June Cheng-Baron

Increased left ventricular twist, untwisting rates, and suction maintain global diastolic function during passive heat stress in humans

Left ventricular (LV) systolic function increases with passive heat stress (HS); however, less is known about diastolic function. Eight healthy subjects (24.0 +/- 2.0 yr of age) underwent whole body passive heating approximately 1 degrees C above baseline (BL). Cardiac magnetic resonance imaging was used to measure biventricular volumes, function, filling velocities, volumetric flow rates, and LV twist and strain at BL and after 45 min of HS. Passive heating reduced left atrial volume (-17.6 +/- 11.7 ml, P < 0.05), right and LV end-diastolic volumes (-22.7 +/- 11.0 and -25.7 +/- 24.9 ml, respectively; P < 0.05), and LV stroke volume (-6.7 +/- 6.8 ml, P < 0.05) from BL. LV ejection fraction (EF), end-systolic elastance, septal and lateral mitral annular systolic velocities, circumferential strain, and peak LV twist increased with HS (P < 0.05). Right ventricular stroke volume, EF, and systolic tissue velocities were unchanged with HS (P > 0.05). Early LV diastolic tissue and blood velocities and strain rates were maintained with HS, whereas untwisting rate increased significantly from 166.4 +/- 46.9 to 268.7 +/- 76.8 degrees /s (P < 0.05). The major novel finding of this study was that, secondary to an increase in peak LV twist and untwisting rate, early diastolic blood and tissue velocities and strain rates are maintained despite a reduction in filling pressure.

Effect of acute high-intensity interval exercise on postexercise biventricular function in mild heart failure

We studied the acute effect of high-intensity interval exercise on biventricular function using cardiac magnetic resonance imaging in nine patients [age: 49 ± 16 yr; left ventricular (LV) ejection fraction (EF): 35.8 ± 7.2%] with nonischemic mild heart failure (HF). We hypothesized that a significant impairment in the immediate postexercise end-systolic volume (ESV) and end-diastolic volume (EDV) would contribute to a reduction in EF. We found that immediately following acute high-intensity interval exercise, LV ESV decreased by 6% and LV systolic annular velocity increased by 21% (both P < 0.05). Thirty minutes following exercise (+30 min), there was an absolute increase in LV EF of 2.4% (P < 0.05). Measures of preload, left atrial volume and LV EDV, were reduced immediately following exercise. Similar responses were observed for right ventricular volumes. Early filling velocity, filling rate, and diastolic annular velocity remained unchanged, while LV untwisting rate increased 24% immediately following exercise (P < 0.05) and remained 18% above baseline at +30 min (P < 0.05). The major novel findings of this investigation are 1) that acute high-intensity interval exercise decreases the immediate postexercise LV ESV and increases LV EF at +30 min in patients with mild HF, and this is associated with a reduction in LV afterload and maintenance of contractility, and 2) that despite a reduction in left atrial volume and LV EDV immediately postexercise, diastolic function is preserved and may be modulated by enhanced LV peak untwisting rate. Acute high-intensity interval exercise does not impair postexercise biventricular function in patients with nonischemic mild HF.

Changes in ventricular twist and untwisting with orthostatic stress: endurance athletes versus normally active individuals

Endurance-trained individuals exhibit larger reductions in left ventricular (LV) end-diastolic volume in response to lower body negative pressure (LBNP) compared with normally active individuals. However, the relationship between LV torsion and untwisting and the LV volume response to LBNP in endurance athletes is unknown. Eight endurance-trained athletes [maximal oxygen consumption (VO2max): 66.4+/-7.2 ml.kg(-1).min(-1)] and eight normally active individuals (VO2max: 41.9+/-9.0 ml.kg(-1).min(-1)) (all men) underwent two cardiac magnetic resonance imaging (MRI) assessments, the first during supine rest and the second during -30 mmHg LBNP. Right ventricular (RV) and LV volumes were assessed, myocardial tagging was applied in order to quantify LV peak torsion and peak untwisting rate, and filling rates were measured with phase-contrast MRI. In response to LBNP, endurance-trained individuals had greater reductions in RV and LV end-diastolic volume and stroke volume (P<0.05). Endurance athletes had reduced untwisting rates (20.3+/-8.7 degrees/s), while normally active individuals had increased untwisting rates (-16.2+/-32.1 degrees/s) in response to LBNP (P<0.05). Changes in peak untwisting rate were significantly correlated with change in peak torsion (R=-0.87, P<0.05), with the change in early filling rate and VO2max, but not with changes in end-diastolic or end-systolic volume (P>0.05). We conclude that increased untwisting rates in normally active subjects may mitigate the drop in early filling rate with LBNP and thus may be a compensatory mechanism for the reduction in stroke volume with volume unloading. The opposite response in athletes, who showed a decreased untwisting rate, may contribute to their larger reductions in LV end-diastolic and stroke volumes with volume unloading and their orthostatic intolerance.

Characterization of the Relationship between Systolic Shear Strain and Early Diastolic Shear Strain Rates: Insights into Torsional Recoil

Early diastolic left ventricular (LV) untwisting has been evaluated as a manifestation of LV recoil, reflecting the release of elastic energy stored during systole. The primary goal of this study was to characterize the relationship between systolic strain (e.g., circumferential strain and the shear strains that comprise twist) with the resulting early diastolic shear strain rates, including the rate of untwisting. A further goal was to characterize these relationships regionally from apical to basal locations. Cardiac magnetic resonance imaging tissue tagging was used to measure circumferential strain, global and regional (apex, mid, basal) twist (theta), and circumferential-longitudinal (epsilon(CL)) and circumferential-radial (epsilon(CR)) shear strains along with the corresponding untwisting rates (dtheta/dt) and diastolic shear strain rates (depsilon/dt) in 32 healthy males (33 +/- 7 yr). LV untwisting rates and shear strain rates measured during early diastole varied significantly with the measurement location from apex to base (P < 0.001) but demonstrated significant linear correlation with their corresponding preceding systolic strains (P < 0.001). Untwisting rates and diastolic shear strain rates were not significantly correlated with circumferential systolic strain or end-systolic volume (P > 0.05). Normalization of the untwisting rates to the peak twist (dtheta/dt(Norm) = -13.6 +/- 2.1 s(-1)) or shear strain rates to peak systolic shear strain (depsilon(CL)/dt(Norm) = -15.0 +/- 5.4 s(-1), and depsilon(CR)/dt(Norm) = -14.2 +/- 7.7 s(-1)) yielded a uniform measure of early diastolic function that was similar for all shear strain and twist components and for all locations from apex to base. These findings support a linear model of torsional recoil in the healthy heart, where diastolic shear strain rates (e.g., untwisting rates) are linearly related to the corresponding preceding systolic shear stain component. Furthermore, these findings suggest that torsional recoil is uncoupled from end-systolic volumes or the associated strains, such as circumferential strain.

Measurements of changes in left ventricular volume, strain, and twist during isovolumic relaxation using MRI

Left ventricular (LV) active relaxation begins before aortic valve closure and is largely completed during isovolumic relaxation (IVR), before mitral valve opening. During IVR, despite closed mitral and aortic valves, indirect assessments of LV volume have suggested volume increases during this period. The aim of this study is to measure LV volume throughout IVR and to determine the sources of any volume changes. For 10 healthy individuals (26.0 + or - 3.8 yr), magnetic resonance imaging was used to measure time courses of LV volume, principal myocardial strains (circumferential, longitudinal, radial), and LV twist. Mitral leaflet motion was observed using echocardiography. During IVR, LV volume measurements showed an apparent increase of 4.6 + or - 1.5 ml (5.0 + or - 2.0% of the early filling volume change), the LV untwisted by 4.5 + or - 1.9 degrees (36.6 + or - 18.0% of peak systolic twist), and changes in circumferential, longitudinal, and radial strains were +0.87 + or - 0.64%, +0.93 + or - 0.57%, and -1.46 + or - 1.66% (4.2 + or - 3.3%, 5.9 + or - 3.3%, and 5.3 + or - 7.5% of peak systolic strains), respectively. The apparent changes in volume correlated (P < 0.01) with changes in circumferential, longitudinal, and radial strains (r = 0.86, 0.69, and -0.37, respectively) and untwisting (r = 0.83). The closed mitral valve leaflets were observed to descend into the LV throughout IVR in all subjects in apical four- and three-chamber and parasternal long-axis views by 6.0 + or - 3.3, 5.1 + or - 2.4, and 2.1 + or - 5.0 mm, respectively. In conclusion, LV relaxation during IVR is associated with changes in principal strains and untwisting, which are all correlated with an apparent increase in LV volume. Since closed mitral and aortic valves ensure true isovolumic conditions, the apparent volume change likely reflects expansion of the LV myocardium and the inward bowing of the closed mitral leaflets toward the LV interior.

Aerobic fitness does not influence the biventricular response to whole body passive heat stress

We examined biventricular function during passive heat stress in endurance trained (ET) and untrained (UT) men to evaluate whether aerobic fitness alters the volumetric response. Body temperature was elevated ~0.8°C above baseline in 20 healthy men (10 ET, 64.4 ± 3.0 ml·kg(-1)·min(-1); and 10 UT, 46.3 ± 6.2 ml·kg(-1)·min(-1)) by circulating warm water (50°C) throughout a tube-lined suit. Cardiac magnetic resonance imaging was used to measure biventricular volumes, function, filling velocities, volumetric flow rates, and left ventricular (LV) twist and circumferential strain at baseline (BL) and after 45 min of heat stress. In both groups, passive heat stress reduced biventricular end-diastolic (ET, -19.5 ± 24.0 ml; UT, -25.1 ± 23.8 ml) and end-systolic (ET, -15.9 ± 8.8 ml; UT, -17.6 ± 7.9 ml) volumes and left atrial volume (ET, -19.2 ± 11.6 ml; UT, -15.0 ± 12.7 ml) and significantly increased heart rate (ET, 29.3 ± 9.0 beats/min; UT, 31.7 ± 10.4 beats/min) and cardiac output (ET, 3.8 ± 2.2 l/min; UT, 3.2 ± 1.4 l/min) similarly, while biventricular stroke volume was unchanged. There were no between-group differences in any parameter. Heat stress increased (P < 0.05), as a percentage of baseline values, biventricular ejection fraction (ET, 3.4 ± 5.3%; UT, 4.4 ± 3.7%), annular systolic tissue velocities (ET, 32.5 ± 34.9%; UT, 44.0 ± 38.1%), and peak LV twist (ET, 51.6 ± 59.7%; UT, 59.7 ± 54.2%) and untwisting rates (ET, 45.5 ± 42.3%; UT, 51.8 ± 55.0%) similarly in both groups. Early LV diastolic tissue and blood velocities, volumetric flow rates, and strain rates (diastole) were unchanged with heat stress in both groups. The present findings indicate that aerobic fitness does not influence the biventricular response to passive heat stress.

Quantification of circumferential, longitudinal, and radial global fractional shortening using steady-state free precession cines: a comparison with tissue-tracking strain and application in Fabry disease.

Conventional calculation of myocardial strain requires tissue‐tracking. A surrogate for strain called global fractional shortening (GFS) is proposed based on changes in dimensions of endocardial and epicardial surfaces without tissue‐tracking.

Reliability of estimates of ACL attachment locations in 3-dimensional knee reconstruction based on routine clinical MRI in pediatric patients.

Background: Current techniques of anterior cruciate ligament (ACL) reconstruction focus on the placement of femoral and tibial tunnels at anatomic ACL attachments, which can be difficult to identify intraoperatively. Purpose: To determine whether the 3-dimensional (3D) center of ACL attachments can be reliably detected from routine magnetic resonance imaging (MRI) in patients with intact ACLs and whether the reliability of this technique changes if the ACL is torn. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A computer technique was developed in which users identify points along ACL attachments on routine clinical MRI of preoperative knees. These attachments are then displayed on a 3D MRI reconstruction, which can be used as a visual guide for the surgeon during arthroscopic surgery. Thirty-seven pediatric patients (age range, 10-17 years) with ACL tears and 37 controls with intact ACLs were examined. Two blinded observers identified cruciate ligament attachments on routine clinical 1.5-T MRI of knees. From the resulting 3D model, the location of the center of each ligament attachment site and its area were calculated and reliability assessed. Results: Mean interobserver variation of the centers of ACL attachments for the intact versus torn ACL was 1.7 ± 0.9 mm versus 1.8 ± 1.1 mm (femoral) and 1.4 ± 0.9 mm versus 1.7 ± 1.0 mm (tibial), respectively (P > .05). The 95% confidence interval for the center location was at most 4 mm. The identified ACL attachment areas were more variable, with interobserver reliability ranging from fair to excellent by the intraclass correlation coefficient. Overlap of ligament areas between observers for the intact versus torn ACL was 70% ± 15% versus 73% ± 12% (femoral) and 79% ± 9% versus 78% ± 10% (tibial), respectively (P > .05). In all cases, intraobserver reliability was superior to interobserver reliability. Conclusion: The 3D locations of ACL tibial and femoral attachment centers were identified from routine clinical MRI with variability averaging less than 2 mm between 2 observers. The margin of error was at most 4 mm, representing the thickness of a single axial MRI slice, whether the ACL was intact or torn. Remnant tissue at attachments allows a reliable assessment even of torn ligaments. Identification of the ligament attachment areas was more user dependent than was identification of the attachment centers.