Atrioventricular Plane Research Articles

Ventricular longitudinal shortening is an independent predictor of death in heart failure patients with reduced ejection fraction

Reduced ventricular longitudinal shortening measured by atrioventricular plane displacement (AVPD) and global longitudinal strain (GLS) are prognostic markers in heart disease. This study aims to determine if AVPD and GLS with cardiovascular magnetic resonance (CMR) are independent predictors of cardiovascular (CV) and all-cause death also in heart failure with reduced ejection fraction (HFrEF). Patients (n = 287) were examined with CMR and AVPD, GLS, ventricular volumes, myocardial fibrosis/scar were measured. Follow-up was 5 years with cause of death retrieved from a national registry. Forty CV and 60 all-cause deaths occurred and CV non-survivors had a lower AVPD (6.4 ± 2.0 vs 8.0 ± 2.4 mm, p < 0.001) and worse GLS (− 6.1 ± 2.2 vs − 7.7 ± 3.1%, p = 0.001). Kaplan–Meier analyses displayed increased survival for patients in the highest AVPD- and GLS-tertiles vs. the lowest tertiles (AVPD: p = 0.001, GLS: p = 0.013). AVPD and GLS showed in univariate analysis a hazard ratio (HR) of 1.30 (per-mm-decrease) and 1.19 (per-%-decrease) for CV death. Mean AVPD and GLS were independent predictors of all-cause death (HR = 1.24 per-mm-decrease and 1.15 per-%-decrease), but only AVPD showed incremental value over age, sex, body-mass-index, EF, etiology and fibrosis/scar for CV death (HR = 1.33 per-mm-decrease, p < 0.001). Ventricular longitudinal shortening remains independently prognostic for death in HFrEF even after adjusting for well-known clinical risk factors.

Atrioventricular plane displacement and regional contribution to stroke volume to predict outcome in pulmonary arterial hypertension

Abstract Background Patients with pulmonary arterial hypertension (PAH) exhibit high mortality, partially related to right heart failure. Right ventricular (RV) volumes and ejection fraction (EF) can be measured accurately with cardiac magnetic resonance (CMR), but EF is a crude measure of cardiac function. Additional methods for risk assessment and prognosis are of value. Stroke volume (SV) is generated by longitudinal, lateral and septal myocardial contraction. Longitudinal contribution to SV (SVlong%) generated from the atrioventricular displacement (AVPD) is the major contributor to SV in both the left ventricle (LV) and RV. AVPD in both sides and LVSVlong% are lower in patients with PAH compared to controls. However, it is unknown if altered AVPD or regional contributions to SV are prognostic in patients with PAH. The aim of this study was therefore to evaluate if AVPD, longitudinal, lateral or septal contribution to LVSV and RVSV are associated with death or lung transplantation in patients with PAH. Purpose To evaluate if biventricular AVPD, and regional contributions to SV are associated with outcome in patients with PAH. Methods Seventy-one patients with PAH and 20 sex and age-matched healthy controls underwent CMR. Endocardial and epicardial borders and RV insertion points were defined in end diastole and end systole in cine short-axis stacks to compute biventricular volumes, SVlat% and SVsept%. Eight atrioventricular points were defined in end diastole and end systole in 2-, 3- and 4-chamber cine long-axis views, for computation of AVPD and SVlong%. Cut-off values for survival analysis were defined as above or below mean ± 2 standard deviations from the healthy controls. Outcome was defined as death or lung-transplantation. Results Median follow-up time was 3.6 [IQR 3.7] years. AVPD, SVlong%, SVlat% in both ventricles and SVsept% were altered in PAH compared to controls. Transplantation-free survival was lower with values below cut-off for LV-AVPD (hazard ratio (HR)=2.1, 95% CI: 1.2–3.9, p=0.02) and RV-AVPD (HR=9.8, 95% CI: 4.6–21.1, p=0.005) (fig 1). In cox regression analysis, decreased LV-AVPD and RV-AVPD inferred lower transplantation-free survival (LV: HR=1.16 per mm decrease, p=0.007; RV: HR=1.11 per mm decrease, p=0.01) (table 1). LVEF, RVEF, LV-SVlong%, RV-SVlong%, LV-SVlat%, RV-SVlat% or SVsept% did not affect outcome (table 1). Conclusions Decreased left and right AVDP were associated with decreased transplantation-free survival in patients with PAH. There were no associations between ejection fraction, longitudinal, lateral or septal contribution to stroke volume. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Skåne University Hospital, Region of Skåne Southern Healthcare Region of Sweden

The relation between left ventricular systolic function parameters and preceding or prepreceding beat-to-beat distance in patients with atrial fibrillation: an echocardiographic study.

We aimed at investigating the relation between left ventricle (LV) systolic parameters and beat-to-beat distances and also whether this relation is different in heart failure with reduced ejection fraction (HFrEF) patients with atrial fibrillation (AF). The relation between peak velocity in left ventricular outflow (VLVOT), left atrioventricular plane displacement (LAVPD) or peak systolic tissue Doppler velocity of lateral mitral annulus (Lateral S') and preceding beat-to-beat distance (RR1) or prepreceding beat-to-beat distance (RR2) were analyzed by linear regression analysis. From this analysis, three parameters were obtained: slope of regression line, constant of regression line, and square of regression coefficient (r2) of linear relation. In the group with HFrEF, the slope and r2 values of the regression line showing the relationship between the RR1 interval and VLVOT, LAVPD, and Lateral S' values were higher and the constants were lower. In the Kendall rank correlation analysis, the slope, constant, and r2 values of the regression analysis between RR1 interval and VLVOT or Lateral S' were in significant correlation with LVEF. The r2 of VLVOT-RR1 analysis, slope of this analysis, and slope of Lateral S'-RR1 regression line values were mostly predictive for detecting HFrEF. It was concluded that the novel parameters obtained by linear regression analysis between LV systolic function parameters and RR1 interval, but not RR2, might be beneficial for evaluating systolic heart failure in patients with AF. They might have potential for future research about the physiopathology of heart and prognosis in patient with AF.

An Intra-Cycle Optimal Control Framework for Ventricular Assist Devices Based on Atrioventricular Plane Displacement Modeling

A promising treatment for congestive heart failure is the implementation of a left ventricular assist device (LVAD) that works as a mechanical pump. Modern LVADs work with adjustable constant rotor speed and provide therefore continuous blood flow; however, recently undertaken efforts try to mimic pulsatile blood flow by oscillating the pump speed. This work proposes an algorithmic framework to construct and evaluate optimal pump speed policies with respect to generic objectives. We use a model that captures the atrioventricular plane displacement, which is a physiological indicator for heart failure. We employ mathematical optimization to adapt this model to patient specific data and to find optimal pump speed policies with respect to ventricular unloading and aortic valve opening. To this end, we reformulate the cardiovascular dynamics into a switched system and thereby reduce nonlinearities. We consider system switches that stem from varying the constant pump speed and that are state dependent such as valve opening or closing. As a proof of concept study, we personalize the model to a selected patient with respect to ventricular pressure. The model fitting results in a root-mean-square deviation of about 6 mmHg. The optimization that considers aortic valve opening and ventricular unloading results in speed modulation akin to counterpulsation. These in silico findings demonstrate the potential of personalized hemodynamical optimization for the LVAD therapy.

Video-based valve motion combined with computational fluid dynamics gives stable and accurate simulations of blood flow in the Realheart total artificial heart.

Patients with end-stage, biventricular heart failure, and for whom heart transplantation is not an option, may be given a Total Artificial Heart (TAH). The Realheart® is a novel TAH which pumps blood by mimicking the native heart with translation of an atrioventricular plane. The aim of this work was to create a strategy for using Computational Fluid Dynamics (CFD) to simulate haemodynamics in the Realheart®, including motion of the atrioventricular plane and valves. The accuracies of four different computational methods for simulating fluid-structure interaction of the prosthetic valves were assessed by comparison of chamber pressures and flow rates with experimental measurements. The four strategies were: prescribed motion of valves opening and closing at the atrioventricular plane extrema; simulation of fluid-structure interaction of both valves; prescribed motion of the mitral valve with simulation of fluid-structure interaction of the aortic valve; motion of both valves prescribed from video analysis of experiments. The most accurate strategy (error in ventricular pressure of 6%, error in flow rate of 5%) used video-prescribed motion. With the Realheart operating at 80 bpm, the power consumption was 1.03 W, maximum shear stress was 15 Pa, and washout of the ventricle chamber after 4 cycles was 87%. This study, the first CFD analysis of this novel TAH, demonstrates that good agreement between computational and experimental data can be achieved. This method will therefore enable future optimisation of the geometry and motion of the Realheart®.

The electrocardiographic forward problem: A benchmark study

BackgroundElectrocardiographic forward problems are crucial components for noninvasive electrocardiographic imaging (ECGI) that compute torso potentials from cardiac source measurements. Forward problems have few sources of error as they are physically well posed and supported by mature numerical and computational techniques. However, the residual errors reported from experimental validation studies between forward computed and measured torso signals remain surprisingly high. ObjectiveTo test the hypothesis that incomplete cardiac source sampling, especially above the atrioventricular (AV) plane is a major contributor to forward solution errors. MethodsWe used a modified Langendorff preparation suspended in a human-shaped electrolytic torso-tank and a novel pericardiac-cage recording array to thoroughly sample the cardiac potentials. With this carefully controlled experimental preparation, we minimized possible sources of error, including geometric error and torso inhomogeneities. We progressively removed recorded signals from above the atrioventricular plane to determine how the forward-computed torso-tank potentials were affected by incomplete source sampling. ResultsWe studied 240 beats total recorded from three different activation sequence types (sinus, and posterior and anterior left-ventricular free-wall pacing) in each of two experiments. With complete sampling by the cage electrodes, all correlation metrics between computed and measured torso-tank potentials were above 0.93 (maximum 0.99). The mean root-mean-squared error across all beat types was also low, less than or equal to 0.10 mV. A precipitous drop in forward solution accuracy was observed when we included only cage measurements below the AV plane. ConclusionFirst, our forward computed potentials using complete cardiac source measurements set a benchmark for similar studies. Second, this study validates the importance of complete cardiac source sampling above the AV plane to produce accurate forward computed torso potentials. Testing ECGI systems and techniques with these more complete and highly accurate datasets will improve inverse techniques and noninvasive detection of cardiac electrical abnormalities.

Atrioventricular plane displacement versus mitral and tricuspid annular plane systolic excursion: A comparison between cardiac magnetic resonance and M-mode echocardiography.

Both echocardiography and CMR imaging are used to quantify longitudinal function. Inter-method variability for mitral (MAPSE) and tricuspid (TAPSE) annular plane systolic excursion, and variability between directly measured MAPSE and TAPSE and as based on atrioventricular plane displacement (AVPD) analysis by CMR, are, however, not known. This study, therefore, assessed inter-method variability and variability between annular plane systolic excursion and AVPD-based values in a healthy adult population. Echocardiography and CMR were performed in 111 adults (35 [32-38] years). Method comparisons were assessed with Deming regression, Bland-Altman analysis and coefficient of variation. Observer reproducibility was assessed by the concordance correlation coefficient. Echocardiography and semi-automatic CMR agreed on MAPSE (17±2mm vs. 17±2mm, p=0.1) and TAPSE (25±3mm vs. 25±3mm, p=0.5), correlated highly between methods (fitted-slope 1.22 [95% CI 1.07-1.38] and 1.12 [95% CI 0.95-1.29]) and showed low bias (0.42 [95% CI-2.05 to 2.88] and-0.18 [95% CI-4.78 to 4.43]). Intra-/inter-observer reproducibility was high for both methods for both MAPSE (echocardiography 0.96/0.86; CMR 0.87/0.85) and TAPSE (echocardiography 0.96/0.95; CMR 0.97/0.96). MAPSE (16±2mm vs. 17±2mm; p<0.001) and TAPSE (24±3 vs. 25±3mm; p<0.001) based on AVPD were similar but statistically different compared with semi-automatic CMR. Echocardiography and semi-automatic CMR have low variability and provide similar values for MAPSE and TAPSE and are thus interchangeable for follow-up studies. Lateral values based on tracked data from AVPD analysis are not clinically significantly different and could be used as a representation of annular displacement.

Underfilling decreases left ventricular function in pulmonary arterial hypertension

To evaluate the association between impaired left ventricular (LV) longitudinal function and LV underfilling in patients with pulmonary arterial hypertension (PAH). Thirty-nine patients with PAH and 18 age and sex-matched healthy controls were included. LV volume and left atrial volume (LAV) were delineated in short-axis cardiac magnetic resonance (CMR) cine images. LV longitudinal function was assessed from atrio-ventricular plane displacement (AVPD) and global longitudinal strain (GLS) was assessed using feature tracking in three long-axis views. LV filling was assessed by LAV and by pulmonary artery wedge pressure (PAWP) using right heart catheterisation. Patients had a smaller LAV, LV volume and stroke volume as well as a lower LV-AVPD and LV-GLS than controls. PAWP was 6 [IQR 5––9] mmHg in patients. LV ejection fraction did not differ between groups. LV stroke volume correlated with LV-AVPD (r = 0.445, p = .001), LV-GLS (r = − 0.549, p < 0.0001) and LAVmax (r = .585, p < 0.0001). Furthermore, LV-AVPD (r = .598) and LV-GLS (r = − 0.675) correlated with LAVmax (p < 0.0001 for both). Neither LV-AVPD, LV-GLS, LAVmax nor stroke volume correlated with PAWP. Impaired LV longitudinal function was associated with low stroke volume, low PAWP and a small LAV in PAH. Small stroke volumes and LAV, together with normal LA pressure, implies that the mechanism causing reduced LV longitudinal function is underfilling rather than an intrinsic LV dysfunction in PAH.

Three-dimensional echocardiography to identify right ventricular dilatation in patients with corrected Fallot anomaly or pulmonary stenosis.

Background3‐Dimensional Echocardiography allows measuring volumes and parameters of myocardial deformation (strain). Myocardial strain has been suggested to be superior to conventional echo parameters in the assessment of right ventricular (RV) function. Myocardial strain can be assessed by cardiac magnetic resonance (CMR) or two‐ and three‐dimensional echocardiography (2D and 3DEcho). We performed a comprehensive assessment of the RV based on 3DEcho and compared the results with those based on CMR and 2DEcho.Methods36 patients with corrected heart defects underwent CMR and 3DEcho to assess RV volume, strain and cardio pulmonary exercise testing with peak VO2 measurement. 2DEcho was used for reference.ResultsThere was a moderate correlation between 3DEcho and CMR for measuring RV end‐diastolic and end‐systolic volumes (r = .82 and .72). 3DEcho tended to underestimate the RV volumes, mean difference EDV 8.5 ± 33 ml (CI −2.8; 19.7 ml) and ESV 13.2 ± 29 ml (CI 3.3; 23 ml). According to method‐specific reference values for RVEDV, 34/35 (3DEcho) and 29/36 (CMR) were dilated. Among those dilated according to CMR, all were identified by 3DEcho. The coefficient of correlation between RV atrioventricular plane displacement measured by CMR and tricuspid annular plane systolic excursion measured by 3D and 2DEcho was r = .6 for both. 2DEcho measured lower LV volumes than CMR. LVEF and GLS were similar in 2DEcho, 3DEcho and CMR. Patients with CMR‐determined RV free wall strain ≤ −14% tended to have lower peak VO2.ConclusionsAlthough 3DEcho underestimated RV volumes, it successfully identified all patients with RV dilatation based on method‐specific reference values.

VP18.03: Automated measurement of atrioventricular plane displacement as a marker in intrauterine growth restriction

VP18.03: Automated measurement of atrioventricular plane displacement as a marker in intrauterine growth restriction

Impact of bi-planar localization of the tricuspid valve on the evaluation of right ventricular functional parameters in the short axis plane.

Primary objective was to evaluate by cardiac MRI the accuracy of right ventricular stroke volume (RVSV) measurement in the short-axis (SA) plane with cross-referencing of the tricuspid plane. 2D phase-contrast measurement at the main pulmonary artery (PSV) was the reference. Secondary objective was to analyze the reproducibility of RV functional parameters. In this single-center retrospective study, 41 patients (mean age 40 ± 18years; age range 16-71years; M/F sex ratio 51%) referred for various acquired and congenital cardiopathies underwent CMR including SA balanced steady state free precession imaging (b-SSFP). Right ventricular vertical long-axis and four chamber views were used for cross-referenced localization of the tricuspid valve. Right ventricular functional parameters were measured on three occasions by two observers using Syngo Via® (Siemens Healthineers, Erlangen, Germany). The Student t-test and Bland Altman plot were used to test for differences between RV stroke volumes derived from cine b-SSFP (RVSV) or 2D PC (PSV). Bland Altman plots, coefficient of variation (COV) and intraclass correlation coefficient (ICC) were used to evaluate intra- and inter-observer reproducibility of RVSV, RVED and RVES volumes, and RV ejection fraction. There was high correlation (r = 0.94) and no significant difference between RVSV and PSV (83 ± 20mL vs. 81 ± 21mL p > 0.05). Intra- (ICC: 0.95; COV: 6.2) and inter-observer reliability (ICC: 0.91; COV: 8.9) of RVSV measurements were excellent. Finally, intra- and inter-observer reproducibility was excellent for RVEF, RVEDV and RVESV. Right ventricular stroke volumes can be routinely derived from SA analysis using cross-referenced localization of the atrioventricular plane. Moreover, all right ventricular systolic function parameters are highly reproducible when using this technique.

Fetal cardiac function at intrauterine transfusion assessed by automated analysis of color tissue Doppler recordings

BackgroundFetal anemia is associated with a hyperdynamic circulation and cardiac remodeling. Rapid intrauterine transfusion (IUT) of blood with high hematocrit and viscosity into the umbilical vein used to treat this condition can temporarily further affect fetal heart function. The aim of this study was to evaluate the short-term changes in fetal myocardial function caused by IUT using automated analysis of cine-loops of the fetal heart obtained by color tissue Doppler imaging (cTDI).MethodsFetal echocardiography was performed before and after IUT. cTDI recordings were obtained in a four-chamber view and regions of interest were placed at the atrioventricular plane in the left ventricular (LV), right ventricular (RV) and septal walls. Myocardial velocities were analyzed by an automated analysis software to obtain peak myocardial velocities during atrial contraction (Am), ventricular ejection (Sm), rapid ventricular filling (Em) and Em/Am ratio was calculated.Myocardial velocities were converted to z-scores using published reference ranges. Delta z-scores (after minus before IUT) were calculated. Correlations were assessed between variables and hemoglobin before IUT.ResultsThirty-two fetuses underwent 70 IUTs. Fourteen were first time transfusions. In the LV and septal walls, all myocardial velocities were significantly increased compared to normal values, whereas in the RV only Sm was increased before IUT (z-scores 0.26–0.52). In first time IUTs, there was a negative correlation between LV Em (rho = − 0.61, p = 0.036) and LV Em/Am (rho = − 0.82, p = 0.001) z-scores and hemoglobin before IUT. The peak myocardial velocities that were increased before IUT decreased, whereas LV Em/Am increased significantly after IUT.ConclusionsThis study showed that peak myocardial velocities assessed by cTDI are increased in fetuses before IUT reflecting the physiology of hyperdynamic circulation. In these fetuses, the fetal heart is able to adapt and efficiently handle the volume load caused by IUT by altering its myocardial function.

Right ventricular function parameters in pulmonary hypertension: echocardiography vs. cardiac magnetic resonance

BackgroundRight ventricular (RV) function is a major determinant of outcome in patients with pulmonary hypertension. Cardiac magnetic resonance (CMR) is gold standard to assess RV ejection fraction (RVEFCMR), however this is a crude measure. New CMR measures of RV function beyond RVEFCMR have emerged, such as RV lateral atrio-ventricular plane displacement (AVPDlat), maximum emptying velocity (S’CMR), RV fractional area change (FACCMR) and feature tracking of the RV free wall (FWSCMR). However, it is not fully elucidated if these CMR measures are in parity with the equivalent echocardiography-derived measurements: tricuspid annular plane systolic excursion (TAPSE), S’-wave velocity (S’echo), RV fractional area change (FACecho) and RV free wall strain (FWSecho). The aim of this study was to compare regional RV function parameters derived from CMR to their echocardiographic equivalents in patients with pulmonary hypertension and to RVEFCMR.MethodsFifty-five patients (37 women, 62 ± 15 years) evaluated for pulmonary hypertension underwent CMR and echocardiography. AVPDlat, S’CMR, FACCMR and FWSCMR from cine 4-chamber views were compared to corresponding echocardiographic measures and to RVEFCMR delineated in cine short-axis stack.ResultsA strong correlation was demonstrated for FAC whereas the remaining measurements showed moderate correlation. The absolute bias for S’ was 2.4 ± 3.0 cm/s (relative bias 24.1 ± 28.3%), TAPSE/AVPDlat 5.5 ± 4.6 mm (33.2 ± 25.2%), FWS 4.4 ± 5.8% (20.2 ± 37.5%) and for FAC 5.1 ± 8.4% (18.5 ± 32.5%). In correlation to RVEFCMR, FACCMR and FWSecho correlated strongly, FACecho, AVPDlat, FWSCMR and TAPSE moderately, whereas S’ had only a weak correlation.ConclusionThis study has demonstrated a moderate to strong correlation of regional CMR measurements to corresponding echocardiographic measures. However, biases and to some extent wide limits of agreement, exist between the modalities. Consequently, the equivalent measures are not interchangeable at least in patients with pulmonary hypertension. The echocardiographic parameter that showed best correlation with RVEFCMR was FWSecho. At present, FACecho and FWSecho as well as RVEFCMR are the preferred methods to assess and follow up RV function in patients with pulmonary hypertension. Future investigations of the CMR right ventricular measures, beyond RVEF, are warranted.

Endurance exercise in seniors: Tonic, toxin or neither?

Cardiac adaptation to sustained exercise in the athletes is established. However, exercise-associated effect on the cardiac function of the elderly has to be elucidated. The aim of this study was to analyse left (LV) and right ventricular (RV) characteristics at different levels of chronic exercise in the senior heart. We studied 178 participants in the World Senior Games (mean age 68±8years, 86 were men; 48%). Three groups were defined based on the type and intensity of sports: low-, moderate- and high-intensity level. Exclusion criteria were coronary artery disease, atrial fibrillation, valvular heart disease or uncontrolled hypertension. LV and RV size and function were evaluated with an echocardiogram. LV trans-mitral inflow deceleration time decreased in parallel to the intensity of chronic exercise: 242±54ms in low-, 221±52ms in moderate- and 215±58ms in high-intensity level, p=.03. Left atrial volume index (LAVI) was larger in high-intensity group, p=.001. The LAVI remained significantly larger when adjusting for age, gender, heart rate, hypertension and diabetes (p=.002). LV and RV sizes were larger in the high-intensity group. LV ejection fraction and RV systolic function evaluated by tissue Doppler velocity, atrioventricular plane displacement and strain did not differ between groups. Left ventricular diastolic filling is not only preserved, but may also be enhanced in long-term, top-level senior athletes. Moreover, LV and RV systolic function remain unchanged at different levels of exercise. This supports the beneficial effects of endurance exercise participation in senior hearts.

Simulating ventricular systolic motion in a four-chamber heart model with spatially varying robin boundary conditions to model the effect of the pericardium

The pericardium affects cardiac motion by limiting epicardial displacement normal to the surface. In computational studies, it is important for the model to replicate realistic motion, as this affects the physiological fidelity of the model. Previous computational studies showed that accounting for the effect of the pericardium allows for a more realistic motion simulation. In this study, we describe the mechanism through which the pericardium causes improved cardiac motion. We simulated electrical activation and contraction of the ventricles on a four-chamber heart in the presence and absence of the effect of the pericardium. We simulated the mechanical constraints imposed by the pericardium by applying normal Robin boundary conditions on the ventricular epicardium. We defined a regional scaling of normal springs stiffness based on image-derived motion from CT images. The presence of the pericardium reduced the error between simulated and image-derived end-systolic configurations from 12.8±4.1 mm to 5.7±2.5 mm. First, the pericardium prevents the ventricles from spherising during isovolumic contraction, reducing the outward motion of the free walls normal to the surface and the upwards motion of the apex. Second, by restricting the inward motion of the free and apical walls of the ventricles the pericardium increases atrioventricular plane displacement by four folds during ejection. Our results provide a mechanistic explanation of the importance of the pericardium in physiological simulations of electromechanical cardiac function.

Atrioventricular Plane Displacement on Echocardiography in Patients with Left Ventricular Systolic Dysfunction

Background: Atrioventricular plane displacement (AVPD) reflects global left ventricular function despite left ventricular asymmetry as it is determined in four different regions of left ventricle. The limitations of agreement between left ventricular ejection fraction (LVEF) and AVPD are not close enough for these two measurements to be interchangeable. There is reason to question whether AVPD provides the same information as LVEF. Aim: The aim of this study was to assess relations of AVPD with LVEF and clinical findings in patients left ventricular failure (LVF). Materials and Methods: One hundred patients aged ≥18 years with coronary artery disease admitted with LVF were included in this cross sectional study. Echocardiographic examination was performed. Left ventricular AVPD was evaluated by M mode, in the four and two chamber views. Primary aim was to compare AVPD with LVEF by echocardiography. Secondary outcome measures were comparison of AVPD with traditional risk factors, clinical features, and pro-B-type natriuretic peptide (BNP) levels. Comparison of qualitative and quantitative variables was done by using Chi-square test/Fisher's exact test and unpaired t-test. Pearson's correlation was used to study correlation. Results: Mean AVPD was significantly lower in patients with severe LVEF as compared to mild, and moderate LVEF. Correlation of AVPD with LVEF, pro BNP, septum, anterior, lateral and posterior wall hypokinesia was 0.895. 0.841, 0.898, 0.911, 0.893 and 0.907 respectively. Conclusions: Mean AVPD was significantly lower in patients with severe LVEF. Mean AVPD positively correlated with LVEF, pro BNP, septum, anterior, lateral and posterior wall hypokinesia.

Changes in left and right ventricular longitudinal function after pulmonary valve replacement in patients with Tetralogy of Fallot.

Timing and indication for pulmonary valve replacement (PVR) in patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) are uncertain. To improve understanding of pumping mechanics, we investigated atrioventricular coupling before and after surgical PVR. Cardiovascular magnetic resonance was performed in patients (n = 12) with rToF and PR > 35% before and after PVR and in healthy controls (n = 15). Atrioventricular plane displacement (AVPD), global longitudinal peak systolic strain (GLS), atrial and ventricular volumes, and caval blood flows were analyzed. Right ventricular (RV) AVPD and RV free wall GLS were lower in patients before PVR compared with controls (P < 0.0001; P < 0.01) and decreased after PVR (P < 0.0001 for both). Left ventricular AVPD was lower in patients before PVR compared with controls (P < 0.05) and decreased after PVR (P < 0.01). Left ventricular GLS did not differ between patients and controls (P > 0.05). Right atrial reservoir volume and RV stroke volume generated by AVPD correlated in controls (r = 0.93; P < 0.0001) and patients before PVR (r = 0.88; P < 0.001) but not after PVR. In conclusion, there is a clear atrioventricular coupling in patients before PVR that is lost after PVR, possibly because of loss of pericardial integrity. Impaired atrioventricular coupling complicates assessment of ventricular function after surgery using measurements of longitudinal function. Changes in atrioventricular coupling seen in patients with rToF may be energetically unfavorable, and long-term effects of surgery on atrioventricular coupling is therefore of interest. Also, AVPD and GLS cannot be used interchangeably to assess longitudinal function in rToF.NEW & NOTEWORTHY There is a clear atrioventricular coupling in patients with Tetralogy of Fallot (ToF) and pulmonary regurgitation before surgical pulmonary valve replacement (PVR) that is lost after operation, possibly because of loss of pericardial integrity. The impaired atrioventricular coupling complicates assessment of ventricular function after surgery when using measurements of longitudinal function. Left ventricular atrioventricular plane displacement (AVPD) found differences between patients and controls and changes after PVR that longitudinal strain could not detect. This indicates that AVPD and strain cannot be used interchangeably to assess longitudinal function in repaired ToF.

Increased pulmonary blood volume variation in patients with heart failure compared to healthy controls: a noninvasive, quantitative measure of heart failure.

Variation of the blood content of the pulmonary vascular bed during a heartbeat can be quantified by pulmonary blood volume variation (PBVV) using magnetic resonance imaging (MRI). The aim was to evaluate whether PBVV differs in patients with heart failure compared with healthy controls and investigate the mechanisms behind the PBVV. Forty-six patients and 10 controls underwent MRI. PBVV was calculated from blood flow measurements in the main pulmonary artery and a pulmonary vein, defined as the maximum difference in cumulative PBV over one heartbeat. PBVV was indexed to stroke volume (SV) in the main pulmonary artery (PBVVSV). Patients displayed higher PBVVSV than controls (58 ± 14 vs. 43 ± 7%, P < 0.001). The change in PBVVSV could be explained by left ventricular (LV) longitudinal contribution to SV (R2 = 0.15, P = 0.02) and the phase shift between in- and outflow (R2 = 0.31, P < 0.001) in patients. Both variables contributed to the multiple regression analysis model and predicted PBVVSV (R2 = 0.38); however, the phase shift alone explained ~30% of the variation in PBVVSV. No correlation was found between PBVVSV and large vessel area. In conclusion, PBVVSV was higher in patients compared with controls. Approximately 40% of the variation of PBVVSV in patients can be explained by the LV longitudinal contribution to SV and the phase shift between pulmonary in- and outflow, where the phase shift alone accounts for ~30%. The remaining variation (60-70%) most likely occurs on a small vessel level. Future studies are needed to show the clinical added value of PBVVSV compared with right-heart catheterization.NEW & NOTEWORTHY This study shows that the pulmonary blood volume variation indexed to the stroke volume is higher in patients with heart failure compared with controls. The mechanisms behind this are lack of systolic suction from the left ventricular atrioventricular plane descent and increased phase shift between the in- and outflow to the pulmonary circulation (~40%), where the phase shift alone accounts for ~30%. The remaining variation (60-70%) is suggested to occur on a small vessel level.

Decreased atrioventricular plane displacement after acute myocardial infarction yields a concomitant decrease in stroke volume.

Acute myocardial infarction (AMI) can progress to heart failure, which has a poor prognosis. Normally, 60% of stroke volume (SV) is attributed to the longitudinal ventricular shortening and lengthening evident in the atrioventricular plane displacement (AVPD) during the cardiac cycle, but there is no information on how the relationship changes between SV and AVPD before and after AMI. Therefore, the aim of this study was to determine how SV depends on AVPD before and after AMI in two swine models. Serial cardiac magnetic resonance imaging was carried out before and 1–2 h after AMI in a microembolization model (n = 12) and an ischemia-reperfusion model (n = 14). A subset of pigs (n = 7) were additionally imaged at 24 h and at 7 days. Cine and late gadolinium enhancement images were analyzed for cardiac function, AVPD measurements and infarct size estimation, respectively. AVPD decreased (P < 0.05) in all myocardial regions after AMI, with a concomitant SV decrease (P < 0.001). The ischemia-reperfusion model affected SV to a higher degree and had a larger AVPD decrease than the microembolization model (−29 ± 14% vs. −15 ± 18%; P < 0.05). Wall thickening decreased in infarcted areas (P < 0.001), and A-wave AVPD remained unchanged (P = 0.93) whereas E-wave AVPD decreased (P < 0.001) after AMI. We conclude that AVPD is coupled to SV independent of infarct type but likely to a greater degree in ischemia-reperfusion infarcts compared with microembolization infarcts. AMI reduces diastolic early filling AVPD but not AVPD from atrial contraction. These findings shed light on the physiological significance of atrioventricular plane motion when assessing acute and subacute myocardial infarction.NEW & NOTEWORTHY The link between cardiac longitudinal motion, measured as atrioventricular plane displacement (AVPD), and stroke volume (SV) is investigated in swine after acute myocardial infarction (AMI). This cardiac magnetic resonance study demonstrates a close coupling between AVPD and SV before and after AMI in an experimental setting and demonstrates that this connection is present in ischemia-reperfusion and microembolization infarcts, acutely and during the first week. Furthermore, AVPD is equally and persistently depressed in infarcted and remote myocardium after AMI.

EP10.02: Agreement between anatomical M‐mode and tissue Doppler imaging in the assessment of fetal atrioventricular annular plane displacement in uncomplicated pregnancies: a prospective longitudinal study

EP10.02: Agreement between anatomical M‐mode and tissue Doppler imaging in the assessment of fetal atrioventricular annular plane displacement in uncomplicated pregnancies: a prospective longitudinal study