title: Noninvasive determination of left ventricular output and wall stress in volume overload and in myocardial disease by cine magnetic resonance imaging.
abstract: The current study used cine magnetic resonance imaging to determine the effect of increasing severity of valvular regurgitation on systolic wall stress and to demonstrate that wall stress was disproportionately increased in relation to the severity of regurgitation in patients with myocardial disease. A total of 39 patients with predominantly mitral (n = 22) or aortic (n = 17) regurgitation with (n = 13) and without (n = 26) myocardial disease and 10 normal volunteers were examined with cine magnetic resonance imaging (MRI) at 1.5 T. Left ventricular (LV) cardiac output (CO) and peak systolic (PS) wall stress (WS) and end-systolic (ES) WS were calculated from blood pressure recordings, carotid pulse tracings, and wall thickness (h) and diameter (D) measurements obtained from cine MRI. Patients were classified into three degrees of severity according to their LV regurgitant volume (RV). Myocardial disease was defined by an ejection fraction (EF) of less than 40%. Mean LV EF was 61 +/- 3% in normal volunteers, 64 +/- 3% in patients with regurgitation, and 25 +/- 2% in patients with myocardial disease. LV CO was directly related to RV in patients without myocardial disease, whereas it was disproportionately low in relation to RV in patients with myocardial disease. PS WS was significantly higher in severe mitral and/or aortic regurgitation compared with moderate, mild, and no mitral and/or aortic regurgitation. Compared with the degree of regurgitation, PS WS was disproportionately higher in patients with myocardial disease. Thus LV CO and WS rise progressively with increasing severity of regurgitation. Disproportionately high systolic WS relative to RV indicates the presence of myocardial disease.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Radiology, University of California School of Medicine, San Francisco.
authors.forename: W
authors.initials: W
authors.lastname: Auffermann
authors.forename: S
authors.initials: S
authors.lastname: Wagner
authors.forename: W W
authors.initials: WW
authors.lastname: Holt
authors.forename: P T
authors.initials: PT
authors.lastname: Buser
authors.forename: B
authors.initials: B
authors.lastname: Kircher
authors.forename: N B
authors.initials: NB
authors.lastname: Schiller
authors.forename: T H
authors.initials: TH
authors.lastname: Lim
authors.forename: C L
authors.initials: CL
authors.lastname: Wolfe
authors.forename: C B
authors.initials: CB
authors.lastname: Higgins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000503:physiopathology; D001810:Blood Volume; D002302:Cardiac Output; D003327:Coronary Disease / Q000503:physiopathology*; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology; D009040:Motion Pictures; D012016:Reference Values; D013314:Stress, Mechanical; D013599:Systole; D016277:Ventricular Function, Left