Circulation, Vol 76, 998-1008, Copyright © 1987 by American Heart Association
DE Hansen, GT Daughters 2d, EL Alderman, EB Stinson, JC Baldwin and DC Miller
Left ventricular systolic torsion and diastolic recoil were quantified in
12 human cardiac transplant recipients with surgically implanted
intramyocardial markers with the use of computer-aided analysis of biplane
cineradiographic images. Measurements were performed between 6 and 16 weeks
after surgery and related to the presence or absence of rejection as
determined by cardiac biopsy. Torsional deformation, defined as twisting
about the left ventricular long axis of the apical region with respect to
the base, was characterized in terms of the rate and amplitude of systolic
torsion and the rate of diastolic recoil by means of an internal reference
system. Comparison of measurements before, during, and after recovery from
14 rejection episodes allowed assessment of the effects of acute reversible
cardiomyopathy on left ventricular torsion and recoil. Compared with
prerejection values, the amplitude of torsional deformation in the
maximally deforming segment (theta max) decreased by 25% from 21.1 +/- 15.2
to 16.0 +/- 5.7 degrees (p less than .005) during acute rejection with
myocyte necrosis; this was associated with significant (p less than .05)
decreases in the peak systolic torsion rate (+d theta/dtmax), whereas the
peak diastolic recoil rate (-d theta/dtmax) was unchanged. This suggests
that the stiffness of elastic components of the myocardium may have
increased, maintaining the rate of diastolic recoil when these elements are
stretched less. With successful treatment of rejection episodes, the
torsional deformation characteristics normalized. Heart rate, mean arterial
pressure, left ventricular end-diastolic volume, stroke volume, ejection
fraction, and peak left ventricular filling rate were unchanged with
rejection episodes, whereas left ventricular end- systolic volume increased
(p less than .05) during acute rejection and returned to normal with
resolution of the rejection process. These data suggest that left
ventricular torsional deformation amplitude and rate are sensitive to
episodes of subclinical left ventricular dysfunction and that such
intramyocardial marker techniques may provide new insights regarding the
elastic properties of the ventricular myocardium and their impact on left
ventricular mechanics.
ARTICLES
Effect of acute human cardiac allograft rejection on left ventricular systolic torsion and diastolic recoil measured by intramyocardial markers
Division of Cardiology, Stanford University School of Medicine, CA.
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