Circulation, Vol 71, 266-272, Copyright © 1985 by American Heart Association
G Shimizu, MR Zile, AS Blaustein and WH Gaasch
Observations that the inner (subendocardial) half of the left ventricular
wall contributes more to total left ventricular wall thickening than the
outer (subepicardial) half may have important implications in the analysis
of myocardial fiber length transients. Accordingly, we measured endocardial
and midwall shortening and lengthening rates in normal and hypertrophic
heart and compared the results obtained with conventional methods of
measurement with those obtained with a modified model that does not depend
on use of conventional assumptions about the midwall. This modified
(two-shell) cylindrical model) method considers the substantial
contribution of inner wall thickening and thus does not require the
assumption of a theoretical midwall fiber that remains at the midwall
throughout the cardiac cycle. Echocardiographic data from six normal
subjects and six patients with concentric left ventricular hypertrophy
(LVH) were examined; left ventricular wall thickness ranged from 8 to 10 mm
in normal subjects and from 11 to 16 mm in the patients with LVH. By
design, the standard measurements of left ventricular size (diastolic and
systolic dimensions) and systolic function (fractional shortening and
endocardial fiber shortening velocities) were equal in the two groups.
Endocardial, conventional midwall, and modified midwall methods all
indicate reduced fiber lengthening rates in patients with LVH; peak fiber
lengthening rates for normal and LVH groups were 4.5 +/- 0.7 vs 3.1 +/- 0.8
sec-1 (p less than .02) at the endocardium, 2.3 +/- 0.4 vs 1.6 +/- 0.4
sec-1 (p less than .02) at the midwall (conventional method), and 2.1 +/-
0.3 vs 1.4 +/- 0.3 sec-1 (p less than .01) at the midwall (modified
method).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Left ventricular chamber filling and midwall fiber lengthening in patients with left ventricular hypertrophy: overestimation of fiber velocities by conventional midwall measurements
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