Paradoxical Motion of the Posterior Left Ventricular Wall Seen in Healthy Subjects in the Upright Position

Sasaki, Hiroyuki; Charuzi, Yzhar; Sugiki, Yuji; Honma, Hiroshi; Ostrzega, Enrique

doi:10.1016/s0894-7317(88)80022-1

Cited by 2 publications

(5 citation statements)

References 4 publications

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“…In the present study, we examined the incidence of PLI in normal subjects on left lateral position and found that 0.11% (9/7843) of subjects exhibit PLI in this condition. On the other hand, PLI was induced by sitting position in 43% of subjects without PLI on left lateral position, consistent with the previous report in which PLI was induced in 55% of normal subjects by upright position 11 . Obviously the incidence of PLI is dependent on its definition.…”

Section: Discussionsupporting

confidence: 91%

“…PLI in supine position was first described in patients with mitral valve prolapse and the incidence of PLI in those patients was reported to be 16% 10 . Subsequently, however, same observation was reported in normal subjects on upright position, 11 indicating that PLI is a physiological phenomenon, although the mechanism of PLI was not revealed in these previous reports. In the present study, we examined the incidence of PLI in normal subjects on left lateral position and found that 0.11% (9/7843) of subjects exhibit PLI in this condition.…”

Section: Discussionmentioning

confidence: 91%

“…On the other hand, PLI was induced by sitting posi- tion in 43% of subjects without PLI on left lateral position, consistent with the previous report in which PLI was induced in 55% of normal subjects by upright position. 11 Obviously the incidence of PLI is dependent on its definition. We defined PLI as the outward movement of LV inferior wall observed during more than 50% of the systolic phase.…”

Section: Incidence Of Plimentioning

confidence: 99%

“…Another less‐characterized exception is that the paradoxical outward movement of LV inferior wall in early systole (referred to hereafter as pseudo‐asynergy of LV inferior wall (PLI)) is occasionally observed in normal subjects at two‐dimensional (2D) echocardiography. Paradoxical outward movement of LV inferior wall in echocardiography was first described in patients with mitral valve prolapse, 10 but was subsequently reported to be found in normal healthy subjects on standing position, 11 indicating the physiological nature of this observation. However, the precise incidence and potential mechanisms of PLI are not known.…”

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confidence: 92%

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Close Physical Contact of the Heart with Diaphragm Causes Pseudo‐Asynergy of Left Ventricular Inferior Wall in Normal Subjects

et al. 2004

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Paradoxical outward movement of left ventricular (LV) inferior wall in systole is occasionally recognized in normal subjects and clinically important in terms of the differential diagnosis between physiological pseudo-asynergy and pathological asynergy. In this study, the potential mechanisms by which pseudo-asynergy of LV inferior wall (PLI) is observed in normal subjects were investigated. PLI was defined as the outward movement of LV inferior wall observed during more than 50% of systole. The incidence of PLI was evaluated in 7843 consecutive subjects in routine echocardiography. The effects of body position and artificial gravity on the manifestation of PLI were also examined. PLI was observed in 0.11% (9/7842) of subjects on left lateral position. Measurement of the angle formed by LV long-axis and the long-axis of the body on frontal plane revealed that hearts in subjects with PLI were in relatively horizontal position. PLI was observed on sitting position in 43% (40/92) of subjects without PLI on left lateral position. The subjects with sitting position-induced PLI exhibited significantly higher obesity index. PLI was also induced by artificial gravity in 67% (14/21) of healthy volunteers on supine position, and the degree of PLI correlated with the intensity of gravity. Although the incidence of PLI in routine echocardiography is relatively low, PLI can be induced in normal subjects by any condition that causes close contact of LV inferior wall to diaphragm. Thus, PLI should be taken into consideration in the differential diagnosis of abnormal LV inferior wall motion, especially when performing exercise echocardiography.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 91%

Section: Incidence Of Plimentioning

confidence: 99%

mentioning

confidence: 92%

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Close Physical Contact of the Heart with Diaphragm Causes Pseudo‐Asynergy of Left Ventricular Inferior Wall in Normal Subjects

et al. 2004

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“…Changes of LV wall motion in the mid-basal inferior and/or posterolateral segments in upright posture, have already been described by Sasaki et al in a cohort of healthy volunteers [37]. The authors hypothesized that the observed changes of LV wall motion in upright posture might be influenced by the anatomic position of the heart, particularly by its proximity to the diaphragm and posterior mediastinum [37].…”

Section: Discussionmentioning

confidence: 82%

The impact of upright posture on left ventricular deformation in athletes

Kandels

Metze

Hagendorff

et al. 2023

Int J Cardiovasc Imaging

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Besides LV ejection fraction (LVEF), global longitudinal strain (GLS) and global myocardial work index (GWI) are increasingly important for the echocardiographic assessment of left ventricular (LV) function in athletes. Since exercise testing is frequently performed on a treadmill, we investigated the impact of upright posture on GLS and GWI. In 50 male athletes (mean age 25.7 ± 7.3 years) transthoracic echocardiography (TTE) and simultaneous blood pressure measurements were performed in upright and left lateral position. LVEF (59.7 ± 5.3% vs. 61.1 ± 5.5%; P = 0.197) was not affected by athletes’ position, whereas GLS (− 11.9 ± 2.3% vs. − 18.1 ± 2.1%; P < 0.001) and GWI (1284 ± 283 mmHg% vs. 1882 ± 247 mmHg%; P < 0.001) were lower in upright posture. Longitudinal strain was most frequently reduced in upright posture in the mid-basal inferior, and/or posterolateral segments. Upright posture has a significant impact on LV deformation with lower GLS, GWI and regional LV strain in upright position. These findings need to be considered when performing echocardiography in athletes. Graphical Abstract

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Paradoxical Motion of the Posterior Left Ventricular Wall Seen in Healthy Subjects in the Upright Position

Cited by 2 publications

References 4 publications

Close Physical Contact of the Heart with Diaphragm Causes Pseudo‐Asynergy of Left Ventricular Inferior Wall in Normal Subjects

Close Physical Contact of the Heart with Diaphragm Causes Pseudo‐Asynergy of Left Ventricular Inferior Wall in Normal Subjects

The impact of upright posture on left ventricular deformation in athletes

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