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Eur Heart J Cardiovasc Imaging. 2018 Jan 1;19(1):12-19. doi: 10.1093/ehjci/jex241.

Dynamic change in left ventricular apical back rotation: a marker of diastolic suction with exercise.

Author information

1
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Republic of Korea.

Abstract

Aims:

We hypothesized that the absence of a decrease in minimal left ventricular (LV) pressure during exercise would be associated with impaired LV apical back rotation during exercise.

Methods and results:

A total of 21 patients (59 ± 10 years) underwent invasive LV pressure measurements and simultaneous echocardiography at rest and during submaximal supine bicycle exercise. Patients were classified according to the changes in minimal LV pressure from rest to maximal exercise (Δminimal LVP); Group 1 (n = 8) had a decrease in minimal LV pressure with exercise, whereas Group 2 (n = 13) had an increase in minimal LV pressure. LV apical back-rotation parameters by speckle-tracking echocardiography at rest and during 50 W of exercise were compared. At rest, there were no differences in LV pressure and echocardiographic parameters between groups. However, at 50 W of exercise, Group 2 had higher LV early and end-diastolic pressures and a prolonged time constant of LV relaxation. In Group 2, e' velocity was lower and E/e' was higher. Apical back rotation at the mitral valve opening (MVO) was reduced and minimal apical back-rotation velocity was lower in Group 2. Δminimal LVP significantly correlated with apical back rotation at MVO (r = -0.77, P = 0.009) and minimal apical back-rotation velocity at 50 W (r = 0.69, P = 0.028).

Conclusion:

The lack of decrease in minimal LV pressure during exercise, a manifestation of impaired LV suction in early diastole, is linked closely with impaired LV apical back rotation during exercise. Dynamic changes in LV apical back rotation during exercise can be used as a non-invasive parameter of diastolic suction during exercise.

KEYWORDS:

blood pressure; diastole; exercise; left ventricle; physiology; ventricular rotation

Comment in

PMID:
29161381
DOI:
10.1093/ehjci/jex241
[Indexed for MEDLINE]

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