(Circulation. 1997;96:535-541.)
© 1997 American Heart Association, Inc.
Articles |
Noninvasive Measurement of Shortening in the Fiber and Cross-Fiber Directions in the Normal Human Left Ventricle and in Idiopathic Dilated Cardiomyopathy
From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Biomedical Engineering (H.A.), Technion IIT, Haifa, Israel; and the University of Antwerp (F.E.R.), Belgium.
Correspondence to Edward P. Shapiro, MD, Division of Cardiology, The Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, Baltimore, MD 21224. E-mail eshapiro{at}welchlink.welch.jhu.edu
Background Studies in anesthetized dogs
have shown that myocardial fibers shorten 
8%. However, in the
endocardium, shortening occurs to a much greater extent at 90° to the
fiber orientation ("cross-fiber shortening") than it does along
the fiber direction. The purpose of this study was to estimate the
extent of fiber and cross-fiber shortening in the normal human left
ventricle and in patients with idiopathic dilated
cardiomyopathy (IDC).
Methods and Results Ten normal subjects and nine patients with IDC were imaged with magnetic resonance tissue tagging. Finite strain analysis was used to calculate endocardial and epicardial shortening in the fiber and cross-fiber directions using anatomic fiber angles from representative autopsy specimens as references. Anatomic fiber angles were not different between normal subjects and IDC patients. Epicardial fiber strain was -0.14±0.01 in normal subjects and -0.08±0.01 in IDC patients (P<.0001 versus normal subjects). Epicardial cross-fiber strain was -0.08±0.01 in normal subjects and -0.06±0.01 in IDC patients (P=NS). Endocardial fiber strain was -0.16±0.01 in normal subjects and -0.09±0.01 in IDC patients (P<.0001), and endocardial cross-fiber strain was -0.26±0.01 in normal subjects and -0.15±0.01 in IDC patients (P<.0001). Cross-fiber shortening was greater than fiber shortening at the endocardium in both normal subjects (P<.0001) and IDC patients (P<.05).
Conclusions In normal humans, the direction of
maximal deformation aligns with the fiber direction in the epicardium
but is perpendicular to the fiber direction in the endocardium. When
strain in a coordinate system aligned to the fibers is estimated,
cross-fiber shortening is found to be the dominant shortening strain at
the endocardium. Normal fiber shortening is 15%, and this is
markedly reduced in IDC. The normal transition in fiber orientation
through the wall is not altered in IDC, and cross-fiber shortening is
still the dominant strain at the endocardium, suggesting that
interactions between myocardial layers persist in these patients.
Key Words: magnetic resonance imaging • mechanics • cardiomyopathy • myocardial contraction
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