Epicardial surface dynamics in the closed-chest normal canine.

Past studies of the changing three-dimensional shape of the heart in the closed chest during the cardiac cycle have been restricted to the measurement of local deformations at a relatively few specific locations, and often have required surgical procedures that alter the measurements obtained. In the study reported here, high precision displacement and velocity measurements were obtained at the epicardial interface using a Compton backscatter imaging technique that does not require a surgical intervention or contrast injections. Displacement and velocity measurements were obtained at more than 200 locations at the epicardial interface at 13 ms intervals throughout the cardiac cycle. Measurements of the changing shape of the heart during the cardiac cycle with this technique are precise to 0.1 mm (S.D.). Displacement and velocity patterns recorded in this study confirm and integrate the studies of many others and also add new information. An unexpected vigorous inward motion of both the LV (39 mm s-1) and RV (26 mm s-1) surfaces during isovolumic relaxation and early rapid refill is demonstrated. Velocities during this period equal or exceed those that occur during ejection. During ejection, inward LV motion at the base of the heart precedes that at the apex by 80-90 ms. Posterior LV displacements and velocities during ejection are 4-6 times greater than those at the anterior and apex. The Compton backscatter imaging technique for obtaining undisturbed measurements of cardiac dynamics in the closed chest has potential as a non-invasive clinical tool for serial studies of cardiac surface motion abnormalities. The data presented can also be used to set surface boundary conditions for biomechanical models of heart deformation.

Inward diastolic motion: a normal component of isovolumic relaxation and rapid refill.

Many reports note expansive events occurring in the left ventricle during isovolumic relaxation. Expansions during isovolumic relaxation require compensatory inward displacements elsewhere in the ventricle. The location and character of such compensatory displacements have been a continuing source of speculation. Using a high-precision Compton backscatter imaging (CBI) technique, we have detected an early diastolic inward motion that initiates during isovolumic relaxation on the right and left epicardial free walls of the heart in 100% of the 14 normal canines we have studied. This inward motion is first detected 20-30 ms after left ventricular maximal rate of pressure decrease over time (-dP/dtmax), lasts into the early rapid filling phase with a mean duration of 92 +/- 5 (SE) ms, and ends approximately 30 ms after opening of the mitral valve. Maximum wall velocities during this time period (approximately 20 mm/s) exceed those occurring in the same regions during systole. Inward surface displacements in the areas undergoing inward motion average 1.1 +/- 0.2 and 0.9 +/- 0.2 mm on the left and right side of the heart, respectively.

The effects of pacing site on left ventricular epicardial surface velocity patterns during systole.

Changes in epicardial LV velocity patterns during isovolumic contraction and ejection as induced by ventricular pacing were studied in 15 canines. A noninvasive imaging technique that provided high temporal resolution was used to study the timing of an outward expansion of the LV during isovolumic contraction and the propagation pattern of an inward LV velocity wavefront during ejection. With this technique, surface displacements were measured (+/- 0.1 mm SD) at 50-70 locations on the LV free wall at 5-msec intervals. Velocities were calculated by differentiating the surface displacement waveforms and an interpolation procedure was used to provide detailed color coded velocity maps of the LV surface. LV surface velocities were determined from data obtained during closed-chest endocardial pacing from each of four sites: right atrium, right ventricular apex, left ventricular apex, and right ventricular outflow tract. These surface velocities showed a distinct spatial and temporal pattern for each pacing site. The results show that this noninvasive mapping procedure has potential for determining the location of an ectopic ventricular focus.

Analysis of edge-tracking errors inherent in fluoroscopic images of the beating heart.

RATIONALE AND OBJECTIVES: Because of the complex relationships between the dynamic three-dimensional cardiac surface shape and its projected image, errors arise with the use of two-dimensional silhouettes to measure displacements of the heart. The character and frequency of such errors are examined. METHODS: A high-precision x-ray scatter imaging technique was used to reconstruct the three-dimensional shape of the left ventricular free wall throughout the cardiac cycle. Displacements of the three-dimensional surface were then compared with those on the two-dimensional projected silhouette. Silhouette displacement errors were determined as a function of time during the cardiac cycle and variability between hearts. RESULTS: Differences between silhouette measurements and those on the cardiac surface range from 0% to 125% of peak-to-peak displacements occur, along 33% to 75% of the silhouette contours and cover 66% of the cardiac cycle. CONCLUSION: Two-dimensional silhouette displacements provide inconsistent measurements of motion patterns on the three-dimensional cardiac surface.

A flying spot X-ray system for Compton backscatter imaging.

A Compton X-ray backscatter imaging (CBI) system using a single detector and a mechanically rastered "flying spot" X-ray beam has been designed, built, and tested. While retaining the essential noninvasive imaging capability of previous multiple detector CBI devices, this single detector system incorporates several advances over earlier CBI devices: more efficient detection of scattered X-rays, reduced X-ray exposure, and a simplified scan protocol more suitable for use with humans. This new CBI system also has specific design features to permit automating data acquisition from multiple two-dimensional image planes for integration into a 3D dynamic surface image. A simulated multislice scan study of a human thorax phantom provided X-ray dosimetry data verifying a very low X-ray dose (~50 mrem) delivered by this imaging device. Validation experiments with mechanical models show that surface displacement at typical heart beat frequencies can be measured to the nearest 0.1 mm (SD).

Ischemia-induced depressed systolic thickening is transiently augmented by remote coronary occlusion.

To determine if ischemia-induced depressed myocardial thickening can be augmented by remote coronary occlusion, posterior wall function (pulsed Doppler crystal) was measured before and after left anterior descending coronary artery occlusion in the presence of reduced circumflex coronary artery flow (of sufficient severity to reduce resting function) in an anesthetized open-chest canine preparation in which the circumflex was pump-perfused with carotid arterial blood. Left anterior descending coronary occlusion elicited an immediate significant increase in posterior bed thickening fraction (TF%) (3.7 +/- 1.5 to 5.9 +/- 1.3%), but by 135 sec TF% had again deteriorated. The transient increase in thickening was not caused by increased flow to the posterior bed (microspheres, n = 3), nor was it related to a Frank-Starling mechanism (echocardiography, n = 3). Despite an ischemic-induced reduction in systolic shortening, systolic thickening can be transiently augmented by remote coronary occlusion. The etiology may be related to systolic unloading.

Systolic thickening increases from subepicardium to subendocardium.

STUDY OBJECTIVE: The aim was to determine the relation between systolic function and depth below the epicardial surface, using pulsed Doppler crystals. DESIGN: Systolic excursion in mm was measured at multiple depths below the epicardial surface. Measurements were made during control conditions. SUBJECTS: Thirty four anaesthetised mongrel dogs were studied. MEASUREMENTS AND MAIN RESULTS: A total of 333 measurements of systolic excursion were made during control conditions at 1 to 3 crystal sites per dog. Two models were constructed; the model which assumed a quadratic relation between depth (d) and systolic excursion (EX) (EX = 0.498 + 0.176d + 0.006d2) fit the data better than did a model which assumed a linear relation (EX = -0.0716 + 0.254d). CONCLUSIONS: These data support the prediction from geometric models that systolic excursion increases in a non-linear fashion from subepicardium to subendocardium.

High precision Compton backscatter maps of myocardial wall dynamics. Theory and applications.

Compton backscatter imaging (CBI) is a technique that uses x-rays scattered from the closed-chest surface of the heart to obtain high frequency (5 msec) and high precision (+/- 0.1 mm SD) measurements of regional surface displacements and velocities. These measurements are acquired in a three-dimensional format that allows the reconstruction of the epicardial surface and the creation of color coded displacement and velocity maps at many time points during the cardiac cycle. Applications of the technique are shown to characterize detailed regional normal wall displacement and velocity patterns, and the significant alteration of those patterns after coronary embolization. The technique is also applied to the characterization of early diastolic wall dynamics. CBI measurements show that a brief and somewhat paradoxical inward displacement of the anterior ventricular wall occurs during early diastole in normal canines. The wall dynamics associated with this inward displacement suggest a brief collapse of the ventricle subsequent to aortic valve closure. Diastolic collapse velocities and displacements are significantly altered subsequent to coronary occlusion with mean and maximum collapse velocities decreasing by 50% and concomitant inward displacements decreasing by 40%. Data acquisition with CBI is non-invasive, does not require contrast agents or radioisotopes, and uses low irradiation levels (125 kVp, 3-5 ma). The average radiation dose to the heart for a typical study is 250 mrem, significantly lower than that of other radiation based imaging techniques.

Coronary artery embolization in closed-chest canines using flexible radiopaque plugs.

A new technique induces localized myocardial infarction in closed-chest dogs by placing discrete plugs in coronary arteries without using cumbersome coaxial catheters or guide wires. Flexible plugs, essential to this method, are formed by extruding a dental impression polymer, rendered radiopaque with sodium iodide, into spaghetti-like strands. Segments of these strands can be injected through a catheter into a selected coronary artery. Contact with blood or saline causes plugs to swell. The mean increase in plug diameter due to swelling was 27 +/- 20%. Eight anesthetized dogs were embolized via carotid approach [6 left anterior descending (LAD), 1 left circumflex (LCX), and 1 LAD and LCX]. Plug positions were monitored fluoroscopically. One animal died at 2 days postembolization. The remaining seven dogs were killed after 14-37 days. Autopsies showed complete vessel occlusion and localized infarction. Infarcts resulting from coronary artery occlusion with one, two, or three plugs involved 2-26% of the left ventricular mass.

Improvement in regional wall motion and left ventricular relaxation after administration of diltiazem in patients with coronary artery disease.

To assess the effect of diltiazem on left ventricular systolic regional wall motion and diastolic function in patients with coronary artery disease (CAD), 22 patients underwent biplane left ventricular cineangiography before and after intravenous diltiazem (plasma concentration 154 +/- 12 ng/ml). Left ventricular and right ventricular pressures were measured by micromanometer-tipped catheters. Regional wall motion was assessed quantitatively with an area ejection fraction technique. Diltiazem decreased mean arterial pressure 11.5% (p less than .0001) and heart rate 6.8% (p less than .005); it increased cardiac index 8.8% (p less than .025) and global ejection fraction 9.1% (p less than .0001). However, left ventricular end-diastolic pressure increased 14.2% (p less than .001) and the left ventricular end-systolic pressure-volume (P-V) ratio decreased 8.8% (p less than .02). Diltiazem decreased the time constant of left ventricular relaxation by 14.3% (p less than .002), despite lack of change in the left ventricular diastolic P-V relationship, in 16 patients. Diltiazem caused a significant increase in area ejection fraction in 53% of hypokinetic areas supplied by diseased arteries compared with 13% of normokinetic areas supplied by diseased arteries (p less than .0001). Response of ejection fraction to diltiazem in areas supplied by normal coronary arteries was less (p less than .05) than that in hypokinetic areas supplied by arteries affected by disease. In conclusion, diltiazem improves regional wall motion abnormalities in patients with CAD and the improvement is associated with better left ventricular relaxation but not with a change in the diastolic P-V relationship. Global indexes of left ventricular systolic performance are favorably influenced by diltiazem, despite a mild negative inotropic effect.

The measurement of multidimensional myocardial dynamics using scattered radiation fields.

A new radiographic device, based upon the analysis of scattered radiation fields, has been developed to measure myocardial dynamics. The device consists of an array of detectors arranged to monitor photons scattering from the epicardial surface. Data synthesis permits real-time dynamic displays of the epicardial surface in two and three dimensions. The system has been tested on close-chest canines. Epicardial surface displacements within the closed chest cavity can be measured to 0.1 mm (S.D.). Right or left ventricular surfaces may be monitored on a given scan. Surfaces behind or in front of outer myocardial boundaries within the direct field of view of the detectors are located with equal accuracy. Except for the use of low levels of fluoroscopic x-rays, the procedure is completely noninvasive. Radiation dose levels and component costs for the prototype system are modest. The detector system attaches to a standard fluoroscopic x-ray generator.