Analysis of Left Ventricular Wall Motion by Reflected Ultrasound

Abstract

Ultrasound echocardiograms from the septal and posterior left ventricular walls were displayed with a simultaneously recorded electrocardiogram, phonocardiogram, and indirect carotid pulse. These echoes differed in both amplitude and waveform. The contour of the posterior wall echo resembled an inverted ventricular volume curve, while the septal echo was of smaller amplitude and had a characteristic notched appearance. Most of the movement of the left ventricular walls relative to the ultrasound transducer was attributable to systolic contraction and diastolic expansion of the cavity. However, superimposed on this motion due to change in cavity size was movement of the left ventricle as a whole, first anteriorly toward the ultrasound transducer during late systole then posteriorly away from it at the beginning of left ventricular relaxation. These movements added to the amplitude of posterior wall motion but subtracted from the motion of the septum and were responsible for the notch in the waveform of this echo. Attachment superiorly to the aortic root might also have limited septal motion which was less near the base than nearer the apex of the left ventricle.The internal left ventricular dimension measured by ultrasound was standardized by using the mitral valve as a landmark and by recording the motion of the left side of the interventricular septum and endocardial surface of the posterior left ventricular wall simultaneously. This measurement was reproducible. In normal subjects, the ultrasonic dimension measured 4.40 + 0.28 cm at the beginning of systole and shortened by 35.5 3.9% at a rate of 1.22 0.31 lengths/sec. By contrast, the average figures for six patients with primary myocardial disease were 6.96 + 0.43 cm, 14.9 + 4.2%, and 0.64 + 0.11 lengths/sec. Calculation of such indices of left ventricular size and of rate and extent of myocardial shortening should be useful in the detection of impaired myocardial function and in following its progress. 14 outflow tra artery; he Myocardial function and with the use of the technic to severity of mitral stenosis.' Edler ly described the echoes arising tricuspid valve, left ventricular ct, aortic valve, and pulmonary also recognized the abnormal

Paradoxical and pseudoparadoxical interventricular septal motion in patients with right ventricular volume overload.

“…1'1 Second, even if septal curvature correction continued throughout systole, its tendency to produce net anterior septal motion would be progressively attenuated by the systolic reduction in left ventricular dimensions, an effect that is maximal in midsystole. 18 This hypothesis implies that the septum moves toward the center of the left ventricle after early systole in patients with RVVO. 16 If this is so, the M mode echocardiographic appearance of anterior motion, or no net motion, of the septum during mid-late systole2' 7 could be explained only by anterior motion of the entire left ventricle during this period.…”

Echoventriculography in acute myocardial infarction. IV. Infarct size and reliability by pathologic anatomic correlations

“…For instance, systolic wall motions at the center of infarctions were mostly paradoxical and systolic thickening was never seen. The latter finding is fundamental in differentiating ischemia and infarction from hypokinetic or even paradoxical regional wall motions caused by more physiological phenomena such as septal asynergy in the right ventricular volume overload (Corya et al, 1977), and in physically highly trained subjects (Nieminen, 1977a), from bundle-branch block, or simply due to the anterior mass motion of the whole heart seen normally in systole (McDonald et al, 1972). Loss of systolic thickening together with reduced or absent systolic motion amplitude is one of the characteristic forms of asynergy in experimental myocardial ischemia or infarction (Heikkila et al, 1972;Kerber and Marcus, 1978;Ross and Franklin, 1976;Sasayama et al, 1976).…”

Enalapril in patients with chronic heart failure: a placebo-controlled, randomized, double-blind study.

“…Transducer position, echographic gain, and patient position were adjusted to obtain optimal recordings of left ventricular dimensions in the minor axis. 12 In all cases repeat echocardiograms were obtained with the patient in the same position as for the baseline study.…”