Quantitative frame by frame analysis of regional contraction and lengthening on left ventricular cineangiograms: Application to the study of normal left ventricles and left ventricles with mitral valve prolapse

Abstract This work attempted to study the segmental wall motion on left ventriculograms, in terms of segmental shortening, velocity of segmental shortening, and temporal sequences of various events in systole as well as in diastole. The ability of such a method to characterize patterns of normal regional wall motion and to detect mild abnormalities such as isolated asynchronisms, was tested on two groups of patients. Group I included 25 patients presenting evidence of a normal left ventricle (LV) after left heart catheterization. Group II consisted of 21 patients suffering from an isolated pure idiopathic mitral valve prolapse (MVP), with no mitral insufficiency and with an unaffected global LV function. In all patients left ventriculography was filmed in the right anterior oblique view at a rate of 50 frames/s. For each patient a cycle was chosen, distant from any premature beat, with acceptably contrasted outlines, and a quantitative frame by frame study of the motion of 10 segments was performed using a semiautomated method derived from the Stanford method. In the control group (Group I), analysis of the segmental motion by means of this method demonstrates a mild nonuniformity of the normal wall motion. This is principally marked by a stronger and faster contraction in anterolateral segments (segments 7, 8, 9) and by a shorter duration of the contraction in this region. In contrast the MVP group (Group II), exhibited a frank asynergy of the anterolateral region occurring from end systole to early diastole. In the anterolateral region, asynergy of the MVP group is characterized mainly by a poor shortening velocity (2.8 ± 0.4 circ/s in segment 8 in Group II vs. 3.4 ± 0.7 circ/s in Group I, p<0.001), an early end of contraction (segment 8: 94.5 ± 4% of systolic time interval in Group II vs. 97.4 ± 3% in Group I, p<0.01), an early beginning of outward motion (shortening velocity of segment 9 at end systole: ‐ 0.58 ± 0.44 in Group II vs. 0 ± 0.48 circ/s in Group I, p<0.01), and finally an altered velocity of lengthening. A subjective estimate provided by a visual inspection of LV cineangiogram is not reliable for evaluating such phenomena. Our method proved a good ability to detect mild abnormalities in the temporal sequence of segmental contraction lengthening. We think that such quantitative methods using a high temporal resolution (0.02 s) are required for an accurate description of nonuniformity phenomena, and could allow early detection of local contractility impairments or local relaxation compliance.