Reference Ranges of Left Ventricular Hemodynamic Forces in Healthy Adults: A Speckle-Tracking Echocardiographic Study

Francesco Ferrara,Francesco Capuano,Rodolfo Citro,Roberto Annunziata,Valentina Capone,Salvatore Chianese,Ciro Mauro,Salvatore Rega,Graziella Lacava,Rosangela Cocchia,Chiara Sepe,Antonello D’Andrea,Carla Contaldi,Filippo Cademartiri,Gianni Pedrizzetti,Andrea Salzano,Eduardo Bossone,Brigida Ranieri

doi:10.3390/jcm10245937

Abstract

Background: The normal limits of left ventricular (LV) hemodynamic forces (HDFs) are not exactly known. The aim of this study was to explore the full spectrum of HDF parameters in healthy subjects and determine their physiologic correlates. Methods: 269 healthy subjects were enrolled (mean age: 43 ± 14 years; 123 (45.7%) men). All participants underwent an echo-Doppler examination. Tri-plane tissue tracking from apical views was used to measure 2D global endocardial longitudinal strain (GLS), circumferential strain (GCS), and LV HDFs. HDFs were normalized with LV volume and divided by specific weight. Results: LV systolic longitudinal HDFs (%) were higher in men (20.8 ± 6.5 vs. 18.9 ± 5.6, p = 0.009; 22.0 ± 6.7 vs. 19.8 ± 5.6, p = 0.004, respectively). There was a significant correlation between GCS (increased) (r = −0.240, p < 0.001) and LV longitudinal HDFs (reduced) (r = −0.155, p = 0.01) with age. In a multivariable analysis age, BSA, pulse pressure, heart rate and GCS were the only independent variables associated with LV HDFs (β coefficient = −0.232, p < 0.001; 0.149, p = 0.003; 0.186, p < 0.001; 0.396, p < 0.001; −0.328, p < 0.001; respectively). Conclusion: We report on the physiologic range of LV HDFs. Knowledge of reference values of HDFs may prompt their implementation into clinical routine and allow a more comprehensive assessment of the LV function.

Highlights

Left ventricular (LV) function is a major diagnostic and prognostic determinant of a wide range of cardiac diseases [1,2,3]
No significant correlation between left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS)
This study demonstrated that LV systolic longitudinal hemodynamic forces (HDFs) and LV impulse were higher in men than in women

Summary

Introduction

Left ventricular (LV) function is a major diagnostic and prognostic determinant of a wide range of cardiac diseases [1,2,3]. The LV ejection fraction (EF) is the most commonly used parameter to evaluate LV function, it only provides global information about the chamber contraction. Advances in post-processing of standard STE technology have permitted to estimate the intraventricular pressure gradients (IVPG), that drive blood flow during LV ejection and filling [10,11,12]. This has led to the definition of the LV hemodynamic forces (HDFs) as IVPG averaged over the LV volume, reflecting the forces effectively exchanged between the blood flow and the LV walls [13,14]. HDFs were proposed as an indicator of the correct sequence of IVPGs generation and of LV pumping function [15]

Objectives

Methods

Conclusion