Author + information
- Rahul Chandrashekhar,
- Scott Akers,
- Amin Vakilipour,
- Prithvi Shiva-Kumar,
- Philip Haines,
- Snigdha Jain,
- Hassam Saif,
- Walter Witschey,
- Victor A. Ferrari and
- Julio A. Chirinos
Systolic myocardial wall stress (MWS) quantifies myocardial afterload. Despite its time-varying nature, little data exist regarding time-resolved MWS in systolic heart failure (HF).
We studied 10 subjects with systolic HF (mean LV ejection fraction=40%). We assessed time-resolved LV volume and central pressure with magnetic resonance imaging and carotid tonometry, respectively. We computed time-resolved MWS using the Arts method and compared observed MWS patterns with previously reported data from subjects with preserved systolic function (n=42).
In the presence of preserved systolic function, early systolic ejection determined a change in LV geometry that sharply reduced MWS relative to pressure during mid-systole (dashed arrow, top left panel), resulting in relatively low late systolic MWS (top mid-panel) even with prominent late systolic pressure augmentation (top right panel). The typical triphasic pressure-stress relation was also observed in subjects with systolic HF, but the normal mid-systolic shift in the pressure-stress relation was blunted (dashed arrow, bottom left panel), resulting in a failure to reduce late systolic wall stress (bottom mid panel) despite little or no pressure augmentation (bottom right panel).
Systolic HF is associated with marked abnormalities in the loading sequence due to an intrinsically abnormal pressure-stress relation. This abnormality may promote a vicious circle of adverse LV remodeling and failure.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: New Diagnostic and Imaging Strategies in Heart Failure
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1136-308
- 2013 American College of Cardiology Foundation