Left ventricular regional wall stress in dilated cardiomyopathy.

Left ventriculography with simultaneous pressure micromanometry was performed in 11 normal control subjects and 17 patients with dilated cardiomyopathy (DCM). Left ventricular silhouettes in the right anterior oblique projection were divided into eight areas, and regional wall stress was computed by Janz's method in each area excluding the two most basal areas. Wall stress was higher in DCM patients than in control subjects (p less than 0.01). The percent area changes from end diastole to end systole in each area were lower in DCM patients than in control subjects (mean for six areas, 22 +/- 14% versus 54 +/- 9%, respectively, p less than 0.01), but the coefficient of variation for the percent area changes in the six areas of the left ventricle in DCM patients was greater than that in control subjects (32 +/- 17% versus 15 +/- 4%, respectively, p less than 0.01), indicating regional differences in hypokinesis. There was a significant negative correlation between end-systolic regional wall stress and percent area change (r = -0.60 to -0.86, p less than 0.05) in each area. Thus, excessive regional afterload may play an important role in causing regional hypokinesis in DCM.

[1]  M. Rousseau,et al.  Assessment of regional left ventricular relaxation in patients with coronary artery disease: importance of geometric factors and changes in wall thickness. , 1984, Circulation.

[2]  J Ross,et al.  Effects of coronary occlusion on early ventricular diastolic events in conscious dogs. , 1979, The American journal of physiology.

[3]  I. McDonald.  Echocardiographic Demonstration of Abnormal Motion of the Interventricular Septum in Left Bundle Branch Block , 1973, Circulation.

[4]  Y. Hirota,et al.  Functional and histopathologic correlation in patients with dilated cardiomyopathy: an integrated evaluation by multivariate analysis. , 1987, Journal of the American College of Cardiology.

[5]  A. Shoukas,et al.  Load Independence of the Instantaneous Pressure‐Volume Ratio of the Canine Left Ventricle and Effects of Epinephrine and Heart Rate on the Ratio , 1973, Circulation research.

[6]  E. Braunwald,et al.  Left ventricular end-systolic stress-shortening and stress-length relations in human. Normal values and sensitivity to inotropic state. , 1982, The American journal of cardiology.

[7]  Y. Nakamura,et al.  Usefulness of negative dP/dt upstroke pattern for assessment of left ventricular relaxation in coronary artery disease. , 1989, American Journal of Cardiology.

[8]  J. Ross,et al.  Afterload mismatch and preload reserve: a conceptual framework for the analysis of ventricular function. , 1976, Progress in cardiovascular diseases.

[9]  L. Brasseur,et al.  Assessment of Left Ventricular Contractility from Late Systolic Stress‐Volume Relations , 1982, Circulation.

[10]  A. Savitzky,et al.  Smoothing and Differentiation of Data by Simplified Least Squares Procedures. , 1964 .

[11]  W. S. Ring,et al.  Myocardial perfusion in compensated and failing hypertrophied left ventricle. , 1985, The American journal of physiology.

[12]  N. Reichek,et al.  Contribution of afterload, hypertrophy and geometry to left ventricular ejection fraction in aortic valve stenosis, pure aortic regurgitation and idiopathic dilated cardiomyopathy. , 1987, The American journal of cardiology.

[13]  E. Sonnenblick,et al.  Assessment of Left Ventricular Stiffness in Primary Myocardial Disease and Coronary Artery Disease , 1974, Circulation.

[14]  W. Kübler,et al.  Coronary dilatory capacity in idiopathic dilated cardiomyopathy: analysis of 16 patients. , 1983, The American journal of cardiology.

[15]  T. Takatsu,et al.  Clinical and experimental studies on cardiomyopathy. , 1975, The New England journal of medicine.

[16]  I. Benjamin,et al.  Cardiac Hypertrophy in Idiopathic Dilated Congestive Cardiomyopathy: A Clinicopathologic Study , 1981, Circulation.

[17]  C. Hanet,et al.  Long-term effects of xamoterol on left ventricular diastolic function and late remodeling: a study in patients with anterior myocardial infarction and single-vessel disease. , 1988, Circulation.

[18]  R. F. Rushmer,et al.  Initial Ventricular Impulse: A Potential Key to Cardiac Evaluation , 1964, Circulation.

[19]  R. Henkin,et al.  Segmental wall motion abnormalities in dilated cardiomyopathy: a common finding and good prognostic sign. , 1984, Journal of the American College of Cardiology.

[20]  P. Agostoni,et al.  Afterload reduction: a comparison of captopril and nifedipine in dilated cardiomyopathy. , 1986, British heart journal.

[21]  W. Grossman,et al.  Determinants of Ventricular Function in Pressure-Overload Hypertrophy in Man , 1979, Circulation.

[22]  J. Carroll,et al.  Physiologic mechanisms governing hemodynamic responses to positive inotropic therapy in patients with dilated cardiomyopathy. , 1988, Circulation.

[23]  E. Braunwald,et al.  Left ventricular end-systolic stress-shortening and stress-length relations in human. Normal values and sensitivity to inotropic state. , 1982 .

[24]  R. Janz,et al.  Estimation of local myocardial stress. , 1982, The American journal of physiology.

[25]  F. Schoen,et al.  Deficient production of cyclic AMP: pharmacologic evidence of an important cause of contractile dysfunction in patients with end-stage heart failure. , 1987, Circulation.

[26]  J. Ritchie,et al.  Congestive cardiomyopathy with segmental wall motion abnormalities and a non-uniform pattern of fibrosis. , 1979, Catheterization and cardiovascular diagnosis.

[27]  R N Vaishnav,et al.  Stress distribution in the canine left ventricle during diastole and systole. , 1970, Biophysical journal.

[28]  W. Kübler,et al.  Quantitative morphologic findings of the myocardium in idiopathic dilated cardiomyopathy. , 1983, The American journal of cardiology.

[29]  C. Boucher,et al.  Value of radionuclide imaging techniques in assessing cardiomyopathy. , 1980, The American journal of cardiology.

[30]  Y. Hirota,et al.  Mechanisms of compensation and decompensation in dilated cardiomyopathy. , 1984, The American journal of cardiology.

[31]  W. Roberts,et al.  Pathological Aspects of Certain Cardiomyopathies , 1974, Circulation research.

[32]  L. Johnson,et al.  Volume Ejected in Early Systole: A Sensitive Index of Left Ventricular Performance in Coronary Artery Disease , 1975, Circulation.

[33]  M. Herman,et al.  Ventriculographic Patterns and Hemodynamics in Primary Myocardial Disease , 1973, Circulation.

[34]  M. Matsuzaki,et al.  Usefulness of negative dPdt upstroke pattern for assessment of left ventricular relaxation in coronary artery disease , 1989 .

[35]  J Ross,et al.  Contractile State of the Left Ventricle in Man: Instantaneous Tension‐Velocity‐Length Relations in Patients With And Without Disease of the Left Ventricular Myocardium , 1968, Circulation research.

[36]  R. S. Williams,et al.  Left bundle branch block: angiographic segmental wall motion abnormalities. , 1979, The American journal of cardiology.

[37]  H. Bolte.  Myocardial Biopsy , 1980, Springer Berlin Heidelberg.

[38]  W. Delius,et al.  Regional Left Ventricular Wall Motion in Congestive Cardiomyopathy , 1978 .