Peak apical recoil rate is a simplified index of left ventricular untwist: validation and application for assessment of diastolic function in children
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 ra...
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| Published in | The international journal of cardiovascular imaging Vol. 38; no. 7; pp. 1505 - 1516 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
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Dordrecht
Springer Netherlands
01.07.2022
Springer Nature B.V |
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| Online Access | Get full text |
| ISSN | 1875-8312 1569-5794 1875-8312 1573-0743 |
| DOI | 10.1007/s10554-022-02587-y |
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| 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 ± 2.9 years), of whom 48 performed straight leg raising exercise and an additional 46 patients (mean 8.4 ± 5.6 years) with documented pulmonary capillary wedge pressures (PCWP) (validation cohort). In addition, we studied 16 dilated cardiomyopathy patients (mean age 9.5 ± 6.3 years) (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 ≥ 12 mmHg 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. |
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| AbstractList | 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 ± 2.9 years), of whom 48 performed straight leg raising exercise and an additional 46 patients (mean 8.4 ± 5.6 years) with documented pulmonary capillary wedge pressures (PCWP) (validation cohort). In addition, we studied 16 dilated cardiomyopathy patients (mean age 9.5 ± 6.3 years) (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 ≥ 12 mmHg 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. 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 ± 2.9 years), of whom 48 performed straight leg raising exercise and an additional 46 patients (mean 8.4 ± 5.6 years) with documented pulmonary capillary wedge pressures (PCWP) (validation cohort). In addition, we studied 16 dilated cardiomyopathy patients (mean age 9.5 ± 6.3 years) (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 ≥ 12 mmHg 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. 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 ± 2.9 years), of whom 48 performed straight leg raising exercise and an additional 46 patients (mean 8.4 ± 5.6 years) with documented pulmonary capillary wedge pressures (PCWP) (validation cohort). In addition, we studied 16 dilated cardiomyopathy patients (mean age 9.5 ± 6.3 years) (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 ≥ 12 mmHg 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. 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 ± 2.9 years), of whom 48 performed straight leg raising exercise and an additional 46 patients (mean 8.4 ± 5.6 years) with documented pulmonary capillary wedge pressures (PCWP) (validation cohort). In addition, we studied 16 dilated cardiomyopathy patients (mean age 9.5 ± 6.3 years) (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 ≥ 12 mmHg 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.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 ± 2.9 years), of whom 48 performed straight leg raising exercise and an additional 46 patients (mean 8.4 ± 5.6 years) with documented pulmonary capillary wedge pressures (PCWP) (validation cohort). In addition, we studied 16 dilated cardiomyopathy patients (mean age 9.5 ± 6.3 years) (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 ≥ 12 mmHg 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. |
| Author | Yubbu, Putri Banerjee, Anirban Montero, Andrea E. Matsubara, Daisuke Calderon-Anyosa, Renzo Sato, Tomoyuki Kauffman, Hunter |
| Author_xml | – sequence: 1 givenname: Putri orcidid: 0000-0001-5477-9847 surname: Yubbu fullname: Yubbu, Putri email: drputri@upm.edu.my organization: Department of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Department of Pediatrics, Faculty of Medicine and Health Science, University Putra Malaysia – sequence: 2 givenname: Hunter surname: Kauffman fullname: Kauffman, Hunter organization: Department of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine – sequence: 3 givenname: Renzo surname: Calderon-Anyosa fullname: Calderon-Anyosa, Renzo organization: Department of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine – sequence: 4 givenname: Andrea E. surname: Montero fullname: Montero, Andrea E. organization: Department of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine – sequence: 5 givenname: Tomoyuki surname: Sato fullname: Sato, Tomoyuki organization: Department of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine – sequence: 6 givenname: Daisuke surname: Matsubara fullname: Matsubara, Daisuke organization: Department of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine – sequence: 7 givenname: Anirban surname: Banerjee fullname: Banerjee, Anirban organization: Department of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35290534$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1016/j.ejheart.2003.12.018 10.1016/j.echo.2014.07.016 10.1016/0002-8703(92)90416-S 10.1152/ajpheart.2001.281.5.H2002 10.1016/s0735-1097(97)88335-0 10.1016/j.echo.2008.06.012 10.1161/01.RES.66.3.814 10.1161/CIRCULATIONAHA.105.596502 10.1161/JAHA.115.002530 10.1067/mje.2003.17 10.1161/CIRCIMAGING.112.000175 10.1016/j.yjmcc.2009.11.013 10.1161/01.RES.70.1.9 10.1093/ehjci/jex067 10.1093/eurheartj/ehm037 10.1016/j.jcmg.2009.01.015 10.1093/ehjci/jew082 10.1161/CIRCULATIONAHA.109.869602 10.1161/01.RES.72.4.795 10.1007/s00246-002-1506-4 10.1016/j.jelectrocard.2005.06.097 10.1016/j.jtcvs.2011.10.066 10.1016/0735-1097(93)90787-2 |
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| Keywords | Diastolic function Speckle tracking echocardiography Peak apical recoil rate Cardiomyopathy Pediatric |
| Language | English |
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| SubjectTerms | Capillary pressure Cardiac Imaging Cardiology Cardiomyopathy Children Clinical medicine Dilated cardiomyopathy Exercise Heart rate Imaging Laboratories Medicine Medicine & Public Health Original Paper Patients Pediatrics Physical fitness Physical training Radiology Recoil Relaxation time Ventricle |
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| Title | Peak apical recoil rate is a simplified index of left ventricular untwist: validation and application for assessment of diastolic function in children |
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