Left ventricular vortex and intraventricular pressure difference in dogs under various loading conditions
Left ventricular vortex and intraventricular pressure difference in dogs under various loading conditions
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DOI：
10.1152/ajpheart.00686.2018
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发表时间：
2019-04-01
影响因子：
4.8
通讯作者：
Tanaka, Ryou
中科院分区：
文献类型：
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作者：
Matsuura, Katsuhiro;Shiraishi, Kenjirou;Tanaka, Ryou
传统的舒张功能评价的局限性已经被认识到，特别是在各种负荷条件下。近年来，新的无创性心室涡流指标被引入，有望反映心功能。生理学上有一种假说，即心室内压差（IVPD）与涡流的形成有关。同时测量IVPD和涡流指数，并探讨两者之间的关系。为了验证舒张期涡度作为舒张期松弛指数的可能性，检查了舒张期涡度与涡度负荷依赖性[时间常数（tau）]之间的相关性。六只健康狗进行了研究，使用经胸超声心动图，压力，和电导导管。使用矢量流图（VFM）分析涡度。采用彩色M型多普勒图像，使用欧拉方程确定IVPD。在基线、胸主动脉球囊扩张以改变后负荷、羟乙基淀粉输注以改变前负荷和米力农给药以改变心室舒张时获得数据。在压力负荷下，中心室的早期室性心动过速（E-Vor）和IVPD（MIVPD）的峰值涡度降低，在容量负荷下无变化，在米力农给药期间增加。在多变量分析中，tau蛋白的独立预测因子是整体纵向应变、早期应变率和E-Vor。MIVPD与E-Vor高度相关（r = 0.84）。在各种载荷条件下，VFM导出的E涡度峰值与IVPD，特别是MIVPD密切相关。这两个新的指标是有前途的可靠指标的心室舒张，独立于preload.NEW & NOTEWORTHY我们显示了涡和心室内压差的密切关系，并表明他们都可以成为新的标记左心室舒张性能。本研究为今后在心血管内血流生理学和临床病理学领域的研究提供了一个范例。
Restrictions on the conventional evaluation of diastolic function have been recognized, especially under various loading conditions. Recently, new noninvasive ventricular vortex indexes have been introduced and are expected to reflect the cardiac function. Physiologically, there is a hypothesis that the intraventricular pressure difference (IVPD) is related to the formation of vortexes. IVPD and vortex indexes were simultaneously measured, and the relationship between the two was investigated. To verify the possibility of diastolic vorticity as an index of diastolic relaxation, a correlation between diastolic vorticity and the load dependency of vorticity [time constant (tau)] was examined. Six healthy dogs were studied using transthoracic echocardiography, pressure, and a conductance catheter. Vorticity was analyzed using vector flow mapping (VFM). IVPD was determined using Euler's equation with color M-mode Doppler images. Data were obtained at baseline, at balloon dilatation in the thoracic aorta to alter afterload, at hydroxyethyl starch infusion to alter preload, and at milrinone administration to alter ventricular relaxation. Peak vorticity at early diastole (E-Vor) and IVPD of the midventricle (MIVPD) decreased under pressure loading, were unchanged under volume loading, and increased during milrinone administration. In multivariate analysis, the independent predictors of tau were global longitudinal strain, strain rate at early diastole, and E-Vor. MIVPD was strongly correlated with E-Vor (r = 0.84). VFM-derived peak E vorticity was strongly related to IVPD, especially MIVPD, under various loading conditions. Both of these novel indexes are promising as reliable indexes of ventricular relaxation, independent from preload.NEW & NOTEWORTHY We showed the close relationship of vortex and intraventricular pressure difference and showed that both of them can become new markers of the left ventricular relaxation property. Our present study creates a paradigm for future studies in the field of intraventircular flow physiology and clinical diastology.