Systolic and diastolic myocardial mechanics in patients with cardiac disease and preserved ejection fraction: impact of left ventricular filling pressure.
BACKGROUND
There are few data on the impact of left ventricular (LV) filling pressure on systolic and diastolic myocardial mechanics in patients with cardiac disease and preserved LV ejection fraction (LVEF) (≥ 50%).


METHODS
Patients referred for cardiac catheterization underwent comprehensive echocardiography within 20 minutes of catheterization. Strain and strain rate in longitudinal, radial, and circumferential directions and torsion were measured in systole and diastole. LV preatrial contraction pressure (pre-A) was measured and averaged over 10 cardiac cycles.


RESULTS
Sixty patients were studied (mean age, 55.3 ± 8.9 years). The 30 patients with LV pre-A ≥ 15 mm Hg had significantly lower longitudinal systolic strain and radial, circumferential, and torsional systolic strain rates than the 30 patients with LV pre-A < 15 mm Hg (P < .05 for all). Similar findings were seen for diastolic variables. There were significant correlations between several systolic and diastolic variables in multiple directions and LV pre-A. On multivariate analysis, the independent predictors of systolic and diastolic speckle-tracking parameters included LVEF and LV pre-A, depending on the specific parameter analyzed.


CONCLUSIONS
In patients with preserved LVEF and cardiac disease, several systolic and diastolic myocardial mechanical parameters significantly correlate with LV filling pressure. These data highlight the notion that patients with preserved LVEF and elevated LV filling pressures have significant abnormalities in systolic function as detected by speckle imaging, findings that may challenge the concept of "isolated diastolic dysfunction." The extent of systolic and diastolic abnormalities in these patients may shed light on the mechanics of heart failure with preserved LVEF.
Department of Medicine, Baylor College of Medicine, Dallas, Texas, USA.
John S
JS
Nguyen
Nasser M
NM
Lakkis
Jaromir
J
Bobek
Rajiv
R
Goswami
Hisham
H
Dokainish
D000368:Aged; D001696:Biomechanical Phenomena; D001794:Blood Pressure / Q000502:physiology*; D006328:Cardiac Catheterization; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003971:Diastole / Q000502:physiology*; D004452:Echocardiography / Q000379:methods*; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D012984:Software; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology