Detection of Left-Ventricular-Wall Motion Disorders in Coronary-Artery Disease by Radarkymography

Kazamias, Thomas M.; Gander, M; Ross, John; Braunwald, Eugene; Byrne, Joseph D.

doi:10.1056/nejm197107082850201

Cited by 65 publications

(7 citation statements)

References 23 publications

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“…The best-characterized anatomic feature of the heart in two dimensions is the epicardial surface. Earlier methods included X-ray video tracking of the heart borders using multiple projections (6). Later, tomographic data were used for surface contour information.…”

Section: Methods Of Cardiac Motion Detectionmentioning

confidence: 99%

Quantitative Tagged Magnetic Resonance Imaging of the Normal Human Left Ventricle

Moore¹,

McVeigh²,

Zerhouni³

2000

Topics in Magnetic Resonance Imaging

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SummaryMagnetic resonance imaging with tissue tagging is a noninvasive technique for measuring threedimensional motion and deformation in the human heart. Tags are regions of tissue whose longitudinal magnetization has been altered before imaging so that they appear dark in subsequent magnetic resonance images. They then move with the underlying tissue and serve as easily identifiable landmarks within the heart for the detailed detection of motion. Many different motion and strain parameters can be determined from tagged magnetic resonance imaging. Strain components that are based on a high density of tag data, such as circumferential and longitudinal shortening, or parameters that are combinations of multiple strain components, have highest measurement precision and tightest normal ranges. The pattern of three-dimensional motion and strain in the heart is important clinically, because it reflects the basic mechanical function of the myocardium at both local and global levels. Localized abnormalities can be detected and quantified if the pattern of deformation in a given heart is compared to the normal range for that region, because normal motion and strain in the left ventricle is spatially heterogeneous. Contraction strains typically are greatest in the anterior and lateral walls and increase toward the apex. The direction of greatest contraction lies along a counter clockwise helix from base to apex (viewed from the base) and approximates the epicardial muscle fiber direction. This fiber geometry also results in long-axis torsion during systole. Ejection is accomplished primarily by radially inward motion of the endocardium and by descent of the base toward the apex during systole. KeywordsMagnetic resonance imaging; Human heart; Three-dimensional strain; Tissue tagging Accurate three-dimensional (3D) measurement of myocardial deformation throughout the heart during contraction is critical to a fundamental understanding of myocardial function (1). Such an analysis is valuable clinically because most ischemic heart disease, the leading cause of death in the United States, typically affects localized regions of the myocardium (2). The time-resolved local strain map of a heart, as compared to a normal database, permits quantification of both the degree and the physical extent of mechanical dysfunction. In addition, it can be used to improve cardiac analytic and finite element models (3-5), which may help characterize tissue properties and predict the effects on the heart of specific abnormalities and surgical treatments.There are two main problems associated with measuring cardiac deformation. First is the scarcity of readily identifiable landmarks on, and especially within, the heart wall. The second difficulty is that the complex 3D motions of the heart through tomographic images prevent Address correspondence and reprint requests to Dr. Christopher C. Moore, Department of Radiology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, U.S.A.. NIH Public Access Author Man...

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Section: Methods Of Cardiac Motion Detectionmentioning

confidence: 99%

Quantitative Tagged Magnetic Resonance Imaging of the Normal Human Left Ventricle

Moore¹,

McVeigh²,

Zerhouni³

2000

Topics in Magnetic Resonance Imaging

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“…Abnormal, ischemic segmental wall motion is characterized by outward movement during the systolic ejection period. Over the anterior chest wall, translational movement of the entire heart is minimal during cardiac systole (Bodenheimer et al, 1975), and for this reason it is possible to record normal continuous systolic inward motion noninvasively by a number of devices (Borer et al, 1977;Detwiler et al, 1975;Eddleman, 1974;Kazamias et al, 1971;Kerber and Abboud, 1973;Sussman et al, 1940). When the recording device is moved over the cardiac apex, however, the translational movement is large in relationship to segmental contractile motion, such that outward motion is recorded in both normal patients and those with ischemia.…”

Section: Discussionmentioning

confidence: 99%

The resting cardiokymogram: Distribution of morphologies in normal patients and in patients with coronary heart disease

Tzivoni¹,

Diamond²,

Vas³

et al. 1980

Clin Cardiol

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Summary:The cardiokymograph, a relatively new noninvasive device capable of recording anterior left ventricular segmental wall motion, was used to evaluate the frequency and type of wall motion abnormalities in 25 normal patients and in 109 patients with ischemic heart disease. Of the 25 patients with normal coronary arteries and normal left ventriculograms, 24 had smooth systolic inward motion which morphologically resembles the normal pattern of systolic shortening as measured in experimental animals by various length gauges. In patients with angiographically established coronary artery disease but normal left ventriculograms and no previous myocardial infarction (MI), systolic outward motion was significantly more common than in normal patients. The most common systolic outward motion pattern seen in this group was partial outward motion characteristic of early stages of myocardial ischemia in experimental animals. In contrast, holosystolic outward motion, characteristic of severe ischemia in animals, was seen most commonly in patients with MI (72% anterior vs. 28% inferior). Thus, holosystolic outward motion was characteristic of MI especially when acute and involving the anterior wall, while partial systolic outward motion was the more common pat- tern in ischemic heart disease without MI, and systolic inward motion was the pattern most commonly seen in normals.

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“…The epicardial method comparable to contrast angiography is cardiac fluoroscopy. Movement of the fluoroscopic image of the left ventricular-lung interface is recorded in our laboratory using the photokymograph (72), other laboratories have used videotracking (58) and dynamic radiography (77). The sequence of changes in wall motion of the posterior wall after acute balloon occlusion of the circumflex coronary artery as recorded by epicardial fluoroscopy is illustrated in Fig.…”

Section: The Pathophysiology Of Ischemiamentioning

confidence: 99%

“…As early as 1912, segmental wall motion was assessed by roentgenkymography (37) and later by electrokymography (42,46). The technologic descendant of these now obsolete techniques is radarkymography (also termed videotracking) (58). The cost and complexity of the necessary equipment for each method has limited its use to research laboratories.…”

Section: Noninvulve Tedmiques For Recording Cardiac Modon In Manmentioning

confidence: 99%

Noninvasive assessment of segmental left ventricular wall motion: Its clinical relevance in detection of ischemia

Pichler

1978

Clinical Cardiology

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Summary: Newly developed noninvasive techniques, using fluoroscopic, electromagnetic, ultrasonic and nuclear medical devices, now make evaluation of segmental wall motion (SWM) widely applicable to man. Experiments in open chest animal preparations have demonstrated that SWM abnormalities (SWMA) are sensitive and specific markers of ischemia. Following coronary occlusion in closed chest dogs, using various techniques, we observed the same sequence of SWMA over a similar time course.In 122 angiographically documented patients, SWMA assessed by stress cardiokymography (CKG) revealed a sensitivity of 74% and a specificity of 94% in detecting coronary heart disease (CHD). The combined predictive power of stress ECG/CKG was superior to either test alone. Using radionucIide eqUilibrium scintigraphy and sitting bicycle exercise, stress induced SWMA revealed a sensitivity of 84% in detectin~ CHD. SWMA were detected in nearly all patients 24 h after acute transmural myocardial infarction (MI). These abnormalities extended beyond the location predicted by ST segment elevation and Q waves in the ECG, significantly more in anterior (15/16) than inferior (9/16) MI (p < 0.05). In inferior MI, precordial ST segment depression was frequently (8/10) associated with anterior SWMA, indicative of ischemia rather than of a reciprocal electrical phenomenon. Scintigraphic assessment of left ventricular SWM correlated poorly with calculated CK-MB infarct size (r = 0.64), suggesting that left ventricular function is determined not only by the necrotic zone but is also related to dysfunction of ischemic segments. SWM of the infarcted as well as the remote zone of the left ventricle showed no consistent directional changes within 10 days after infarction.In conclusion, noninvasive analysis of SWM is of clinical relevance 1. during diagnostic stress testing to detect ischemia,.2. in chronic stable CHD to assess the extent of mechanical dysfunction, 3. in acute MI to localize and assess extent and severity of regional myocardial dysfunction.

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Detection of Left-Ventricular-Wall Motion Disorders in Coronary-Artery Disease by Radarkymography

Cited by 65 publications

References 23 publications

Quantitative Tagged Magnetic Resonance Imaging of the Normal Human Left Ventricle

Quantitative Tagged Magnetic Resonance Imaging of the Normal Human Left Ventricle

The resting cardiokymogram: Distribution of morphologies in normal patients and in patients with coronary heart disease

Noninvasive assessment of segmental left ventricular wall motion: Its clinical relevance in detection of ischemia

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