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Quantitation of variations in regional left ventricular function in isolated disease of the left anterior descending
D Sapoznikov1, S Welber, C Lotan
1Cardiology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Insights
Left ventricular contraction defects were identified in patients with left anterior descending (LAD) artery disease, particularly in the anterior wall and apex. These defects were significant in most infarction subsets but not in those without infarction.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Left ventricular (LV) function is crucial for cardiac health.
- Assessing LV contraction patterns aids in diagnosing and understanding heart disease.
- Cineangiography provides detailed visualization of cardiac motion.
Purpose of the Study:
- To quantitatively analyze left ventricular endocardial wall contraction patterns.
- To identify and characterize spatial and temporospatial defects in contraction.
- To compare contraction patterns in patients with left anterior descending (LAD) coronary artery disease to normal subjects.
Main Methods:
- Utilized a frame-by-frame radial technique with a fixed centroid on right anterior oblique cineangiograms.
- Measured radial shortening fraction and time-contraction integral to quantify contraction defects.
- Analyzed 12 normal subjects and 32 patients with isolated LAD coronary artery disease, divided into seven clinicopathological subsets.
Main Results:
- Five patient subsets with LAD disease showed significant quantitative differences in LV contraction compared to normal subjects.
- A typical contraction defect was observed in the distal two-thirds of the anterior wall, apex, and distal quarter of the inferior wall.
- Patients with LAD obstruction but without clinical myocardial infarction exhibited only mild LV dysfunction and did not significantly differ from normal.
Conclusions:
- Isolated LAD coronary artery disease leads to characteristic left ventricular contraction abnormalities.
- The location and severity of contraction defects correlate with infarction status and LAD obstruction.
- Quantitative analysis of LV contraction using cineangiography is valuable for assessing myocardial dysfunction in LAD disease.
Abstract:
The pattern of contraction of the endocardial wall of the left ventricle in the right anterior oblique cineangiogram was studied by using a frame by frame radial technique and a fixed centroid without correction for rotation and translation motion during the cardiac cycle. Spatial defects of contraction were quantitated by measuring the shortening fraction of each radius and temporospatial defects by using a time-contraction integral. Twelve normal subjects were used as a basis for comparison. Thirty-two patients with isolated disease of the left anterior descending (LAD) coronary artery were divided into seven arbitrary clinicopathological subsets. Five subsets showed significant quantitative differences in contraction from the normal subjects but there was no significant difference between the subsets. They had a typical defect of contraction in the distal two thirds of the anterior wall, the apex and distal quarter of the inferior wall of the left ventricle. The subsets included: (1) patients who had undergone an anterior myocardial infarction and who had total occlusion of the LAD artery and a large anterior infarction on ECG; (2) patients with a previous classical myocardial infarction but with only 95% residual narrowing of the LAD; (3) patients with an anterior infarction and total occlusion of the LAD with return of the R waves in the anterior precordial leads; (4) patients with anterior infarction, LAD obstruction and left bundle branch block and (5) patients with anterior infarction but with early successful reperfusion with intracoronary streptokinase. Two other subsets, (1) patients with total obstruction of the LAD without a clinical myocardial infarction or (2) subtotal occlusion of the LAD without infarction, had mild left ventricular dysfunction at rest and did not differ significantly from normal.