Functional importance of the long axis dynamics of the human left ventricle.

Abstract

The role of longitudinally and circumferentially oriented fibres in left ventricular wall motion was examined by digitising echocardiograms of the mitral ring (whose motion reflects long axis change) and of the standard minor axis in 36 healthy individuals, 36 patients with coronary artery disease, 16 with left ventricular hypertrophy, 44 with mitral valve disease (24 of whom had undergone mitral valve replacement). In the controls long axis shortening significantly preceded minor axis shortening (mean (1 SD) difference 25 (40) ms) so that the minor axis increased more during isovolumic contraction (0 25 v 0 09 cm), indicating that the left ventricle became more spherical. Changes in the long and short axes were synchronous at end ejection and in early diastole in the controls. Epicardial excursion preceded endocardial excursion by 50 (20) ms at its peak. These time relations were consistently disturbed in all patient groups, irrespective of the extent of fractional shortening of the minor axis. The onset of long axis shortening was delayed, and this was often associated with premature shortening of the minor axis, the normal spherical shape change during isovolumic contraction was lost, and peak epicardial and endocardial changes became more synchronous. In patients with coronary disease these changes are the expected consequence of ischaemic injury to longitudinally orientated subendocardial fibres. In left ventricular hypertrophy their presence consistently showed systolic dysfunction when orthodox measures were still normal. They were more pronounced after mitral valve replacement when the papillary muscles had been sectioned; long axis shortening was reduced during systole and prolonged into early diastole, while normal shortening of the minor axis was maintained only by abnormal epicardial excursion.Relations between long and short axis motion in healthy individuals are characteristic, and their loss is an early index of systolic ventricular disease. These disturbances precede changes in orthodox measures such as fractional shortening or peak velocity of circumferential fibre shortening.Anatomical studies'2 have shown longitudinal as well as circumferential fibres with a continuous variation in fibre angle across the left ventricular wall. The function of these longitudinal fibres has not been extensively studied. Because effective ventricular function during ejection and filling is likely to depend upon the coordinated action of all myocardial layers, we set out to study the timing and extent of changes in the long axis, comparing them with those of the minor axis in healthy controls and those with left ventricular disease. In addition, we investigated patients after mitral valve replacement where a component of the longitudinal fibres (the papillary muscles) had been sectioned. Patients and methods CONTROLS AND PATIENTSCross sectionally guided M mode echocardiograms were recorded and analysed in 36 patients with coronary artery disease, 16 with left ventricular hypertrophy, 44 patients with mitr...

Blood pressure and left ventricular geometric pattern determine diastolic function in hypertensive myocardial hypertrophy

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