Abstract
Over the past years, a number of studies have demonstrated the relevance of strain assessed by two-dimensional speckle tracking echocardiography (STE) in evaluating ventricular function. The aim of this study was to analyze changes in left (LV) and right ventricular (RV) longitudinal strain associated with variations of heart rate (HR) in participants with and without chronic heart failure (CHF). We enrolled 45 patients, 38 of these diagnosed with CHF and carrying an implantable cardioverter defibrillator, and seven patients with pacemakers and without CHF. The frequency of atrial stimulation was increased to 90 beats/min and an echocardiogram was performed at each increase of 10 beats/min. Global LV and RV longitudinal strain (LVGLS and RVGLS, respectively) and RV free wall longitudinal strain (RVfwLS) were calculated at each HR. When analyzed as continuous variables, significant reductions in LVGLS were detected at higher HRs, whereas improvements in both RVGLS and RVfwLS were observed. Patients with a worsening of LVGLS (76% overall) were more likely to present lower baseline LV function. Only a few patients (18% for RVGLS and 16% for RVfwLS) exhibited HR-related deteriorations of RV strain measures, which was associated with lower levels of baseline RV function and higher pulmonary systolic pressures. Finally, 21 (47%) and 25 (56%) participants responded with improvements in RVGLS and RVfwLS, respectively. Our findings revealed heterogeneous RV and LV responses to increases in HR. These findings might ultimately be used to optimize cardiac functionality in patients diagnosed with CHF.
Highlights
Introduction published maps and institutional affilNovel methods for the non-invasive assessment of the heart chamber function have been developed during the last decades
We identified deteriorations in LVGLS at higher heart rate (HR); this response is most apparent among the participants who presented with diminished LV function at baseline, as determined by measures of longitudinal strain, Tei index, and left ventricular ejection fraction (LVEF)
Our findings demonstrate that increases in HR have distinct and heterogeneous effects on both right ventricular (RV) and LV function in patients diagnosed with chronic heart failure (CHF), as estimated by measurements of two-dimensional longitudinal strain
Summary
Introduction published maps and institutional affilNovel methods for the non-invasive assessment of the heart chamber function have been developed during the last decades. In chronic heart failure (CHF), left (LV) and right (RV) ventricular strain measured by twodimensional speckle tracking echocardiography (STE) have been identified as powerful predictors of clinical outcome [2,3,4] These measures are correlated with cardiac contractile responses to exertional or pharmacologic stimuli [5,6] and functional capacity [7], but there are few data about the relationship between heart rate (HR) increase independent from sympathetic activation and ventricular longitudinal strain. This issue is even more relevant for the clinical management of CHF patients. The HR-dependent increased contractility (i.e., the Bowditch Treppe phenomenon) is depressed [8,9] and a low sinus heart rate is a therapeutic target when iations
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