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Noninvasive estimation of impaired left ventricular untwisting velocity by peak early diastolic intra-ventricular pressure gradients using vector flow mapping

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Abstract

Background

Introduction of vector flow mapping (VFM) based on the combination of color Doppler and speckle-tracking echocardiography provides noninvasive assessment of early diastolic intra-ventricular pressure gradient (ED-IVPG). The purpose of this study was to evaluate the value of peak ED-IVPG measurement just after aortic valve closure using VFM for noninvasive estimation of impaired LV untwisting velocity as the index of LV relaxation in the clinical setting.

Methods and results

The study included 65 consecutive patients in whom echocardiography was performed for the assessment of LV function. We assessed peak ED-IVPG between LV apex and base by VFM analysis software. We also measured peak LV untwisting velocity and LV twisting by speckle-tracking strain analysis. Peak ED-IVPG was successfully and quickly assessed in all the study patients. Peak ED-IVPG was significantly reduced in patients with impaired peak LV untwisting velocity (< 70 degrees/s) compared with patients without impaired peak LV untwisting velocity. The receiver operating characteristic analysis showed the best cut-off value of peak ED-IVPG for determining impaired peak LV untwisting velocity was 0.40 mmHg (sensitivity 81%, specificity 74%, and area under the curve 0.81). There was a well correlation between peak ED-IVPG and peak LV untwisting velocity (r = 0.64, p < 0.0001).

Conclusions

The present results suggest that peak ED-IVPG just after aortic valve closure measured by VFM may be used as noninvasive index for estimation of impaired LV untwisting velocity in the clinical setting.

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References

  1. Sabbah HN, Stein PD. Pressure-diameter relations during early diastole in dogs: incompatibility with the concept of passive left ventricular filling. Circ Res. 1981;48:357–65.

    Article  CAS  Google Scholar 

  2. Hori M, Yeliin EL, Sonnenblick EH. Left ventricular suction as a mechanism of ventricular filling. Jpn Circ J. 1982;46:124.

    Article  CAS  Google Scholar 

  3. Yellin EL, Hori M, Yoran C, et al. Left ventricular relaxation in the filling and nonfilling intact canine heart. Am J Physiol. 1986;250:H620–9.

    CAS  PubMed  Google Scholar 

  4. Courtois M, Kovacs SJ Jr, Ludbrook PA. Transmitral pressure-flow velocity relation: importance of regional pressure gradients in the left ventricle during diastole. Circulation. 1988;78:661–71.

    Article  CAS  Google Scholar 

  5. Nikolic SD, Feneley MP, Pajaro OE, et al. Origin of regional pressure gradients in the left ventricle during early diastole. Am J Physiol. 1995;268:H550–7.

    CAS  PubMed  Google Scholar 

  6. Dong SJ, Hees PS, Siu CO, et al. MRI assessment of LV relaxation by untwisting rate: a new isovolumic phase measure of tau. Am J Physiol Heart Circ Physiol. 2001;281:H2002-2009.

    Article  CAS  Google Scholar 

  7. Firstenberg MS, Smedira NG, Greenberg NL, et al. Relationship between early diastolic intraventricular pressure gradients, an index of elastic recoil, and improvements in systolic and diastolic function. Circulation. 2001;104:I-330-I–335.

    Article  CAS  Google Scholar 

  8. Notomi Y, Martin-Miklovic MG, Oryszak SJ, et al. Enhanced ventricular untwisting during exercise: a mechanistic manifestation of elastic recoil described by Doppler tissue imaging. Circulation. 2006;113:2524–33.

    Article  Google Scholar 

  9. Notomi Y, Popovic ZB, Yamada H, et al. Ventricular untwisting: a temporal link between left ventricular relaxation. Am J Physiol Heart Circ Physiol. 2008;294:H505-513.

    Article  CAS  Google Scholar 

  10. Burns AT, Gerche AL, Prior DL, et al. Left ventricular untwisting is an important determinant of early diastolic function. JACC Cardiovac Imaging. 2009;2:709–16.

    Article  Google Scholar 

  11. Smiseth OA, Steine K, SandbÆk G, et al. Mechanics of intraventricular filling: study of LV early diastolic pressure gradients and flow velocities. Am J Physiol (Heart Circ Physiol). 1998;275:H1062–9.

    Article  CAS  Google Scholar 

  12. Greenberg NL, Vandervoort PM, Firstenberg MS, et al. Estimation of diastolic intraventricular pressure gradients by Doppler M-mode echocardiography. Am J Physiol (Heart Circ Physiol). 2001;280:H2507–15.

    Article  CAS  Google Scholar 

  13. Steine K, Stugaard M, Smiseth OA. Mechanisms of diastolic intraventricular regional pressure differences and flow in the inflow and outflow tracts. J Am Coll Cardiol. 2002;40:983–90.

    Article  Google Scholar 

  14. Yotti R, Bermejo J, Antoranz JC, et al. A noninvasive method for assessing impaired diastolic suction in patients with dilated cardiomyopathy. Circulation. 2005;112:2921–9.

    Article  Google Scholar 

  15. Iwano H, Kamimura D, Fox E, et al. Altered spatial distribution of the diastolic left ventricular pressure difference in heart failure. J Am Soc Echocardiogr. 2015;28:597–605.

    Article  Google Scholar 

  16. Ohtsuki S, Tanaka M. The flow velocity distribution from the Doppler information on a plane in three-dimensional flow. J Vis. 2006;9:69–82.

    Article  Google Scholar 

  17. Tanaka M, Sakamoto T, Sugawara S, et al. Blood flow structure and dynamics, and ejection mechanism in the left ventricle: analysis using echo-dynamography. J Cardiology. 2008;52:86–101.

    Article  Google Scholar 

  18. Uejima T, Koike A, Sawada H, et al. A new echocardiographic method for identifying vortex flow in the left ventricle: numerical validation. Ultrasound Med Biol. 2010;36:772–88.

    Article  Google Scholar 

  19. Itatani K, Okada T, Uejima T, et al. Intraventricular flowvelocity vector visualization based on the continuity equation and measurementsof vorticity and wall shear stress. Jpn J Appl Phys. 2013;52:07HF16.

    Article  Google Scholar 

  20. Asami R, Tanaka T, Kawabata K, et al. Accuracy and limitations of vector flow mapping: left ventricular phantom validation using stereo particle image velocimetory. J Echocardiography. 2017;15:57–66.

    Article  Google Scholar 

  21. Tanaka T, Okada T, Nishiyama T, et al. Relative pressure imaging in left ventricle using ultrasonic vector flow mapping. Jpn J Appl Phys. 2017;56:07JF26.

    Article  Google Scholar 

  22. van Dalen BM, Soliman OI, Kauer F, et al. Alterations in left ventricular untwisting with ageing. Circ J. 2010;74:101–8.

    Article  Google Scholar 

  23. Wang J, Khoury DS, Yue Y, et al. Left ventricular untwisting rate by speckle tracking echocardiography. Circulation. 2007;116:2580–6.

    Article  Google Scholar 

  24. Przewlocka-Kosmala M, Marwick TH, Yang H, et al. Association of reduced apical untwisting with incident HF in asymptomatic patients with HF risk factors. J Am Coll Cardiol Img. 2020;13:187–94.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan

    Yuki Nakajima, Takeshi Hozumi, Kazushi Takemoto, Suwako Fujita, Teruaki Wada, Manabu Kashiwagi, Kunihiro Shimamura, Yasutsugu Shiono, Akio Kuroi, Takashi Tanimoto, Takashi Kubo, Atsushi Tanaka & Takashi Akasaka

Authors
  1. Yuki Nakajima
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  2. Takeshi Hozumi
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  3. Kazushi Takemoto
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  4. Suwako Fujita
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  5. Teruaki Wada
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  6. Manabu Kashiwagi
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  7. Kunihiro Shimamura
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  8. Yasutsugu Shiono
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  9. Akio Kuroi
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  10. Takashi Tanimoto
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  11. Takashi Kubo
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  12. Atsushi Tanaka
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  13. Takashi Akasaka
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Corresponding author

Correspondence to Takeshi Hozumi.

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Conflict of interest

Yuki Nakajima, Takeshi Hozumi, Kazushi Takemoto, Suwako Fujita, Teruaki Wada, Manabu Kashiwagi, Yasutsugu Shiono, Kunihiro Shimamura, Akio Kuroi, Takashi Tanimoto, Takashi Kubo, Atsushi Tanaka, and Takashi Akasaka declare that they have no conflict of interest.

Human rights statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

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Informed consent was obtained from all patients for being included in the study.

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Nakajima, Y., Hozumi, T., Takemoto, K. et al. Noninvasive estimation of impaired left ventricular untwisting velocity by peak early diastolic intra-ventricular pressure gradients using vector flow mapping. J Echocardiogr 19, 166–172 (2021). https://doi.org/10.1007/s12574-021-00520-1

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  • DOI: https://doi.org/10.1007/s12574-021-00520-1

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