Circulation, Vol 67, 1234-1245, Copyright © 1983 by American Heart Association
RV Haendchen, HL Wyatt, G Maurer, W Zwehl, M Bear, S Meerbaum and E Corday
Regional differences in wall motion and wall thickening were quantitated in
the normal left ventricle using two-dimensional echocardiography (2-D
echo). Using a computer-aided system, the left ventricle was subdivided in
a standardized manner into 40 segments of five 2-D echo short-axis cross
sections from the mitral valve level to the low left ventricle or apex.
Measurements of sectional and segmental cavity areas, muscle areas and
endocardial as well as epicardial perimeters, allowed assessment of
contractile function using such indexes as endocardial systolic fractional
area change (FAC), wall thickening (WTh), and circumferential fiber
shortening (shortening). In 50 normal anesthetized, closed-chest dogs
(including 10 studies in the conscious state) and in 32 normal humans, left
ventricular contractile function increased significantly from base to apex.
Thus, in anesthetized dogs, sectional FAC, WTh and shortening increased
from left ventricular base to apex as follows: 39.4 +/- 5.1% to 61.6 +/-
7.2%, 20.5 +/- 6.6% to 46.7 +/- 11.5% and 22.7 +/- 3.4% to 35.4 +/- 5.9%,
respectively. Similar trends were noted in conscious dogs. In man,
sectional FAC, WTh and shortening also increased from the mitral valve to
the low left ventricular level: 38.8 +/- 3.3% to 60.7 +/- 4.5%, 23.9 +/-
5.6% to 28.9 +/- 7.6% and 21.4 +/- 5.0% to 30.6 +/- 5.6%, respectively.
Detailed segmental analysis in individual cross sections also revealed
regional differences in contraction. Generally, contraction was most
vigorous in posterior regions of the left ventricle. The septal regions
exhibited lowest contraction at the base, but also the greatest increase
from base to apex, both in the canine and human. Lateral regions did not
show significant changes along the length of the left ventricle. Diastolic
wall thickness also varied. We conclude that contraction in the normal left
ventricle cannot be assumed to be uniform or symmetrical. These normal
regional differences in function should be taken into account when
evaluating altered physiologic states and in studying effects of
therapeutic interventions.
ARTICLES
Quantitation of regional cardiac function by two-dimensional echocardiography. I. Patterns of contraction in the normal left ventricle
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