Longitudinal shortening remains the principal component of left ventricular pumping in patients with chronic myocardial infarction even when the absolute atrioventricular plane displacement is decreased

Figures

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  Fig. 1. Illustration of the method for quantifying atrioventricular plane displacement (AVPD), septal and lateral contribution to left ventricular stroke volume (LVSV). Short-axis (SA) and four-chamber (4Ch), three-chamber (3Ch) and 2-chamber (2Ch) images are shown in end-diastole (ED) and end-systole (ES). The epicardial border of the SA is shown as a solid line in ED and broken line in ES. The ED epicardial contour is transposed on the ES image for comparison. The difference between the epicardial contours in the SA images are defined as the radial pumping and is subdivided into the septal (black arrows) and lateral (white arrows) contributions as defined by the right ventricular septal insertion points (marked with circles). The AVPD was calculated by marking the most basal part of the muscular wall in ED and ES as denoted by the white circles. The position of the AV-plane in ED is transposed to the ES image for comparison and the AVPD is marked by the double-headed arrows

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  Fig. 2. Mean extent of myocardial infarction for the two vessel territories LAD (left) and RCA (right). Extent is normalized to the population size of each group for comparison between territories, and 0–100% indicate the number of patients having myocardial infarction in a certain area. Overlaid is the standard 17-segment AHA model

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  Fig. 3. Comparison of the longitudinal contribution to LV stroke volume for patients with MI in the LAD and RCA vessel territories and controls. There was no significant difference between the groups. Solid line indicates the mean

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  Fig. 4. Comparison of the septal contribution to LV stroke volume for patients with MI in the LAD and RCA vessel territories and controls. Septal contribution to SV was significantly lower for the LAD-MI compared to both RCA-MI and controls. There was, however, no significant difference between RCA-MI and controls. Negative values of septal contribution are explained by dyskinesia of the septum, i.e. septal movement toward the RV in systole. Solid line indicates the mean. *P < 0.05, **P < 0.01 NS non-significant

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  Fig. 5. Comparison of the lateral contribution to LV stroke volume for patients with MI in the LAD and RCA vessel territories and controls. Lateral contribution to SV was lower for the RCA-MI compared to LAD-MI. Solid line indicates the mean. *P < 0.05, *** P < 0.001

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  Fig. 6. Illustration of differences in longitudinal, septal and lateral contributions to left ventricular pumping in a patient with LAD-MI (top row) and RCA-MI (bottom row). Cine images in the left-ventricular outflow tract view are shown in end diastole (left column) and end systole (middle column) and the corresponding late gadolinium enhancement (LGE) images (right column, c and f) show the extent of the infarcted area (arrows). The solid white outline of the LV in end diastole (a and d) is superimposed on the images in end systole (b and e) where the ventricles in end systole have been outlined with a dashed line. The AV-plane displacement (AVPD) is the difference of the horizontal white line at base of LV in end-diastole and end-systole and marked by double arrow at the base of ventricle in e. Longitudinal pumping is the difference in the basal contours at end diastole and end systole. Radial pumping is caused by the displacement of the epicardial border from end diastole and end systole. Note in b that the lateral component of radial pumping is increased (arrow at lateral wall in b) and compensates for the decreased longitudinal and septal contributions to LV pumping. As a…

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  Fig. 7. An example of a patient who has developed a very large apical aneurysm secondary to a myocardial infarction within the LAD territory. The upper row is in end diastole while the lower row is in end systole. In this case most of the stroke volume is generated by longitudinal AVPD (≈ 90%) of the viable myocardium at the base of the LV