Peak apical recoil rate is a simplified index of left ventricular untwist: validation and application for assessment of diastolic function in children.

Putri Yubbu,Tomoyuki Sato,Renzo Calderon-Anyosa,Hunter Kauffman,Daisuke Matsubara,Andrea E Montero,Anirban Banerjee

doi:10.1007/s10554-022-02587-y

Abstract

The use of untwisting rate as a novel index of LV diastolic function in clinical practice has been limited due to its tedious and time-consuming analysis. Therefore, we simplify the untwist measurement by only measuring the LV apex's recoil rate and validating and applying peak apical recoil rate (PARR) as an index of diastolic dysfunction (DD) in pediatric subjects during increased and decreased lusitropic states. We recruited 153 healthy subjects (mean age 13.8 ± 2.9years), of whom 48 performed straight leg raising exercise and an additional 46 patients (mean 8.4 ± 5.6years) with documented pulmonary capillary wedge pressures (PCWP) (validation cohort). In addition, we studied 16 dilated cardiomyopathy patients (mean age 9.5 ± 6.3years) (application cohort). PARR and isovolumic relaxation time (IVRT) were compared to PCWP. Both PARR and PARR normalized by heart rate (nPARR) were excellent in detecting patients with PCWP ≥ 12mmHg and greatly superior to IVRT in this respect (AUC: 0.98, 95% CI [0.96, 1.0] vs. AUC: 0.7 95%CI [0.54,0.86]). In DCM patients, PARR and nPARR were greatly decreased compared to controls (-38.6 ± 18.6º/s vs -63.1 ± 16.3º /s, p < 0.001) and (-0.43 ± 0.20 º/ s/min vs -0.83 ± 0.28º/s/min, p < 0.0001) but increased with straight leg raising exercise (-59.4 ± 19.4º/s vs -97.8 ± 39.0 º/s, p < 0.01) and -0.85 ± 0.36 vs -1.4 ± 0.62 º/s/min (p < 0.0001) respectively. PARR and nPARR successfully detected increased and decreased lusitropic states and superior to IVRT in correlation with PCWP. This highly reproducible parameter offers incremental value over traditional indices of DD and may potentially serve as a useful index of elevated PCWP in children.

Highlights

Conventional techniques for evaluating left ventricular (LV) diastolic function in adults are often imprecise in children
peak apical recoil rate (PARR) successfully detected increased and decreased lusitropic states and was not affected by age when normalized with heart rate
Both PARR and nPARR are superior to isovolumic relaxation time (IVRT) in their correlation with pulmonary capillary wedge pressures (PCWP) and offer incremental value over traditional indices of diastolic dysfunction (DD). This highly reproducible parameter may potentially serve as a useful index of elevated PCWP in children

Summary

Introduction

Conventional techniques for evaluating left ventricular (LV) diastolic function in adults are often imprecise in children. Due to the dominant rotation of the LV apex versus the base, potential energy is stored in the apical region of the LV when it contracts (restoring force). The release of this potential energy in early diastole may be responsible for the rapid untwist phenomenon, generating enough suction that initiates LV filling [3]. The measurement of untwisting by 2D echocardiography (2DE) involves evaluating both apical and basal rotations by performing off-line measurements. This may prove complicated and burdensome in busy clinical laboratories, thereby, explaining its limited use in clinical practice [2]

Methods

Results

Conclusion