Skip to main content
Erschienen in: Wiener klinische Wochenschrift 5/2015

01.12.2015 | original article

Non-invasive measuring of the acceleration of contraction of the left ventricle with the Doppler echocardiography

verfasst von: Igor Krajnc, MD, Prof. Andreja Sinkovič, MD, PhD, Assist. Prof. Franjo Naji, MD, PhD, Prof. Ivan Krajnc, MD, PhD

Erschienen in: Wiener klinische Wochenschrift | Sonderheft 5/2015

Einloggen, um Zugang zu erhalten

Summary

Background

Echocardiographically measured ejection fraction (EF) of the left ventricle (LV) is the most useful standard of the LV systolic function. Its limitations are poor delineation of the LV endocardium, pronounced regional disorders of contractility, dyssynchrony of the LV and in particular significant mitral regurgitation. The aim of this research is to evaluate the advantage of Doppler indices of left ventricular function such as index of acceleration of contraction of the LV (AccLV) over EF in patients with heart failure.

Methods

We performed a prospective observational study. We included 45 patients with known chronic heart failure and 76 healthy subjects. We performed standard echocardiographic measurements. AccLV was calculated by the following formula: AccLV = Vmax LVOT/dt × EDV [cm/s2 ml]. Vmax LVOT represents the maximum velocity during ejection in the left ventricular outflow tract (LVOT), dt stands for the interval from the beginning of the LV contraction to the achieved Vmax LVOT, EDV represents end-diastolic volume of the LV.

Results

Between patients and healthy subjects we observed statistically significant differences in mean EF values (65.4 ± 6.7 % vs. 38.6 ± 18.0 %; p < 0.001) and of AccLV (12.1 ± 2.88 cm/s2ml vs. 4.4 ± 2.1 cm/s2ml; p < 0.001). Receiver operating characteristic (ROC) curve showed higher area under the curve values for AccLV in comparison to EF (0.996 vs. 0.897). In the patient group we observed more important correlation between AccLV index and the New York Heart Association (NYHA) functional classes (r = − 0.657; p < 0.001), than between EF and the NYHA classes (r = − 0.539; p < 0.001).

Conclusions

We could distinguish with higher accuracy between healthy subjects and patients with heart failure LV by calculated AccLV in comparison to EF. AccLV values correlated with NYHA functional classes in patients with heart failure better than EF values.
Literatur
1.
Zurück zum Zitat Abraham J, Abraham TP. The role of echocardiography in hemodinamic assessment in heart failure. Heart Fail Clin. 2009;5(2):191–208.CrossRefPubMed Abraham J, Abraham TP. The role of echocardiography in hemodinamic assessment in heart failure. Heart Fail Clin. 2009;5(2):191–208.CrossRefPubMed
2.
Zurück zum Zitat Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1–39.CrossRefPubMed Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1–39.CrossRefPubMed
3.
Zurück zum Zitat Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D. Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol. 1999;33(7):1948–55.CrossRefPubMed Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D. Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol. 1999;33(7):1948–55.CrossRefPubMed
4.
Zurück zum Zitat Gudmundsson P, Rydberg E, Winter R, Willenheimer R. Visually estimated left ventricular ejection fraction by echocardiography is closely correlated with formal quantitative methods. Int J Cardiol. 2005;101(2):209–12.CrossRefPubMed Gudmundsson P, Rydberg E, Winter R, Willenheimer R. Visually estimated left ventricular ejection fraction by echocardiography is closely correlated with formal quantitative methods. Int J Cardiol. 2005;101(2):209–12.CrossRefPubMed
5.
Zurück zum Zitat Starling MR, Kirsh MM, Montgomery DG, Gross MD. Impaired left ventricular contractile function in patients with long-term mitral regurgitation and normal ejection fraction. J Am Coll Cardiol. 1993;22(1):239–50.CrossRefPubMed Starling MR, Kirsh MM, Montgomery DG, Gross MD. Impaired left ventricular contractile function in patients with long-term mitral regurgitation and normal ejection fraction. J Am Coll Cardiol. 1993;22(1):239–50.CrossRefPubMed
6.
Zurück zum Zitat Quiñones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA, Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the nomenclature and standards committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002;15(2):167–84.CrossRefPubMed Quiñones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA, Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the nomenclature and standards committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002;15(2):167–84.CrossRefPubMed
7.
Zurück zum Zitat Bauer F, Jones M, Shiota T, Firstenberg MS, Qin JX, Tsujino H, et al. Left ventricular outflow tract mean systolic acceleration as a surrogate for the slope of the left ventricular end-systolic pressure-volume relationship. J Am Coll Cardiol. 2002;40(7):1320–7.CrossRefPubMed Bauer F, Jones M, Shiota T, Firstenberg MS, Qin JX, Tsujino H, et al. Left ventricular outflow tract mean systolic acceleration as a surrogate for the slope of the left ventricular end-systolic pressure-volume relationship. J Am Coll Cardiol. 2002;40(7):1320–7.CrossRefPubMed
8.
Zurück zum Zitat Cikes M, Kalinic H, Baltabaeva A, Loncaric S, Parsai C, Milicic D, et al. The shape of the aortic outflow velocity profile revisited: is there a relation between its asymmetry and ventricular function in coronary artery disease? Eur J Echocardiogr. 2009;10(7):847–57.CrossRefPubMed Cikes M, Kalinic H, Baltabaeva A, Loncaric S, Parsai C, Milicic D, et al. The shape of the aortic outflow velocity profile revisited: is there a relation between its asymmetry and ventricular function in coronary artery disease? Eur J Echocardiogr. 2009;10(7):847–57.CrossRefPubMed
9.
Zurück zum Zitat Cikes M, Kalinic H, Baltabaeva A, Loncaric S, Parsai C, SeparovicHanzevacki J, et al. Does symmetry of the aortic outflow velocity profile reflect contractile function in coronary artery disease? An automated analysis using mathematical modeling. [cited 2015 August 25]. In: the 2008 World Congress of Cardiology Abstracts, Buenos Aires, Argentina, May 18–21, 2008. Circulation. 2008;118(12):e357. (Available from: http://circ.ahajournals.org/content/118/12/e162.full.pdf+html). Cikes M, Kalinic H, Baltabaeva A, Loncaric S, Parsai C, SeparovicHanzevacki J, et al. Does symmetry of the aortic outflow velocity profile reflect contractile function in coronary artery disease? An automated analysis using mathematical modeling. [cited 2015 August 25]. In: the 2008 World Congress of Cardiology Abstracts, Buenos Aires, Argentina, May 18–21, 2008. Circulation. 2008;118(12):e357. (Available from: http://​circ.​ahajournals.​org/​content/​118/​12/​e162.​full.​pdf+html).
10.
Zurück zum Zitat Bargiggia GS, Bertucci C, Recusani F, Raisaro A, de Servi S, Valdes-Cruz LM, et al. A new method for estimating left ventricular dP/dt by continuous wave Doppler-echocardiography. Validation studies at cardiac catheterization. Circulation. 1989;80(5):1287–92.CrossRefPubMed Bargiggia GS, Bertucci C, Recusani F, Raisaro A, de Servi S, Valdes-Cruz LM, et al. A new method for estimating left ventricular dP/dt by continuous wave Doppler-echocardiography. Validation studies at cardiac catheterization. Circulation. 1989;80(5):1287–92.CrossRefPubMed
11.
Zurück zum Zitat Chung N, Nishimura RA, Holmes DR Jr, Tajik AJ. Measurement of left ventricular dp/dt by simultaneous Doppler echocardiography and cardiac catheterization. J Am Soc Echocardiogr. 1992;5(2):147–52.CrossRefPubMed Chung N, Nishimura RA, Holmes DR Jr, Tajik AJ. Measurement of left ventricular dp/dt by simultaneous Doppler echocardiography and cardiac catheterization. J Am Soc Echocardiogr. 1992;5(2):147–52.CrossRefPubMed
12.
Zurück zum Zitat Ge Z, Zhang Y, Kang W, Fan D, Duran C. A simultaneous study of Doppler-echo and catheterization in nonivasive assessment of the left ventricular dp/dt. Clin Cardiol. 1993;16(5):422–8.CrossRefPubMed Ge Z, Zhang Y, Kang W, Fan D, Duran C. A simultaneous study of Doppler-echo and catheterization in nonivasive assessment of the left ventricular dp/dt. Clin Cardiol. 1993;16(5):422–8.CrossRefPubMed
13.
Zurück zum Zitat Broka SM, Ducart AR, Jamart J, Collard EL, Fournet XR, Chevalier S, et al. Doppler-derived left ventricular rate of pressure rise and inotropic requirements during mitral valve surgery. J Cardiothorac Vasc Anesth. 1998;12(1):27–32.CrossRefPubMed Broka SM, Ducart AR, Jamart J, Collard EL, Fournet XR, Chevalier S, et al. Doppler-derived left ventricular rate of pressure rise and inotropic requirements during mitral valve surgery. J Cardiothorac Vasc Anesth. 1998;12(1):27–32.CrossRefPubMed
15.
Zurück zum Zitat Perrino AC, Reeves ST. A Practical approach to transesophageal echocardiography. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2008. Perrino AC, Reeves ST. A Practical approach to transesophageal echocardiography. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2008.
16.
Zurück zum Zitat Garcia MJ, Rodriguez L, Ares M, Griffin BP, Klein AL, Stewart WJ, et al. Myocardial wall velocity assessment by pulsed Doppler tissue imaging: characteristics findings in normal subjects. Am Heart J. 1996;132(3):648–56.CrossRefPubMed Garcia MJ, Rodriguez L, Ares M, Griffin BP, Klein AL, Stewart WJ, et al. Myocardial wall velocity assessment by pulsed Doppler tissue imaging: characteristics findings in normal subjects. Am Heart J. 1996;132(3):648–56.CrossRefPubMed
17.
Zurück zum Zitat Vogel M, Redington AN. Assessment of contractile function by Doppler myocardial imaging: isovolumic versus ejection phase indices. In: Sutherland GR, Hatle L, Claus P, Dhooge J, Bijnens BH, editors. Doppler myocardial imaging. 1st ed. Hasselt: BSWK BVBA; 2006: pp. 79–84. Vogel M, Redington AN. Assessment of contractile function by Doppler myocardial imaging: isovolumic versus ejection phase indices. In: Sutherland GR, Hatle L, Claus P, Dhooge J, Bijnens BH, editors. Doppler myocardial imaging. 1st ed. Hasselt: BSWK BVBA; 2006: pp. 79–84.
18.
Zurück zum Zitat Shimizu M, Nii M, Konstantinov IE, Li J, Redington AN. Isovolumic but not ejection phase Doppler tissue indices detect left ventricular dysfunction caused by coronary stenosis. J Am Soc Echocardiogr. 2005;18(12):1241–6.CrossRefPubMed Shimizu M, Nii M, Konstantinov IE, Li J, Redington AN. Isovolumic but not ejection phase Doppler tissue indices detect left ventricular dysfunction caused by coronary stenosis. J Am Soc Echocardiogr. 2005;18(12):1241–6.CrossRefPubMed
19.
Zurück zum Zitat Oner FA, Yurdakul S, Oner E, Uzum AK, Erguney M. Evaluation of the effect of L-thyroxin therapy on cardiac functions by using novel tissue Doppler-derived indices in patients with subclinical hypothyroidism. Acta Cardiol. 2011;66(1):47–55.PubMed Oner FA, Yurdakul S, Oner E, Uzum AK, Erguney M. Evaluation of the effect of L-thyroxin therapy on cardiac functions by using novel tissue Doppler-derived indices in patients with subclinical hypothyroidism. Acta Cardiol. 2011;66(1):47–55.PubMed
20.
Zurück zum Zitat Tigen MK, Karaahmet T, Gürel E, Dündar C, Pala S, Cevik C, et al. The role of isovolumic acceleration in predicting subclinical right and left ventricular systolic dysfunction in hypertensive obese patients. Turk Kardiyol Dern Ars. 2011;39(1):9–15.PubMed Tigen MK, Karaahmet T, Gürel E, Dündar C, Pala S, Cevik C, et al. The role of isovolumic acceleration in predicting subclinical right and left ventricular systolic dysfunction in hypertensive obese patients. Turk Kardiyol Dern Ars. 2011;39(1):9–15.PubMed
21.
Zurück zum Zitat Pauliks LB, Vogel M, Mädler CF, Williams RI, Payne N, Redington AN, et al. Regional response of myocardial acceleration during isovolumic contraction during dobutamine stress echocardiography: a color tissue Doppler study and comparison with angiocardiographic findings. Echocardiography. 2005;22(10):797–808.CrossRefPubMed Pauliks LB, Vogel M, Mädler CF, Williams RI, Payne N, Redington AN, et al. Regional response of myocardial acceleration during isovolumic contraction during dobutamine stress echocardiography: a color tissue Doppler study and comparison with angiocardiographic findings. Echocardiography. 2005;22(10):797–808.CrossRefPubMed
22.
Zurück zum Zitat Margulescu AD, Thomas DE, Ingram TE, Vintila VD, Egan MA, Vinereanu D, et al. Can isovolumic acceleration be used in clinical practice to estimate ventricular contractile function? Reproducibility and regional variation of a new noninvasive index. J Am Soc Echocardiogr. 2010;23(4):423–31.CrossRefPubMed Margulescu AD, Thomas DE, Ingram TE, Vintila VD, Egan MA, Vinereanu D, et al. Can isovolumic acceleration be used in clinical practice to estimate ventricular contractile function? Reproducibility and regional variation of a new noninvasive index. J Am Soc Echocardiogr. 2010;23(4):423–31.CrossRefPubMed
23.
Zurück zum Zitat Šantl Letonja M, Letonja M, Nikolajević Starčević J, Petrović D. Ultrasonographic and classical risk factors of carotid atherosclerosis in patients with type-2 diabetes mellitus. Acta Medico-Biotechnica. 2013;6(1):33–44. Šantl Letonja M, Letonja M, Nikolajević Starčević J, Petrović D. Ultrasonographic and classical risk factors of carotid atherosclerosis in patients with type-2 diabetes mellitus. Acta Medico-Biotechnica. 2013;6(1):33–44.
24.
Zurück zum Zitat McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC committee for practice guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–847. doi:10.1093/eurheartj/ehs104.CrossRefPubMed McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC committee for practice guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–847. doi:10.​1093/​eurheartj/​ehs104.CrossRefPubMed
25.
Zurück zum Zitat Otto MC. Textbook of clinical echocardiography. 3rd ed. Philadelphia: Elsevier Saunders; 2004. Otto MC. Textbook of clinical echocardiography. 3rd ed. Philadelphia: Elsevier Saunders; 2004.
26.
Zurück zum Zitat Anderson B. Echocardiography. 1st ed. Brisbane: MGA Graphics; 2002. Anderson B. Echocardiography. 1st ed. Brisbane: MGA Graphics; 2002.
Metadaten
Titel
Non-invasive measuring of the acceleration of contraction of the left ventricle with the Doppler echocardiography
verfasst von
Igor Krajnc, MD
Prof. Andreja Sinkovič, MD, PhD
Assist. Prof. Franjo Naji, MD, PhD
Prof. Ivan Krajnc, MD, PhD
Publikationsdatum
01.12.2015
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe Sonderheft 5/2015
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-015-0916-2

Weitere Artikel der Sonderheft 5/2015

Wiener klinische Wochenschrift 5/2015 Zur Ausgabe