Quantitative analysis of segmental wall motion throughout systole and diastole in the normal human left ventricle.

Abstract

SUMMARY We traced left ventricular contours, frame-by-frame throughout systole and diastole, of normal sinus beats from 300 right anterior oblique ventriculograms from 32 normal patients. We separated both systole and diastole into 19 equal time intervals each and calculated regional lengths (R), normalized by both end-diastolic length and relative time interval (T) in systole and diastole, for the middle inferior wall, distal inferior wall, apex, distal anterior wall, middle anterior wall, and proximal anterior wall. We also computed the relative velocities of R, AR/AT, over each quarter of systole and diastole.Comparing systole with diastole, we found significant differences between paired values of R at all regions except the distal inferior wall, but these differences were not the same between regions. Between regions, mean R and AR/AT values were significantly different as early as tde first quarter of systole. Within a region, there were significant differences between mean R and AR/AT values over intervals as short as one-fourth of systole or diastole.Thus, there is no homogeneity between regions in normal wall motion in both systole and diastole. This normal lack of homogeneity has important clinical implications for identifying abnormal wall motion in individual patients from ventriculographic measurements, and for using the information present in the diastolic portion of the ventriculogram to characterize normal and abnormal segmental function.QUANTITATIVE ANALYSIS of left ventricular segmental wall motion has become an important tool for evaluating the ventricular function of patients with ischemic heart disease.'1-7 Despite the widespread application of quantitative techniques to characterize localized abnormalities of contraction, there have been relatively few detailed studies of regional differences in normal contraction.1' 7 10, 17-19 Further, there are few data available about normal patterns of segmental wall motion during diastole20 22 or the normal relationships between systolic and diastolic motion in the same region.22In this study, we measured segmental wall motion throughout systole and diastole in 32 patients who were catheterized for evaluation of chest discomfort syndromes and found to have normal cardiac function and no significant coronary artery disease. We quantified regional patterns of normal wall motion throughout the cardiac cycle, examined relationships between systolic and diastolic motion in each region, and compared patterns both between regions at the same points in the cardiac cycle and between points in the cardiac cycle at the same region. Methods Patient PopulationWe used ventriculograms obtained in 13 men and 19 women, average age 52 ± 10 years (mean ± SD), who Thirty-degree right anterior oblique (RAO) left ventriculograms were recorded at 60 frames/sec on 16-mm cine film as meglumine diatrizoate (Renografin-76) was injected into the ventricle at a rate of 15 ml/sec for 3 seconds. We reviewed each ventriculogram and only analyzed sinus beats that were not preceded by...

Two-dimensional ultrasonic tissue characterization: backscatter power, endocardial wall motion, and their phase relationship for normal, ischemic, and infarcted myocardium.

“…As time progressed beyond 90 min the cyclic backscatter power increased so that by 5 hr after occlusion the cyclic variation was very near the normal baseline value. We have defined ischemia (reversible) as the ACUTE INFARCT STUDY IN 10) A (N= 15 ) Cyclic Power ( db. ) 5 degrees, which has a significance level when compared to the ischemic period of p < .001.…”

Regional comparison of midwall segment and area shortening in the canine left ventricle.

“…Techniques such as contrast left ventriculography (Liedtke et al, 1973;Sniderman et al, 1973;Bove et al, 1978;Gelberg et al, 1979;Klausner et al, 1982;Sheehan et al, 1983) and echocardiography (Shapiro et al, 1981;Haendchen et al, 1983) demonstrate considerable nonuniformity of the contraction process. However, these techniques a priori impose a certain level of uniformity on the contraction process by presuming that different endocardial sites will all move along a perpendicular pathway to a common long axis, or along a prescribed radial pathway to a common center of mass.…”

“…We were particularly interested in the minor axis level because several indices of systolic function estimate the amount of circumferential shortening at this level by measuring the resultant shortening of an internal diameter, radius, or minor axis chord. Although considerable nonuniformity of contraction has been demonstrated by techniques such as left ventriculography (Liedtke et al, 1973;Sniderman et al, 1973;Bove et al, 1978;Gelberg et al, 1979;Klausner et al, 1982;Sheehan et al, 1983), echocardiography (Shapiro et al, 1981;Haendchen et al, 1983) and fluoroscopic tracking of midwall markers (Ingels et al, 1980(Ingels et al, , 1981, these methods do not directly measure regional circumferential shortening, but rather infer this from the resultant motion which occurs perpendicular to the assumed major direction of shortening.…”

Global and regional right ventricular function in normal infants and infants with transposition of the great arteries after Senning operation.

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