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The impact of preload reduction with head-up tilt testing on longitudinal and transverse left ventricular mechanics: a study utilizing deformation volume analysis
Echo Research & Practice volume 5, pages 11–18 (2018)
Abstract
Background Left ventricular (LV) function is dependent on load, intrinsic contractility and relaxation with a variable impact on specific mechanics. Strain (ε) imaging allows the assessment of cardiac function; however, the direct relationship between volume and strain is currently unknown. The aim of this study was to establish the impact of preload reduction through head-up tilt (HUT) testing on simultaneous left ventricular (LV) longitudinal and transverse function and their respective contribution to volume change.
Methods: A focused transthoracic echocardiogram was performed on 10 healthy male participants (23 ± 3 years) in the supine position and following 1 min and 5 min of HUT testing. Raw temporal longitudinal ε (Ls) and transverse ε (Ts) values were exported and divided into 5% increments across the cardiac cycle and corresponding LV volumes were traced at each 5% increment. This provided simultaneous LV longitudinal and transverse ε and volume loops (deformation volume analysis–DVA).
Results: There was a leftward shift of the ε-volume loop from supine to 1 min and 5 min of HUT (P < 0.001). Moreover, longitudinal shortening was reduced (P < 0.001) with a concomitant increase in transverse thickening from supine to 1 min, which was further augmented at 5 min (P = 0.018).
Conclusions: Preload reduction occurs within 1 min of HUT but does not further reduce at 5 min. This decline is associated with a decrease in longitudinal ε and concomitant increase in transverse ε. Consequently, augmented transverse relaxation appears to be an important factor in the maintenance of LV filling in the setting of reduced preload. DVA provides information on the relative contribution of mechanics to a change in LV volume and may have a role in the assessment of clinical populations.
References
Andersen NH, Terkelsen CJ, Sloth E, & Poulsen SH. Influence of preload alterations on parameters of systolic left ventricular long-axis function: a Doppler tissue study. Journal of the American Society of Echocardiography 200417 941–947. https://doi.org/10.1016/j.echo.2004.05.004)
Levick JR. An Introduction to Cardiovascular Physiology. London, UK: Butterworth-Heinemann, 2013.
Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M & Banchs J. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography 201427 911–939. https://doi.org/10.1016/j.echo.2014.07.012)
Williams AM, Shave RE, Stembridge M & Eves ND. Females have greater left ventricular twist mechanics than males during acute reductions to preload. American Journal of Physiology: Heart and Circulatory Physiology 2016311 H76–H84. https://doi.org/10.1152/ajpheart.00057.2016)
Choi JO, Shin DH, Cho SW, Song YB, Kim JH, Kim YG & Park SW. Effect of preload on left ventricular longitudinal strain by 2D speckle tracking. Echocardiography 200825 873–879. https://doi.org/10.1111/j.1540-8175.2008.00707.x)
Oxborough D, Heemels A, Somauroo J, McClean G, Mistry P, Lord R, Utomi V, Jones N, Thijssen D, Sharma S, et al. Left and right ventricular longitudinal strain-volume/area relationships in elite athletes. International Journal of Cardiovascular Imaging 201621 1–3. https://doi.org/10.1007/s10554-016-0910-4)
Hulshof HG, van Dijk AP, George KP, Hopman MT, Thijssen DH & Oxborough DL. Exploratory assessment of left ventricular strain–volume loops in severe aortic valve diseases. Journal of Physiology 2017595 3961–3971. https://doi.org/10.1113/JP273526)
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L & Lancellotti P. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography 201528 1–39. https://doi.org/10.1016/j.echo.2014.10.003)
Bazett HC. An analysis of time relations of the electrocardiograms. Heart 19207 353–370.
Oxborough D, Shave R, Warburton D, Williams K, Oxborough A, Charlesworth S, Foulds H, Hoffman MD, Birch K & George K. Dilatation and dysfunction of the right ventricle immediately following ultra-endurance exercise: exploratory insights from conventional 2-dimensional and speckle tracking echocardiography. Circulation: Cardiovascular Imaging 20114 253–263. https://doi.org/10.1161/CIRCIMAGING.110.961938)
Stöhr EJ, González-Alonso J, Pearson J, Low DA, Ali L, Barker H & Shave R. Dehydration reduces left ventricular filling at rest and during exercise independent of twist mechanics. Journal of Applied Physiology 2011111 891–897. https://doi.org/10.1152/japplphysiol.00528.2011)
Esch BT & Warburton DE. Left ventricular torsion and recoil: implications for exercise performance and cardiovascular disease. Journal of Applied Physiology 2009106 362–369. https://doi.org/10.1152/japplphysiol.00144.2008)
Moss RL & Fitzsimons DP. Frank-starling relationship. Circulation Research 200290 11–13. https://doi.org/10.1161/hh0102.102977)
Thomas JD & Popović ZB. Assessment of left ventricular function by cardiac ultrasound. Journal of the American College of Cardiology 200648 2012–2025. https://doi.org/10.1016/j.jacc.2006.06.071)
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Schneider, C., Forsythe, L., Somauroo, J. et al. The impact of preload reduction with head-up tilt testing on longitudinal and transverse left ventricular mechanics: a study utilizing deformation volume analysis. Echo Res Pract 5, 11–18 (2018). https://doi.org/10.1530/ERP-17-0064
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DOI: https://doi.org/10.1530/ERP-17-0064