Kinematic analysis of diastolic function using the freely available software Echo E-waves – feasibility and reproducibility

Sundqvist, Martin; Salman, Katrin; Tornvall, Per

doi:10.1186/s12880-016-0162-8

Cited by 10 publications

(8 citation statements)

References 12 publications

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“…E-waves were recorded by placing the pulsed wave (PW) Doppler sample volume at the mitral valve tips as recommended in the guidelines [ 9 ]. PDF analysis was performed in a freely available software application, the use of which has been described previously [ 7 ]. For the purpose of the analysis of diastolic function, only resting images were available, as the study material consists of examinations performed in a clinical setting, where diastolic parameters are registered only at rest.…”

Section: Methodsmentioning

confidence: 99%

“…In the PDF method, the E-wave velocity data is fitted to a mathematical function describing the resulting recoil velocities of any combination of x 0 , k and c ; thus each E-wave analyzed yields the constants x 0 , k and c , describing the properties of the LV during that episode of diastolic filling. The PDF method has been extensively validated, [ 5 , 6 ], and a software program facilitating the application of the method has been described and made freely available [ 7 ]. In this study, as a secondary aim, we sought to explore the value of retrospective analysis of a single E-wave per patient.…”

Section: Introductionmentioning

confidence: 99%

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Diastolic function and its association with diabetes, hypertension and age in an outpatient population with normal stress echocardiography findings

Sundqvist

Sahlén

Ding

2020

Cardiovasc Ultrasound

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Background Diastolic dysfunction can be caused by hypertension or diabetes mellitus, and it is also often found with increasing age. In a given patient, the cause of diastolic dysfunction is therefore not always obvious. We sought to study the interplay of these risk factors for diastolic dysfunction in an outpatient population with a low likelihood of ischemic heart disease. Methods Consecutive patients referred for stress echocardiography were included retrospectively. Exclusion criteria included pathological stress response, atrial arrhythmia, left ventricular ejection fraction < 55%, and more than mild valvular disease. Standard diastolic parameters were recorded in all patients. In a subset of patients, mechanistic analysis of early filling was performed using the parameterized diastolic filling (PDF) method. Results We included 726 patients (median [interquartile range] age 56 (44–65) years, 57% male). The prevalence of diabetes and hypertension was 43 and 49%, respectively. In multiple linear regression modeling, the presence of diabetes, hypertension, sex and increasing age explained a moderate amount of the variance in e’ velocities, E/A ratio and E/e’ (R2 = 0.31–0.48, p < 0.001), and a low amount of the variance in left atrial volume index (LAVI) and the PDF parameters (n = 446, R2 = 0.05–0.17, p < 0.001). Sex was only related to LAVI and E/e’ for the conventional parameters (beta − 0.94, p = 0.04, and beta − 0.91, p < 0.001, respectively). Conclusions Diabetes, hypertension, increasing age, and to a lesser extent sex, explain a moderate amount of the variance in conventional diastolic parameters related to myocardial tissue velocities and E/A ratio in a healthy outpatient population. The effect of these risk factors was substantially less pronounced on left atrial volume index and the PDF parameters.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diastolic function and its association with diabetes, hypertension and age in an outpatient population with normal stress echocardiography findings

Sundqvist

Sahlén

Ding

2020

Cardiovasc Ultrasound

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“…Images were analyzed using freely available and validated software for PDF analysis (Echo E-waves, echoewaves.org ) [ 20 ]. The program’s feature for edge detection estimated the curve describing the velocity envelope of each E-wave, and manual adjustments were made to optimize fit with the Doppler signal contour (see Fig.…”

Section: Methodsmentioning

confidence: 99%

Mechanistic validation of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging Guidelines for the assessment of diastolic dysfunction in heart failure with reduced ejection fraction

Goldberg

Megyessi

Flam

et al. 2020

Cardiovasc Ultrasound

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Background The American Society for Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) 2016 guidelines for assessment of diastolic dysfunction (DD) are based primarily on the effects of diastolic dysfunction on left ventricular filling hemodynamics. However, these measures do not provide quantifiable mechanistic information about diastolic function. The Parameterized Diastolic Filling (PDF) formalism is a validated theoretical framework that describes DD in terms of the physical properties of left ventricular filling. Aims We hypothesized that PDF analysis can provide mechanistic insight into the mechanical properties governing higher grade DD. Methods Patients referred for echocardiography showing reduced left ventricular ejection fraction (< 45%) were prospectively classified into DD grade according to 2016 ASE/EACVI guidelines. Serial E-waves acquired during free breathing using pulsed wave Doppler of transmitral blood flow were analyzed using the PDF formalism. Results Higher DD grade (grade 2 or 3, n = 20 vs grade 1, n = 30) was associated with increased chamber stiffness (261 ± 71 vs 169 ± 61 g/s2, p < 0.001), increased filling energy (2.0 ± 0.9 vs 1.0 ± 0.5 mJ, p < 0.001) and greater peak forces resisting filling (median [interquartile range], 18 [15–24] vs 11 [8–14] mN, p < 0.001). DD grade was unrelated to chamber viscoelasticity (21 ± 4 vs 20 ± 6 g/s, p = 0.32). Stiffness was inversely correlated with ejection fraction (r = − 0.39, p = 0.005). Conclusions Higher grade DD was associated with changes in the mechanical properties that determine the physics of poorer left ventricular filling. These findings provide mechanistic insight into, and independent validation of the appropriateness of the 2016 guidelines for assessment of DD.

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“…; Sundqvist et al . ). This model predicts the velocity ( v ( t )):

v false(t false) = \frac{k x_{normalo}}{ω} e^{- \frac{c}{2} t} \times \sin false(ω t false)

where ω = (√(4 k − c 2 ))/2 and x o is an initial displacement.…”

Section: Exercise Exercise Tolerance and Cardiac Passive Stiffnessmentioning

confidence: 97%

“…While this formulation is popular and accurate in hearts with healthy diastolic function, the formulation underestimates cardiac stiffness when impaired relaxation is present (Shmuylovich & Kovacs, 2007). Instead of using only the period following peak velocity, a kinematic model that describes the entire E-wave with both stiffness (k) and viscous or impaired relaxation (c) properties has been validated (Kovacs et al 1987;Sundqvist et al 2016). This model predicts the velocity (v(t)):…”

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confidence: 99%

The link between exercise and titin passive stiffness

Lalande

Mueller

Chung

2017

Experimental Physiology

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Exercise can help alleviate the negative effects of cardiovascular disease and cardiovascular co-morbidities associated with sedentary behaviour; this may be especially true in diseases that are associated with increased left ventricular passive stiffness. In this review, we discuss the inverse relationship between exercise tolerance and cardiac passive stiffness. Passive stiffness is the physical property of cardiac muscle to produce a resistive force when stretched, which, in vivo, is measured using the left ventricular end diastolic pressure-volume relationship or is estimated using echocardiography. The giant elastic protein titin is the major contributor to passive stiffness at physiological muscle (sarcomere) lengths. Passive stiffness can be modified by altering titin isoform size or by post-translational modifications. In both human and animal models, increased left ventricular passive stiffness is associated with reduced exercise tolerance due to impaired diastolic filling, suggesting that increased passive stiffness predicts reduced exercise tolerance. At the same time, exercise training itself may induce both short and long-term changes in titin-based passive stiffness, suggesting that exercise may be a treatment for diseases associated with increased passive stiffness. Direct modification of passive stiffness to improve exercise tolerance is a potential therapeutic approach. Titin passive stiffness itself may be a treatment target based on the recent discovery of RNA Binding Motif 20 (RBM20), which modifies titin isoform size and passive stiffness. Translating these discoveries that link exercise and left ventricular passive stiffness may provide new methods to enhance exercise tolerance and treat patients with cardiovascular disease.

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Kinematic analysis of diastolic function using the freely available software Echo E-waves – feasibility and reproducibility

Cited by 10 publications

References 12 publications

Diastolic function and its association with diabetes, hypertension and age in an outpatient population with normal stress echocardiography findings

Diastolic function and its association with diabetes, hypertension and age in an outpatient population with normal stress echocardiography findings

Mechanistic validation of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging Guidelines for the assessment of diastolic dysfunction in heart failure with reduced ejection fraction

The link between exercise and titin passive stiffness

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