A Hemodynamic Study of Left Ventricular Aneurysm

Klein, Michael D.; Herman, Michael V.; Gorlin, Richard; Vayo, H. Westcott

doi:10.1161/01.cir.35.4.614

Cited by 272 publications

(65 citation statements)

References 29 publications

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“…Both interobserver and intraobserver variability were also similar to beat-to-beat variability (figures 3 and 4). Significant differences were found at 14 chords: beat-to-beat variability was lower than interobserver variability at 6 chords in the anterior wall and at 4 Variability from study to study was considerably higher than between different observations in the same study (figures 3 and 4), even though heart rate, ejection fraction, and end-diastolic volume were similar in the two stud,ies (table 1). Variability averaged 1.06 ± 0.42 SF units (range 0.64 to 1.99) or 30.1 ± 13.3%o of normal motion (range 16.3% to 77.3%).…”

Section: Resultsmentioning

confidence: 85%

Variability in the measurement of regional left ventricular wall motion from contrast angiograms.

Sheehan¹,

Stewart²,

Dodge³

et al. 1983

Circulation

139

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Four types of variability affecting quantification of regional wall motion from contrast left ventriculograms (LVgrams) were studied. These included beat-to-beat variability in 24 LVgrams, intraobserver and interobserver variability in 20 LVgrams, and study-to-study variability in serial LVgrams of 21 patients with stable coronary artery disease. Motion was measured at 100 equidistant chords perpendicular to a center line drawn midway between the end-diastolic and end-systolic contours and normalized for heart size. Variability was computed as the absolute difference between observations. Beat-to-beat, intraobserver, and interobserver variability at the 100 chords were similar, averaging 14%, 14%, and 17%, respectively, of the mean motion in 64 patients with normal ventriculograms. Study-to-study variability was significantly higher, averaging 30% of mean normal motion, but was reduced when regional motion was calculated as the mean motion of chords within a region of interest. Variability peaked at the apex. Realignment to correct for cardiac rotation significantly increased variability. Investigators whose methods of wall motion analysis rely on identification of the apex as a landmark should be aware of this source of potential variability and error. Circulation 68, No. 3, 550-559, 1983. IT HAS LONG BEEN KNOWN that coronary artery stenosis results in abnormal regional left ventricular wall motion. ' Early studies in which wall motion was gauged subjectively were hampered by large interobserver variability that resulted in poor reproducibility of results.2-More recently, quantitative methods of measuring regional wall motion have been developed. With these methods, wall motion abnormalities in patients with coronary artery and valvular disease have been measured and related to the site and severity of coronary disease, to the amount of fibrosis in infarcted myocardium, and to the development of congestive heart failure.5'-' The reproducibility or variability in motion measurements by the various quantitative methods, however, has not yet been determined. Knowledge of variability is necessary to gauge the significance of measured abnormalities in wall motion and of changes observed in serial studies performed to assess progression of disease or response to a therapeutic intervention. Therefore, our study was performed to determine

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Section: Resultsmentioning

confidence: 85%

Variability in the measurement of regional left ventricular wall motion from contrast angiograms.

Sheehan¹,

Stewart²,

Dodge³

et al. 1983

Circulation

139

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“…15 Ventricular contraction was classified as follows'5: (1) The average rate of rise of isovolumic pressure was reduced in the 10 subjects in whom this could be analyzed. 16 The normal period of isovolumic contraction seen in two patients may possibly be explained by the unusually small rise in systolic pressure required by I.…”

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confidence: 92%

The Apexcardiogram in Myocardial Asynergy

et al. 1968

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SUMMARYThe apexcardiogram was analyzed in 41 patients with an altered pattern of left ventricular contraction. Four types were distinguished: type I, an early sustained systolic bulge which occurred in 12 patients, all of whom had large aneurysms and large enddiastolic volumes; type II, a bulge confined to midsystole which occurred in 13 patients, 11 of whom had some form of ventricular asynergy; type III, a late or end-systolic bulge which occurred in 12 patients, seven of whom had ventricular asynergy; type IV, a prominent spike during diastolic filling which occurred in four patients who had large zones of ventricular asynergy. Additional Indexing Words:Aneurysm Abnormal myocardial contraction THE NORMAL apexcardiogram and its temporal relationship to electrical, acoustical, and mechanical cardiac events has been the subject of previous communications from various laboratories,1 2 including our own.3 The normal pattern is uniform, reproducible, and clearly correlated with known hemodynamic events.Lack of general agreement about the genesis of the apexcardiogram and technical difficulties in recording it have discouraged a more general use. The low frequency vibrations, which result from relative movement in the chest wall beneath the cup applicator, are thought to result from actual movement of the heart and great vessels, from changes in volume and velocity of movement of the heart, and from changes in the consistency and curvature of the heart wall.4' 5 Particular difficulty arises in attempting to evaluate systolic events from the apexcardiogram.

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“…Ventricular aneurysm as a pathological entity has been described in detail, but this is usually noted to be a thinned out and dilated scarred area of myocardium (21), without specific information about the actual elasticity of the walls of the aneurysm or pressure-volume relationships of the ventricle. On occasion in patients with ventricular aneurysm the ventricular volume may be normal or nearly so despite elevated left ventricular end-diastolic pressure (22). In addition ventriculograms in such patients often show immobility or absence of motion rather than aneurysmal bulging during systole, suggesting that the ventricular wall may be relatively stiff and inelastic (22).…”

Section: Resultsmentioning

confidence: 99%

“…On occasion in patients with ventricular aneurysm the ventricular volume may be normal or nearly so despite elevated left ventricular end-diastolic pressure (22). In addition ventriculograms in such patients often show immobility or absence of motion rather than aneurysmal bulging during systole, suggesting that the ventricular wall may be relatively stiff and inelastic (22). However most of these clinical observations have been made in patients with chronic ischemic lesions, and may not be applicable to the early healing phase of myocardial infarction considered in the present investigation.…”

Section: Resultsmentioning

confidence: 99%

Experimental myocardial infarction

Hood¹,

Bianco²,

Kumar³

et al. 1970

J. Clin. Invest.

169

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A B S T R A C T Compliance of the infarcted left ventricle was studied in dogs 3-5 days after occlusion of the left anterior descending coronary artery. Compliance was assessed from postmortem pressure-volume curves and from pressure-length measurements (mercury-in-silastic segment length gauges) made both in vivo and postmortem. Postmortem pressure-volume curves showed reduced compliance compared to sham-operated animals. Postmortem pressure-length curves of infarcted and adjacent normal myocardium indicated that the diminished total compliance could be attributed to an increase in stiffness of the infarcted area. This was confirmed by in vivo end-diastolic pressure-length changes produced by transient aortic occlusion. The infarcted area was akinetic, showing neither contraction nor aneurysmal bulging. In addition, anesthetized dogs with infarcts, when compared with sham-operated animals, had similar left ventricular end-diastolic volumes (indicator dilution method), but higher left ventricular enddiastolic pressures. Taken with previous observations, which show that systolic aneurysmal bulging is uniformly present at the onset of ischemia, these results indicate that stiffening of the ischemic myocardium occurs during the first 5 days after infarction, and show that elevation of left ventricular filling pressure does not necessarily signify ventricular dilatation. The results also suggest a mechanism whereby ventricular performance may improve during recovery from acute myocardial infarction.

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A Hemodynamic Study of Left Ventricular Aneurysm

Cited by 272 publications

References 29 publications

Variability in the measurement of regional left ventricular wall motion from contrast angiograms.

Variability in the measurement of regional left ventricular wall motion from contrast angiograms.

The Apexcardiogram in Myocardial Asynergy

Experimental myocardial infarction

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