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Circulation, Vol 86, 1919-1928, Copyright © 1992 by American Heart Association
SE Maier, SE Fischer, GC McKinnon, OM Hess, HP Krayenbuehl and P Boesiger
BACKGROUND. Segmental wall motion was assessed noninvasively in eight
patients with hypertrophic cardiomyopathy and six healthy volunteers by
magnetic resonance myocardial tagging. METHODS AND RESULTS. Localization
scans were performed for determination of the true short- axis views of the
left ventricle (double-angulated view). Spatial modulation of magnetization
was used to produce a rectangular grid of landmarks. Distortion of the grid
was assessed at end diastole, mid systole, and end systole with multiphase
gradient echoes. Image sets were acquired at three different planes,
namely, the base, the equator, and the apex. Quantitative evaluation was
carried out by computer- assisted image analysis. Each individual grid
crossing point was identified automatically and the displacement
calculated. A polar coordinate system with the center of gravity as motion
reference point was chosen to assess fractional rotation and radial
displacement at the endocardial, midwall, and epicardial layers of the
septal, anterior, posterior, and inferior regions. A wringing motion of the
left ventricle with a clockwise rotation of 5.0 +/- 2.4 degrees at the base
and a counterclockwise rotation of -9.6 +/- 2.9 degrees at the apex was
observed in control subjects. An equal rotation of 5.0 +/- 2.5 degrees at
the base and a slightly reduced rotation of -7.3 +/- 5.2 degrees at the
apex was found in patients with hypertrophic cardiomyopathy. A transmural
gradient in fractional rotation and radial displacement was observed, with
the highest values in the endocardial layer. Rotation in patients with
hypertrophic cardiomyopathy was significantly less than in normal
volunteers in the posterior region of the equatorial and apical planes.
Furthermore, radial displacement was significantly reduced in the septum
and inferior wall. In the anterior and posterior wall segments, a reduction
of the radial displacement was observed only in the epicardium and midwall
layers. CONCLUSIONS. Magnetic resonance myocardial tagging allows the
noninvasive assessment of regional wall motion. Both in normal volunteers
and in patients with hypertrophic cardiomyopathies, cardiac motion occurs
in a complex mode, with the base and the apex rotating in opposite
directions and the equatorial plane as a transitional zone (wringing
motion). A reduced cardiac rotation can be observed in patients with
hypertrophic cardiomyopathy mainly in the posterior region, whereas a
reduced radial displacement is found in the inferior septal zone.
ARTICLES
Evaluation of left ventricular segmental wall motion in hypertrophic cardiomyopathy with myocardial tagging
Institute of Biomedical Engineering and Medical Informatics, University of Zurich, Switzerland.
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