Journal Article Presence and Implication of Temporal Nonuniformity of Early Diastolic Left Ventricular Wall Expansion in Patients With Heart Failure

Iwano, Hiroyuki  ,  Kamimura, Daisuke  ,  Fox, Ervin R.  ,  Hall, Michael E.  ,  Vlachos, Pavlos  ,  Little, William C.

22 ( 12 )  , pp.945 - 953 , 2016-12 , Elsevier
Background: Early-diastolic left ventricular (LV) longitudinal expansion is delayed with diastolic dysfunction. We hypothesized that, in patients with heart failure (HF) regardless of LV ejection fraction (EF), there is diastolic temporal non-uniformity with a delay of longitudinal relative to circumferential expansion. Methods and Results: Echocardiography was performed in 143 HF patients: 50 with preserved EF (HFpEF) and 93 with reduced EF (HFrEF) and 31 normal controls. The delay of early-diastolic mitral annular velocity from the mitral Doppler E (TE-e′) was measured as a parameter of the longitudinal-expansion delay. The delay of the longitudinal early-diastolic global strain rate (SRE) relative to circumferential SRE (DelayC-L) was calculated as a parameter of temporal non-uniformity. Intra LV pressure difference (IVPD) was estimated by using color M-mode Doppler data as a parameter of LV diastolic suction. Although normal controls had symmetrical LV expansion in early diastole, TE-e′ and DelayC-L were significantly prolonged in HF regardless of EF (P<0.01 vs controls for all). Multivariate analysis revealed that DelayC-L was the independent determinant of IVPD among the parameters of LV geometry and contraction (β=-0.21, P<0.05). Conclusion: An abnormal temporal non-uniformity of early-diastolic expansion is present in HF regardless of EF, which was associated with reduced LV suction.

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