Characterization of left ventricular chamber distortion: alterations in cavity shape and orientation in mitral stenosis.
Distortion of the left ventricular (LV) chamber silhouette was identified in 28 patients with mitral stenosis (MS) by disparity between normally identical chamber volumes calculated independently from the frontal (AP) and lateral (LAT) views of biplane cineangiograms (AP end diastolic volume 157.8 +/- 10.0 ml, LAT end diastolic volume 115.6 +/- 7.2 ml, p less than .001). Similar systematic disparity was observed in estimates of end systolic volume in these views. While no directional difference in ejection fraction was found, identical (+/- 10%) AP and LAT measurements were obtained in only 36% of patients, indicating poor reproducibility of the estimate of LV function between single radiographic views. A technique was also devised for determining the spatial orientation of the LV long axis (mid mitral valve to apex) from biplane cineangiograms; this axis was shown to intercept the frontal plane at an angle of 50.9 +/- 2.4 degrees in 12 subjects with normal LV anatomy and 36.1 +/- 4.5 degrees in seven patients with MS, indicating that the long axis was rotated posteriorly toward alignment with the frontal plane in the latter group. The presence and magnitude of LV chamber distortion was clearly related to the degree of angiographically estimated right ventricular dilatation. Implications of these observations, particularly with reference to the estimation of single plane LV volume characteristics in patients with MS, are discussed.
J H
JH
Gault
R D
RD
Gentzler
M M
MM
Cooper
J C
JC
Reed
D000790:Angiocardiography; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008946:Mitral Valve Stenosis / Q000473:pathology* / Q000503:physiopathology; D012044:Regression Analysis; D013318:Stroke Volume