Propagation of vibration caused by electrical excitation in the normal human heart

The ability to noninvasively detect regional dynamic myocardial damage related to action potentials and mechanical properties affected by heart disease is of great clinical importance. Though there are invaluable clinical tools for diagnosis of a broad range of cardiac conditions, such myocardial properties cannot be evaluated. We have previously shown that pulsive vibration occurs on the myocardium after electrical stimulation of an isolated heart. In this study, using a novel technique for ultrasonic measurement of the myocardial motion, we detected pulsive vibrations spontaneously caused by electrical excitation and by valve closure. Using a sparse sector scan, the vibrations were measured almost simultaneously at about 10,000 points set in the heart wall at a high temporal resolution. The consecutive spatial distributions of the phase of the vibrations revealed wave propagation along the wall in healthy subjects for the first time in vivo. At around the time of the Q-wave of the electrocardiogram, the propagation started from the interventricular septum and extended to both the base and apical sides of the heart with a speed of 1 m/s, which corresponds to the propagation of electrical excitation from the Purkinje fiber-myocyte junction in the interventricular septum. Other vibrations then propagated from the base at several m/s, although some of them had dispersion properties. These are shear waves caused by the mitral-valve closure, corresponding to the first heart sound. These phenomena have potential for detection of regional myocardial tissue damage related to propagation of the action potentials and regional myocardial viscoelasticity.