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• W2789362595 abstract "I read with great interest the paper “Effect of Gravitational Gradients on Cardiac Filling and Performance,” by Negishi et al.,1Negishi K. Borowski A.G. Popović Z.B. Greenberg N.L. Martin D.S. Bungo M.W. et al.Effect of gravitational gradients on cardiac filling and performance.J Am Soc Echocardiogr. 2017; 30: 1180-1188Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar which demonstrates effects of increasing body tilt on measures of left ventricle performance. The study is a comprehensive assessment of hemodynamic changes with increasing tilt angle. It also highlights some of the hemodynamic differences between strain rate and strain. The interpretation that reduced tilt simulates generally reduced gravity is interesting. In their report, the authors interpret the results that increasing tilt does not reduce the magnitude of strain rate, while it substantially reduces strain, to show that strain rate is not preload dependent while strain is preload dependent. This interpretation, being contrary to general physiological knowledge, needs some comments. First, there is a significant 8% decrease in the magnitude of global longitudinal strain rate (GLSR) with increasing tilt, even with the small sample size, although global longitudinal strain (GLS) decreases more, by 26%. Thus, tilt affects both, but to a different degree. Basic physiological experiments have shown that both strain rate and strain are preload dependent, and not to a very different degree, all other factors being equal.2Sonnenblick E.H. Force-velocity relations in mammalian heart muscle.Am J Physiol. 1962; 202: 931-939Crossref PubMed Scopus (336) Google Scholar This is logical, as the Frank-Starling effect is about force generation. On the other hand, strain rate (and peak systolic velocity [S’], being equivalent) is far less afterload dependent, being early systolic, and close to the initial rate of shortening, while strain is end ejection and related to stroke volume (SV).3Thorstensen A. Dalen H. Amundsen B.H. Støylen A. Peak systolic velocity indices are more sensitive than end-systolic indices in detecting contraction changes assessed by echocardiography in young healthy humans.Eur J Echocardiogr. 2011; 12: 924-930Crossref PubMed Scopus (22) Google Scholar, 4Weidemann F. Jamal F. Sutherland G.R. Claus P. Kowalski M. Hatle L. et al.Myocardial function defined by strain rate and strain during alterations in inotropic states and heart rate.Am J Physiol Heart Circ Physiol. 2002; 283: H792-H799Crossref PubMed Scopus (345) Google Scholar Thus, it is the difference in afterload dependence that is responsible for the closer correlation of strain rate to elastance.5Greenberg N.L. Firstenberg M.S. Castro P.L. Main M. Travaglini A. Odabashian J.A. et al.Doppler-derived myocardial systolic strain rate is a strong index of left ventricular contractility.Circulation. 2002; 105: 99-105Crossref PubMed Scopus (442) Google Scholar Finally, contractile force is also heart rate (HR) dependent through the force-frequency relation, but increased HR will decrease SV without increased venous return, so this will affect strain rate and strain in opposite directions. Looking closely at the results (and the measures are commendably complete), it is evident that tilt manipulates much more than preload. At 22° there is no decrease in end-diastolic volume (EDV - preload) but a modest decrease in Doppler SV and thus decrease in GLS but not GLSR. At 41° there is a modest decrease in EDV, a substantial decrease in SV, and an increase in vascular resistance (SVR). This increase in afterload contributes further to reduced SV. Consistent with this being mainly an effect of afterload increase, there is a substantial decrease in GLS but nearly no change in GLSR and S’. At 80° there is a further decrease in EDV, SV, and GLS, no change in GLSR or S’, but a further increase in SVR, and in addition an increased HR. This might be interpreted as being an effect of decreased preload but for GLSR and S’ by the increase in HR, as well as an afterload effect on GLS. This interpretation is more in accordance with established physiology. Effect of Gravitational Gradients on Cardiac Filling and PerformanceJournal of the American Society of EchocardiographyVol. 30Issue 12PreviewGravity affects every aspect of cardiac performance. When gravitational gradients are at their greatest on Earth (i.e., during upright posture), orthostatic intolerance may ensue and is a common clinical problem that appears to be exacerbated by the adaptation to spaceflight. We sought to elucidate the alterations in cardiac performance during preload reduction with progressive upright tilt that are relevant both for space exploration and the upright posture, particularly the preload dependence of various parameters of cardiovascular performance. Full-Text PDF Authors’ ReplyJournal of the American Society of EchocardiographyVol. 31Issue 7PreviewWe read with great interest the letter of Professor Stoylen1 commenting on our recent publication, “Effect of Gravitational Gradients on Cardiac Filling and Performance,”2 and we believe he has raised a number of important points. Full-Text PDF" @default.
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• W2789362595 date "2018-07-01" @default.
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• W2789362595 title "Strain and Strain Rate: Different Preload Dependence?" @default.
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• W2789362595 doi "https://doi.org/10.1016/j.echo.2018.01.020" @default.
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