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Contribution of mitral annular excursion and shape dynamics to total left ventricular volume change
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Department of Medicine and Care, Center for Medical Image Science and Visualization. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0003-2198-9690
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Department of Medicine and Care, Center for Medical Image Science and Visualization. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Department of Medicine and Care, Center for Medical Image Science and Visualization. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Biomedical Engineering. Linköping University, Department of Medicine and Care, Center for Medical Image Science and Visualization. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0001-5526-2399
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2004 (English)In: American Journal of Physiology. Heart and Circulatory Physiology, ISSN 0363-6135, E-ISSN 1522-1539, Vol. 287, no 4, H1836-H1841 p.Article in journal (Refereed) Published
Abstract [en]

The mitral annulus (MA) has a complex shape and motion, and its excursion has been correlated to left ventricular (LV) function. During the cardiac cycle the annulus’ excursion encompasses a volume that is part of the total LV volume change during both filling and emptying. Our objective was to evaluate the contribution of MA excursion and shape variation to total LV volume change. Nine healthy subjects aged 56 ± 11 (means ± SD) years underwent transesophageal echocardiography (TEE). The MA was outlined in all time frames, and a four-dimensional (4-D) Fourier series was fitted to the MA coordinates (3-D+time) and divided into segments. The annular excursion volume (AEV) was calculated based on the temporally integrated product of the segments’ area and their incremental excursion. The 3-D LV volumes were calculated by tracing the endocardial border in six coaxial planes. The AEV (10 ± 2 ml) represented 19 ± 3% of the total LV stroke volume (52 ± 12 ml). The AEV correlated strongly with LV stroke volume (r = 0.73; P < 0.05). Peak MA area occurred during middiastole, and 91 ± 7% of reduction in area from peak to minimum occurred before the onset of LV systole. The excursion of the MA accounts for an important portion of the total LV filling and emptying in humans. These data suggest an atriogenic influence on MA physiology and also a sphincter-like action of the MA that may facilitate ventricular filling and aid competent valve closure. This 4-D TEE method is the first to allow noninvasive measurement of AEV and may be used to investigate the impact of physiological and pathological conditions on this important aspect of LV performance.

Place, publisher, year, edition, pages
2004. Vol. 287, no 4, H1836-H1841 p.
Keyword [en]
annular physiology, ventricular long axis function, echocardiography, three dimension, four dimension
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-24050DOI: 10.1152/ajpheart.00103.2004Local ID: 3608OAI: oai:DiVA.org:liu-24050DiVA: diva2:244366
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Annular dynamics of the human heart: novel echocardiographic approaches to assess ventricular function
Open this publication in new window or tab >>Annular dynamics of the human heart: novel echocardiographic approaches to assess ventricular function
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The complex myocardial fiber architecture of the left ventricle (LV) enables long-axis motion (annular excursion), short-axis motion and also a small torsional deformation throughout the cardiac cycle. The contribution of the long-axis motion has proven to be important in generating ventricular filling and emptying, and the analysis of annular excursion has become a well established diagnostic tool for the assessment of ventricular function. Cardiac motion can be accurately described with modem non-invasive imaging teclmiques, and this is important ground for deeper understanding and more reliable diagnosis of cardiovascular disease. The focus of this thesis was to provide new insights into cardiac pump function using variables originating from the annular excursion and dynamic changes in shape, applying both established and novel echocardiographic imaging approaches.

The traditional method of evaluating systolic ventricular fimction according to the total annular excursion overestimates the excursion amplitude in relation to true systolic fimction. A novel method presented here, measurement of the systolic annular excursion, more accurately reflects the timing of true systole, and was applied both in patients with heart disease and in healthy subjects. To date, the form of asynchronous myocardial motion called postsystolic shortening (PSS) has mainly been observed in the setting of myocardial ischemia. The significance of PSS in hypertensive heart disease remains incompletely described. We found that a subgroup of hypertensive patients with PSS along the LV long-axis had signs of more severe cardiac involvement unrelated to the level of blood pressure. Endurance trained subjects showed a larger LV long-axis motion as compared to strength trained and untrained controls. Mitral annular (MA) excursion correlated strongly to LV stroke volume, end-diastolic volume and maximal oxygen consumption per body weight, but weakly to LV ejection fraction. These findings provide further evidence of the importance of annular excursion to normal cardiac performance. In order to assess the contribution of MA excursion and shape dynamics to total LV volume change in humans, a novel 4-dimensional transesophageal echocardiography teclmique was developed. The excursion of the annulus accounted for an important portion (19±3%) of the total LV filling and emptying in healthy human subjects. Furthermore, our findings elucidate an atrial influence on MA physiology in humans, as well as a sphincter-like action of the MA. These temporal changes may facilitate ventricular filling by annular expansion during early and mid diastole, and aid competent valve closure during the marked decrease in annular area during late diastole and early systole.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2004. 72 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 871
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-23445 (URN)2897 (Local ID)91-7373-847-6 (ISBN)2897 (Archive number)2897 (OAI)
Public defence
2004-12-03, Elsa Brändströmsalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2013-12-17Bibliographically approved

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Carlhäll, CarljohanWigström, LarsHeiberg, EinarKarlsson, MattsNylander, Eva

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Carlhäll, CarljohanWigström, LarsHeiberg, EinarKarlsson, MattsNylander, Eva
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Clinical PhysiologyCenter for Medical Image Science and VisualizationFaculty of Health SciencesDepartment of Biomedical Engineering
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American Journal of Physiology. Heart and Circulatory Physiology
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