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Early and late systolic wall stress differentially relate to myocardial contraction and relaxation in middle-aged adults: the Asklepios study

(2013) HYPERTENSION. 61(2). p.296-303
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The Asklepios Study
Abstract
Experimental studies implicate late systolic load as a determinant of impaired left ventricular (LV) relaxation. We aimed to assess the relationship between the myocardial loading sequence and left ventricular (LV) contraction and relaxation. Time-resolved central pressure and time-resolved LV geometry were measured with carotid tonometry and speckle-tracking echocardiography, respectively, for computation of time-resolved ejection-phase myocardial wall stress (EP-MWS) among 1,214 middle-aged adults without manifest cardiovascular disease from the general population. Early diastolic annular velocity, systolic annular velocities were measured with tissue Doppler imaging and segmentaveraged longitudinal strain was measured with speckle-tracking echocardiography. After adjustment for age, gender and potential confounders, late EP-MWS was negatively associated with early diastolic mitral annular velocity (e', standardized β=-0.25; P<0.0001) and mitral inflow propagation velocity (Vpe, standardized β=-0.13; P=0.02). In contrast, early EP-MWS was positively associated with e' (standardized β=0.18; P<0.0001) and Vpe (standardized β=0.22; P<0.0001). A higher late EP-MWS predicted a lower systolic mitral annular velocity (S', standardized β=-0.31; P<0.0001) and lesser myocardial longitudinal strain (standardized β=0.32; P<0.0001), whereas a higher early EP-MWS was associated with a higher S' (standardized β=0.16; P=0.002) and greater longitudinal strain (standardized β=-0.24; P=0.002). The loading sequence remained independently associated with e' after adjustment for S' or systolic longitudinal strain. In the context of available experimental data, our findings support the role of the myocardial loading sequence as a determinant of LV systolic and diastolic function. A loading sequence characterized by prominent late systolic wall stress was associated with lower longitudinal systolic function and diastolic relaxation.
Keywords
ARTERIAL LOAD, CARDIAC-MUSCLE, DEPENDENT RELAXATION, LOADING SEQUENCE, INTACT CANINE HEART, WAVE REFLECTION MAGNITUDE, LEFT-VENTRICULAR RELAXATION, PRESSURE FALL, DETERMINANTS, VELOCITY. afterload, diastolic function, loading sequence, myocardial function, myocardial wall stress, systolic function, tissue Doppler imaging

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Citation

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Chicago
Chirinos Medina, Julio, Patrick Segers, Ernst Rietzschel, Marc De Buyzere, Muhammad W Raja, Tom Claessens, Dirk De Bacquer, Martin St-John Sutton, and Thierry Gillebert. 2013. “Early and Late Systolic Wall Stress Differentially Relate to Myocardial Contraction and Relaxation in Middle-aged Adults: The Asklepios Study.” Hypertension 61 (2): 296–303.
APA
Chirinos Medina, J., Segers, P., Rietzschel, E., De Buyzere, M., Raja, M. W., Claessens, T., De Bacquer, D., et al. (2013). Early and late systolic wall stress differentially relate to myocardial contraction and relaxation in middle-aged adults: the Asklepios study. HYPERTENSION, 61(2), 296–303.
Vancouver
1.
Chirinos Medina J, Segers P, Rietzschel E, De Buyzere M, Raja MW, Claessens T, et al. Early and late systolic wall stress differentially relate to myocardial contraction and relaxation in middle-aged adults: the Asklepios study. HYPERTENSION. 2013;61(2):296–303.
MLA
Chirinos Medina, Julio, Patrick Segers, Ernst Rietzschel, et al. “Early and Late Systolic Wall Stress Differentially Relate to Myocardial Contraction and Relaxation in Middle-aged Adults: The Asklepios Study.” HYPERTENSION 61.2 (2013): 296–303. Print.
@article{3064829,
  abstract     = {Experimental studies implicate late systolic load as a determinant of impaired left ventricular (LV) relaxation. We aimed to assess the relationship between the myocardial loading sequence and left ventricular (LV) contraction and relaxation. Time-resolved central pressure and time-resolved LV geometry were measured with carotid tonometry and speckle-tracking echocardiography, respectively, for computation of time-resolved ejection-phase myocardial wall stress (EP-MWS) among 1,214 middle-aged adults without manifest cardiovascular disease from the general population. Early diastolic annular velocity, systolic annular velocities were measured with tissue Doppler imaging and segmentaveraged longitudinal strain was measured with speckle-tracking echocardiography. After adjustment for age, gender and potential confounders, late EP-MWS was negatively associated with early diastolic mitral annular velocity (e', standardized \ensuremath{\beta}=-0.25; P{\textlangle}0.0001) and mitral inflow propagation velocity (Vpe, standardized \ensuremath{\beta}=-0.13; P=0.02). In contrast, early EP-MWS was positively associated with e' (standardized \ensuremath{\beta}=0.18; P{\textlangle}0.0001) and Vpe (standardized \ensuremath{\beta}=0.22; P{\textlangle}0.0001). A higher late EP-MWS predicted a lower systolic mitral annular velocity (S', standardized \ensuremath{\beta}=-0.31; P{\textlangle}0.0001) and lesser myocardial longitudinal strain (standardized \ensuremath{\beta}=0.32; P{\textlangle}0.0001), whereas a higher early EP-MWS was associated with a higher S' (standardized \ensuremath{\beta}=0.16; P=0.002) and greater longitudinal strain (standardized \ensuremath{\beta}=-0.24; P=0.002). The loading sequence remained independently associated with e' after adjustment for S' or systolic longitudinal strain. In the context of available experimental data, our findings support the role of the myocardial loading sequence as a determinant of LV systolic and diastolic function. A loading sequence characterized by prominent late systolic wall stress was associated with lower longitudinal systolic function and diastolic relaxation.},
  author       = {Chirinos Medina, Julio and Segers, Patrick and Rietzschel, Ernst and De Buyzere, Marc and Raja, Muhammad W and Claessens, Tom and De Bacquer, Dirk and St-John Sutton, Martin and Gillebert, Thierry},
  issn         = {0194-911X},
  journal      = {HYPERTENSION},
  keyword      = {ARTERIAL LOAD,CARDIAC-MUSCLE,DEPENDENT RELAXATION,LOADING SEQUENCE,INTACT CANINE HEART,WAVE REFLECTION MAGNITUDE,LEFT-VENTRICULAR RELAXATION,PRESSURE FALL,DETERMINANTS,VELOCITY. afterload,diastolic function,loading sequence,myocardial function,myocardial wall stress,systolic function,tissue Doppler imaging},
  language     = {eng},
  number       = {2},
  pages        = {296--303},
  title        = {Early and late systolic wall stress differentially relate to myocardial contraction and relaxation in middle-aged adults: the Asklepios study},
  url          = {http://dx.doi.org/10.1161/HYPERTENSIONAHA.111.00530},
  volume       = {61},
  year         = {2013},
}

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