Scholarly article on topic 'Diastolic preparation for left ventricular ejection - A marker of inefficiency of the failing heart'

Diastolic preparation for left ventricular ejection - A marker of inefficiency of the failing heart Academic research paper on "Veterinary science"

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Academic research paper on topic "Diastolic preparation for left ventricular ejection - A marker of inefficiency of the failing heart"

Eriksson et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O84 http://jcmr-online.com/content/13/S1/O84

Magnetic Resonance

ORAL PRESENTATION Open Access

Diastolic preparation for left ventricular ejection -A marker of inefficiency of the failing heart

Jonatan Eriksson1*, Petter Dyverfeldt1, Jan Engvall1, Ann F Bolger2, Tino Ebbers1, Carl Johan Carlhall1

From 2011 SCMR/Euro CMR Joint Scientific Sessions Nice, France. 3-6 February 2011

Background

Heart failure represents the final stage of various cardiac disorders. In dilated and hypocontractile left ventricles (LV), alterations in intraventricular blood flow patterns have been observed [1,2]. Whether or not these alterations reflect LV pumping efficiency is not completely understood.

Hypothesis

We hypothesized that diastolic flow in the normal LV would prepare an effective systolic ejection by virtue of increased end-diastolic (ED) kinetic energy (KE) of the ejected blood. Further, we hypothesized that this pre-systolic preparation for LV ejection would be impaired in the failing LV.

Methods

In eight dilated cardiomyopathy (DCM) patients (4 female, 51±13 years [mean±SD]) and twelve healthy (H) subjects (5 female, 44±17 years), 4D phase-contrast CMR velocity data and morphological images were acquired at 1.5T (Philips Achieva). A previously validated method was used for the analysis (3): The LV endocardium was segmented (http://segment.heiberg.se) from short-axis images at ED and end-systole (ES). Pathlines were emitted from the LV ED blood volume and traced forward and backward in time until ES. Accordingly, the ED blood volume could be automatically separated into ejecting blood and non-ejecting blood (Figure 1). The KE was calculated over the cardiac cycle for these flow components based on the volume occupied by each pathline, its velocity, and blood density.

Results

The LV ED diameter was larger and LV ejection fraction was smaller in DCM compared to H (61±6 vs 46±4 mm, and 42±5 vs 61±3 %, respectively, both p<0.001). At ED, the "KE of the non-ejecting blood" was higher in DCM compared to H (0.8±0.4 vs 0.2±0.1 mJ, p<0.001), whereas there was no difference in the "KE of the ejecting blood" between the groups (0.9±0.3 vs 0.7±0.2 mJ, NS). At ED, the "KE of the ejecting bloodT'IIE of the total ED blood"-ratio was lower in DCM compared to H (p<0.001) (Figure 2).

Conclusion

Diastolic flow is quantitatively altered in dilated and hypocontractile LVs. At ED, the "KE of the ejecting blood" represented a significantly smaller fraction of the "KE of the total ED blood" in failing LVs compared to normal LVs. Loss of this "energetic preparation" for

Figure 1 Pathline visualization at end-diastole of LV ejecting blood (purple color) and non-ejecting (orange color), respectively. A) Healthy; B) Patient. Semi-transparent three-camber image provides anatomicalorientation. Ao, aorta; LA, left atrium; LV, left ventricle.

1Center for Medicallmage Science and Visualization (CMIV), Linkôping University, Linkôping, Sweden

Full list of author information is available at the end of the article

© 2011 Eriksson et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons CGntfcll Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Eriksson et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O84 Page 2 of 2

http://jcmr-online.com/content/13/S1/O84

Figure 2 Illustration of the "KE of the ejecting blood"/"KE of the totalend-diastolic blood" fraction at end-diastole A) Healthy; B) DCM patients.

doi:10.1186/1532-429X-13-S1-O84

Cite this article as: Eriksson et al.: Diastolic preparation for left ventricular ejection - A marker of inefficiency of the failing heart.

Journal of Cardiovascular Magnetic Resonance 2011 13(Suppl 1):O84.

ensuing ejection may contribute to the inefficiency of the failing LV. Medical or interventional strategies that preserve physiological flow in the diastolic LV may also improve systolic performance.

Author details

1Center for Medicallmage Science and Visualization (CMIV), Linköping University, Linköping, Sweden. 2University of California San Francisco, San Francisco, CA, USA.

Published: 2 February 2011 References

1. Bolger AF, et al. JCMR 2007, 9:741-47.

2. Carlhäll CJ, Bolger AF: Circ Heart Failure 2010, 3:326-31.

3. Eriksson J, et al: JCMR 2010, 12:9.

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