Figure 5

Tissue velocities, radial axis. This representative example shows the tissue velocities from the inferior/posterior left ventricular base, with aortic valve opening (AVO) and aortic valve closure (AVC) marked. Isovolumic contraction (IVC) and the peak systolic velocity (PSV) are also shown. Isovolumic relaxation (IVR) is sometimes a subtle finding, and early diastolic velocity (E’) and late diastolic velocity (A’) are marked. E’ was often difficult to identify during the whole preload reduction sequence, as load decreased. b. Tissue velocities from apical 4 chamber image, septal base region, signal from multiple beats during vena cava occlusion and adrenaline intervention. PSV coincides with the maximal velocities, which remain relative constant throughout the load reduction (see also progressively changing E’ and A’, which move to a fusion curve during the last beats in the sequence. The goal in signal acquisition (septum) was to be as close to the septal annulus as possible, though as illustrated here, occasionally, signal quality dictated that interrogation was performed a small distance from the annulus. This was accepted since the main findings involve relative changes from beat-to-beat over the load reduction sequence. c. Strain in the apical 4 chamber view. The values at zero represent zero deformation during diastole, and the peak systolic strain starts at values of approximately −45% (long axis shortening). In the radial axis, peak systolic strain is positive, starting from a diastolic zero deformation, since the ventricular wall thickens.