Impacts of mitral E/e′ on myocardial contractile motion and synchronicity in heart failure patients with reduced ejection fraction: An exercise-echocardiography study

Yi Chih Wang, Chih Chieh Yu, Fu Chun Chiu, Chia Ti Tsai, Ling Ping Lai, Juey Jen Hwang, Jiunn Lee Lin

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background The association between diastolic abnormality and postexercise contractile decompensation is uncertain in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF). Hypothesis The higher mitral E/annular early diastolic velocity (E/e′) is relevant to postexercise regional myocardial contractile maladaptation. Methods Seventy HF patients with LVEF <50 % (56 males, 58 ± 15 years) were studied pre- and postexercise using tissue Doppler echocardiography. We evaluated the mean and standard deviation of systolic myocardial velocity (Sm) and electromechanical delay (Ts) of 12 left ventricular segments, and further analyzed the corresponding changes of septal and posterolateral segments. Results The higher mitral E/e′ was associated with more blunted heterogeneity of Sm and greater ventricular dyssynchrony after exercise. This is due to the posterolateral wall not being able to increase Sm with exercise to the same degree as the septum (decreased posterolateral/septal Sm ratio). Furthermore, the postexercise aggravated difference of Ts between septum and posterolateral segments leads to more dyssynchronous contraction in the higher E/e′ groups. An E/e′ ≥10 predicted a postexercise posterolateral/septal Sm ≤ 1 (odds ratio [OR]: 5.8, 95% confidence interval [CI]: 1.5-22.6, P = 0.011), and a difference of Ts between septum and posterolateral segments >65 ms (OR: 64, 95% CI: = 6-651, P < 0.001) in HF patients with reduced LVEF in multivariate analysis. Conclusions The higher mitral E/e′-related postexercise maladaptation of myocardial contractile motion and synchronicity suggests the involvement of systolic abnormality in exercise pathophysiology in HF patients with reduced LVEF.

Original languageEnglish
Pages (from-to)462-467
Number of pages6
JournalClinical Cardiology
Volume36
Issue number8
DOIs
Publication statusPublished - Aug 1 2013
Externally publishedYes

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Stroke Volume
Echocardiography
Heart Failure
Exercise
Multivariate Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Impacts of mitral E/e′ on myocardial contractile motion and synchronicity in heart failure patients with reduced ejection fraction : An exercise-echocardiography study. / Wang, Yi Chih; Yu, Chih Chieh; Chiu, Fu Chun; Tsai, Chia Ti; Lai, Ling Ping; Hwang, Juey Jen; Lin, Jiunn Lee.

In: Clinical Cardiology, Vol. 36, No. 8, 01.08.2013, p. 462-467.

Research output: Contribution to journalArticle

Wang, Yi Chih ; Yu, Chih Chieh ; Chiu, Fu Chun ; Tsai, Chia Ti ; Lai, Ling Ping ; Hwang, Juey Jen ; Lin, Jiunn Lee. / Impacts of mitral E/e′ on myocardial contractile motion and synchronicity in heart failure patients with reduced ejection fraction : An exercise-echocardiography study. In: Clinical Cardiology. 2013 ; Vol. 36, No. 8. pp. 462-467.
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abstract = "Background The association between diastolic abnormality and postexercise contractile decompensation is uncertain in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF). Hypothesis The higher mitral E/annular early diastolic velocity (E/e′) is relevant to postexercise regional myocardial contractile maladaptation. Methods Seventy HF patients with LVEF <50 {\%} (56 males, 58 ± 15 years) were studied pre- and postexercise using tissue Doppler echocardiography. We evaluated the mean and standard deviation of systolic myocardial velocity (Sm) and electromechanical delay (Ts) of 12 left ventricular segments, and further analyzed the corresponding changes of septal and posterolateral segments. Results The higher mitral E/e′ was associated with more blunted heterogeneity of Sm and greater ventricular dyssynchrony after exercise. This is due to the posterolateral wall not being able to increase Sm with exercise to the same degree as the septum (decreased posterolateral/septal Sm ratio). Furthermore, the postexercise aggravated difference of Ts between septum and posterolateral segments leads to more dyssynchronous contraction in the higher E/e′ groups. An E/e′ ≥10 predicted a postexercise posterolateral/septal Sm ≤ 1 (odds ratio [OR]: 5.8, 95{\%} confidence interval [CI]: 1.5-22.6, P = 0.011), and a difference of Ts between septum and posterolateral segments >65 ms (OR: 64, 95{\%} CI: = 6-651, P < 0.001) in HF patients with reduced LVEF in multivariate analysis. Conclusions The higher mitral E/e′-related postexercise maladaptation of myocardial contractile motion and synchronicity suggests the involvement of systolic abnormality in exercise pathophysiology in HF patients with reduced LVEF.",
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T1 - Impacts of mitral E/e′ on myocardial contractile motion and synchronicity in heart failure patients with reduced ejection fraction

T2 - An exercise-echocardiography study

AU - Wang, Yi Chih

AU - Yu, Chih Chieh

AU - Chiu, Fu Chun

AU - Tsai, Chia Ti

AU - Lai, Ling Ping

AU - Hwang, Juey Jen

AU - Lin, Jiunn Lee

PY - 2013/8/1

Y1 - 2013/8/1

N2 - Background The association between diastolic abnormality and postexercise contractile decompensation is uncertain in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF). Hypothesis The higher mitral E/annular early diastolic velocity (E/e′) is relevant to postexercise regional myocardial contractile maladaptation. Methods Seventy HF patients with LVEF <50 % (56 males, 58 ± 15 years) were studied pre- and postexercise using tissue Doppler echocardiography. We evaluated the mean and standard deviation of systolic myocardial velocity (Sm) and electromechanical delay (Ts) of 12 left ventricular segments, and further analyzed the corresponding changes of septal and posterolateral segments. Results The higher mitral E/e′ was associated with more blunted heterogeneity of Sm and greater ventricular dyssynchrony after exercise. This is due to the posterolateral wall not being able to increase Sm with exercise to the same degree as the septum (decreased posterolateral/septal Sm ratio). Furthermore, the postexercise aggravated difference of Ts between septum and posterolateral segments leads to more dyssynchronous contraction in the higher E/e′ groups. An E/e′ ≥10 predicted a postexercise posterolateral/septal Sm ≤ 1 (odds ratio [OR]: 5.8, 95% confidence interval [CI]: 1.5-22.6, P = 0.011), and a difference of Ts between septum and posterolateral segments >65 ms (OR: 64, 95% CI: = 6-651, P < 0.001) in HF patients with reduced LVEF in multivariate analysis. Conclusions The higher mitral E/e′-related postexercise maladaptation of myocardial contractile motion and synchronicity suggests the involvement of systolic abnormality in exercise pathophysiology in HF patients with reduced LVEF.

AB - Background The association between diastolic abnormality and postexercise contractile decompensation is uncertain in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF). Hypothesis The higher mitral E/annular early diastolic velocity (E/e′) is relevant to postexercise regional myocardial contractile maladaptation. Methods Seventy HF patients with LVEF <50 % (56 males, 58 ± 15 years) were studied pre- and postexercise using tissue Doppler echocardiography. We evaluated the mean and standard deviation of systolic myocardial velocity (Sm) and electromechanical delay (Ts) of 12 left ventricular segments, and further analyzed the corresponding changes of septal and posterolateral segments. Results The higher mitral E/e′ was associated with more blunted heterogeneity of Sm and greater ventricular dyssynchrony after exercise. This is due to the posterolateral wall not being able to increase Sm with exercise to the same degree as the septum (decreased posterolateral/septal Sm ratio). Furthermore, the postexercise aggravated difference of Ts between septum and posterolateral segments leads to more dyssynchronous contraction in the higher E/e′ groups. An E/e′ ≥10 predicted a postexercise posterolateral/septal Sm ≤ 1 (odds ratio [OR]: 5.8, 95% confidence interval [CI]: 1.5-22.6, P = 0.011), and a difference of Ts between septum and posterolateral segments >65 ms (OR: 64, 95% CI: = 6-651, P < 0.001) in HF patients with reduced LVEF in multivariate analysis. Conclusions The higher mitral E/e′-related postexercise maladaptation of myocardial contractile motion and synchronicity suggests the involvement of systolic abnormality in exercise pathophysiology in HF patients with reduced LVEF.

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