Relation of Left Ventricular Chamber Stiffness at Rest to Exercise Capacity in Hypertrophic Cardiomyopathy

Dumont, C; Monserrat, Lorenzo; Peteiro, Jesús; Soler, Rafaela; Rodrı́guez, Esther; Bouzas, Alberto; Fernández, Xusto; Pérez, R. Fornell; Bouzas, Beatriz; Castro‐Beiras, Alfonso

doi:10.1016/j.amjcard.2006.12.077

Cited by 23 publications

(18 citation statements)

References 27 publications

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“…Left ventricular outflow tract obstruction has been found to be an important determinant of clinical symptoms in HCM by preventing augmentation of stroke volume [26,27]. Although Lele et al reported that exercise capacity in HCM depends primarily on stroke volume response rather than inability to increase heart rate [28], our results suggest that exercise intolerance in these patients is multifactorial.…”

Section: The Relation Between Chronotropic Incompetence and Exercise contrasting

confidence: 64%

Chronotropic incompetence and its relation to exercise intolerance in hypertrophic cardiomyopathy

Efthimiadis

Giannakoulas

Parcharidou

et al. 2011

International Journal of Cardiology

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Section: The Relation Between Chronotropic Incompetence and Exercise contrasting

confidence: 64%

Chronotropic incompetence and its relation to exercise intolerance in hypertrophic cardiomyopathy

Efthimiadis

Giannakoulas

Parcharidou

et al. 2011

International Journal of Cardiology

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“…In another study, maximal workloads were more than 80 watts and maximal specific oxygen uptake 41% lower in patients with diastolic dysfunction than in normals [46] (Table 1). Also, a negative correlation exists between exercise capacity and left ventricular stiffness in hypertensive patients [57] and an index of left ventricular filling pressure at exercise (duration of diastolic reverse pulmonary vein flow and mitral flow at atrial contraction) in patients with acromegaly [58].…”

Section: Diastolic Dysfunction and Exercise Capacitymentioning

confidence: 99%

Diastolic dysfunction in exercise and its role for exercise capacity

et al. 2008

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Diastolic dysfunction is frequent in elderly subjects and in patients with left ventricular hypertrophy, vascular disease and diabetes mellitus. Patients with diastolic dysfunction demonstrate a reduced exercise capacity and might suffer from congestive heart failure (CHF). Presence of symptoms of CHF in the setting of a normal systolic function is referred to as heart failure with normal ejection fraction (HFNEF) or, if evidence of an impaired diastolic function is observed, as diastolic heart failure (DHF). Reduced exercise capacity in diastolic dysfunction results from a number of pathophysiological alterations such as slowed myocardial relaxation, reduced myocardial distensibility, elevated filling pressures, and reduced ventricular suction forces. These alterations limit the increase of ventricular diastolic filling and cardiac output during exercise and lead to pulmonary congestion. In healthy subjects, exercise training can enhance diastolic function and exercise capacity and prevent deterioration of diastolic function in the course of aging. In patients with diastolic dysfunction, exercise capacity can be enhanced by exercise training and pharmacological treatment, whereas improvement of diastolic function can only be observed in few patients.

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“…Interestingly, others have encountered the same range in humans when making measurements of chamber stiffness. 10 Although encouraging, these methodologic results need to be viewed as preliminary, while application in selected pathophysiologic groups is undertaken. However, the overall results reinforce the power of kinematic modeling and associated mathematical reasoning through which the full range of DF determinants can be characterized and elucidated.…”

Section: Discussionmentioning

confidence: 98%

Kinematic Modeling-based Left Ventricular Diastatic (Passive) Chamber Stiffness Determination with In-Vivo Validation

Mossahebi

Kovács

2011

Ann Biomed Eng

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The slope of the diastatic pressure-volume relationship (D-PVR) defines passive left ventricular (LV) stiffness κ. Although κ is a relative measure, cardiac catheterization, which is an absolute measurement method, is used to obtain the former. Echocardiography, including transmitral flow velocity (Doppler E-wave) analysis, is the preferred quantitative diastolic function (DF) assessment method. However, E-wave analysis can provide only relative, rather than absolute pressure information. We hypothesized that physiologic mechanism-based modeling of E-waves allows derivation of the D-PVR(E-wave) whose slope, κ(E-wave), provides E-wave-derived diastatic, passive chamber stiffness. Our kinematic model of filling and Bernoulli's equation were used to derive expressions for diastatic pressure and volume on a beat-by-beat basis, thereby generating D-PVR(E-wave), and κ(E-wave). For validation, simultaneous (conductance catheter) P-V and echocardiographic E-wave data from 30 subjects (444 total cardiac cycles) having normal LV ejection fraction (LVEF) were analyzed. For each subject (15 beats average) model-predicted κ(E-wave) was compared to experimentally measured κ(CATH) via linear regression yielding as follows: κ(E-wave) = ακ(CATH) + b (R(2) = 0.92), where, α = 0.995 and b = 0.02. We conclude that echocardiographically determined diastatic passive chamber stiffness, κ(E-wave), provides an excellent estimate of simultaneous, gold standard (P-V)-defined diastatic stiffness, κ(CATH). Hence, in chambers at diastasis, passive LV stiffness can be accurately determined by means of suitable analysis of Doppler E-waves (transmitral flow).

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Relation of Left Ventricular Chamber Stiffness at Rest to Exercise Capacity in Hypertrophic Cardiomyopathy

Cited by 23 publications

References 27 publications

Chronotropic incompetence and its relation to exercise intolerance in hypertrophic cardiomyopathy

Chronotropic incompetence and its relation to exercise intolerance in hypertrophic cardiomyopathy

Diastolic dysfunction in exercise and its role for exercise capacity

Kinematic Modeling-based Left Ventricular Diastatic (Passive) Chamber Stiffness Determination with In-Vivo Validation

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