CLINICAL RESEARCH: CARDIAC IMAGING
Impact of Arterial Load and Loading Sequence on Left Ventricular Tissue Velocities in Humans
Barry A. Borlaug, MD*,*,
Vojtech Melenovsky, MD, PhD ,1,
Margaret M. Redfield, MD, FACC*,
Kristy Kessler, RN, BSN,
Hyuk-Jae Chang, MD, PhD,
Theodore P. Abraham, MD, FACC and
David A. Kass, MD, FACC
* Mayo Clinic College of Medicine, Rochester, Minnesota
Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Manuscript received March 7, 2007;
revised manuscript received July 16, 2007,
accepted July 23, 2007.
* Reprint requests and correspondence: Dr. Barry A. Borlaug, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905. (Email: borlaug.barry{at}mayo.edu).
Objectives: The aim of this study was to examine the relationship between individual components of left ventricular (LV) afterload and tissue Doppler echocardiography (TDE) velocities in humans.
Background: Acute increases in afterload slow diastolic relaxation as assessed invasively, yet little is known about chronic effects of load and loading sequence on LV TDE velocities.
Methods: Forty-eight subjects underwent echo Doppler and color-coded TDE with comprehensive noninvasive vascular assessment. Arterial afterload was measured by effective arterial elastance (Ea) and systemic vascular resistance index (SVRI), and loading sequence was quantified by early- (carotid characteristic impedance [Zc]) and late-systolic loads (augmentation index [cAI]; late pressure-time integral [PTI3]). Vascular stiffness was measured by carotid-femoral pulse wave velocity (PWV) and total arterial compliance.
Results: Early-diastolic velocity (E') varied inversely with Zc, SVRI, Ea, and PWV (r = –0.4 to 0.5; β = 1.0 to 1.2; p  0.004), but late-systolic load (cAI and PTI3 r = –0.6; β = 1.6; both p < 0.0001) and arterial compliance (r = 0.6; β = 1.4; p < 0.0001) had the strongest associations with E'. Load dependence was not altered by the presence of hypertension, and in multivariate analysis only cAI and Zc significantly predicted E', even after adjusting for age (p < 0.05). Peak systolic velocity was additionally found to be inversely related to afterload, whereas other measures of contractility were not.
Conclusions: Diastolic and systolic tissue velocities vary inversely with arterial afterload, with late-systolic load having the greatest influence on E'. These findings may partly explain the decrease in early relaxation velocity noted with aging, hypertension, and patients with heart failure. Strategies to reduce afterload, vascular stiffening, and wave reflections may prove useful to enhance early diastolic relaxation.
|
Abbreviations and Acronyms
| | cAI = carotid augmentation index | | EDV(I) = end-diastolic volume (index) | | ESV(I) = end-systolic volume (index) | | LV = left ventricular | | MBP = mean blood pressure | | PTI3 = last (third) tertile of central pulse pressure-time integral | | PWV = carotid-femoral pulse wave velocity | | rAI = radial augmentation index | | SBP = systolic blood pressure | | SV = stroke volume | | SVRI = systemic vascular resistance index | | TDE = tissue Doppler echocardiography | | Zc = carotid characteristic impedance |
|
This article has been cited by other articles:
|
|
|
|
 
K. G. Hollingsworth, A. M. Blamire, B. D. Keavney, and G. A. MacGowan
Left ventricular torsion, energetics, and diastolic function in normal human aging
Am J Physiol Heart Circ Physiol,
February 1, 2012;
302(4):
H885 - H892.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Schwartzenberg, M. M. Redfield, A. M. From, P. Sorajja, R. A. Nishimura, and B. A. Borlaug
Effects of Vasodilation in Heart Failure With Preserved or Reduced Ejection Fraction: Implications of Distinct Pathophysiologies on Response to Therapy
J. Am. Coll. Cardiol.,
January 31, 2012;
59(5):
442 - 451.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Donal, C. Thebault, L. H. Lund, G. Kervio, A. Reynaud, T. Simon, E. Drouet, E. Nonotte, C. Linde, and J.-C. Daubert
Heart failure with a preserved ejection fraction additive value of an exercise stress echocardiography
Eur Heart J Cardiovasc Imaging,
January 29, 2012;
(2012)
jes010v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. D. Chantler, V. Melenovsky, S. P. Schulman, G. Gerstenblith, L. C. Becker, L. Ferrucci, J. L. Fleg, E. G. Lakatta, and S. S. Najjar
Use of the Frank-Starling mechanism during exercise is linked to exercise-induced changes in arterial load
Am J Physiol Heart Circ Physiol,
January 1, 2012;
302(1):
H349 - H358.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. D. Nelson, L. A. Altamirano-Diaz, S. R. Petersen, D. S. DeLorey, M. K. Stickland, R. B. Thompson, and M. J. Haykowsky
Left ventricular systolic and diastolic function during tilt-table positioning and passive heat stress in humans
Am J Physiol Heart Circ Physiol,
August 1, 2011;
301(2):
H599 - H608.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Borlaug, W. A. Jaber, S. R. Ommen, C. S. P. Lam, M. M. Redfield, and R. A. Nishimura
Diastolic relaxation and compliance reserve during dynamic exercise in heart failure with preserved ejection fraction
Heart,
June 15, 2011;
97(12):
964 - 969.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Miyoshi, Y. Mizuguchi, Y. Oishi, A. Iuchi, N. Nagase, N. Ara, and T. Oki
Early detection of abnormal left atrial-left ventricular-arterial coupling in preclinical patients with cardiovascular risk factors: evaluation by two-dimensional speckle-tracking echocardiography
Eur Heart J Cardiovasc Imaging,
June 1, 2011;
12(6):
431 - 439.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. O'Connor, J. Magne, M. Rosca, L. A. Pierard, and P. Lancellotti
Left atrial function and remodelling in aortic stenosis
Eur Heart J Cardiovasc Imaging,
April 1, 2011;
12(4):
299 - 305.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Y. Shim, S. Park, D. Choi, W.-I. Yang, I.-J. Cho, E.-Y. Choi, N. Chung, and J.-W. Ha
Sex Differences in Central Hemodynamics and Their Relationship to Left Ventricular Diastolic Function
J. Am. Coll. Cardiol.,
March 8, 2011;
57(10):
1226 - 1233.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Borlaug
Sex, Load, and Relaxation: Are Women More Susceptible to Load-Dependent Diastolic Dysfunction?
J. Am. Coll. Cardiol.,
March 8, 2011;
57(10):
1234 - 1236.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Borlaug and W. J. Paulus
Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment
Eur. Heart J.,
March 2, 2011;
32(6):
670 - 679.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. R. Tomczak, R. B. Thompson, I. Paterson, F. Schulte, J. Cheng-Baron, R. G. Haennel, and M. J. Haykowsky
Effect of acute high-intensity interval exercise on postexercise biventricular function in mild heart failure
J Appl Physiol,
February 1, 2011;
110(2):
398 - 406.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. F. O'Rourke, M. E. Safar, and V. Dzau
The Cardiovascular Continuum extended: Aging effects on the aorta and microvasculature
Vascular Medicine,
December 1, 2010;
15(6):
461 - 468.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S.-J. Park, R. A. Nishimura, B. A. Borlaug, P. Sorajja, and J. K. Oh
The effect of loading alterations on left ventricular torsion: a simultaneous catheterization and two-dimensional speckle tracking echocardiographic study
Eur Heart J Cardiovasc Imaging,
October 1, 2010;
11(9):
770 - 777.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Kasner, R. Gaub, D. Sinning, D. Westermann, P. Steendijk, W. Hoffmann, H.-P. Schultheiss, and C. Tschope
Global strain rate imaging for the estimation of diastolic function in HFNEF compared with pressure-volume loop analysis
Eur Heart J Cardiovasc Imaging,
October 1, 2010;
11(9):
743 - 751.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. T. Maeder, J. A. Mariani, and D. M. Kaye
Hemodynamic Determinants of Myocardial B-Type Natriuretic Peptide Release: Relative Contributions of Systolic and Diastolic Wall Stress
Hypertension,
October 1, 2010;
56(4):
682 - 689.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. T. Maeder, B. R. Thompson, H.-P. Brunner-La Rocca, and D. M. Kaye
Hemodynamic Basis of Exercise Limitation in Patients With Heart Failure and Normal Ejection Fraction
J. Am. Coll. Cardiol.,
September 7, 2010;
56(11):
855 - 863.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. S. Heffernan, J. E. Sharman, E. S. Yoon, E. J. Kim, S. J. Jung, and S. Y. Jae
Effect of increased preload on the synthesized aortic blood pressure waveform
J Appl Physiol,
August 1, 2010;
109(2):
484 - 490.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. T. Tan, F. Wenzelburger, E. Lee, G. Heatlie, M. Frenneaux, and J. E. Sanderson
Abnormal left ventricular function occurs on exercise in well-treated hypertensive subjects with normal resting echocardiography
Heart,
June 1, 2010;
96(12):
948 - 955.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. Holland, J. E. Sharman, R. L. Leano, and T. H. Marwick
Gender differences in systolic tissue velocity: role of left ventricular length
Eur Heart J Cardiovasc Imaging,
December 1, 2009;
10(8):
941 - 946.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E. Sharman, J. E. Davies, C. Jenkins, and T. H. Marwick
Augmentation Index, Left Ventricular Contractility, and Wave Reflection
Hypertension,
November 1, 2009;
54(5):
1099 - 1105.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Borlaug, C. S.P. Lam, V. L. Roger, R. J. Rodeheffer, and M. M. Redfield
Contractility and Ventricular Systolic Stiffening in Hypertensive Heart Disease: Insights Into the Pathogenesis of Heart Failure With Preserved Ejection Fraction
J. Am. Coll. Cardiol.,
July 28, 2009;
54(5):
410 - 418.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. T. Tan, F. Wenzelburger, E. Lee, G. Heatlie, F. Leyva, K. Patel, M. Frenneaux, and J. E. Sanderson
The Pathophysiology of Heart Failure With Normal Ejection Fraction: Exercise Echocardiography Reveals Complex Abnormalities of Both Systolic and Diastolic Ventricular Function Involving Torsion, Untwist, and Longitudinal Motion
J. Am. Coll. Cardiol.,
June 30, 2009;
54(1):
36 - 46.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G W-K Yip, Q Shang, L-S Tam, Q Zhang, E K-M Li, J W-H Fung, and C-M Yu
Disease chronicity and activity predict subclinical left ventricular systolic dysfunction in patients with systemic lupus erythematosus
Heart,
June 15, 2009;
95(12):
980 - 987.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Shingu, N. Shiiya, T. Ooka, T. Tachibana, S. Kubota, S. Morita, and Y. Matsui
Augmentation Index Is Elevated in Aortic Aneurysm and Dissection
Ann. Thorac. Surg.,
May 1, 2009;
87(5):
1373 - 1377.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. F O'Rourke
How stiffening of the aorta and elastic arteries leads to compromised coronary flow
Heart,
June 1, 2008;
94(6):
690 - 691.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Park, J.-W. Ha, C. Y. Shim, E.-Y. Choi, J.-M. Kim, J.-A. Ahn, S.-W. Lee, S.-J. Rim, and N. Chung
Gender-Related Difference in Arterial Elastance During Exercise in Patients With Hypertension
Hypertension,
April 1, 2008;
51(4):
1163 - 1169.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Weyman
The Year in Echocardiography
J. Am. Coll. Cardiol.,
March 25, 2008;
51(12):
1221 - 1229.
[Full Text]
[PDF]
|
|
|
|
