Circulation, Vol 85, 1423-1432, Copyright © 1992 by American Heart Association
AJ Feiring and JA Rumberger
BACKGROUND. This study tested two hypotheses: 1) regional left ventricular
radius-to-wall thickness ratios (R/T) are uniform in normal subjects, and
2) patients with left ventricular hypertrophy secondary to compensated
volume overload normalize global and regional R/T. METHODS AND RESULTS.
Ultrafast computed tomography was used to measure regional short-axis
ventricular R/T in 11 normal subjects and 13 patients with compensated
aortic insufficiency (AI) of moderate severity (regurgitant fraction,
greater than or equal to 25%). Radius and wall thickness dimensions were
calculated by two different methods. In method 1, the average radius and
wall thickness were determined for each planimetric transaxial tomographic
image. In method 2, the left ventricle was three-dimensionally
reconstructed; then, new radii and wall thickness were recalculated as if
all the images were acquired orthogonal to the endocardial surface at each
tomographic level. In normals, the mean R/T ratio was 1.75 +/- 0.11 (SEM)
with method 1 and 1.80 +/- 0.07 with method 2. The R/T ratios varied as a
function of the relative apex-to-base position. R/T ratios at the basal
four levels were relatively uniform, whereas R/T at the lower three
tomographic levels were significantly less than those at the base (p less
than 0.01). Patients with AI had a mean regurgitant fraction of 44 +/- 3.8%
(range, 25-63%). The mean R/T ratio was 2.18 +/- 0.16 with method 1 and
2.55 +/- 0.18 with method 2. Similar to the pattern observed in normals,
the regional R/T ratios at the lower three or four levels were
significantly less than the basal R/T ratios (p less than 0.01). Regional
comparison of the normal to the volume-overloaded ventricles demonstrated
that R/T ratios in the AI patients were significantly greater at the upper
five levels with method 1 and at all eight levels with method 2 (p less
than 0.01-0.001, AI versus normal). CONCLUSIONS. These findings demonstrate
that regional R/T ratios are heterogeneous in both normals and patients
with left ventricular hypertrophy secondary to compensated aortic
insufficiency. Furthermore, these findings challenge the accepted
hypothesis that global and regional R/T ratios normalize in patients with
compensated volume-overload hypertrophy.
ARTICLES
Ultrafast computed tomography analysis of regional radius-to-wall thickness ratios in normal and volume-overloaded human left ventricle
Division of Cardiology, Medical College of Wisconsin, WI 53226.
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