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Contribution of mitral annular dynamics to LV diastolic filling with alteration in preload and inotropic state
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0003-2198-9690
Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
Linköping University, Faculty of Health Sciences.
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2007 (English)In: American Journal of Physiology. Heart and Circulatory Physiology, ISSN 0363-6135, E-ISSN 1522-1539, Vol. 293, no 3, G1473-H1479 p.Article in journal (Refereed) Published
Abstract [en]

Mitral annular (MA) excursion during diastole encompasses a volume that is part of total left ventricular (LV) filling volume (LVFV). Altered excursion or area variation of the MA due to changes in preload or inotropic state could affect LV filling. We hypothesized that changes in LV preload and inotropic state would not alter the contribution of MA dynamics to LVFV. Six sheep underwent marker implantation in the LV wall and around the MA. After 7–10 days, biplane fluoroscopy was used to obtain three-dimensional marker dynamics from sedated, closed-chest animals during control conditions, inotropic augmentation with calcium (Ca), preload reduction with nitroprusside (N), and vena caval occlusion (VCO). The contribution of MA dynamics to total LVFV was assessed using volume estimates based on multiple tetrahedra defined by the three-dimensional marker positions. Neither the absolute nor the relative contribution of MA dynamics to LVFV changed with Ca or N, although MA area decreased (Ca, P < 0.01; and N, P < 0.05) and excursion increased (Ca, P < 0.01). During VCO, the absolute contribution of MA dynamics to LVFV decreased (P < 0.001), based on a reduction in both area (P < 0.001) and excursion (P < 0.01), but the relative contribution to LVFV increased from 18 ± 4 to 45 ± 13% (P < 0.001). Thus MA dynamics contribute substantially to LV diastolic filling. Although MA excursion and mean area change with moderate preload reduction and inotropic augmentation, the contribution of MA dynamics to total LVFV is constant with sizeable magnitude. With marked preload reduction (VCO), the contribution of MA dynamics to LVFV becomes even more important.

Place, publisher, year, edition, pages
2007. Vol. 293, no 3, G1473-H1479 p.
National Category
Engineering and Technology
URN: urn:nbn:se:liu:diva-41883DOI: 10.1152/ajpheart.00208.2007Local ID: 59289OAI: diva2:262738
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2013-12-17
In thesis
1. Invasive and Non-Invasive Quantification of Cardiac Kinematics
Open this publication in new window or tab >>Invasive and Non-Invasive Quantification of Cardiac Kinematics
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The ability to measure and quantify myocardial motion and deformation provides a useful tool to assist in the diagnosis, prognosis and management of heart disease. Myocardial motion can be measured by means of several different types of data acquisition. The earliest myocardial motion tracking technique was invasive, based on implanting radiopaque markers into the myocardium around the left ventricle, and recording the marker positions during the cardiac cycle by biplane cineradiography. Until recently, this was the only method with high enough spatial resolution of three-dimensional (3D) myocardial displacements to resolve transmural behaviors. However, the recent development of magnetic resonance imaging techniques, such as displacement encoding with stimulated echoes (DENSE), make detailed non-invasive 3D transmural kinematic analyses of human myocardium possible in the clinic and for research purposes.

Diastolic left ventricular filling is a highly dynamic process with early and late transmitral inflows and it is determined by a complex sequence of many interrelated events and parameters. Extensive research has been performed to describe myocardial kinematics during the systolic phase of the cardiac cycle, but not by far the same amount of research has been accomplished during diastole. Measures of global and regional left ventricular kinematics during diastole are important when attempting to understand left ventricular filling characteristics in health and disease.

This thesis presents methods for invasive and non-invasive quantification of cardiac kinematics, with focus on diastole. The project started by quantification of changes in global left ventricular kinematics during diastolic filling. The helical myocardial fiber architecture of the left ventricle produces both long- and short-axis motion as well as torsional deformation. The longitudinal excursion of the mitral annular plane is an important component of left ventricular filling and ejection. This was studied by analyzing the contribution of mitral annular dynamics to left ventricular filling volume in the ovine heart.

In order to quantify strains for a specific body undergoing deformation, displacements for a set of internal points at a deformed configuration relative to a reference configuration are needed. A new method for strain quantification from measured myocardial displacements is presented in this thesis. The method is accurate and robust and delivers analytical expressions of the strain components. The developed strain quantification method is simple in nature which aids to bridge a possible gap in understanding between different disciplines and is well suited for sparse arrays of displacement data.

Analyses of myocardial kinematics at the level of myocardial fibers require knowledge of cardiac tissue architecture. Temporal changes in myofiber directions during the cardiac cycle have been analyzed in the ovine heart by combining histological measurements of transmural myocardial architecture and local transmural strains.

Rapid early diastolic filling is an essential component of the left ventricular function. Such filling requires a highly compliant chamber immediately after systole, allowing inflow at low driving pressures. Failure of this process can lead to exercise intolerance and ultimately to heart failure. A thorough analysis of the relation between global left ventricular kinematics and local myocardial strain at the level of myocardial fibers during early diastole in the ovine heart was performed by applying the method for strain quantification and the technique for computing temporal changes in myocardial architecture on measures of myocardial displacements and tissue architecture in the ovine heart.

As data acquisition technologies develop, quantification methods for cardiac kinematics need to be adapted and validated on the new types of data. Recent improvements of DENSE magnetic resonance imaging enable non-invasive transmural strain analyses in the human heart. The strain quantification method was first tailored to displacement data from a surgically implanted bead array but has been extended to applications on non-invasive DENSE data measured in two and three dimensions. Validation against an analytical standard reveals accurate results and in vivo strains agree with values for normal human hearts from other studies.

The method has in this thesis been used with displacement data from invasive marker technology and non-invasive DENSE magnetic resonance imaging, but can equally well be applied on any type of displacement data provided that the spatial resolution is high enough to resolve local strain variations.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 49 p.
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1322
National Category
Engineering and Technology
urn:nbn:se:liu:diva-60202 (URN)978-91-7393-375-9 (ISBN)
Public defence
2010-08-17, sal C3, Hus C, Campus Valla, Linköpings universitet, Linköping, 10:15
Available from: 2010-10-07 Created: 2010-10-07 Last updated: 2013-10-30Bibliographically approved

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Carlhäll, CarljohanKindberg, KatarinaWigström, LarsDaughters, G. T.Millers, D. C.Karlsson, MattsIngels Jr, N. B.
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