Heart filling exceeds emptying during late ventricular systole in patients with systolic heart failure and healthy subjects – a cardiac MRI study
(2019) In Clinical Physiology and Functional Imaging 39(3). p.192-200- Abstract
Background: Total heart volume (THV) within the pericardium is not constant throughout the cardiac cycle and THV would intuitively be lowest at end systole. We have, however, observed a phase shift between ventricular outflow and atrial inflow which causes the minimum THV to occur before end systole. The aims were to explain the mechanism of the late-systolic net inflow to the heart and determine whether this net inflow is affected by increased cardiac output or systolic heart failure. Methods and Results: Healthy controls (n = 21) and patients with EF<35% (n = 14) underwent magnetic resonance imaging with flow measurements in vessels to and from the heart, and this was repeated in nine controls during 140 μgram kg−1... (More)
Background: Total heart volume (THV) within the pericardium is not constant throughout the cardiac cycle and THV would intuitively be lowest at end systole. We have, however, observed a phase shift between ventricular outflow and atrial inflow which causes the minimum THV to occur before end systole. The aims were to explain the mechanism of the late-systolic net inflow to the heart and determine whether this net inflow is affected by increased cardiac output or systolic heart failure. Methods and Results: Healthy controls (n = 21) and patients with EF<35% (n = 14) underwent magnetic resonance imaging with flow measurements in vessels to and from the heart, and this was repeated in nine controls during 140 μgram kg−1 min−1 adenosine infusion. Minimum THV occurred 78 ± 6 ms before end of systolic ejection (8 ± 1% of the cardiac cycle) in controls. The late-systolic net inflow was 12·3 ± 1·1 ml or 6·0 ± 0·5% of total stroke volume (TSV). Cardiac output increased 66 ± 8% during adenosine but late-systolic net inflow to the heart did not change (P = 0·73). In patients with heart failure, late-systolic net inflow of the heart′s left side was lower (3·4 ± 0·5%) compared to healthy subjects (5·3 ± 0·6%, P = 0·03). Conclusions: Heart size increases before end systole due to a late-systolic net inflow which is unaffected by increased cardiac output. This may be explained by inertia of blood that flows into the atria generated by ventricular systole. The lower late-systolic net inflow in patients with systolic heart failure may be a measure of decreased ventricular filling due to decreased systolic function, thus linking systolic to diastolic dysfunction.
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- author
- Carlsson, Marcus LU ; Ugander, Martin LU ; Kanski, Mikael LU ; Borgquist, Rasmus LU ; Ekelund, Ulf LU and Arheden, Håkan LU
- organization
- publishing date
- 2019
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- cardiac output, cardiac pumping, diastolic dysfunction
- in
- Clinical Physiology and Functional Imaging
- volume
- 39
- issue
- 3
- pages
- 192 - 200
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- pmid:30506862
- scopus:85057974000
- ISSN
- 1475-0961
- DOI
- 10.1111/cpf.12555
- language
- English
- LU publication?
- yes
- id
- 7b37519c-21d1-46e9-8d72-76117af27cc9
- date added to LUP
- 2019-01-02 09:37:57
- date last changed
- 2024-06-25 03:44:03
@article{7b37519c-21d1-46e9-8d72-76117af27cc9, abstract = {{<p>Background: Total heart volume (THV) within the pericardium is not constant throughout the cardiac cycle and THV would intuitively be lowest at end systole. We have, however, observed a phase shift between ventricular outflow and atrial inflow which causes the minimum THV to occur before end systole. The aims were to explain the mechanism of the late-systolic net inflow to the heart and determine whether this net inflow is affected by increased cardiac output or systolic heart failure. Methods and Results: Healthy controls (n = 21) and patients with EF<35% (n = 14) underwent magnetic resonance imaging with flow measurements in vessels to and from the heart, and this was repeated in nine controls during 140 μgram kg<sup>−1</sup> min<sup>−1</sup> adenosine infusion. Minimum THV occurred 78 ± 6 ms before end of systolic ejection (8 ± 1% of the cardiac cycle) in controls. The late-systolic net inflow was 12·3 ± 1·1 ml or 6·0 ± 0·5% of total stroke volume (TSV). Cardiac output increased 66 ± 8% during adenosine but late-systolic net inflow to the heart did not change (P = 0·73). In patients with heart failure, late-systolic net inflow of the heart′s left side was lower (3·4 ± 0·5%) compared to healthy subjects (5·3 ± 0·6%, P = 0·03). Conclusions: Heart size increases before end systole due to a late-systolic net inflow which is unaffected by increased cardiac output. This may be explained by inertia of blood that flows into the atria generated by ventricular systole. The lower late-systolic net inflow in patients with systolic heart failure may be a measure of decreased ventricular filling due to decreased systolic function, thus linking systolic to diastolic dysfunction.</p>}}, author = {{Carlsson, Marcus and Ugander, Martin and Kanski, Mikael and Borgquist, Rasmus and Ekelund, Ulf and Arheden, Håkan}}, issn = {{1475-0961}}, keywords = {{cardiac output; cardiac pumping; diastolic dysfunction}}, language = {{eng}}, number = {{3}}, pages = {{192--200}}, publisher = {{John Wiley & Sons Inc.}}, series = {{Clinical Physiology and Functional Imaging}}, title = {{Heart filling exceeds emptying during late ventricular systole in patients with systolic heart failure and healthy subjects – a cardiac MRI study}}, url = {{http://dx.doi.org/10.1111/cpf.12555}}, doi = {{10.1111/cpf.12555}}, volume = {{39}}, year = {{2019}}, }