Showing papers on "Cardiac cycle published in 1987"

A new intracavitary probe for detecting the site of origin of ectopic ventricular beats during one cardiac cycle.

Abstract: An olive-shaped probe (25 X 12 mm) with 41 evenly distributed recording electrodes on its surface was introduced into the left ventricles of seven open-chest dogs via the left atrium. In two other dogs a cylindrical probe (40 X 3 mm) was used. Electrical stimuli were delivered at 66 endocardial, midwall, or epicardial sites in the left and right ventricular walls and the septum. Mechanical stimuli were also applied at various epicardial sites. On-line mapping of equipotential contour lines on the surface of the probe invariably revealed a clear-cut potential minimum on the electrode that faced the pacing site. Time of appearance of potential minimum was 3 to 5 msec after endocardial stimuli, 10 to 25 msec for midwall and epicardial pacing, and 30 msec or more for right ventricular stimulation. Simultaneous stimulation at two sites 1.2 cm apart gave rise to two separate minima on the maps. "Pseudoisochrones" derived from electrograms recorded by the new probe were slightly less accurate in indicating the site of origin of extrasystoles. We conclude that equipotential and "isochrone" contour maps recorded from an array of semidirect electrodes, regularly distributed on the surface of an intraventricular probe, provide information on the site of origin (location and intramural depth) of ectopic paced beats in a normal dog heart.

Load-dependent relaxation with late systolic volume steps: servo-pump studies in the intact canine heart.

Abstract: In isolated heart muscle preparations an abrupt increase in load during the latter portion of contraction (at a time when there is little if any potential to develop additional force) causes a premature and more rapid relaxation; this load-dependent relaxation characterizes relaxation in myocardium with normal sarcoplasmic reticulum. The purpose of our study was to assess whether or not the phenomenon of load-dependent relaxation is present in the intact heart and to describe the left ventricular response to abrupt load increments (volume steps) throughout the cardiac cycle. Using a microcomputer-controlled servo-pump attached to the apex of an intact canine heart, we studied the effects of 6 ml steps on left ventricular pressure transients during relaxation. Each volume step was carried out in a single beat with 20 stabilization beats separating the intervention beats; thus, at a heart rate of 120 beats/min, a sequence of 10 intervention beats could be carried out in less than 2 min. By performing the experiments on a single-beat basis (control vs intervention beat), we were able to minimize reflex and other physiologic feedback mechanisms that might alter the results. Studies were performed in five anesthetized dogs. In ejecting beats, an early step (immediately after aortic valve opening) caused an increase (3%) in the duration of systole (the time from the onset of pressure rise to the instant at which left ventricular pressure had declined to one-half its maximal value); in contrast, a late step (just before aortic value closure) caused a decrease (7%) in the duration of systole.(ABSTRACT TRUNCATED AT 250 WORDS)

Magnetic resonance velocity mapping: clinical application of a new technique.

Abstract: Magnetic resonance velocity mapping is a new technique which provides a display of velocity within the cardiovascular system at any point of the cardiac cycle. A short field echo sequence with even echo rephasing is used to obtain a signal from rapidly moving blood and a cine display is provided by rapid repetition of the sequence. The amplitude image shows the anatomy, with blood giving a high signal and areas of turbulent flow no signal. The phase image is a map of velocities at each point in the image plane. Thirteen cases are described in which the technique either provided a diagnosis or helped in functional assessment. Flow through atrial and ventricular septal defects was seen, although turbulent flow distal to the ventricular shunts led to some loss of quantitative information. In three patients with valve disease jets of abnormal flow were seen because of signal loss and it is suggested that the size of the area of turbulence may be used to quantify the severity of regurgitation. Velocities were measured in four coronary artery bypass grafts in two patients, and low velocity was seen in a graft with distal disease that supplied the infarcted territory. Velocity was reduced distal to an aortic coarctation and it was increased at the site of narrowing caused by thrombosis in a deep vein. The speed and direction of flow in the central vessels in a patient with complex congenital heart disease helped to establish the anatomy. The technique provides useful information in a wide range of disorders of the cardiovascular system, and in some cases may avoid the need for invasive investigation.

Influence of heart rate on left ventricular performance in conscious dogs.

Abstract: The effects of atrial pacing on the left ventricular end-systolic pressure-volume relation, a relatively load-insensitive index of left ventricular performance, were studied in 8 chronically instrumented, conscious dogs. Six of the dogs were studied while autonomically intact, and 2 were studied after autonomic blockade with 2 mg/kg i.v. propranolol and 0.2 mg/kg i.v. atropine. Left ventricular pressure was measured with a micromanometer and left ventricular volume was determined from 3 ultrasonic orthogonal dimensions. Pressure was varied by caval occlusions at control heart rate and after atrial pacing at 100, 120, 140, 160, 180, and 200 bpm. The end-systolic pressure-volume relation was linear in every case (r = 0.97 +/- 0.03, SD). In the autonomically intact dogs, Emax, the slope of the end-systolic pressure-volume relation, was directly and monotonically related to heart rate in every dog, increasing to 238 +/- 99% of control at peak pacing rate (p less than 0.05). V0, the zero pressure intercept of the relation was also directly related to heart rate in every dog and increased 8.6 +/- 5.5 ml from control to peak pacing rate (p less than 0.05). Autonomic blockade did not attenuate these effects. This rightward shift of the end-systolic pressure-volume relation results in a reduced stroke volume from any end-diastolic volume, modulating the hemodynamic benefits of enhanced contractility. T, the time constant of isovolumic pressure fall during ventricular relaxation, was determined from beats with matched end-systolic pressures. T was related to heart rate, falling by 20 +/- 10.3% over the range of rates studied in the autonomically intact dogs and by 23.1 +/- 6.2% in the autonomically blocked dogs. Thus, the ventricle relaxes more rapidly at higher heart rates. We conclude that the frequency of contraction is concluded as an important determinant of overall pump function throughout the cardiac cycle in conscious dogs.

Noninvasive continuous mean arterial blood prssure monitor

Abstract: An apparatus and a method use noninvasive electrical bioimpedance measurments to monitor the mean arterial blood pressure of a patient on a continuous (heartbeat-by-heartbeat) basis. The apparatus and method process the electrical impedance across two segments of body tissue to provide a signal for each segment that indicates the increase in blood flow in each segment at the beginning of each cardiac cycle. The apparatus and method process the signals corresponding to each segment to measure the arterial pulse propagation delay between the two segments. The arterial pulse propagation delay is inversely related to the mean arterial blood pressure of the patient. The apparatus and method use the measured arterial pulse propagation delay to calculate the mean arterial blood pressure of the patient. The cardiac output of the patient is also advantageously measured and the cardiac index of the patient calculated from the cardiac output. The cardiac index and the mean arterial blood pressure are then used by the apparatus and method to calculate the left cardiac work index and the systemic vascular resistance index of the patient.

Cine MR determination of left ventricular ejection fraction

Abstract: Cine MR imaging provides tomographic images of the heart with both high spatial and high temporal resolution. As many as 32 images per cardiac cycle can be acquired with up to four separate anatomic slices and a total imaging time of 128 cardiac cycles. End-diastolic and end-systolic volumes were determined in 11 patients, and ejection fractions were calculated. The results correlated linearly with those from cardiac catheterization (correlation coefficient of .88). We conclude that cine MR imaging can be used to obtain quantitative information about the heart and has the potential to become a valuable noninvasive means of cardiac evaluation.

Changes in Doppler echocardiographic indexes of left ventricular function as potential markers of acute cardiac rejection.

Abstract: Changes in left ventricular filling and ejection as potential markers of cardiac allograft rejection were evaluated by serial Doppler echocardiography performed in 23 normal volunteers and within 24 hr of endomyocardial biopsy in 22 patients aged 14 to 53 years (mean 37). Peak aortic velocity, left ventricular ejection time index (ETI), isovolumic relaxation time (IVRT), mitral valve pressure half-time (PHT), peak early mitral flow velocity (M1), and velocity following donor atrial systole (M2) were measured without prior knowledge of endomyocardial biopsy findings. Biopsy specimens were graded histologically as: no rejection, mild rejection (cellular infiltrate), and moderate rejection (myocyte necrosis). A total of 120 biopsy-correlated Doppler echocardiographic studies were performed during 16 weeks after cardiac transplantation. Heart rate and mean arterial pressure were significantly higher in transplant recipients than in normal subjects. IVRT and PHT were significantly longer, while M1 and M2 were similar. Peak aortic velocity was higher in normal subjects than in transplant recipients, while ejection time was similar. Rejection of increasing severity was associated with a progressive shortening of IVRT and PHT and with an increase in M1 (p less than .0005 for all comparisons). Peak aortic velocity and ejection time index did not change significantly with rejection. These data indicate that acute cardiac rejection is accompanied by alteration in left ventricular filling dynamics detectable by Doppler echocardiography, without measureable changes in systolic function. These changes may provide noninvasive markers for surveillance of rejection.

Relation of Doppler-derived left ventricular filling parameters to age and radius/thickness ratio in normal and pathologic states.

Abstract: Transmitral diastolic inflow velocities determined by Doppler echocardiography have been shown to reflect left ventricular (LV) filling rates, and are therefore dependent on ventricular compliance. Radius to wall thickness ratio is an index of cavity to wall volume ratio, an important determinant of LV compliance. Accordingly, Doppler measurements of mitral anulus peak early diastolic velocity, peak atrial velocity and atrial filling fraction were made in 25 normal control subjects, mean age 46 years (range 28 to 75), and 29 patients with dilated cardiomyopathy or concentric LV hypertrophy, mean age 54 years (range 12 to 78). In addition, radius/thickness ratio was determined by 2-dimensionally guided M-mode recordings of the left ventricle. In the normal group, peak early velocity, the ratio of early to atrial velocity and atrial filling fraction correlated with age (r = −0.905, −0.823 and 0.810, respectively), but not with radius/thickness ratio. In the group with LV hypertrophy or dilatation, peak early velocity, ratio of early to atrial velocity and atrial filling fraction correlated with radius/thickness ratio (r = 0.625, 0.752 and −0.631, respectively), but not with age. Thus, with normal aging, early LV filling is reduced and atrial systole is augmented, probably reflecting instrinsic alterations in myocardial stiffness with age. In chronic LV disease, changes in radius/thickness ratio and, consequently, in chamber stiffness, influence early filling directly and atrial filling inversely, overriding the effects of age. Age-related standards are needed, however, to evaluate individual effects of a disease process on LV filling dynamics by Doppler.

Instantaneous pressure-volume relation of the ejecting canine left atrium

Abstract: To characterize the pump function of the left atrium, we determined the instantaneous pressure-volume relation of the isolated supported left atrium. A physiologic after-loading system for the low-pressure atrium was created by coupling it to a real-time computer-simulated ventricle and a simulated venous impedance network via a volume servo-pump. In 10 atria loaded with such systems, multiple isochronal sets of pressure-volume data were collected from many ejecting or isovolumic contractions obtained under a constant inotropic state, and the time-varying elastance, E(t), as well as the volume-axis intercepts, VO(t), were calculated. E(t) is the ensemble of slopes, and VO(t), the volume-axis intercepts resulting from the linear regression of instantaneous pressure on instantaneous volume at multiple instants throughout the cardiac cycle. The systolic portion of the left atrial E(t) was insensitive to loading conditions, as was VO(t), which, in addition, proved to be similar to the right atrial and right ventricular VO(t) waveforms in its time dependence. These results indicate that E(t) and VO(t) adequately represent the instantaneous pressure-volume relation of the left atrium in systole irrespective of the mode of contraction. Whatever the underlying mechanism might be, the load insensitivity and similarity of the basic shape of the left atrial E(t) among different atria suggests that the characterization reflects fundamental features of left atrial contraction.

Mitral regurgitation after cardiac transplantation.

Abstract: The contribution of the left atrium to mitral valve competence was assessed using the model of altered atrial size and geometry created by atrial anastomosis during cardiac transplantation. Sixteen patients underwent Doppler and 2-dimensional echocardiography after orthotopic transplantation. Mitral regurgitation was present in 14 of 16 patients. Left atrial geometry was uniformly abnormal, in a "snowman" configuration. Compared with 16 normal control subjects, the transplanted left atria were dilated (23 +/- 6 vs 13 +/- 3 cm2 during ventricular systole, p less than 0.001). Mitral valve anular diameter indexes, anular systolic reduction and ventricular function were normal in both groups. Ventricular volumes were small in the transplanted heart relative to donor body size (15 +/- 5 vs 20 +/- 8 cm3/m2 in systole, p less than 0.05). The ratio between ventricular length and anular diameter was smaller in the transplant patients (0.87 +/- 0.1 vs 1.0 +/- 0.2, p less than 0.05). In the presence of abnormal left atria, mitral regurgitation may occur without other structural abnormalities of the mitral apparatus. This study suggests that the left atrium plays an important role in mitral valve competence for primary cardiac disease associated with left atrial enlargement, even in the absence of intrinsic mitral valve disease or left ventricular dysfunction.

Localisation of cardiac related impedance changes in the thorax

Abstract: The existence of variations of normal human thoracic impedance, during the cardiac cycle to high frequency electrical current is well known. Since the impedance variations within the thorax are synchronous with the electrocardiogram (ECG), they are attributed to cardiac activity. They can arise from the change of either the rate of blood flow or the blood volume in the heart chambers, the great blood vessels and the lungs. However, their relative contribution is not known. Many investigators have worked on the non-invasive determination of some cardiac parameters using surface electrode impedance measurements on the thorax. Since the relationships between the measurement results and the pulsatile circulation of blood in various organs inside the chest are not well known, the information determined by surface impedance measurements is not as accurate as the results of invasive techniques. Recent advances in the clinical use of applied potential tomography (APT), or electrical impedance imaging, showed that the APT system gives a good soft-tissue contrast and has good sensitivity to resistivity changes. It is therefore concluded that the origin of thoracic impedance changes related to cardiac activity can be deduced from APT images. Our initial studies of ECG gated dynamic APT images of the thorax show that cardiac related thoracic impedance variations originating from different organs can be separated. Sequential APT images of the thorax during the cardiac cycle are presented. The movement of blood from the ventricles to the lungs and vascular system and back to the ventricles is observable in these images.(ABSTRACT TRUNCATED AT 250 WORDS)

Measurement of aortic blood flow with MR imaging: comparative study with Doppler US.

Abstract: An innovative magnetic resonance imaging technique was applied to the measurement of blood flow in the abdominal aorta. The technique combines selective excitation and visualization from an orthogonal view. The distance that fluid has moved is directly visualized. The blood flow velocity at every 50 msec throughout the cardiac cycle was measured in a short time (about 4 minutes) using electrocardiographic gating and repeated excitations in each cycle. Measurements were compared with those obtained by Doppler ultrasound (US) as a reference. The pulsatile change of flow velocity in the cycle correlated well with the Doppler US recording. Two flow velocity indexes, peak flow velocity and the velocity integral, also showed good correlation (r = .98 for both). This method is applicable for clinical use and is useful for measurement of high flow rates, as found in arteries.

Influence of recipient atrial contraction on left ventricular filling dynamics of the transplanted heart assessed by Doppler echocardiography

Abstract: Recipient atrial remnants retain electrical and mechanical activity after orthotopic cardiac transplantation. This study investigated the influence of recipient atrial contraction timing on Doppler ultrasound mitral flow velocity curves, isovolumic relaxation time, peak early mitral flow velocity (M1), mitral valve pressure half-time and peak mitral flow velocity due to atrial systole (M2). Clearly identifiable recipient atrial electrical activity (P waves) was present in 7 of 10 patients studied early postoperatively 2 to 6 months (mean 2.5) (early group) and in 20 of 24 patients seen 1 to 11 years (mean 3) after transplantation (late group). Median age and gender distribution were similar in both groups. For analysis of its influence on isovolumic relaxation time, pressure half-time and M1, recipient atrial contraction was classified by its position in the cardiac cycle as early systole, late systole or diastole. For analysis of M2, it was classified as early diastole, late diastole or systole. Compared with its occurrence in diastole, recipient atrial contraction in late systole was associated with a shorter isovolumic relaxation time, shorter pressure half-time and higher M1. In early systole it was associated with a longer pressure half-time and lower M1 than in diastole; isovolumic relaxation time was unchanged. Recipient atrial contraction in early diastole resulted in a lower M2 than in systole, whereas simultaneous contraction of recipient and donor atria in late diastole resulted in an increase in M2. These results indicate that the timing of recipient atrial contraction and relaxation significantly influences left ventricular filling dynamics.

Quantification of cardiac function by conventional and cine magnetic resonance imaging.

Abstract: Magnetic resonance imaging (MRI) has been effective for depicting cardiac anatomy and is already established as a technique for the evaluation of some structural abnormalities of the heart and pericardium. With recent advances, MRI can now be used to quantitate cardiac function. Multiphasic ECG-gated spin-echo imaging has been used to quantitate right and left ventricular volumes and ejection fraction. left ventricular mass, and regional myocardial wall thickening. The new technique of cine MRI acquires frames during the cardiac cycle with a time resolution corresponding to 20 msec up to approximately 40 frames for an average cardiac cycle. This technique uses narrow flip angle (30°) and gradient refocused echoes. Cine MRI has been used to measure ventricular volumes and ejection fraction and regional myocardial wall thickening. It is also sensitive to the detection of valvular regurgitation and can provide quantitation of regurgitant volume. This article reviews the current status of MRI for quantitating cardiac function.

Ventricular septal defect: visualization of shunt flow and determination of shunt size by cine MR imaging.

Abstract: Cine MR imaging is a new, fast technique that employs low flip angles, short repetition and echo times, and gradient-refocused echoes. This technique was used in three patients with documented ventricular septal defects (VSDs) to obtain transverse and oblique sections of the heart spanning the cardiac cycle. In all patients, cine MR imaging showed high-velocity turbulent blood flow across the defect as areas of low signal intensity extending from the left ventricle to the right ventricle. In the oblique sections oriented parallel to the interventricular septum it was possible to identify the cross-sectional area of the VSD. Quantification of the left-to-right shunt was performed by comparing left and right ventricular stroke volumes determined from end-diastolic and end-systolic volumes of both ventricles. Cine MR imaging provides important functional information and anatomic detail in patients with VSD and may be useful for diagnosis, determination of severity, and noninvasive monitoring of the disease.

Influence of ventricular contractility on non-work-related myocardial oxygen consumption

Abstract: The relationship between myocardial oxygen consumption (MVO2) and the total pressure-volume area (PVA), which represents the total mechanical work performed during a cardiac cycle, has been shown to be linear and independent of loading conditions: MVO2=aPVA+b. When inotropic state is enhanced, the MVO2-PVA relation shifts upward (increase inb), and when inotropic state is depressed the relation shifts downward (decrease inb). However, thequantitative relationship between contractility andb (the non-work-related myocardial oxygen consumption) determined over a wide range of contractilities is not known. In seven isolated blood perfused canine hearts, left ventricular (LV) contractility was increased by dobutamine and decreased with nifedipine or reduction of coronary blood flow. At each level of contractility, the end-systolic pressure-volume relationship (ESPVR) and the MVO2-PVA relation were determined. For each heart, the resulting values ofb (ml O2/beat) were plotted as a function of Emax (mmHg/ml), an index of contractility defined as the slope of the ESPVR. There was a linear relation between Emax andb over a wide range of contractilities; on average,b (ml O2/beat)=0.0036 Emax (mmHg/ml) + 0.0101 [r=0.929–0.978 (95% confidence interval)], when Emax was varied over an average range of 2.8–9.6 mmHg/ml. These results suggest a common underlying determinant of contractility and non-work-related oxygen consumption.

MR imaging of pulmonary arterial hypertension and pulmonary emboli

Abstract: Intraluminal signal in the pulmonary arteries on spin-echo, ECG-gated MR images is limited to the diastolic phase of the cardiac cycle in normal subjects. Initial experience has indicated that signal persisting during systole may be characteristic of slow blood flow associated with pulmonary arterial hypertension (PAH) or of thrombotic material secondary to pulmonary embolism. This study analyzes our cumulative experience (31 patients) with multiphasic, double spin-echo MR for assessing PAH and/or suspected pulmonary embolism. In PAH, the abnormal systolic signal showed an intensity increase from first to second echo. This pattern was observed in 92% of PAH patients, including 100% of patients with pulmonary systolic pressures greater than or equal to 80 mm Hg and 60% of patients with pressures less than 80 mm Hg. At any focus in the pulmonary arteries, such signal disappeared at some phase of the cardiac cycle. In patients with pulmonary embolism, signal from thrombus was fixed throughout the cardiac cyc...

Cardiac function: evaluation with fast-echo MR imaging.

Abstract: Magnetic resonance (MR) imaging of the heart has, to date, been limited in its ability to evaluate cardiac function. The authors have implemented a technique for functional assessment of the heart using shorter echo times than those generally used for conventional spin-echo imaging. With these short echo times, multiple images can be obtained in a multisection mode approximately within the isovolumetric phases of the cardiac cycle. This permits a pair of image stacks to be obtained, one in end systole and the other in end diastole. With the use of a modified Simpson rule, left ventricular volume and ejection fraction were calculated and compared with results obtained from contrast material-enhanced ventriculography. Preliminary results indicate that this method has promise for the evaluation of a variety of functional parameters in the heart. The short acquisition times for this functional study permit it to be combined with a tissue characterization study within the time constraints of a clinical MR imag...

Coronary input impedance during cardiac cycle as determined by impulse response method

Abstract: The coronary arterial system was characterized by its input impedance determined in systole and diastole from impulse response functions in five dogs. The impulse response technique was verified on a known hydraulic system. A second confirmation was obtained on the circumflex artery: reflected pulses were correlated with site of reflections generated by occlusions. The impulse response indicates discrete reflections, superimposed on the tail of the response, resulting from diffuse reflections. Input impedance was calculated from Fourier analysis of the impulse response. Characteristic impedance was 1.0 +/- 0.2 X 10(9) Pa X s X m-3 (0.13 +/- 0.02 mmHg X ml-1 X min) and impedance at 0 Hz was 2.6 +/- 0.8 X 10(9) Pa X s X m-3. No significant differences between systole and diastole were found in both characteristic impedance and impedance at 0 Hz. It is concluded that the coronary system consists of a proximal part that can be described with the three-element windkessel and a distal part not seen by oscillatory pressure or flow perturbations, which depends on the phase of cardiac contraction.

Intramyocardial blood volume change in first moments of cardiac arrest in anesthetized goats.

Abstract: The effect of cardiac relaxation on the intramyocardial blood volume was studied by measuring the integrated difference between arterial inflow and great cardiac venous outflow. In nine anesthetized goats, the left main coronary artery was perfused under constant pressure. The great cardiac vein was drained under pressure control. The venous flow signal was amplified so that the integrated intramyocardial blood volume was constant in the beating heart. With normal vasomotor tone, the mean change in vascular volume was 3.01 +/- 0.18 (SE) ml/100 g left ventricle (LV); 67% of the volume change was achieved in 1.60 +/- 0.09 s. For the fully dilated bed (adenosine infusion), the values were 4.13 +/- 0.33 ml/100 g and 0.96 +/- 0.06 s, respectively. The volume change could be correlated with the venous pressure during cardiac arrest (Pvd) and the change in mean left ventricular pressure after cardiac arrest (r = 0.95). The correlation improved when data were selected for Pvd less than 6 mmHg to r = 0.98. We assumed that the change in vascular transmural pressure can be approximated as half the mean left ventricular pressure change. The intramyocardial vascular compliance was then estimated as 0.104 +/- 0.012 and 0.146 +/- 0.028 ml X mmHg-1 X 100 g-1 for control and adenosine conditions, respectively. The long time constants excluded the large epicardial veins as the site of volume change; they were much longer than the duration of diastole in the beating heart. We conclude that the intramyocardial vascular compartment is capable of volume expansion on the order of 20% of its normal volume when myocardial compression by ventricular systole is suspended.

Timing of the triggering action of shooting in relation to the cardiac cycle.

Abstract: The purpose of this study was to verify the timing of triggering in relation to the cardiac cycle in shooting. The test subjects were six Finnish rifle and pistol champions as well as three beginners at shooting. The electrical activity of the trigger finger muscle (m. flexor digitorum superficialis; surface electrodes) and the heart cycle were fed into a two-channel x-t recorder. The movements of the gun were recorded using a laser technique and, at the same time, cardiac cycles were also monitored. Results showed that the champion shooters triggered during diastole whereas the beginners triggered both during diastole and systole. The results of those beginners triggering during diastole were better than those triggering during systole.

Role of extrastimulus site and tachycardia cycle length in inducibility of atrial preexcitation by premature ventricular stimulation during reciprocating tachycardia

Abstract: Preexcitation of the atria during reciprocating tachycardia (RT) by a premature ventricular complex occurring when the His bundle is refractory provides direct evidence of the presence of accessory atrioventricular (AV) connection. The impact of ventricular stimulation site and RT cycle length on inducibility of atrial preexcitation was assessed in 38 patients with RT utilizing a single accessory AV connection (right free wall in 5 patients, left free wall in 21 and posterior septal/paraseptal in 12). Extrastimuli were inserted at right ventricular (RV) apical, left ventricular (LV) septal and LV free wall sites. Inducibility of and magnitude of atrial preexcitation increased as stimulation site approached accessory AV connection site. Thus, for RV free wall connections, RV extrastimuli preexcited the atria in 5 of 5 patients, LV septal in 1 of 5 and LV free wall in 0 of 4. For LV free wall accessory connections, RV extrastimuli preexcited the atria in only 3 of 21 patients, compared with 12 of 17 with LV septal and 20 of 21 with LV free wall stimulation. Additionally, the magnitude of atrial preexcitation achieved was related to RT cycle length, diminishing as cycle length shortened. Finally, in a few instances both RV apical and LV free wall extrastimuli failed to elicit preexcitation in patients with a posterior septal connection. Thus, ventricular pacing site and RT cycle length contribute importantly to induction of atrial preexcitation by ventricular extrastimulation technique and should be considered during evaluation of patients with RT in whom accessory AV connections may be present.

Transseptal pressure gradient and diastolic ventricular septal motion in patients with mitral stenosis.

Abstract: Previous studies from our laboratory have shown that the position of the ventricular septum relative to the two ventricles at end-diastole is determined by the instantaneous transseptal pressure gradient (TSG) defined as left ventricular minus simultaneous right ventricular pressure. Since patients with mitral stenosis often have exaggerated leftward (paradoxic) motion of the ventricular septum during early diastole, we studied seven patients with mitral stenosis undergoing cardiac catheterization to determine if position (and therefore motion) of the ventricular septum was determined by TSG throughout diastole. M Mode echocardiograms derived from a two-dimensional parasternal short-axis view were recorded with simultaneous micromanometer measurements of left ventricular and right ventricular pressures. Six of seven patients demonstrated abnormal early diastolic leftward motion of the ventricular septum in at least one cardiac cycle. TSG measured at intervals throughout diastole ranged from -2.5 to +20 mm Hg, with abnormal TSG observed in most of the 40 cardiac cycles selected for analysis. The intracardiac position of the ventricular septum, defined as the distance from the right ventricular epicardium (RVEpi) to the left surface of the ventricular septum normalized for total cardiac dimension (RVEpi-VS), was plotted against left ventricular pressure, right ventricular pressure, and TSG. Linear regression of pooled data from all patients (164 observations) demonstrated a highly significant correlation between the instantaneous TSG and the relative intracardiac position of the ventricular septum (RVEpi-VS = 1.52 TSG + 42.7; r = .79, p less than .0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in size and magnetic resonance signal intensity of the cerebral CSF spaces during the cardiac cycle as studied by gated, high-resolution magnetic resonance imaging.

Abstract: In 1966, du Boulay demonstrated the pulsatile nature of CSF flow in the cerebral aqueduct by using air cineventriculography, which disturbs normal CSF dynamics by replacing part of the incompressible CSF with air. To investigate this phenomenon noninvasively, 35 normal volunteers were studied using high-resolution, cardiac-gated MR imaging. Specifically, we wished to document changes in size and configuration of the CSF spaces and the incidence and magnitude of signal loss (an indication of CSF motion) in these spaces as they related to time in the cardiac cycle. Changes in size and configuration were measurable in the third ventricle only (size increased during systole in seven of the 35 volunteers). Except for the lateral ventricles, some loss in signal intensity was seen in all CSF spaces at least during systole in all 35 volunteers--findings consistent with those of du Boulay. However, contrary to du Boulay's observations, asymmetric loss of signal, consistent with pulsatile CSF flow, was demonstrated at the level of the foramen of Monro in 15 of the 35 volunteers. Based on the pattern of flow void at the level of the foramen of Monro and on the expansion of the third ventricle during systole, we propose a theory of synchronous CSF flow at the foramen of Monro and aqueduct, which unifies our MR findings with du Boulay's cineventriculographic observations.

Respiratory modulation of cardiac time intervals

Abstract: To determine the effect of respiration on systolic and diastolic time intervals, simultaneous phonocardiograms, carotid pulse tracings, M mode echocardiograms, and respiratory curve tracings were measured in 25 healthy subjects. The positioning of each cardiac cycle in relation to the phase of respiration was assessed and the dependency of heart rate and cardiac time intervals on respiration was examined. Heart rate clearly varied over the respiratory cycle. Where necessary the time intervals were corrected for heart rate or RR interval. The systolic time intervals showed a stronger dependency on respiratory group than the diastolic time intervals. The decrease in left ventricular ejection time and increase in pre-ejection period and isovolumic contraction time during inspiration support the idea that a relative increase in afterload in inspiration determines left ventricular systolic function. Isovolumic relaxation time also showed cyclic behaviour whereas the left ventricular filling time was affected by inspiration only. Filling time increased significantly when there was a transition from expiration to inspiration during left ventricular ejection. It seems that when isovolumic contraction takes place in expiration the diastolic intervals of this cycle take on an expiratory character. The increase in filling can be viewed as a compensatory effect that partly offsets the loss of stroke volume during inspiration.

Computing the Depolarization Sequence at the Ventricular Surface from Body Surface Potentials

Abstract: Throughout the cardiac cycle the cells that constitute the heart muscle deliver varying amounts of electric current to the surrounding tissues. The effect of this at the body surface are potentials which change continuously during the course of a heart beat. In clinical electrocardiography it has been traditionally the time course of potential differences between standarized recording sites on the body surface which have been used to assist in the diagnosis of the state of the heart muscle. More recently a more extensive form of analysis has been developed in which the distribution of the potentials at the body surface is recorded by a regular grid of electrodes, closely spaced over the thoracic wall. The sequence of these potential distributions, displayed using, e.g., isopotential lines, can be used to study the full electrocardiographic information that is available at the body surface to any desired level of accuracy. A representation of the potential distribution at some fixed time instant within the cardiac cycle is referred to as a body surface potential map or “BSPM.” In chapters 16 to 20 techniques for recording and interpreting BSPM’s are discussed.