Impact of Afterload Increase on Left Ventricular Myocardial Deformation Indices

J Am Soc Echocardiogr. 2016 Dec;29(12):1217-1228. doi: 10.1016/j.echo.2016.09.006. Epub 2016 Oct 14.

Abstract

Background: Left ventricular (LV) afterload could be associated with reduced myocardial contractility. The aim of this study was to evaluate the relative impact of increased afterload on LV myocardial deformation indices in chronic aortic constriction, with regard to hypertrophy, myocardial fibrosis, and mitochondrial function, and to differentiate acute versus chronic afterload effect.

Methods: Young pigs underwent aortic banding (n = 11) or sham (n = 7) operations. Nineteen weeks later, LV morphology and systolic function, including myocardial deformation, were assessed by echocardiography before and after banding release or acute aortic constriction (in the sham group). After the animals were euthanized, mitochondrial function and LV interstitial fibrosis were assessed.

Results: The chronic banding group (n = 8) presented with significant LV hypertrophy compared with the sham group (n = 7), and longitudinal strain (LS) was significantly altered (16.9 ± 0.7% vs 20.3 ± 0.7%, P = .001) while circumferential, radial strain, and ejection fraction were not. LS abnormalities were situated mostly on the basal and mid segments and on the septal wall. There was also significantly more myocardial fibrosis in the chronic banding group compared with the sham group, while mitochondrial function was preserved. The relative contributions of hypertrophic and fibrotic remodeling and of afterload to alter global LS were 62%, and 38%, respectively. Acute aortic banding also significantly altered LS. The ratio of LS to septal wall thickness enabled differentiation between chronic and acute afterload increase (1.9 ± 0.2 in the chronic group vs 2.9 ± 0.3 in the acute group, P = .001).

Conclusions: LS is susceptible to both hypertrophic and fibrotic remodeling and afterload increase, particularly on the basal and mid LV segments of the septum. The ratio of LS to septal wall thickness enables differentiation of acute from chronic afterload LS alteration.

Keywords: Animal model; Aortic stenosis; Echocardiography; Left ventricular afterload; Left ventricular hypertrophy; Myocardial strain.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Aortic Valve Stenosis / complications
  • Aortic Valve Stenosis / diagnostic imaging*
  • Aortic Valve Stenosis / physiopathology*
  • Blood Pressure*
  • Echocardiography / methods
  • Elastic Modulus
  • Elasticity Imaging Techniques / methods
  • Male
  • Myocardial Contraction*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Stress, Mechanical
  • Stroke Volume*
  • Swine
  • Ventricular Dysfunction, Left / diagnostic imaging*
  • Ventricular Dysfunction, Left / etiology
  • Ventricular Dysfunction, Left / physiopathology*