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Annular dynamics of the human heart: novel echocardiographic approaches to assess ventricular function
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Department of Medicine and Care, Center for Medical Image Science and Visualization. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0003-2198-9690
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The complex myocardial fiber architecture of the left ventricle (LV) enables long-axis motion (annular excursion), short-axis motion and also a small torsional deformation throughout the cardiac cycle. The contribution of the long-axis motion has proven to be important in generating ventricular filling and emptying, and the analysis of annular excursion has become a well established diagnostic tool for the assessment of ventricular function. Cardiac motion can be accurately described with modem non-invasive imaging teclmiques, and this is important ground for deeper understanding and more reliable diagnosis of cardiovascular disease. The focus of this thesis was to provide new insights into cardiac pump function using variables originating from the annular excursion and dynamic changes in shape, applying both established and novel echocardiographic imaging approaches.

The traditional method of evaluating systolic ventricular fimction according to the total annular excursion overestimates the excursion amplitude in relation to true systolic fimction. A novel method presented here, measurement of the systolic annular excursion, more accurately reflects the timing of true systole, and was applied both in patients with heart disease and in healthy subjects. To date, the form of asynchronous myocardial motion called postsystolic shortening (PSS) has mainly been observed in the setting of myocardial ischemia. The significance of PSS in hypertensive heart disease remains incompletely described. We found that a subgroup of hypertensive patients with PSS along the LV long-axis had signs of more severe cardiac involvement unrelated to the level of blood pressure. Endurance trained subjects showed a larger LV long-axis motion as compared to strength trained and untrained controls. Mitral annular (MA) excursion correlated strongly to LV stroke volume, end-diastolic volume and maximal oxygen consumption per body weight, but weakly to LV ejection fraction. These findings provide further evidence of the importance of annular excursion to normal cardiac performance. In order to assess the contribution of MA excursion and shape dynamics to total LV volume change in humans, a novel 4-dimensional transesophageal echocardiography teclmique was developed. The excursion of the annulus accounted for an important portion (19±3%) of the total LV filling and emptying in healthy human subjects. Furthermore, our findings elucidate an atrial influence on MA physiology in humans, as well as a sphincter-like action of the MA. These temporal changes may facilitate ventricular filling by annular expansion during early and mid diastole, and aid competent valve closure during the marked decrease in annular area during late diastole and early systole.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2004. , 72 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 871
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-23445Local ID: 2897ISBN: 91-7373-847-6 (print)OAI: oai:DiVA.org:liu-23445DiVA: diva2:243759
Public defence
2004-12-03, Elsa Brändströmsalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2013-12-17Bibliographically approved
List of papers
1. A novel method to assess systolic ventricular function using atrioventricular plane displacement: a study in young healthy males and patients with heart disease
Open this publication in new window or tab >>A novel method to assess systolic ventricular function using atrioventricular plane displacement: a study in young healthy males and patients with heart disease
2004 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 24, no 4, 190-195 p.Article in journal (Refereed) Published
Abstract [en]

Analysis of atrioventricular plane displacement (AVPD) is a well established method for assessment of both systolic and diastolic ventricular function. For several years, AVPD has been a clinical tool and there are many current, as well as potential, areas of application. However, clinical work has shown that the traditional method for evaluation of systolic ventricular function, called total AVPD, does not temporally reflect true systole. Systolic AVPD is a new approach for measuring AVPD to assess ventricular systolic function. We wished to apply this new model in healthy subjects and in patients with different common heart diseases. Twenty-eight young healthy males and 30 patients (aortic stenosis, left sided regurgitant lesions, postmyocardial infarction) were enrolled. AVPD was obtained at the four standard sites by M-mode. Total AVPD was measured in the conventional way and systolic AVPD by identifying true systole, by means of mitral- and aortic valve closure respectively. Ventricular volumes were calculated according to biplane Simpson's rule. The systolic AVPD measurements were significantly lower than the total measurements, at both atrioventricular planes in all groups (P<0·001). This discrepancy was greater at the mitral than at the tricuspid annulus in the patients 24·2% vs. 15·5% (P<0·001), but did not differ in the healthy subjects. At the mitral annulus, this discrepancy also seemed to be more pronounced in the patients than in the healthy subjects 24·2% vs. 10·7%. When assessing ventricular systolic function by AVPD, the conventional method overestimates the amplitude in relation to true systolic function in both patients with heart disease and in young healthy males. Thus, there are uncertainties regarding earlier estimations of AVPD in terms of expression of systolic function and regarding previously presented reference values. We recommend the proposed methodology.

Keyword
echocardiography, overestimation, reference values, systolic performance, ventricular long axis motion
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-23404 (URN)10.1111/j.1475-097X.2004.00547.x (DOI)2846 (Local ID)2846 (Archive number)2846 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
2. Is left ventricular postsystolic long-axis shortening a marker for severity of hypertensive heart disease?
Open this publication in new window or tab >>Is left ventricular postsystolic long-axis shortening a marker for severity of hypertensive heart disease?
2003 (English)In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 91, no 12, 1490-1493 p.Article in journal (Refereed) Published
Abstract [en]

No abstract available.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26833 (URN)10.1016/S0002-9149(03)00407-7 (DOI)11448 (Local ID)11448 (Archive number)11448 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
3. Atrioventricular plane displacement correlates closely to circulatory dimensions but not to ejection fraction in normal young subjects
Open this publication in new window or tab >>Atrioventricular plane displacement correlates closely to circulatory dimensions but not to ejection fraction in normal young subjects
2001 (English)In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 21, no 5, 621-628 p.Article in journal (Refereed) Published
Abstract [en]

Aims Mitral atrioventricular plane displacement (AVPD) provides information about left ventricular systolic function. M-mode of systolic annulus amplitude or tissue Doppler imaging of systolic annulus velocity are the current methods of evaluating AVPD. A correlation to ejection fraction (EF) has been demonstrated in patients with coronary artery disease and left ventricular dysfunction. Our aim was (i) to investigate the mitral AVPD of normal subjects with different physical work capacities and (ii) to further evaluate AVPD as an index of left ventricular systolic function.

Methods and results Twenty-eight healthy men mean age 28 years (20–39) were included: endurance trained (ET) (n=10), strength trained (ST) (n=9) and untrained (UT) (n=9). The systolic AVPD was recorded at four sites, septal, lateral, anterior and posterior, using M-mode. Left ventricular volumes were calculated according to Simpson’s rule. Systolic AVPD was higher in endurance trained, 16·9 ± 1·5 mm, as compared with both strength trained, 13 ± 1·6 (P<0·001) and untrained, 14 ± 1·6 (P<0·001). Left ventricular systolic AVPD correlated strongly with end-diastolic volume (r=0·82), stroke volume (r=0·80) and maximal oxygen consumption per body weight (r=0·72). The correlation between AVPD and EF was poor (r=0·22).

Conclusion  In the subjects studied, with a range of normal cardiac dimensions, AVPD correlated to stroke volume, end-diastolic volume and maximal oxygen consumption per body weight, but not to EF. On theoretical grounds, it also seems reasonable that a dimension like AVPD is related to other cardiac dimensions and volumes, rather than to a fraction, like EF. AVPD is one parameter that is useful for evaluation of left ventricular systolic function but is not interchangeable with other measurements such as EF.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26832 (URN)10.1046/j.1365-2281.2001.00356.x (DOI)11447 (Local ID)11447 (Archive number)11447 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
4. Contribution of mitral annular excursion and shape dynamics to total left ventricular volume change
Open this publication in new window or tab >>Contribution of mitral annular excursion and shape dynamics to total left ventricular volume change
Show others...
2004 (English)In: American Journal of Physiology. Heart and Circulatory Physiology, ISSN 0363-6135, E-ISSN 1522-1539, Vol. 287, no 4, H1836-H1841 p.Article in journal (Refereed) Published
Abstract [en]

The mitral annulus (MA) has a complex shape and motion, and its excursion has been correlated to left ventricular (LV) function. During the cardiac cycle the annulus’ excursion encompasses a volume that is part of the total LV volume change during both filling and emptying. Our objective was to evaluate the contribution of MA excursion and shape variation to total LV volume change. Nine healthy subjects aged 56 ± 11 (means ± SD) years underwent transesophageal echocardiography (TEE). The MA was outlined in all time frames, and a four-dimensional (4-D) Fourier series was fitted to the MA coordinates (3-D+time) and divided into segments. The annular excursion volume (AEV) was calculated based on the temporally integrated product of the segments’ area and their incremental excursion. The 3-D LV volumes were calculated by tracing the endocardial border in six coaxial planes. The AEV (10 ± 2 ml) represented 19 ± 3% of the total LV stroke volume (52 ± 12 ml). The AEV correlated strongly with LV stroke volume (r = 0.73; P < 0.05). Peak MA area occurred during middiastole, and 91 ± 7% of reduction in area from peak to minimum occurred before the onset of LV systole. The excursion of the MA accounts for an important portion of the total LV filling and emptying in humans. These data suggest an atriogenic influence on MA physiology and also a sphincter-like action of the MA that may facilitate ventricular filling and aid competent valve closure. This 4-D TEE method is the first to allow noninvasive measurement of AEV and may be used to investigate the impact of physiological and pathological conditions on this important aspect of LV performance.

Keyword
annular physiology, ventricular long axis function, echocardiography, three dimension, four dimension
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24050 (URN)10.1152/ajpheart.00103.2004 (DOI)3608 (Local ID)3608 (Archive number)3608 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved

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