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Development of suction force during early diastole from the left atrium to the left ventricle in infants, children, and adolescents

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Abstract

Although the suction force that moves blood into the left ventricle during early diastole is thought to play an important role in diastolic function, there have been a few studies of this phenomenon in normal children. Suction force is measured as the intraventricular pressure difference (IVPD) and intraventricular pressure gradient (IVPG), which is calculated as IVPD divided by left ventricular length. The purpose of this study was to determine the suction force in infants, children, and adolescents using IVPD and IVPG. We included 120 normal children categorized into five groups based on age: G1 (0–2 years), G2 (3–5 years), G3 (6–8 years), G4 (9–11 years), and G5 (12–16 years). The total, basal, and mid–apical IVPD and IVPG were calculated using color M-mode Doppler imaging of the mitral valve inflow using the Euler equation. The total IVPD increased with age from G1 to G5 (1.75 + 0.51 vs. 2.95 + 0.72 mmHg, respectively; p < 0.001), due to an increase in mid–apical IVPD with constant basal IVPD. Although total IVPG was constant, mid–apical IVPG was larger in G5 than in G1 (0.21 + 0.06 vs. 0.16 + 0.07 mmHg/cm, respectively; p = 0.006). Total, basal, and mid–apical IVPDs were significantly correlated with age and the parameters of heart size and mitral annular eʹ. Mid–apical IVPG correlated with age and e′ positively, but basal IVPG did with age negatively and did not with e′. The suction force increased at the mid–apical segment, correlating with increasing heart size and developing left ventricular relaxation, even after adjustment for left ventricular length.

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References

  1. Mangner N, Scheuermann K, Winzer E, Wagner I, Hoellriegel R, Sandri M, Zimmer M, Mende M, Linke A, Kiess W, Schuler G, Körner A, Erbs S (2014) Childhood obesity: impact on cardiac geometry and function. JACC Cardiovasc Imaging 7:1198–1205

    Article  PubMed  Google Scholar 

  2. McMahon CJ, Nagueh SF, Pignatelli RH, Denfield SW, Dreyer WJ, Price JF, Clunie S, Bezold LI, Hays AL, Towbin JA, Eidem BW (2004) Characterization of left ventricular diastolic function by tissue Doppler imaging and clinical status in children with hypertrophic cardiomyopathy. Circulation 109:1756–1762

    Article  PubMed  Google Scholar 

  3. Margossian R, Sleeper LA, Pearson GD, Barker PC, Mertens L, Quartermain MD, Su JT, Shirali G, Chen S, Colan SD (2016) Assessment of diastolic function in single-ventricle patients after the Fontan procedure. J Am Soc Echocardiogr 29:1066–1073

    Article  PubMed  PubMed Central  Google Scholar 

  4. Voges I, Jerosch-Herold M, Hedderich J, Hart C, Petko C, Scheewe J (2013) Implications of early aortic stiffening in patients with transposition of the great arteries after arterial switch operation. Circ Cardiovasc Imaging 6:245–253

    Article  PubMed  Google Scholar 

  5. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 29:277–314

    Article  Google Scholar 

  6. Kobayashi M, Takahashi K, Yamada M, Yazaki K, Matsui K, Tanaka N, Shigemitsu S, Akimoto K, Kishiro M, Nakanishi K, Kawasaki S, Nii M, Itatani K, Shimizu T (2017) Assessment of early diastolic intraventricular pressure gradient in the left ventricle among patients with repaired tetralogy of Fallot. Heart Vessels 32:1364–1374

    Article  PubMed  Google Scholar 

  7. Yamamoto Y, Takahashi K, Takemoto Y, Kobayashi M, Itatani K, Shimizu T, Itakura A, Takeda S (2017) Evaluation of myocardial function according to early diastolic intraventricular pressure difference in fetuses. J Am Soc Echocardiogr 30:1130–1137

    Article  PubMed  Google Scholar 

  8. Ohara T, Niebel CL, Stewart KC, Charonko JJ, Pu M, Vlachos PP, Little WC (2012) Loss of adrenergic augmentation of diastolic intra-LV pressure difference in patients with diastolic dysfunction: evaluation by color M-mode echocardiography. JACC Cardiovasc Imaging 5:861–870

    Article  PubMed  Google Scholar 

  9. Yotti R, Bermejo J, Antoranz JC, Desco MM, Cortina C, Rojo-Alvarez JL, Allué C, Martín L, Moreno M, Serrano JA, Muñoz R, García-Fernández MA (2005) A noninvasive method for assessing impaired diastolic suction in patients with dilated cardiomyopathy. Circulation 112:2921–2929

    Article  PubMed  Google Scholar 

  10. Notomi Y, Popovic ZB, Yamada H, Wallick DW, Martin MG, Oryszak SJ, Shiota T, Greenberg NL, Thomas JD (2008) Ventricular untwisting: a temporal link between left ventricular relaxation and suction. Am J Physiol Heart Circ Physiol 294:H505–H513

    Article  CAS  PubMed  Google Scholar 

  11. Popović ZB, Richards KE, Greenberg NL, Rovner A, Drinko J, Cheng Y, Penn MS, Fukamachi K, Mal N, Levine BD, Garcia MJ, Thomas JD (2006) Scaling of diastolic intraventricular pressure gradients is related to filling time duration. Am J Physiol Heart Circ Physiol 291:H762–H769

    Article  CAS  PubMed  Google Scholar 

  12. Thomas JD, Popovic ZB (2005) Intraventricular pressure differences a new window into cardiac function. Circulation 112:1684–1686

    Article  PubMed  Google Scholar 

  13. Yotti R, Bermejo J, Benito Y, Antoranz JC, Desco MM, Rodríguez-Pérez D, Cortina C, Mombiela T, Barrio A, Elízaga J, Fernández-Avilés F (2011) Noninvasive estimation of the rate of relaxation by the analysis of intraventricular pressure gradients. Circ Cardiovasc Imaging 4:94–104

    Article  PubMed  Google Scholar 

  14. Iwano H, Kamimura D, Fox E, Hall M, Vlachos P, Little WC (2015) Altered spatial distribution of the diastolic left ventricular pressure difference in heart failure. J Am Soc Echocardiogr 28:597–605

    Article  PubMed  PubMed Central  Google Scholar 

  15. Greenberg NL, Vandervoort PM, Firstenberg MS, Garcia MJ, Thomas JD (2001) Estimation of diastolic intraventricular pressure gradients by Doppler M-mode echocardiography. Am J Physiol Heart Circ Physiol 280:H2507–H2515

    Article  CAS  PubMed  Google Scholar 

  16. Tate CA, Taffet GE, Hudson EK, Blaylock SL, McBride RP, Michael LH (1990) Enhanced calcium uptake of cardiac sarcoplasmic reticulum in exercise-trained old rats. Am J Physiol 258:H431–H435

    CAS  PubMed  Google Scholar 

  17. Spinale FG (2002) Matrix metalloproteinases: regulation and dysregulation in the failing heart. Circ Res 90:520–530

    Article  CAS  PubMed  Google Scholar 

  18. Lahmers S, Wu Y, Call DR, Labeit S, Granzier H (2004) Developmental control of titin isoform expression and passive stiffness in fetal and neonatal myocardium. Circ Res 94:505–513

    Article  CAS  Google Scholar 

  19. Marwick TH, Gillebert TC, Aurigemma G, Chirinos J, Derumeaux G, Galderisi M, Gottdiener J, Haluska B, Ofili E, Segers P, Senior R, Tapp RJ, Zamorano JL (2015) Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). J Am Soc Echocardiogr 28:727–754

    Article  PubMed  Google Scholar 

  20. Notomi Y, Srinath G, Shiota T, Martin-Miklovic MG, Beachler L, Howell K, Oryszak SJ, Deserranno DG, Freed AD, Greenberg NL, Younoszai A, Thomas JD (2006) Maturational and adaptive modulation of left ventricular torsional biomechanics: Doppler tissue imaging observation from infancy to adulthood. Circulation 113:2534–2541

    Article  PubMed  Google Scholar 

  21. Eidem BW, McMahon CJ, Cohen RR, Wu J, Finkelshteyn I, Kovalchin JP, Ayres NA, Bezold LI, O’Brian Smith E, Pignatelli RH (2004) Impact of cardiac growth on Doppler tissue imaging velocities: a study in healthy children. J Am Soc Echocardiogr 17:212–221

    Article  Google Scholar 

  22. Little WC, Oh JK (2009) Echocardiographic evaluation of diastolic function can be used to guide clinical care. Circulation 120:802–809

    Article  PubMed  Google Scholar 

  23. Hasegawa H, Little WC, Ohno M, Brucks S, Morimoto A, Cheng HJ, Cheng CP (2003) Diastolic mitral annular velocity during the development of heart failure. J Am Coll Cardiol 41:1590–1597

    Article  PubMed  Google Scholar 

  24. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102:1788–1794

    Article  CAS  PubMed  Google Scholar 

  25. Voon WC, Su HM, Lin TH, Lee MY, Lin CT, Yen HW, Lai WT, Sheu SH (2005) Left ventricular inflow propagation velocity at pulsed wave Doppler analysis: an index of relaxation. J Am Soc Echocardiogr 18:326–329

    Article  PubMed  Google Scholar 

  26. Masutani S, Little WC, Hasegawa H, Cheng HJ, Cheng CP (2008) Restrictive left ventricular filling pattern does not result from increased left atrial pressure alone. Circulation 117:1550–1554

    Article  PubMed  Google Scholar 

  27. Cantinotti M, Lopez L (2013) Nomograms for blood flow and tissue Doppler velocities to evaluate diastolic function in children: a critical review. J Am Soc Echocardiogr 26:126–141

    Article  PubMed  Google Scholar 

  28. Sanchez-Quintana D, Anderson RH, Ho SY (1996) Ventricular myoarchitecture in tetralogy of Fallot. Heart 76:280–286

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Sanchez-Quintana D, Climent V, Ho SY, Anderson RH (1999) Myoarchitecture and connective tissue in hearts with tricuspid atresia. Heart 81:182–191

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank the members of the Japanese Pediatric Echocardiographic Research Team and the staff of Shizuoka Children’s Hospital for collecting the echocardiographic data of children without cardiac defects.

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Authors and Affiliations

  1. Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Ken Takahashi, Noboru Tanaka, Kotoko Matsui, Sachie Shigemitsu, Mariko Yamada, Maki Kobayashi, Kana Yazaki & Toshiaki Shimizu

  2. Department of Cardiology, Shizuoka Children’s Hospital, 860 Urushiyama Aoi-ku, Shizuoka, 420-0953, Japan

    Masaki Nii

  3. Department of Pediatric Cardiology, Nagano Children’s Hospital, 3100 Toyoshina Azunimo-shi, Nagano, 399-8288, Japan

    Kiyohiro Takigiku

  4. Department of Pediatrics, Graduate School of Medicine, Organ Function-Oriented Medicine, Akita University, 1-1-1 Hondou Akita-shi, Akita, 010-8543, Japan

    Manatomo Toyono

  5. Department of Pediatrics, Chutoen General Medical Cente, 1-1 Shoubugaike, Kakegawa-shi, Shizuoka, 436-0040, Japan

    Satoru Iwashima

  6. Department of Pediatrics, Seirei Hamamatsu General Hospital, 2-12-12 Sueyoshi, Nakaku, Hamamatsu-shi, Shizuoka, 430-8558, Japan

    Nao Inoue

  7. Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, 465 Kajicho, Hirokoji, Kawaracho Kamigyo-ku, Kyoto-shi, Kyoto, 602-8526, Japan

    Keiichi Itatani

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  1. Ken Takahashi
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  2. Masaki Nii
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  3. Kiyohiro Takigiku
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  7. Noboru Tanaka
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  8. Kotoko Matsui
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  9. Sachie Shigemitsu
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  13. Keiichi Itatani
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  14. Toshiaki Shimizu
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Corresponding author

Correspondence to Ken Takahashi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from the parents or legal guardians of all individual participants included in the study.

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Takahashi, K., Nii, M., Takigiku, K. et al. Development of suction force during early diastole from the left atrium to the left ventricle in infants, children, and adolescents. Heart Vessels 34, 296–306 (2019). https://doi.org/10.1007/s00380-018-1239-9

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  • DOI: https://doi.org/10.1007/s00380-018-1239-9

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