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Left Ventricular Torsion Shear Angle Volume Approach for Noninvasive Evaluation of Diastolic Dysfunction in Preserved Ejection Fraction

BACKGROUND: Accurate noninvasive diagnostic tools for evaluating left ventricular (LV) diastolic dysfunction (LVDD) are limited in preserved LV ejection fraction. We previously proposed the relationship of normalized rate of change in LV torsion shear angle (φ′) to corresponding rate of change in LV...

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Autores principales: Sharifov, Oleg F., Schiros, Chun G., Aban, Inmaculada, Perry, Gilbert J., Dell'italia, Louis J., Lloyd, Steven G., Denney, Thomas S., Gupta, Himanshu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778962/
https://www.ncbi.nlm.nih.gov/pubmed/29288156
http://dx.doi.org/10.1161/JAHA.117.007039
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author Sharifov, Oleg F.
Schiros, Chun G.
Aban, Inmaculada
Perry, Gilbert J.
Dell'italia, Louis J.
Lloyd, Steven G.
Denney, Thomas S.
Gupta, Himanshu
author_facet Sharifov, Oleg F.
Schiros, Chun G.
Aban, Inmaculada
Perry, Gilbert J.
Dell'italia, Louis J.
Lloyd, Steven G.
Denney, Thomas S.
Gupta, Himanshu
author_sort Sharifov, Oleg F.
collection PubMed
description BACKGROUND: Accurate noninvasive diagnostic tools for evaluating left ventricular (LV) diastolic dysfunction (LVDD) are limited in preserved LV ejection fraction. We previously proposed the relationship of normalized rate of change in LV torsion shear angle (φ′) to corresponding rate of change in LV volume (V′) during early diastole (represented as −dφ′/dV′) as a measure of LV diastolic function. We prospectively evaluated diagnostic accuracy of −dφ′/dV′ in respect to invasive LV parameters. METHODS AND RESULTS: Participants (n=36, age 61±7 years) with LV ejection fraction ≥50% and no acute myocardial infarction undergoing coronary angiography for chest pain and/or dyspnea evaluation were studied. High‐fidelity invasive LV pressure measurements and cardiac magnetic resonance imaging with tissue tagging were performed. τ, the time constant of LV diastolic relaxation, was 58±10 milliseconds (mean±SD), and LV end‐diastolic pressure was 14.5±5.5 mm Hg. Cardiac magnetic resonance imaging‐derived −dφ′/dV′ was 5.6±3.7. The value of −dφ′/dV′ correlated with both τ and LV end‐diastolic pressure (r=0.39 and 0.36, respectively, P<0.05). LVDD was defined as τ>48 milliseconds and LV end‐diastolic pressure >12 mm Hg (LVDD1), or, alternatively, τ>48 milliseconds and LV end‐diastolic pressure >16 mm Hg (LVDD2). Area under the curve (AUC) of −dφ′/dV′ for identifying LVDD1 was 0.83 (0.67‐0.98, P=0.001), with sensitivity/specificity of 72%/100% for −dφ′/dV′ ≥6.2. AUC of −dφ′/dV′ for identifying LVDD_2 was 0.82 (0.64‐1.00, P=0.006), with sensitivity/specificity of 76%/85% for −dφ′/dV′ ≥6.9. There were good limits of agreement between pre‐ and post‐nitroglycerin −dφ′/dV′. CONCLUSIONS: The −dφ′/dV′ obtained from the LV torsion volume loop is a promising parameter for assessing global LVDD with preserved LV ejection fraction and requires further evaluation.
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spelling pubmed-57789622018-01-31 Left Ventricular Torsion Shear Angle Volume Approach for Noninvasive Evaluation of Diastolic Dysfunction in Preserved Ejection Fraction Sharifov, Oleg F. Schiros, Chun G. Aban, Inmaculada Perry, Gilbert J. Dell'italia, Louis J. Lloyd, Steven G. Denney, Thomas S. Gupta, Himanshu J Am Heart Assoc Original Research BACKGROUND: Accurate noninvasive diagnostic tools for evaluating left ventricular (LV) diastolic dysfunction (LVDD) are limited in preserved LV ejection fraction. We previously proposed the relationship of normalized rate of change in LV torsion shear angle (φ′) to corresponding rate of change in LV volume (V′) during early diastole (represented as −dφ′/dV′) as a measure of LV diastolic function. We prospectively evaluated diagnostic accuracy of −dφ′/dV′ in respect to invasive LV parameters. METHODS AND RESULTS: Participants (n=36, age 61±7 years) with LV ejection fraction ≥50% and no acute myocardial infarction undergoing coronary angiography for chest pain and/or dyspnea evaluation were studied. High‐fidelity invasive LV pressure measurements and cardiac magnetic resonance imaging with tissue tagging were performed. τ, the time constant of LV diastolic relaxation, was 58±10 milliseconds (mean±SD), and LV end‐diastolic pressure was 14.5±5.5 mm Hg. Cardiac magnetic resonance imaging‐derived −dφ′/dV′ was 5.6±3.7. The value of −dφ′/dV′ correlated with both τ and LV end‐diastolic pressure (r=0.39 and 0.36, respectively, P<0.05). LVDD was defined as τ>48 milliseconds and LV end‐diastolic pressure >12 mm Hg (LVDD1), or, alternatively, τ>48 milliseconds and LV end‐diastolic pressure >16 mm Hg (LVDD2). Area under the curve (AUC) of −dφ′/dV′ for identifying LVDD1 was 0.83 (0.67‐0.98, P=0.001), with sensitivity/specificity of 72%/100% for −dφ′/dV′ ≥6.2. AUC of −dφ′/dV′ for identifying LVDD_2 was 0.82 (0.64‐1.00, P=0.006), with sensitivity/specificity of 76%/85% for −dφ′/dV′ ≥6.9. There were good limits of agreement between pre‐ and post‐nitroglycerin −dφ′/dV′. CONCLUSIONS: The −dφ′/dV′ obtained from the LV torsion volume loop is a promising parameter for assessing global LVDD with preserved LV ejection fraction and requires further evaluation. John Wiley and Sons Inc. 2017-12-29 /pmc/articles/PMC5778962/ /pubmed/29288156 http://dx.doi.org/10.1161/JAHA.117.007039 Text en © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Sharifov, Oleg F.
Schiros, Chun G.
Aban, Inmaculada
Perry, Gilbert J.
Dell'italia, Louis J.
Lloyd, Steven G.
Denney, Thomas S.
Gupta, Himanshu
Left Ventricular Torsion Shear Angle Volume Approach for Noninvasive Evaluation of Diastolic Dysfunction in Preserved Ejection Fraction
title Left Ventricular Torsion Shear Angle Volume Approach for Noninvasive Evaluation of Diastolic Dysfunction in Preserved Ejection Fraction
title_full Left Ventricular Torsion Shear Angle Volume Approach for Noninvasive Evaluation of Diastolic Dysfunction in Preserved Ejection Fraction
title_fullStr Left Ventricular Torsion Shear Angle Volume Approach for Noninvasive Evaluation of Diastolic Dysfunction in Preserved Ejection Fraction
title_full_unstemmed Left Ventricular Torsion Shear Angle Volume Approach for Noninvasive Evaluation of Diastolic Dysfunction in Preserved Ejection Fraction
title_short Left Ventricular Torsion Shear Angle Volume Approach for Noninvasive Evaluation of Diastolic Dysfunction in Preserved Ejection Fraction
title_sort left ventricular torsion shear angle volume approach for noninvasive evaluation of diastolic dysfunction in preserved ejection fraction
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778962/
https://www.ncbi.nlm.nih.gov/pubmed/29288156
http://dx.doi.org/10.1161/JAHA.117.007039
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