The impact of cardiac loading on a novel metric of left ventricular diastolic function in healthy middle‐aged adults: Systolic–diastolic coupling

MacNamara, James P.; Koshti, Vivek; Dias, Katrin A.; Howden, Erin J.; Hearon, Christopher M.; Cheng, I-Jou; Hynan, Linda S.; Levine, Benjamin D.; Sarma, Satyam

doi:10.14814/phy2.15129

Cited by 3 publications

(8 citation statements)

References 43 publications

(71 reference statements)

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“…Previous studies from our group have shown that, like LV relaxation, S-D coupling declines with age, and S-D coupling is preload independent, unlike early diastolic recoil velocity (e'). 13,24 The present study demonstrates that in healthy adults the link between fitness and S-D coupling appears primarily driven by age. The fitness of most adults is "cardiac-limited" as the stroke volume and heart rate cannot increase indefinitely to support higher peak V Ȯ2 .…”

Section: Impaired Myocardial Mechanics and Exercise Intolerance In Hcmmentioning

confidence: 51%

“…An advantage of S-D coupling is that it is a relative marker and independent of heart size. 24 Future studies characterizing S-D coupling are needed to determine the effects of body size. Fourth, the non-invasive nature of this study limits our ability to assess important parameters of diastolic function, including LV relaxation, LV stiffness, and LV filling pressures.…”

Section: Limitationsmentioning

confidence: 99%

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Impaired longitudinal systolic–diastolic coupling and cardiac response to exercise in patients with hypertrophic cardiomyopathy

MacNamara,

Turlington,

Dias

et al. 2024

Echocardiography

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BackgroundIn patients with hypertrophic cardiomyopathy (HCM), impaired augmentation of stroke volume and diastolic dysfunction contribute to exercise intolerance. Systolic–diastolic (S‐D) coupling characterizes how systolic contraction of the left ventricle (LV) primes efficient elastic recoil during early diastole. Impaired S‐D coupling may contribute to the impaired cardiac response to exercise in patients with HCM.MethodsPatients with HCM (n = 25, age = 47 ± 9 years) and healthy adults (n = 115, age = 49 ± 10 years) underwent a cardiopulmonary exercise testing (CPET) and echocardiogram. S‐D coupling was defined as the ratio of LV longitudinal excursion of the mitral annulus during early diastole (EDexc) and systole (Sexc) and compared between groups. Peak oxygen uptake (peak V̇O2) (Douglas bags), cardiac index (C2H2 rebreathe), and stroke volume index (SVi) were assessed during CPET. Linear regression was performed between S‐D coupling and peak V̇O2, peak cardiac index, and peak SVi.ResultsS‐D coupling was lower in HCM (Controls: 0.63 ± 0.08, HCM: 0.56 ± 0.10, p < 0.001). Peak V̇O2 and stroke volume reserve were lower in patients with HCM (Peak VO2 Controls: 28.5 ± 5.5, HCM: 23.7 ± 7.2 mL/kg/min, p < 0.001, SV reserve: Controls 39 ± 16, HCM 30 ± 18 mL, p = 0.008). In patients with HCM, S‐D coupling was associated with peak V̇O2 (r = 0.47, p = 0.018), peak cardiac index (r = 0.60, p = 0.002), and peak SVi (r = 0.63, p < 0.001).ConclusionSystolic–diastolic coupling was impaired in patients with HCM and was associated with fitness and the cardiac response to exercise. Inefficient S‐D coupling may link insufficient stroke volume generation, diastolic dysfunction, and exercise intolerance in HCM.

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Section: Impaired Myocardial Mechanics and Exercise Intolerance In Hcmmentioning

confidence: 51%

Section: Limitationsmentioning

confidence: 99%

Impaired longitudinal systolic–diastolic coupling and cardiac response to exercise in patients with hypertrophic cardiomyopathy

MacNamara,

Turlington,

Dias

et al. 2024

Echocardiography

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“…Assessing mechanical dispersion, myocardial work, isovolumetric relaxation and systolic-diastolic coupling can provide complementary information on the global and regional LV function and performance in healthy subjects. All of these parameters have demonstrated clinical value [1,[11][12][13][14][15][16][17][18][19][20]27,[32][33][34][35][36][37][38][39][40].…”

Section: Discussionmentioning

confidence: 99%

“…A close relationship between systolic contraction and relaxation (systolic-diastolic coupling) influences global LV performance. E VTI /S VTI , a measure of systolic-diastolic coupling, describes the ratio of early diastolic recoil to systolic excursion, as explained by MacNamara et al [27] with the spring model of LV longitudinal motion. In other words, it shows which part of the systolic movement of the LV base toward the apex is compensated during early diastole.…”

Section: Discussionmentioning

confidence: 99%

“…Velocity time integrals were measured by tracing the systolic signal to measure mitral annulus systolic excursion (S VTI ) and the early diastolic signal to measure early diastolic excursion (E VTI ). These values were then used to calculate average S and E velocities, E/E ratio and E VTI /S VTI ratio [27]. IVRT was also measured as the interval between the end of S and the beginning of E from the same tissue Doppler signal.…”

Section: Echocardiographymentioning

confidence: 99%

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Interrelationships between Peak Strain Dispersion, Myocardial Work Indices, Isovolumetric Relaxation and Systolic–Diastolic Coupling in Middle-Aged Healthy Subjects

Minczykowski,

Guzik,

Sajkowska

et al. 2023

JCM

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In echocardiography, peak strain dispersion (PSD) is the standard deviation of the time to peak longitudinal strain for each left ventricular (LV) segment during systole. It assesses the coordination and synchrony of LV segment contractility. Global work efficiency (GWE) and global wasted work (GWW) quantify LV myocardial work and, if impaired, the coupling between LV systolic contraction and early relaxation. Isovolumetric relaxation (IVRT) measures the duration of initial LV relaxation, while the ratio of early diastolic recoil to systolic excursion (E′VTI/S′VTI) describes systolic–diastolic coupling. We evaluated these parameters in 69 healthy subjects and found that PSD correlated negatively with GWE (r = −0.49, p < 0.0001) and E′VTI/S′VTI (r = −0.44, p = 0.0002), but positively with GWW (r = 0.4, p = 0.0007) and IVRT (r = 0.53, p < 0.0001). GWE correlated negatively with GWW (r = −0.94, p < 0.0001) and IVRT (r = −0.30, p = 0.0127), but positively with E′VTI/S′VTI (r = 0.3, p = 0.0132). In addition, E′VTI/S′VTI was negatively correlated with GWW (r = −0.35, p = 0.0032) and IVRT (r = −0.36, p = 0.0024). These associations remained significant after adjustment for sex, age and LV mass index of the subjects. In conclusion, there is an interaction between measures of LV asynchrony, myocardial work, diastolic function and its systolic–diastolic coupling in middle-aged healthy subjects. The clinical value of these interactions requires further investigation.

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Importance of preload in understanding impaired longitudinal systolic–diastolic coupling in patients with hypertrophic cardiomyopathy

Peverill

2024

Echocardiography

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LETTER TO THE EDITOR contributing to energy storage and recoil cannot be more than S exc -LA exc, a difference which is essentially equal to ED exc . Relative preservation of S exc during a decrease in ED exc which occurs via an increase in LA exc must be due to an increase in the preload component of S exc .That the ratio of ED exc /S exc is not affected by changes in LA pressure is useful information, but it clearly does not mean that the ratio is preload independent. The significance of LA contraction can be easily appreciated in atrial fibrillation where if LA exc is absent then S exc is equal to ED exc . Understanding the role of LA exc is particularly pertinent to the study of HCM as LA exc may not increase and therefore cannot compensate for the reduced ED exc in this condition. 4 Failure to increase LA exc in HCM could be due to an atrial myopathy or failure of contraction of the thinned wall atrium to stretch a thick disordered myocardium.

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The impact of cardiac loading on a novel metric of left ventricular diastolic function in healthy middle‐aged adults: Systolic–diastolic coupling

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 3 publications

References 43 publications

Impaired longitudinal systolic–diastolic coupling and cardiac response to exercise in patients with hypertrophic cardiomyopathy

Impaired longitudinal systolic–diastolic coupling and cardiac response to exercise in patients with hypertrophic cardiomyopathy

Interrelationships between Peak Strain Dispersion, Myocardial Work Indices, Isovolumetric Relaxation and Systolic–Diastolic Coupling in Middle-Aged Healthy Subjects

Importance of preload in understanding impaired longitudinal systolic–diastolic coupling in patients with hypertrophic cardiomyopathy

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