Can Isovolumic Acceleration Be Used in Clinical Practice to Estimate Ventricular Contractile Function? Reproducibility and Regional Variation of a New Noninvasive Index

Mărgulescu, Andrei D.; Thomas, Deepak; Ingram, Thomas E.; Vintila, V.; Egan, Margaret A.; Vinereanu, Dragoş; Fraser, Alan G.

doi:10.1016/j.echo.2010.01.008

Cited by 21 publications

(13 citation statements)

References 32 publications

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“…Its use in clinical echocardiography has been hampered by lack of a consistent, published normal value for IVA. A normal value of 1.9 m/s 2 for the lateral wall IVA has been proposed [1] as has a lateral wall IVA value of 1.3 m/s 2 for normal hearts, patients with atrial septal defects, and transplanted hearts [9,11,13]. One study showed a much greater septal and lateral wall IVA of 2.92 and 3.00 m/s 2 , respectively [21].…”

Section: Discussionmentioning

confidence: 95%

Tissue Doppler-Derived Measurement of Isovolumic Myocardial Contraction in the Pediatric Population

2012

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Multiple echocardiographic techniques have been utilized to quantify systolic function. The shortening and ejection fraction remain the most commonly used and accepted methods. However, these measures are affected by altered loading conditions, and are not applicable when ventricular geometry differs from the prolate ellipsoid typical of a left ventricle. Mitral valve annular acceleration during isovolumic contraction (IVA) has been proposed as a load independent index of left ventricular contractility. However, published values for IVA demonstrating normal function vary. In addition, the value of IVA which may discern impaired systolic function has not been established. The purpose of this study is to determine a threshold IVA value for abnormal left ventricular function in the pediatric population. Structurally/functionally normal control (n = 90) and dilated cardiomyopathy (study = 64) patients were compared for differences in left ventricular: wall stress (WS), velocity of circumferential fiber shortening (VCFc), ejection fraction (EF), ejection force, and pulsed wave-derived medial and lateral wall IVA. No difference in body surface area (p = 0.61) or gender (p = 0.53) was noted. Left ventricular ejection fraction, ejection force, VCFc, and IVA were significantly lower and WS was significantly higher in the study group (p < 0.01). The medial IVA was 1.71 ± 0.89 m/s(2) for an EF <40%, 1.74 ± 0.70 m/s(2) for an EF = 40-50%, 2.46 ± 0.89 m/s(2) for an EF >50%. The lateral IVA was 1.81 ± 1.03 m/s(2) for an EF <40%, 2.07 ± 0.78 m/s(2) for an EF = 40-50%, 2.54 ± 0.99 m/s(2) for an EF >50%. ROC analysis demonstrated a medial IVA of 1.97 m/s(2) as the cut-off for predicting an EF<50% with a 77% sensitivity of and specificity of 66% (AUC = 0.75, CI = 0.67-0.83, p < 0.01). ROC analysis demonstrated a lateral IVA of 2.31 m/s(2) as the cut-off for predicting an EF <50% with a 73% sensitivity of and specificity of 63% (AUC = 0.72, CI = 0.63-0.82, p < 0.01). IVA lateral of 1.93 m/s(2) or less was associated with heart transplant and death. ICC analysis demonstrated some interobserver variability in IVA measurement (0.57-0.65). The normal IVA of the medial and lateral mitral valve annulus measure over 1.97 m/s(2) and 2.31 m/s(2), respectively; values less than this cut-off are associated with EF <50%. Despite some problems with reproducibility IVA remains a promising method of screening for diminished ventricular contractility in the setting of abnormal geometry.

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Section: Discussionmentioning

confidence: 95%

Tissue Doppler-Derived Measurement of Isovolumic Myocardial Contraction in the Pediatric Population

2012

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“…Recently, a study has confirmed that IVA may be used as a research tool if it is measured at the medial mitral annulus, but its clinical applicability is hampered by low reproducibility, especially in patients with impaired left ventricular function in whom it would otherwise be most useful [19]. …”

Section: Tdi Parametersmentioning

confidence: 99%

“…Recently, tissue Doppler imaging (TDI) has been used to assess systolic and diastolic function [27]. Several studies have shown that the early mitral annulus velocity is a relatively preload-independent assessment of LV relaxation [28, 29] and the ratio of peak early diastolic mitral inflow velocity (E) over the myocardial velocity can be used to estimate LV filling pressure [19-31]. …”

Section: Tdi Parametersmentioning

confidence: 99%

Tissue Doppler Imaging in Coronary Artery Diseases and Heart Failure

Correale

Totaro²,

Ieva³

et al. 2012

CCR

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Recent studies have explored the prognostic role of TDI-derived parameters in major cardiac diseases, such as coronary artery disease (CAD) and heart failure (HF). In these conditions, myocardial mitral annular systolic (S’) and early diastolic (E’) velocities have been shown to predict mortality or cardiovascular events. In heart failure non invasive assessment of LV diastolic pressure by transmitral to mitral annular early diastolic velocity ratio (E/E’) is a strong prognosticator, especially when E/E’ is > or =15. Moreover, other parameters derived by TDI, as cardiac time intervals and Myocardial Performance Index, might play a role in the prognostic stratification in CAD and HF. Recently, a three-dimensional (3-D) TDI imaging modality, triplane TDI, has become available, and this allows calculation of 3-Dvolumes and LV ejection fraction. We present a brief update of TDI.

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“…13 IVA has been proposed as a load-independent index of LV contractility. 2,14 Changes in IVA during dobutamine and esmolol infusion were correlated to invasively measured systolic elastance, and IVA was unaffected by preload reduction within a physiological range. In patients, IVA remained unchanged during inferior vena cava occlusion or after closure of an atrial septal defect, whereas myocardial velocities were significantly altered.…”

Section: Peak Ivc Velocity and Iva Measured By Tdimentioning

confidence: 99%

Influence of Atrioventricular Interaction on Mitral Valve Closure and Left Ventricular Isovolumic Contraction Measured by Tissue Doppler Imaging

Decloedt

Verheyen

Sys

et al. 2013

Circ: Cardiovascular Imaging

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Background-The influence of atrioventricular (AV) interaction on mitral valve closure (MVC) and left ventricular (LV)isovolumic contraction is not fully clarified. We investigated the relationship among AV delay, MVC, and LV isovolumic contraction using a horse model because of the low heart rate and physiologically long AV delay. Methods and Results-Six horses were evaluated during sinus rhythm, right ventricular pacing without preceding atrial contraction, and dual-chamber pacing at AV delays of 150 to 350 ms, programmed at a constant rate. Right parasternal 4-chamber views were recorded for simultaneous measurements of MVC from anatomic M-mode and radial tissue Dopplerbased LV pre-ejection velocity and isovolumic acceleration. During sinus rhythm and long AV delays (≥300 ms), 2 positive pre-ejection velocity peaks were present. The first peak was identified as LV recoil during atrial relaxation and consistently preceded MVC by 33±17 ms. The second peak was related to LV isovolumic contraction, occurring after MVC. This suggests that MVC was caused by atrial relaxation and followed by true isovolumic contraction. During short AV delays (<300 ms) and right ventricular pacing, MVC occurred significantly later. Only 1 pre-ejection peak was present, of which the end coincided with MVC with a mean difference of -1.5±10 ms. This suggests that LV contraction caused MVC. Peak velocity and isovolumic acceleration were significantly higher (P<0.001) because the mitral valve was open at the onset of LV contraction. Conclusions-Depending on the AV delay, MVC can be atrio-or ventriculogenic, resulting in significant alterations of the LV peak pre-ejection velocity and isovolumic acceleration. (Circ Cardiovasc Imaging. 2013;6:109-116.)

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Can Isovolumic Acceleration Be Used in Clinical Practice to Estimate Ventricular Contractile Function? Reproducibility and Regional Variation of a New Noninvasive Index

Cited by 21 publications

References 32 publications

Tissue Doppler-Derived Measurement of Isovolumic Myocardial Contraction in the Pediatric Population

Tissue Doppler-Derived Measurement of Isovolumic Myocardial Contraction in the Pediatric Population

Tissue Doppler Imaging in Coronary Artery Diseases and Heart Failure

Influence of Atrioventricular Interaction on Mitral Valve Closure and Left Ventricular Isovolumic Contraction Measured by Tissue Doppler Imaging

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