Circulation, Vol 83, 1676-1684, Copyright © 1991 by American Heart Association
G Shimizu, Y Hirota, Y Kita, K Kawamura, T Saito and WH Gaasch
BACKGROUND. Left ventricular (LV) midwall geometry has been described
conventionally as the sum of the chamber radius and half of the wall
thickness; this convention is based on the assumption of uniform transmural
thickening during systole. However, theoretical considerations and
experimental data indicate that the inner half (inner shell) of the LV wall
thickens more than the outer half (outer shell). Thus, an end-diastolic
circumferential midwall fiber exhibits a relative migration toward the
epicardium during systole. As a result, the conventional method provides an
overestimate of the extent of the midwall fiber shortening. METHODS AND
RESULTS. We developed an ellipsoidal model with a concentric two-shell
geometry (nonuniform thickening) to assess midwall fiber length transients
throughout the cardiac cycle. This modified midwall method was used in the
analysis of LV cineangiograms from 15 patients with systemic arterial
hypertension and 14 normal subjects. Study groups were classified according
to LV mass index (LVMI): 14 normal subjects (group I), eight hypertensive
patients with a normal LVMI (group II), and seven hypertensive patients
with an increased LVMI (group III). There were no significant differences
in LV end-diastolic pressure or volume among the three groups; the ejection
fraction was slightly greater in group II (70 +/- 5%) than in groups I (65
+/- 8%) and III (66 +/- 4%), but this trend did not achieve statistical
significance. Values for endocardial and conventional midwall fractional
shortening (FS) were also similar in the three groups. By contrast, FS by
the concentric two-shell geometry (modified midwall method) in group III
(16 +/- 2%) was significantly less than that seen in groups I and II (21
+/- 4% and 21 +/- 5%, respectively; both p less than 0.05). This difference
achieves greater importance when it is recognized that mean systolic
circumferential stress was lower in group III (151 +/- 22 g/cm2) than in
groups I and II (244 +/- 37 g/cm2 and 213 +/- 38 g/cm2, respectively; both
p less than 0.01). The midwall stress-shortening coordinates in six of the
seven group III patients were outside the 95% confidence limits for the
normal (group I) subjects. Thus, despite a normal ejection fraction,
systolic function is subnormal in hypertensive patients with LV
hypertrophy. CONCLUSIONS. Chamber dynamics provide an overestimate of
myocardial function, especially when LV wall thickness is increased. This
is due to a relatively greater contribution of inner shell thickening in
pressure-overload hypertrophy.
ARTICLES
Left ventricular midwall mechanics in systemic arterial hypertension. Myocardial function is depressed in pressure-overload hypertrophy
Department of Internal Medicine, Osaka Medical College, Japan.
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