The heart as a spring, the measurement of myocardial bounce to assess left ventricular function on cardiac MR


Little has been reported on the left ventricular myocardial distension (bounce) and its utility to assess cardiac function. The purpose of this study is to determine whether myocardial bounce at end diastole is reproducibly visualized by blinded observers and to determine whether it corresponds to systolic and diastolic function. 144 Consecutive cardiac MR exams between September and December 2017 were selected for analysis. The bounce was graded by two blinded observers, and the change in LV diameter pre and post bounce was measured. The bounce was defined as the rapid change in LV volume that occurs at the end of diastole during atrial contraction just prior to systolic ejection. Inter-reader agreement was summarized using Cohen’s kappa. Spearman’s rank correlation coefficient was used to evaluate associations between bounce grade and cardiac physiology parameters. Overall agreement was good with unweighted kappa = 0.69 (95% CI 0.60–0.79). Bounce grade was significantly correlated with the average change in LV diameter before and after the bounce (Spearman’s rho = 0.76, p < 0.001). Median diameter changes were 0.0, 1.9, and 4.2 mm in grades 0 (no bounce), 1 (small bounce), and 2 (normal), respectively. The bounce lasted 8 to 12 ms in all patients. Bounce grade was significantly correlated with LV EF (Spearman’s rho = 0.43, p < 0.001). Median EF was 44%, 51%, and 58% in grades 0, 1, and 2, respectively. Of the 87 patients who had E/A ratio or E/e′ ratio measured, bounce grade was also significantly correlated with E/A ratio (r =  − 0.24, p = 0.034) and E/e′ ratio (r =  − 0.24, p = 0.022), with lower grades having higher ratio values on average (Table 4). Of the 15 patients with a bounce grade of 0 by one or both readers and EF ≥ 50%, 8 had E/A ratio measurements and 7 had E/e′ ratio measurements. The E/A ratio values ranged from 1 to 2.7 (median 1.5). The E/e′ ratio values ranged from 4.8 to 9.6 (median 7.7). The simple observation of a normal myocardial bounce during cine loop review of cardiac MR exams was predictive of normal diastolic and systolic cardiac function. Lack of myocardial bounce was highly associated with both systolic and diastolic dysfunction. The subpopulation of patients with loss of myocardial bounce and normal ejection fraction appear to represent patients with early diastolic dysfunction. Further studies with more diastolic dysfunction MRs are needed to examine this relationship. This study suggests changes to the myocardial bounce seen on cardiac MR may be a simple useful tool for detecting cardiac dysfunction. This study is not to replace, but rather aid the clinical diagnosis and management of both diastolic and systolic dysfunction.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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  1. 1.

    Heidenreich PA, Albert NM, Allen LA et al (2013) Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail 6(3):606–619

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Arques S, Ambrosi P, Roux E et al (2008) Tissue Doppler echocardiography for the diagnosis of new-onset heart failure with normal ejection fraction: influence of serum protein concentration on clinical interpretation in elderly patients. Arch Cardiovasc Dis 101(5):343–350

    PubMed  Article  Google Scholar 

  3. 3.

    Baan J, van der Velde ET, Steendijk P (1992) Ventricular pressure–volume relations in vivo. Eur Heart J 13(Suppl E):2–6

    PubMed  Article  Google Scholar 

  4. 4.

    Yip GW, Zhang Q, Xie JM et al (2011) Resting global and regional left ventricular contractility in patients with heart failure and normal ejection fraction: insights from speckle-tracking echocardiography. Heart 97(4):287–294

    PubMed  Article  Google Scholar 

  5. 5.

    Haubrich WS (2003) Starling of Starling’s law. Gastroenterology 124(7):1766

    PubMed  Article  Google Scholar 

  6. 6.

    Giuliodori MJ, Lujan HL, Briggs WS et al (2009) Hooke’s law: applications of a recurring principle. Adv Physiol Educ 33(4):293–296

    PubMed  Article  Google Scholar 

  7. 7.

    Braunwald E, Frahm CJ, Ross J Jr (1961) Studies on Starling’s law of the heart V Left ventricular function in man. J Clin Investig 40:1882–1890

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Sequeira V, van der Velden J (2015) Historical perspective on heart function: the Frank-Starling Law. Biophys Rev 7(4):421–447

    PubMed  Article  Google Scholar 

  9. 9.

    Babu A, Sonnenblick E, Gulati J (1988) Molecular basis for the influence of muscle length on myocardial performance. Science 240(4848):74–76

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Abel FL (2001) Pmax, end systolic elastance, and Starling’s law of the heart. Shock 15(1):56–59

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Le Guennec JY, Peineau N, Argibay JA et al (1990) A new method of attachment of isolated mammalian ventricular myocytes for tension recording: length dependence of passive and active tension. J Mol Cell Cardiol 22(10):1083–1093

    PubMed  Article  Google Scholar 

  12. 12.

    Brady AJ (1966) Onset of contractility in cardiac muscle. J Physiol 184(3):560–580

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Hess OM (1993) Hemodynamics in heart failure: systolic and diastolic dysfunction. Ther Umsch 50(6):414–418

    CAS  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Moibenko OO, Hryhorash HA, Kostylev MV (1995) Disorders of myocardial contractile function and the mechanisms of their compensation in ischemic heart disease in man. Fiziol Zh 41(5–6):70–79

    CAS  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Takeuchi Y, Yokota Y, Tsumura Y et al (1992) Left atrial ejection performance in heart failure as assessed by transesophageal Doppler echocardiography. J Cardiol 22(1):193–200

    CAS  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Tan YT, Wenzelburger F, Lee E et al (2009) The pathophysiology of heart failure with normal ejection fraction: exercise echocardiography reveals complex abnormalities of both systolic and diastolic ventricular function involving torsion, untwist, and longitudinal motion. J Am Coll Cardiol 54(1):36–46

    PubMed  Article  Google Scholar 

  17. 17.

    Iwase M, Aoki T, Maeda M et al (1988) Relationship between beat to beat interval and left ventricular function in patients with atrial fibrillation. Int J Card Imaging 3(4):217–226

    PubMed  Article  Google Scholar 

  18. 18.

    Klein HO, Keren G, Bakst A et al (1998) Transient bradycardia induced by carotid sinus pressure increases outflow obstruction in hypertrophic obstructive cardiomyopathy but not in valvular aortic stenosis. Chest 114(2):469–476

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Qirko S, Tase M, Lushnjari V et al (1996) Left atrial contractility function in hypertension. Arch Mal Coeur Vaiss 89(8):1003–1007

    CAS  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Nagueh SF, Smiseth OA, Appleton CP et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 17(12):1321–1360

    Article  Google Scholar 

  21. 21.

    Pourmoghaddas M, Sanei H, Tavassoli A et al (2011) Estimation of left ventricular end diastolic pressure (LVEDP) in patients with ischemic heart disease by echocardiography and compare it with the results of cardiac catheterization. ARYA Atheroscler 7(1):1–6

    PubMed  PubMed Central  Google Scholar 

  22. 22.

    Gordon AM, Huxley AF, Julian FJ (1966) The variation in isometric tension with sarcomere length in vertebrate muscle fibres. J Physiol 184(1):170–192

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Ramos JG, Fyrdahl A, Wieslander B et al (2020) Comprehensive cardiovascular magnetic resonance diastolic dysfunction grading shows very good agreement compared with echocardiography. JACC Cardiovasc Imaging.

    PubMed  Article  PubMed Central  Google Scholar 

  24. 24.

    Ramos JG, Fyrdahl A, Wieslander B et al (2020) Cardiovascular magnetic resonance 4D flow analysis has a higher diagnostic yield than Doppler echocardiography for detecting increased pulmonary artery pressure. BMC Med Imaging 20(1):28

    PubMed  Article  Google Scholar 

  25. 25.

    Mordi IR, Singh S, Rudd A et al (2018) Comprehensive echocardiographic and cardiac magnetic resonance evaluation differentiates among heart failure with preserved ejection fraction patients, hypertensive patients, and healthy control subjects. JACC Cardiovasc Imaging 11(4):577–585

    PubMed  Article  Google Scholar 

  26. 26.

    Omar AM, Vallabhajosyula S, Sengupta PP (2015) Left ventricular twist and torsion: research observations and clinical applications. Circ Cardiovasc Imaging 8(6):e003029.

    PubMed  Article  Google Scholar 

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All authors contributed to the study conception and design. Material preparation and data collection were performed by TJD and EQ. Statistical analysis were performed by DSH and TJD. The first draft of the manuscript was written by EQ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Erica Qiao.

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Video 1.

(AVI 9450 kb) Cine loop short axis view of Fig. 1 demonstrating the normal diastolic “bounce” that occurs at end diastole during atrial contraction

Video 2.

(AVI 8866 kb) Cine loop four-chamber view of Fig. 1 demonstrating the normal diastolic “bounce” that occurs at end diastole during atrial contraction

Video 3.

(AVI 8014 kb) Cine loop short axis view as seen in Fig. 5 demonstrating no myocardial bounce at end diastole. In this case, minimal atrial contraction is evident in Video 4

Video 4.

(AVI 7952 kb) Cine loop four-chamber view as seen in Fig. 5 demonstrating no myocardial bounce at end diastole. In this case, minimal atrial contraction is evident

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Qiao, E., Amin, K., Hippe, D.S. et al. The heart as a spring, the measurement of myocardial bounce to assess left ventricular function on cardiac MR. Int J Cardiovasc Imaging (2021).

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  • Assessment of cardiac function
  • Heart failure
  • Myocardial bounce
  • Systolic and diastolic function
  • Cardiac MRI
  • Diagnosis and management of systolic and diastolic dysfunction