left Ventricular ◽

Handgrip Exercise ◽

Isometric Handgrip ◽

Isometric Handgrip Exercise ◽

Artificial Cardiac Pacemaker

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A left ventricular phantom for 3D echocardiographic twist measurements

Biomedical Engineering / Biomedizinische Technik ◽

10.1515/bmt-2019-0096 ◽

2020 ◽

Vol 65 (2) ◽

pp. 209-218

Author(s):

Johannes Just Hjertaas ◽

Knut Matre

Keyword(s):

Stroke Volume ◽

Spatial Resolution ◽

Reference Method ◽

3D Ultrasound ◽

Left Ventricular ◽

Apical Rotation ◽

Mock Circulation ◽

Custom Made ◽

Wide Range ◽

2D Ultrasound

AbstractTraditional two-dimensional (2D) ultrasound speckle tracking echocardiography (STE) studies have shown a wide range of twist values, also for normal hearts, which is due to the limitations of short-axis 2D ultrasound. The same limitations do not apply to three-dimensional (3D) ultrasound, and several studies have shown 3D ultrasound to be superior to 2D ultrasound, which is unreliable for measuring twist. The aim of this study was to develop a left ventricular twisting phantom and to evaluate the accuracy of 3D STE twist measurements using different acquisition methods and volume rates (VR). This phantom was not intended to simulate a heart, but to function as a medium for ultrasound deformation measurement. The phantom was made of polyvinyl alcohol (PVA) and casted using 3D printed molds. Twist was obtained by making the phantom consist of two PVA layers with different elastic properties in a spiral pattern. This gave increased apical rotation with increased stroke volume in a mock circulation. To test the accuracy of 3D STE twist, both single-beat, as well as two, four and six multi-beat acquisitions, were recorded and compared against twist from implanted sonomicrometry crystals. A custom-made software was developed to calculate twist from sonomicrometry. The phantom gave sonomicrometer twist values from 2.0° to 13.8° depending on the stroke volume. STE software tracked the phantom wall well at several combinations of temporal and spatial resolution. Agreement between the two twist methods was best for multi-beat acquisitions in the range of 14.4–30.4 volumes per second (VPS), while poorer for single-beat and higher multi-beat VRs. Smallest offset was obtained at six-beat multi-beat at 17.1 VPS and 30.4 VPS. The phantom proved to be a useful tool for simulating cardiac twist and gave different twist at different stroke volumes. Best agreement with the sonomicrometer reference method was obtained at good spatial resolution (high beam density) and a relatively low VR. 3D STE twist values showed better agreement with sonomicrometry for most multi-beat recordings compared with single-beat recordings.

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