Determinants of Left Ventricular Early-Diastolic Lengthening Velocity

Opdahl, Anders; Remme, Espen W.; Helle-Valle, Thomas; Lyseggen, Erik; Vartdal, Trond; Pettersen, Eirik; Edvardsen, Thor; Smiseth, Otto A.

doi:10.1161/circulationaha.108.791681

Cited by 178 publications

(73 citation statements)

References 31 publications

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“…These findings are best interpreted in light of recent data demonstrating that, in addition to early diastolic load (lengthening load), e' is determined not only by intrinsic myocardial relaxation, but also prominently influenced by restoring forces, particularly in the presence of normal LV function. 26 The amount of potential energy stored during contraction and released during relaxation is negatively related to end-systolic length and volume. The ability to reduce end-systolic length or volume, therefore, contributes to the active restoration of LV dimensions in early diastole and enhances the rate of relaxation.…”

Section: Discussionmentioning

confidence: 99%

Early and Late Systolic Wall Stress Differentially Relate to Myocardial Contraction and Relaxation in Middle-Aged Adults

et al. 2013

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A fterload is recognized as an important determinant of myocardial function. Experimental animal studies demonstrate that increased afterload impacts diastolic relaxation. [1][2][3][4][5] Furthermore, studies in healthy instrumented dogs showed that, within physiological ranges, increased afterload results in differential responses in relaxation depending on its timing. In anesthetized open-chest dogs, mild-to-moderate increases in early systolic load resulted in unchanged or slightly enhanced relaxation, whereas increases in late systolic load resulted in a slow rate of diastolic ventricular pressure fall. 2,6 This, however, was not observed in conscious dogs subjected to a similar protocol.7 More recently, greater late systolic pressure assessed from a carotid pressure waveform 8 or an invasively measured aortic pressure waveform 9 has been shown to be associated with impaired early diastolic relaxation in humans. These studies implicate the loading sequence as a potential mechanistic determinant of diastolic relaxation.Whereas analyses of central arterial pressure and pressureflow relations are highly informative regarding arterial properties and ventricular-arterial interactions, they do not describe the time-varying mechanical load (stress) on the myocardium, which is determined by complex interactions between myocardial contractile elements, instantaneous leftventricular (LV) geometry and the time-varying hydraulic Abstract-Experimental studies implicate late systolic load as a determinant of impaired left-ventricular relaxation. We aimed to assess the relationship between the myocardial loading sequence and left-ventricular contraction and relaxation.

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Section: Discussionmentioning

confidence: 99%

Early and Late Systolic Wall Stress Differentially Relate to Myocardial Contraction and Relaxation in Middle-Aged Adults

et al. 2013

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“…52 Tan et al found that at rest, the extent and velocity of LV untwisting was impaired in HFpEF patients compared with controls, and further tended to be impaired during dynamic exercise, indicating that in addition to inadequate relaxation reserve, limitations in LV untwisting contribute. 14 Using nuclear scintigraphy, Phan et al observed that while peak diastolic filling rates were similar in HFpEF patients and controls at rest, the ability to enhance the time to peak filling was markedly attenuated in HFpEF.…”

Section: Pathophysiology Of Exercise Intolerance In Hfpefmentioning

confidence: 99%

Mechanisms of Exercise Intolerance in Heart Failure With Preserved Ejection Fraction

Borlaug

2014

Circ J

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Approximately half of patients with heart failure (HF) have a preserved ejection fraction (HFpEF), and with the changing age and comorbidity characteristics in the adult population, this number is growing rapidly. The defining symptom of HFpEF is exercise intolerance, but the specific mechanisms causing this common symptom remain debated and inadequately understood. Although diastolic dysfunction was previously considered to be the sole contributor to exercise limitation, recent studies have identified the importance of ventricular systolic, chronotropic, vascular, endothelial and peripheral factors that all contribute in a complex and highly integrated fashion to produce the signs and symptoms of HF. This review will explore the mechanisms underlying objective and subjective exercise intolerance in patients with HFpEF. (Circ J 2014; 78: 20 -32)

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“…Supporting such supposition, IVRT has been shown to improve with short-term training among sedentary subjects (20). Similarly, e 0 is primarily dependent on LV relaxation and reflects a combination of active, energy-consuming steps plus elastic recoil representing the cyclic restoration forces of the myocardium (21). E 0 has shown to be rather independent of LV preload (22,23), to decrease with diminished coronary blood flow, and to improve with exercise (20,24).…”

Section: Discussionmentioning

confidence: 95%

Metformin is associated with improved left ventricular diastolic function measured by tissue Doppler imaging in patients with diabetes

Andersson

Søgaard²,

Hoffmann³

et al. 2010

European Journal of Endocrinology

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Objective: To examine the association between selected glucose-lowering medications and left ventricular (LV) diastolic function in patients with diabetes. Design: Retrospective cohort study (years 2005-2008). Methods: Echocardiograms of 242 patients with diabetes undergoing coronary angiography were analyzed. All patients had an LV ejection fraction (LVEF) R20% and were without atrial fibrillation, bundle branch block, valvular disease, or cardiac pacemaker. Patients were grouped according to the use of metformin (nZ56), sulfonylureas (nZ43), insulin (nZ61), and combination treatment (nZ82). Results: Mean age (66G10 years) and mean LVEF (45G11%) were similar across the groups. Mean isovolumic relaxation time (IVRT) was 66G31, 79G42, 69G23, and 66G29 ms in metformin, sulfonylureas, insulin, and combination treatment groups respectively (PZ0.4). Mean early diastolic longitudinal tissue velocity (e 0 ) was 5.3G1.6, 4.6G1.6, 5.3G1.8, and 5.4G1.7 cm/s in metformin, sulfonylureas, insulin, and combination treatment groups (PZ0.04). In adjusted linear regression models, the use of metformin was associated with a shorter IVRT (parameter estimate K9.9 ms, PZ0.049) and higher e 0 (parameter estimate C0.52 cm/s, PZ0.03), compared with no use of metformin. The effects of metformin were not altered by concomitant use of sulfonylureas or insulin (P for interactions O0.4). Conclusions: The use of metformin is associated with improved LV relaxation, as compared with no use of metformin.

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Determinants of Left Ventricular Early-Diastolic Lengthening Velocity

Abstract: Background-Peak

Cited by 178 publications

References 31 publications

Early and Late Systolic Wall Stress Differentially Relate to Myocardial Contraction and Relaxation in Middle-Aged Adults

Early and Late Systolic Wall Stress Differentially Relate to Myocardial Contraction and Relaxation in Middle-Aged Adults

Mechanisms of Exercise Intolerance in Heart Failure With Preserved Ejection Fraction

Metformin is associated with improved left ventricular diastolic function measured by tissue Doppler imaging in patients with diabetes

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