Relation Between Longitudinal, Circumferential, and Oblique Shortening and Torsional Deformation in the Left Ventricle of the Transplanted Human Heart

The present study was designed to investigate the anisotropy of systolic chord shortening in the lateral, inferior, septal, and anterior regions of the human left ventricle. At the time of surgery, 12 miniature radlopaque markers were implanted into the left ventricular midwall of the donor heart in 15 cardiac transplant recipients. Postoperative biplane cineradiograms were computer-analyzed to yield the three-dimensional coordinates of these markers at 16.7-msec intervals. In each of the four left ventricular regions, chords were constructed from a central marker to outlying markers, and the percent systolic shortening of each chord was calculated. In each region, chord angles were measured with respect to the circumferential direction (positive angles counterclockwise) and each chord was assigned to one of four angular groups: I. oblique, -45±22.5° or 135±22.5°; II. circumferential, 0±22.5° or 180±22.5°; III. oblique, 45±22.5° or -135±22.5°; or IV. longitudinal, 90±22.5° or -90±22.5°. In the lateral, inferior, and septal regions, respectively, systolic shortening (mean± SD percent;) was significantly greater in Group I chords (19±5percent;, 17±5percent;, and 15±4percent;) than those in Group II (15±5percent;, 12±4percent;, and 11±4percent;), Group III (12±4percent;, 12±5percent;, and 11±4percent;), or Group IV (13±5percent;, 13±6percent;, and 12±5percent;). The anterior region was unique hi exhibiting equal shortening in both Group I and Group n chords (16±5percent;), although the shortening of these chords was significantly greater than that of Group III and Group IV (12±5percent;) in this region. A cylindrical mathematical model was developed to relate longitudinal, circumferential, and oblique systolic shortening to torsional deformation about the long axis of the left ventricle. Torsional deformations measured in these 15 hearts were of sufficient magnitude and correct sense to agree with model predictions. These data suggest that torsional deformations of the left ventricle are of fundamental importance in Unking the one-dimensional contraction of the helically wound myocytes to the three-dimensional anisotropic systolic shortening encountered in the transplanted human heart.

[1]  P S Reddy,et al.  Development of coronary artery disease in cardiac transplant patients receiving immunosuppressive therapy with cyclosporine and prednisone. , 1987, Circulation.

[2]  T. Robinson,et al.  A variety of intercellular connections in heart muscle. , 1981, Journal of molecular and cellular cardiology.

[3]  R S Reneman,et al.  Torsion of the left ventricle during the ejection phase in the intact dog. , 1984, Cardiovascular research.

[4]  J W Covell,et al.  Regional Differences in Myocardial Performance in the Left Ventricle of the Dog , 1975, Circulation research.

[5]  J. Hurlé,et al.  Myocardial fiber architecture of the human heart ventricles , 1982, The Anatomical record.

[6]  W D Spotnitz,et al.  Cellular basis for volume related wall thickness changes in the rat left ventricle. , 1974, Journal of molecular and cellular cardiology.

[7]  K Wildenthal,et al.  Geometrical studies of the left ventricle utilizing biplane cinefluorography. , 1969, Federation proceedings.

[8]  J C Greenfield,et al.  The Three‐Dimensional Dynamic Geometry of the Left Ventricle in the Conscious Dog , 1976, Circulation research.

[9]  Edward W. Hawthorne,et al.  Dynamic geometry of the left ventricle , 1966 .

[10]  S. M. Collins,et al.  Finite Element Analysis of Myocardial Diastolic Function Using Three‐Dimensional Echocardiographic Reconstructions: Application of a New Method for Study of Acute Ischemia in Dogs , 1987, Circulation research.

[11]  A J Buda,et al.  Direct measurement of inner and outer wall thickening dynamics with epicardial echocardiography. , 1986, Circulation.

[12]  M. Billingham.  Some recent advances in cardiac pathology. , 1979, Human pathology.

[13]  J. Covell,et al.  Relation Between Transmural Deformation and Local Myofiber Direction in Canine Left Ventricle , 1988, Circulation research.

[14]  R S Reneman,et al.  Epicardial deformation and left ventricular wall mechanisms during ejection in the dog. , 1982, The American journal of physiology.

[15]  S A MacKay,et al.  Methods for evaluating cardiac wall motion in three dimensions using bifurcation points of the coronary arterial tree. , 1983, Investigative radiology.

[16]  P. Hairston,et al.  Myocardial contractile force as influenced by direct coronary surgery. , 1973, The Annals of thoracic surgery.

[17]  G. Daughters,et al.  Left Ventricular Midwall Dynamics from Surgically Implanted Markers in Intact Unanesthetized Man , 1982 .

[18]  R. F. Rushmer,et al.  The Functional Anatomy of Ventricular Contraction , 1953, Circulation research.

[19]  I G McDonald,et al.  The shape and movements of the human left ventricle during systole. A study by cineangiography and by cineradiography of epicardial markers. , 1970, The American journal of cardiology.

[20]  Y. Fung,et al.  Transmural Myocardial Deformation in the Canine Left Ventricle: Normal in Vivo Three‐Dimensional Finite Strains , 1985, Circulation research.

[21]  S. Shroff,et al.  Collagen in the hypertrophied, pressure-overloaded myocardium. , 1987, Circulation.

[22]  P. Hugenholtz,et al.  Quantification of function in normal and infarcted regions of the left ventricle. , 1972, Cardiovascular research.

[23]  J. Mitchell,et al.  Instantaneous changes in the left ventricular lengths occurring in dogs during the cardiac cycle. , 1969, Federation proceedings.

[24]  G A Klassen,et al.  Transmural myocardial deformation in the canine left ventricular wall. , 1978, The American journal of physiology.

[25]  A E Becker,et al.  Left ventricular fibre architecture in man. , 1981, British heart journal.

[26]  Donald C. Harrison,et al.  Studies on Cardiac Dimensions in Intact, Unanesthetized Man , 1963, Circulation research.

[27]  K. Gallagher,et al.  Dissociation between epicardial and transmural function during acute myocardial ischemia. , 1985, Circulation.

[28]  C L Seidel,et al.  Doppler measurement of myocardial thickening with a single epicardial transducer. , 1983, The American journal of physiology.

[29]  R S Chadwick,et al.  Theoretical analysis of the effects of a radial activation wave and twisting motion on the mechanics of the left ventricle. , 1988, Biorheology.

[30]  G W Moore,et al.  Shape of the human cardiac ventricles. , 1978, The American journal of cardiology.

[31]  M. Yacoub,et al.  Left ventricular contractility and contractile reserve in humans after cardiac transplantation. , 1985, Circulation.

[32]  W. Lew,et al.  Regional Comparison of Midwall Segment and Area Shortening in the Canine Left Ventricle , 1986, Circulation research.

[33]  R. Beyar,et al.  A Computer Study of the Left Ventricular Performance Based on Fiber Structure, Sarcomere Dynamics, and Transmural Electrical Propagation Velocity , 1984, Circulation research.

[34]  A D McCulloch,et al.  Left ventricular epicardial deformation in isolated arrested dog heart. , 1987, The American journal of physiology.

[35]  J A Koziol,et al.  Subepicardial Segmental Function during Coronary Stenosis and the Role of Myocardial Fiber Orientation , 1982, Circulation research.

[36]  L. Cohn,et al.  Time course of resolution of pulmonary hypertension and right ventricular remodeling after orthotopic cardiac transplantation. , 1987, Circulation.

[37]  H D McIntosh,et al.  Assessment of regional myocardial performance from biplane coronary cineangiograms. , 1971, The American journal of cardiology.

[38]  R. W. Brower,et al.  Direct method for determining regional myocardial shortening after bypass surgery from radiopaque markers in man. , 1978, The American journal of cardiology.

[39]  G M Hutchins,et al.  The architecture of the human ventricular myocardium. , 1972, The Johns Hopkins medical journal.

[40]  G Osakada,et al.  Nonuniformity of inner and outer systolic wall thickening in conscious dogs. , 1985, The American journal of physiology.

[41]  Comments on "Relationship between myocardial fiber direction and segment shortening in the midwall of the canine left ventricle". , 1985, Circulation research.

[42]  F. TorrentGuasp.  Macroscopic structure of the ventricular myocardium , 1980 .

[43]  J. Fleiss,et al.  Some Statistical Methods Useful in Circulation Research , 1980, Circulation research.

[44]  R. Helfant,et al.  Contrasting ischemic contraction patterns by zone and layer in canine myocardium. , 1982, The American journal of physiology.

[45]  T K Borg,et al.  The collagen matrix of the heart. , 1981, Federation proceedings.

[46]  Neil B. Ingels,et al.  Torsional Deformation of the Left Ventricular Midwall in Human Hearts With Intramyocardial Markers: Regional Heterogeneity and Sensitivity to the Inotropic Effects of Abrupt Rate Changes , 1988, Circulation research.

[47]  M. Pasque,et al.  The comparative effects of dopamine and dobutamine on ventricular mechanics after coronary artery bypass grafting: a pressure-dimension analysis. , 1984, Circulation.

[48]  N B Ingels,et al.  Measurement of Midwall Myocardial Dynamics in Intact Man by Radiography of Surgically Implanted Markers , 1975, Circulation.

[49]  Fox Cc,et al.  The architecture of the human ventricular myocardium. , 1972 .

[50]  D. C. Miller,et al.  Effect of acute human cardiac allograft rejection on left ventricular systolic torsion and diastolic recoil measured by intramyocardial markers. , 1987, Circulation.

[51]  T Arts,et al.  Fiber shortening in the inner layers of the left ventricular wall as assessed from epicardial deformation during normoxia and ischemia. , 1984, Journal of biomechanics.

[52]  N B Ingels,et al.  Stereo photogrammetric studies on the dynamic geometry of the canine left ventricular epicardium. , 1971, Journal of biomechanics.

[53]  J W Covell,et al.  Relationship between Myocardial Fiber Direction and Segment Shortening in the Midwall of the Canine Left Ventricle , 1985, Circulation research.

[54]  J. Dieudonné,et al.  Gradients de directions et de déformations principales dans la paroi ventriculaire gauche normale. , 1969 .

[55]  D. Durrer,et al.  Total Excitation of the Isolated Human Heart , 1970, Circulation.

[56]  A. Fishman,et al.  Muscle fiber orientation and connective tissue content in the hypertrophied human heart. , 1982, Laboratory investigation; a journal of technical methods and pathology.

[57]  F. Yin,et al.  Ventricular wall stress. , 1981, Circulation research.

[58]  F. P. Mall,et al.  On the muscular architecture of the ventricles of the human heart , 1911 .

[59]  H N Sabbah,et al.  The relative role of subendocardium and subepicardium in left ventricular mechanics. , 1981, The American journal of physiology.

[60]  Dd. Streeter,et al.  Gross morphology and fiber geometry of the heart , 1979 .

[61]  A. Wechsler,et al.  Segmental mid-wall myocardial dimensions in man recorded by sonomicrometry. , 1978, The Journal of thoracic and cardiovascular surgery.