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Dynamic change in left ventricular apical back rotation: a marker of diastolic suction with exercise

 Sung-Jin Hong  ;  Chi Young Shim  ;  Darae Kim  ;  In-Jeong Cho  ;  Geu-Ru Hong  ;  Sun-Ha Moon  ;  Hyun-Jin Lee  ;  Jin-Kyung Lee  ;  Donghoon Choi  ;  Yangsoo Jang  ;  Jong-Won Ha 
 European Heart Journal-Cardiovascular Imaging, Vol.19(1) : 43453, 2018 
Journal Title
 European Heart Journal-Cardiovascular Imaging 
Issue Date
blood pressure ; diastole ; exercise ; left ventricle ; physiology ; ventricular rotation
Aims: We hypothesized that the absence of a decrease in minimal left ventricular (LV) pressure during exercise would be associated with impaired LV apical back rotation during exercise. Methods and results: A total of 21 patients (59 +/- 10 years) underwent invasive LV pressure measurements and simultaneous echocardiography at rest and during submaximal supine bicycle exercise. Patients were classified according to the changes in minimal LV pressure from rest to maximal exercise (Deltaminimal LVP); Group 1 (n = 8) had a decrease in minimal LV pressure with exercise, whereas Group 2 (n = 13) had an increase in minimal LV pressure. LV apical back-rotation parameters by speckle-tracking echocardiography at rest and during 50 W of exercise were compared. At rest, there were no differences in LV pressure and echocardiographic parameters between groups. However, at 50 W of exercise, Group 2 had higher LV early and end-diastolic pressures and a prolonged time constant of LV relaxation. In Group 2, e' velocity was lower and E/e' was higher. Apical back rotation at the mitral valve opening (MVO) was reduced and minimal apical back-rotation velocity was lower in Group 2. Deltaminimal LVP significantly correlated with apical back rotation at MVO (r = -0.77, P = 0.009) and minimal apical back-rotation velocity at 50 W (r = 0.69, P = 0.028). Conclusion: The lack of decrease in minimal LV pressure during exercise, a manifestation of impaired LV suction in early diastole, is linked closely with impaired LV apical back rotation during exercise. Dynamic changes in LV apical back rotation during exercise can be used as a non-invasive parameter of diastolic suction during exercise.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김다래(Kim, Da Rae)
심지영(Shim, Chi Young) ORCID logo https://orcid.org/0000-0002-6136-0136
장양수(Jang, Yang Soo) ORCID logo https://orcid.org/0000-0002-2169-3112
조인정(Cho, In Jeong)
최동훈(Choi, Dong Hoon) ORCID logo https://orcid.org/0000-0002-2009-9760
하종원(Ha, Jong Won) ORCID logo https://orcid.org/0000-0002-8260-2958
홍그루(Hong, Geu Ru) ORCID logo https://orcid.org/0000-0003-4981-3304
홍성진(Hong, Sung Jin) ORCID logo https://orcid.org/0000-0003-4893-039X
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