Strain rate imaging for the assessment of preload-dependent changes in regional left ventricular diastolic longitudinal function

doi:10.1067/mje.2002.116536

Journal of the American Society of Echocardiography

Volume 15, Issue 1, January 2002, Pages 13-19

https://doi.org/10.1067/mje.2002.116536 Get rights and content

Abstract

Background: Strain rate imaging is a new and intriguing way of displaying myocardial deformation properties by means of echocardiography. With high frame rate strain rate imaging we observed a spatial inhomogeneity in diastolic longitudinal strain rates in healthy persons. A base-to-apex time delay in diastolic lengthening could be seen both in early diastole and at atrial contraction. Methods and Results: We investigated this consistent finding and its dependence on loading conditions in 20 healthy volunteers. Propagation velocities of lengthening of 91 ± 31 cm/s (E-wave) and 203 ± 11 cm/s (A-wave) at rest (equal to time delays of 104 ± 29 ms and 56 ± 24 ms, respectively) increased significantly to 101 ± 27 cm/s (E) and 283 ± 17 cm/s (A) with lifting the volunteers' legs. Applying nitroglycerine sublingually and sitting upright significantly decreased propagation velocities (E-wave 76 ± 20 cm/s, A-wave 172 ± 93 cm/s and E-wave 66 ± 17 cm/s, A-wave 150 ± 64 cm/s, respectively). Free lateral walls showed a lower propagation velocity than septal walls. Conclusion: We conclude that the propagation velocities of left ventricular lengthening waves are dependent on preload changes and increase with increasing preload. (J Am Soc Echocardiogr 2002;15:13-9.)

Section snippets

Study population

We studied 20 young, healthy volunteers (16 males, 4 females, mean age 24.2 years) with no evidence of cardiac disease in either their history or electrocardiographic (ECG) or standard echocardiographic examination. The study was performed according to the ethical regulations of Erlangen University, and all participants had given prior informed consent.

Protocol

Ultrasound images were acquired from the apical view. This allowed equal access to imaging all parts of the left ventricular wall. Cine loops of

Results

Reconstruction and analysis of useful strain rate data were successful in most cine loops from our volunteers. The typical data acquisition frame rate was 178 fps, which resulted in a minimal measurable period of 5.6 ms.

Localized “blue lines” of short duration were frequently seen in the mid part of the walls at the beginning of the isovolumic relaxation period and propagating toward the apex, suggesting a local myocardial extension before mitral valve opening. (Fig. 3, Fig. 4).

During diastole,

Discussion

It can be assumed from intraventricular measurements that a pressure difference between ventricular base and apex is one of the driving forces of diastolic filling.¹⁰ On the basis of such invasive measurements, Courtois and other authors¹¹ have proposed an early diastolic suction effect because of elastic recoil of the relaxing apical myocardium. Recently, Steine et al¹² and others13, 14 compared simultaneously acquired pressure tracings with peak mitral inflow velocity propagation measured

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Strain imaging is widely used to measure myocardial deformation and allow early detection of subclinical LV dysfunction, but it cannot measure the myocardial stiffness directly and quantitatively (Grondin et al. 2017). Voigt et al. (2002) described that the base-to-apex time delay in diastolic lengthening could be observed in both early diastole and atrial contraction. Kanai (2005) found that the pulsive wave spontaneously activated because of the aortic valve closure at the beginning of the isovolumic relaxation period and propagated along the interventricular septum from the base to the apex.
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^*: Reprint requests: Dr med Jens-Uwe Voigt, Medical Clinic II, University Erlangen-Nuernberg, Oestliche Stadtmauerstrasse 29, 91054 Erlangen, Germany (E-mail: [email protected]).

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Original ArticlesStrain rate imaging for the assessment of preload-dependent changes in regional left ventricular diastolic longitudinal function*

Abstract

Section snippets

Study population

Protocol

Results

Discussion

J Am Soc Echocardiogr

Am J Cardiol

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Original Articles
Strain rate imaging for the assessment of preload-dependent changes in regional left ventricular diastolic longitudinal function*