Circulation, Vol 85, 1572-1581, Copyright © 1992 by American Heart Association
FE Rademakers, MB Buchalter, WJ Rogers, EA Zerhouni, ML Weisfeldt, JL Weiss and EP Shapiro
BACKGROUND. Efficient early diastolic filling is essential for normal
cardiac function. Diastolic suction, as evidenced by a decreasing left
ventricular pressure during early filling, could result from restoring
forces (the release of potential energy stored during systolic deformation)
dependent on myofilament relaxation. Although these restoring forces have
been envisioned within individual myofibers, recent studies suggest that
gross fiber rearrangement involving the connective tissue network occurs
easy in diastole. This may lead to the release of potential energy stored
during systole and suction-aided filling. METHODS AND RESULTS. To establish
precisely the timing and extent of restoration of the systolic torsional
deformation of the left ventricle with respect to early filling at baseline
and with enhanced relaxation, we studied untwisting during control
conditions and with catecholamine stimulation. Using noninvasive and
nondestructive magnetic resonance tagging, torsional deformation of the
left ventricle was measured at 20-msec intervals in 10 open-chest, atrially
paced dogs, starting at aortic valve closure. Eight equiangular tags
intersected the epicardium and endocardium in three short-axis imaging
planes (base, mid, and apex). From the intersection points, epicardial and
endocardial circumferential chord and arc lengths were measured and angular
twist of mid and apical levels with respect to the base (maximal torsion
and its reversal, untwisting) was calculated. Echo- Doppler provided timing
of aortic valve closure and of mitral valve opening. Zero torsion was
defined at end diastole. Torsion at the apical level reversed rapidly
between its maximum and the time immediately after mitral valve opening:
from 7.0 +/- 5.8 degrees to 3.2 +/- 5.4 degrees and 12.0 +/- 8.5 degrees to
6.9 +/- 7.8 degrees (mean +/- SD, both p less than 0.01) at the epicardium
and endocardium, respectively. During the same period, no significant
circumferential segment length changes occurred. As expected, after mitral
valve opening, filling resulted in significant circumferential segment
lengthening, whereas further reversal of torsion was small and
nonsignificant. During dobutamine infusion, torsion at end systole was
greater and reversal during isovolumic relaxation was much more rapid and
greater in extent (p less than 0.01). Torsion reversed from 11.5 +/- 4.3
degrees to 5.7 +/- 4.8 degrees and 17.4 +/- 6.4 degrees to 6.9 +/- 7.7
degrees at epicardium and endocardium. CONCLUSIONS. Untwisting occurs
principally during isovolumic relaxation before filling and is markedly
enhanced in speed and magnitude by catecholamines. This partial return of
the left ventricle to its preejection configuration before mitral valve
opening could represent an important mechanism for the release of potential
energy stored in elastic elements during the systolic deformation. These
myocardial restoring forces would be markedly enhanced by physiological
changes consequent to catecholamines such as during exercise, offsetting
the concomitant shortening of the filling period.
ARTICLES
Dissociation between left ventricular untwisting and filling. Accentuation by catecholamines
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Md.
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