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Circulation, Vol 90, 1200-1209, Copyright © 1994 by American Heart Association
SJ Dong, JH MacGregor, AP Crawley, E McVeigh, I Belenkie, ER Smith, JV Tyberg and R Beyar
BACKGROUND: Regional performance of the hypertrophied left ventricle (LV)
in hypertrophic cardiomyopathy (HCM) is still incompletely characterized
with studies variably reporting that the hypertrophied myocardium is
hypokinetic, akinetic, or has normal function. Different imaging modalities
(M-mode or two-dimensional echocardiography) and methods of analysis (fixed
or floating frame of reference for wall motion analysis) yield different
results. We assessed regional function in terms of systolic wall thickening
and shortening and related these parameters to end-diastolic thickness
using tagged magnetic resonance imaging and the three-dimensional
volume-element approach. METHODS AND RESULTS: In 17 patients with HCM and 6
healthy volunteers, four parallel short-axis images with 12 radial tags and
two mutually orthogonal long-axis images with four parallel tags were
obtained at end diastole and end systole. After the LV endocardial and
epicardial borders were traced, three-dimensional volume elements were
constructed by connecting two matched planar segments in two adjacent
short-axis image planes, accounting for translation, twist, and long-axis
shortening. A total of 72 such volume elements encompassed the entire LV.
From each of these elements, end-diastolic thickness and systolic function
(fractional thickening and circumferential shortening) were calculated. The
average end-diastolic thickness was 15.8 +/- 4.2 mm in patients with HCM,
which was significantly greater than that in healthy subjects (8.6 +/- 2.1
mm, P < .001). Fractional thickening was significantly less in patients
with HCM than in healthy subjects (0.31 +/- 0.22 versus 0.56 +/- 0.23, P
< .001). There was a highly significant inverse correlation between
fractional thickening and end- diastolic thickness that was independent of
the type of hypertrophy or age group. Similar inverse relations were
observed between circumferential shortening and end-diastolic wall
thickness. CONCLUSIONS: The myocardium in patients with HCM is
heterogeneously thickened and the fractional thickening and circumferential
shortening of the abnormally thickened myocardium are reduced compared with
healthy subjects. The decrease in fractional thickening and shortening is
inversely related to the local thickness.
ARTICLES
Left ventricular wall thickness and regional systolic function in patients with hypertrophic cardiomyopathy. A three-dimensional tagged magnetic resonance imaging study
Department of Medicine, University of Calgary, Alberta, Canada.
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