Tissue Doppler Image-Derived Measurements During Isovolumic Contraction Predict Exercise Capacity in Patients With Reduced Left Ventricular Ejection Fraction

Eun Joo Cho, Giuseppe Caracciolo, Bijoy K. Khandheria, D Eric Steidley, Robert L Scott, Walter P. Abhayaratna, Krishnaswamy Chandrasekaran, Partho P. Sengupta

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Abstract

Objectives: We explored the incremental value of quantification of tissue Doppler (TD) velocity during the brief isovolumic contraction (IVC) phase of the cardiac cycle for the prediction of exercise performance in patients referred for cardiopulmonary exercise testing (CPET). Background: Experimental studies have shown that rapid left ventricular (LV) shape change during IVC is essential for optimal onset of LV ejection. However, the incremental value of measuring IVC velocities in clinical settings remains unclear. Methods: A total of 82 subjects (age 53 ± 14 years, 56 men) were studied with echocardiography and CPET. Reduced LV ejection fraction (EF) (EF <50%) was present in 38 (46%) subjects. Pulsed-wave annular TD velocities were averaged from the LV lateral and septal annulus during isovolumic contraction (IVCa), ejection, isovolumic relaxation, and early and late diastole (Aa) and compared with peak oxygen consumption (VO2) and percentage of the predicted peak VO2 (% predicted peak VO2) obtained from CPET. Results: Patients with reduced EF had lower IVCa (6.3 vs. 4.5 cm/s, p = 0.04), ejection (7.7 vs. 5.5 cm/s, p < 0.001), and Aa velocities (7.9 vs. 6.6 cm/s, p = 0.04). Similarly, % predicted peak VO2 was lower in patients with reduced EF (52.9% vs. 73.1%, p < 0.001) and correlated with the variations in IVCa (r = 0.7, p = 0.001). Multivariate analysis of 2-dimensional and Doppler variables in the presence of reduced LV EF revealed only IVCa and Aa as independent predictors of % predicted peak VO2 (r2 = 0.612, p = 0.02 for IVCa and p = 0.009 for Aa). The overall performance of IVCa in the prediction of exercise capacity was good (area under the curve = 0.86, p < 0.001). Conclusions: Assessment of TD-derived IVC and atrial stretch velocities provide independent prediction of exercise capacity in patients with reduced LV EF. Assessment of LV pre-ejectional stretch and shortening mechanics at rest may be useful for determining the myocardial functional reserve of patients with reduced EF.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalJACC: Cardiovascular Imaging
Volume3
Issue number1
DOIs
StatePublished - Jan 2010

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Stroke Volume
Exercise
Diastole
Mechanics
Oxygen Consumption
Area Under Curve
Echocardiography
Multivariate Analysis

Keywords

  • exercise capacity
  • left ventricular dysfunction
  • tissue velocity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Tissue Doppler Image-Derived Measurements During Isovolumic Contraction Predict Exercise Capacity in Patients With Reduced Left Ventricular Ejection Fraction. / Cho, Eun Joo; Caracciolo, Giuseppe; Khandheria, Bijoy K.; Steidley, D Eric; Scott, Robert L; Abhayaratna, Walter P.; Chandrasekaran, Krishnaswamy; Sengupta, Partho P.

In: JACC: Cardiovascular Imaging, Vol. 3, No. 1, 01.2010, p. 1-9.

Research output: Contribution to journalArticle

Cho, Eun Joo ; Caracciolo, Giuseppe ; Khandheria, Bijoy K. ; Steidley, D Eric ; Scott, Robert L ; Abhayaratna, Walter P. ; Chandrasekaran, Krishnaswamy ; Sengupta, Partho P. / Tissue Doppler Image-Derived Measurements During Isovolumic Contraction Predict Exercise Capacity in Patients With Reduced Left Ventricular Ejection Fraction. In: JACC: Cardiovascular Imaging. 2010 ; Vol. 3, No. 1. pp. 1-9.
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abstract = "Objectives: We explored the incremental value of quantification of tissue Doppler (TD) velocity during the brief isovolumic contraction (IVC) phase of the cardiac cycle for the prediction of exercise performance in patients referred for cardiopulmonary exercise testing (CPET). Background: Experimental studies have shown that rapid left ventricular (LV) shape change during IVC is essential for optimal onset of LV ejection. However, the incremental value of measuring IVC velocities in clinical settings remains unclear. Methods: A total of 82 subjects (age 53 ± 14 years, 56 men) were studied with echocardiography and CPET. Reduced LV ejection fraction (EF) (EF <50{\%}) was present in 38 (46{\%}) subjects. Pulsed-wave annular TD velocities were averaged from the LV lateral and septal annulus during isovolumic contraction (IVCa), ejection, isovolumic relaxation, and early and late diastole (Aa) and compared with peak oxygen consumption (VO2) and percentage of the predicted peak VO2 ({\%} predicted peak VO2) obtained from CPET. Results: Patients with reduced EF had lower IVCa (6.3 vs. 4.5 cm/s, p = 0.04), ejection (7.7 vs. 5.5 cm/s, p < 0.001), and Aa velocities (7.9 vs. 6.6 cm/s, p = 0.04). Similarly, {\%} predicted peak VO2 was lower in patients with reduced EF (52.9{\%} vs. 73.1{\%}, p < 0.001) and correlated with the variations in IVCa (r = 0.7, p = 0.001). Multivariate analysis of 2-dimensional and Doppler variables in the presence of reduced LV EF revealed only IVCa and Aa as independent predictors of {\%} predicted peak VO2 (r2 = 0.612, p = 0.02 for IVCa and p = 0.009 for Aa). The overall performance of IVCa in the prediction of exercise capacity was good (area under the curve = 0.86, p < 0.001). Conclusions: Assessment of TD-derived IVC and atrial stretch velocities provide independent prediction of exercise capacity in patients with reduced LV EF. Assessment of LV pre-ejectional stretch and shortening mechanics at rest may be useful for determining the myocardial functional reserve of patients with reduced EF.",
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AU - Cho, Eun Joo

AU - Caracciolo, Giuseppe

AU - Khandheria, Bijoy K.

AU - Steidley, D Eric

AU - Scott, Robert L

AU - Abhayaratna, Walter P.

AU - Chandrasekaran, Krishnaswamy

AU - Sengupta, Partho P.

PY - 2010/1

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N2 - Objectives: We explored the incremental value of quantification of tissue Doppler (TD) velocity during the brief isovolumic contraction (IVC) phase of the cardiac cycle for the prediction of exercise performance in patients referred for cardiopulmonary exercise testing (CPET). Background: Experimental studies have shown that rapid left ventricular (LV) shape change during IVC is essential for optimal onset of LV ejection. However, the incremental value of measuring IVC velocities in clinical settings remains unclear. Methods: A total of 82 subjects (age 53 ± 14 years, 56 men) were studied with echocardiography and CPET. Reduced LV ejection fraction (EF) (EF <50%) was present in 38 (46%) subjects. Pulsed-wave annular TD velocities were averaged from the LV lateral and septal annulus during isovolumic contraction (IVCa), ejection, isovolumic relaxation, and early and late diastole (Aa) and compared with peak oxygen consumption (VO2) and percentage of the predicted peak VO2 (% predicted peak VO2) obtained from CPET. Results: Patients with reduced EF had lower IVCa (6.3 vs. 4.5 cm/s, p = 0.04), ejection (7.7 vs. 5.5 cm/s, p < 0.001), and Aa velocities (7.9 vs. 6.6 cm/s, p = 0.04). Similarly, % predicted peak VO2 was lower in patients with reduced EF (52.9% vs. 73.1%, p < 0.001) and correlated with the variations in IVCa (r = 0.7, p = 0.001). Multivariate analysis of 2-dimensional and Doppler variables in the presence of reduced LV EF revealed only IVCa and Aa as independent predictors of % predicted peak VO2 (r2 = 0.612, p = 0.02 for IVCa and p = 0.009 for Aa). The overall performance of IVCa in the prediction of exercise capacity was good (area under the curve = 0.86, p < 0.001). Conclusions: Assessment of TD-derived IVC and atrial stretch velocities provide independent prediction of exercise capacity in patients with reduced LV EF. Assessment of LV pre-ejectional stretch and shortening mechanics at rest may be useful for determining the myocardial functional reserve of patients with reduced EF.

AB - Objectives: We explored the incremental value of quantification of tissue Doppler (TD) velocity during the brief isovolumic contraction (IVC) phase of the cardiac cycle for the prediction of exercise performance in patients referred for cardiopulmonary exercise testing (CPET). Background: Experimental studies have shown that rapid left ventricular (LV) shape change during IVC is essential for optimal onset of LV ejection. However, the incremental value of measuring IVC velocities in clinical settings remains unclear. Methods: A total of 82 subjects (age 53 ± 14 years, 56 men) were studied with echocardiography and CPET. Reduced LV ejection fraction (EF) (EF <50%) was present in 38 (46%) subjects. Pulsed-wave annular TD velocities were averaged from the LV lateral and septal annulus during isovolumic contraction (IVCa), ejection, isovolumic relaxation, and early and late diastole (Aa) and compared with peak oxygen consumption (VO2) and percentage of the predicted peak VO2 (% predicted peak VO2) obtained from CPET. Results: Patients with reduced EF had lower IVCa (6.3 vs. 4.5 cm/s, p = 0.04), ejection (7.7 vs. 5.5 cm/s, p < 0.001), and Aa velocities (7.9 vs. 6.6 cm/s, p = 0.04). Similarly, % predicted peak VO2 was lower in patients with reduced EF (52.9% vs. 73.1%, p < 0.001) and correlated with the variations in IVCa (r = 0.7, p = 0.001). Multivariate analysis of 2-dimensional and Doppler variables in the presence of reduced LV EF revealed only IVCa and Aa as independent predictors of % predicted peak VO2 (r2 = 0.612, p = 0.02 for IVCa and p = 0.009 for Aa). The overall performance of IVCa in the prediction of exercise capacity was good (area under the curve = 0.86, p < 0.001). Conclusions: Assessment of TD-derived IVC and atrial stretch velocities provide independent prediction of exercise capacity in patients with reduced LV EF. Assessment of LV pre-ejectional stretch and shortening mechanics at rest may be useful for determining the myocardial functional reserve of patients with reduced EF.

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