Correlation between segmental early relaxation of the left ventricular wall and coronary occlusive disease

Wilson, Charles S.; Krueger, Stephen; Forker, Alan D.; Weaver, Walt F.

doi:10.1016/0002-8703(75)90154-4

Cited by 40 publications

(18 citation statements)

References 10 publications

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“…The former explanation seems more likely, since there was close correlation between these changes and the extent of outward wall movement before mitral valve opening, which is a direct measure of the severity of the isovolumic disturbance. Such changes have previously been documented angiographically (Altieri et al, 1973;Ruttley et al, 1974;Hamby et al, 1974;Wilson et al, 1975;, and by echocardiography (Upton et al, 1976).…”

Section: Discussionmentioning

confidence: 76%

Relation between apex cardiogram and changes in left ventricular pressure and dimension.

Venco¹,

Gibson²,

Brown³

1977

Heart

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The relation between the apex cardiogram and changes in left ventricular pressure measured by micromanometer, and dimension measured by echocardiography, was studied in 12 normal subjects and 64 patients with heart disease. In 12 patients, the apex cardiogram was delayed with respect to simultaneous left ventricular pressure by 17±18 ms during the upstroke and 28±16 ms during the downstroke. In the normal subjects, changes in left ventricular dimension during the upstroke and downstroke of the apex cardiogram were small, amounting to 6±5 and 21 ± 7 per cent total excursion, respectively. In 10 patients with mitral regurgitation, there was significant inward wall movement during the upstroke and in 10 patients with aortic regurgitation, significant outward movement during the downstroke, both reflecting valvular regurgitation. In 20 patients with ischaemic heart disease and segmental abnormalities on left ventricular angiography, apex cardiogramecho dimension relations were abnormal in all, because of inward or outward wall movement during the upstroke, increased outward movement before the 'O' point, or abnormal inward movement during the downstroke. These disturbances were displayed by constructing apex cardiogram-echo dimension loops, which appear to be a sensitive means of detecting incoordinate left ventricular contraction, analogous to those between pressure and dimension.A limitation in the use of M-mode echocardiography in studying left ventricular function is that wall movement is recorded from only a localized region of cavity, so that it is not possible to tell whether a change in dimension results from filling or ejection on the one hand, or from an isovolumic shape change on the other. The value of the technique would, therefore, be increased if information were simultaneously available allowing this distinction to be made, and incoordinate contraction and relaxation detected and quantified. We have previously shown that these abnormalities may lead to characteristic alterations in the time relations between left ventricular dimensions measured by echocardiography and left ventricular pressure , particularly when a pressure-dimension loop is constructed. In the present study, we have explored the possibility of substituting the apex cardiogram for the pressure pulse in order to obtain the same information noninvasively. We have, therefore, investigated the time relations between the various phases of the

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Section: Discussionmentioning

confidence: 76%

Relation between apex cardiogram and changes in left ventricular pressure and dimension.

Venco¹,

Gibson²,

Brown³

1977

Heart

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“…An outward ventricular wall motion during the isovolumic relaxation period has been observed using left ventriculography [10, 11, 12, 13]and an associated intraventricular flow has been revealed by Doppler echocardiography [14, 15, 16]. Using pulsed Doppler echocardiography, Tanaka et al [15]reported that the pattern of IRF velocity waveforms at the center of the left ventricle was affected by LV relaxation and related to the LV outward wall motion observed during the isovolumic relaxation period.…”

Section: Discussionmentioning

confidence: 99%

Is the Blood Flow in the Left Ventricle during the Isovolumic Relaxation Period a Useful Parameter of Left Ventricular Systolic and Early Diastolic Performance?

Ohte

Narita²,

Hashimoto³

et al. 1999

Cardiology

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Left ventricular (LV) early diastolic performance is determined by LV behavior in the late systole to early diastole and may relate to the physical potential of patients. Isovolumic relaxation flow (IRF) velocity was obtained by continuous Doppler echocardiography in the left ventricle from the apex in 26 patients with atypical chest pain and 63 patients with coronary artery disease (CAD) with or without prior myocardial infarction (MI) who underwent cardiac catheterization. In each patient, a time constant of LV relaxation (τ) was calculated from the LV pressure waves obtained by a catheter-tipped micromanometer. The LV end-systolic volume index was measured using contrast left ventriculography. IRF velocity in patients having CAD with prior MI (24.8 ± 5.4 cm/s) was significantly less than in those with atypical chest pain (41.2 ± 9.6 cm/s). It was also significantly less than in patients having CAD without prior MI (37.3 ± 6.8 cm/s). IRF velocity significantly correlated with the time constant τ (r = –0.42, p < 0.001) and LV end-systolic volume index (r = –0.84, p < 0.001). This study indicates that IRF velocity obtained by continuous Doppler echocardiography in the left ventricle provides important information regarding LV systolic performance and early diastolic performance.

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“…In the literature with Doppler echocardiography, there is a rapid flow toward the cardiac base at the isometric relaxation period in the case of apical infarction,13,14 which relates to the asynchronous relaxation. [15][16][17][18] As the counterflow is not significant in cases of apical akinesis, part of the inflow blood seems to flow toward the apex along the posterior wall.…”

Section: Pathway Of Bloodmentioning

confidence: 99%

Abnormal blood pathways in left ventricular cavity in acute myocardial infarction. Experimental observations with special reference to regional wall motion abnormality and hemostasis.

et al. 1988

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To elucidate the mechanism of regional hemostasis in the left ventricular (LV) cavity during myocardial infarction, the blood pathway in LV cavity was examined with contrast echocardiography injected from the left atrium before and after coronary ligation in nine canines. Before coronary ligation, contrast echoes spread over LV cavity with one rush. After ligation, smokelike echoes indicating hemostasis were observed at the apical middle of the LV cavity in five dogs with apical akinesis and at the apical area in four dogs with apical dyskinesis. The contrast echoes did not reach the apex within one diastolic period but turned upward to the outflow tract in the middle of the cavity in all dogs. In the cardiac beats that followed, some contrast echoes spread slowly toward the apex, forming a thin layer along the posterior wall in cases with akinesis but not in cases with dyskinesis. The area separated from the blood pathway developed where the smokelike echoes had been developed. Tachycardia exaggerated the abnormality of blood pathway and widened the contrast echo-free area. The abnormal pathway of the blood in apical myocardial infarction develops hemostasis in the apex. This should be one of the mechanisms of thrombus formation in myocardial infarction. (Circulation 1988;78:157-164)

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Correlation between segmental early relaxation of the left ventricular wall and coronary occlusive disease

Cited by 40 publications

References 10 publications

Relation between apex cardiogram and changes in left ventricular pressure and dimension.

Relation between apex cardiogram and changes in left ventricular pressure and dimension.

Is the Blood Flow in the Left Ventricle during the Isovolumic Relaxation Period a Useful Parameter of Left Ventricular Systolic and Early Diastolic Performance?

Abnormal blood pathways in left ventricular cavity in acute myocardial infarction. Experimental observations with special reference to regional wall motion abnormality and hemostasis.

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