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J Am Coll Cardiol, 1999; 33:1735-1742
© 1999 by the American College of Cardiology Foundation
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EXPERIMENTAL STUDIES

Mapping of regional myocardial strain and work during ventricular pacing: experimental study using magnetic resonance imaging tagging

Frits W. Prinzen, PhDa, William C. Hunter, PhD*, Bradley T. Wyman, MSc* and Elliot R. McVeigh, PhD*

a Department of Physiology, Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands
* Department of Biomedical Engineering, Johns Hopkins University Medical School, Baltimore, Maryland, USA

Manuscript received April 24, 1998; revised manuscript received December 15, 1998, accepted January 20, 1999.

Reprint requests and correspondence: Dr. Frits W. Prinzen, Department of Physiology, Cardiovascular Research Institute Maastricht, University of Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands
frits.prinzen{at}fys.unimaas.nl

OBJECTIVES

The purpose of this study was to determine the spatial distribution of myocardial function (myofiber shortening and work) within the left ventricular (LV) wall during ventricular pacing.

BACKGROUND

Asynchronous electrical activation, as induced by ventricular pacing, causes various abnormalities in LV function, perfusion and structure. These derangements may be caused by abnormalities in regional contraction patterns. However, insight into these patterns during pacing is as yet limited.

METHODS

In seven anesthetized dogs, high spatial and temporal resolution magnetic resonance–tagged images were acquired in three orthogonal planes. Three-dimensional deformation data and LV cavity pressure and volume were used to determine midwall circumferential strain and external and total mechanical work at 192 sites around the left ventricle.

RESULTS

During ventricular pacing, systolic fiber strain and external work were approximately zero in regions near the pacing site, and gradually increased to more than twice the normal value in the most remote regions. Total mechanical work, normalized to the value during right atrial pacing, was 38 ± 13% (right ventricular apex [RVapex] pacing) and 61 ± 23% (left ventricular base [LVbase] pacing) close to the pacing site, and 125 ± 48% and 171 ± 60% in remote regions, respectively (p < 0.05 between RVapex and LVbase pacing). The number of regions with reduced work was significantly larger during RVapex than during LVbase pacing. This was associated with a reduction of global LV pump function during RVapex pacing.

CONCLUSIONS

Ventricular pacing causes a threefold difference in myofiber work within the LV wall. This difference appears large enough to regard local myocardial function as an important determinant for abnormalities in perfusion, metabolism, structure and pump function during asynchronous electrical activation. Pacing at sites that cause more synchronous activation may limit the occurrence of such derangements.

Abbreviations and Acronyms
  ANOVA = analysis of variance
  LBBB = left bundle branch block
  LV = left ventricular, left ventricle
  LVbase = left ventricular base
  MRI = magnetic resonance imaging
  PVA = pressure-volume area
  RA = right atrium, right atrial
  RF = radiofrequency
  RV = right ventricular, right ventricle
  RVapex = right ventricular apex
  3D = three dimensional
  SD = significant difference




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Asynchrony of ventricular activation affects magnitude and timing of fiber stretch in late-activated regions of the canine heart
Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H754 - H761.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
D. Jeyaraj, L. D. Wilson, J. Zhong, C. Flask, J. E. Saffitz, I. Deschenes, X. Yu, and D. S. Rosenbaum
Mechanoelectrical Feedback as Novel Mechanism of Cardiac Electrical Remodeling
Circulation, June 26, 2007; 115(25): 3145 - 3155.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
W. Y. Vanagt, R. N. Cornelussen, T. C. Baynham, A. Van Hunnik, Q. P. Poulina, F. Babiker, J. Spinelli, T. Delhaas, and F. W. Prinzen
Pacing-Induced Dyssynchrony During Early Reperfusion Reduces Infarct Size
J. Am. Coll. Cardiol., May 1, 2007; 49(17): 1813 - 1819.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
P. P. Sengupta, B. K. Khandheria, J. Korinek, A. Jahangir, S. Yoshifuku, I. Milosevic, and M. Belohlavek
Left Ventricular Isovolumic Flow Sequence During Sinus and Paced Rhythms: New Insights From Use of High-Resolution Doppler and Ultrasonic Digital Particle Imaging Velocimetry
J. Am. Coll. Cardiol., February 27, 2007; 49(8): 899 - 908.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
L. F. Tops, M. J. Schalij, E. R. Holman, L. van Erven, E. E. van der Wall, and J. J. Bax
Right Ventricular Pacing Can Induce Ventricular Dyssynchrony in Patients With Atrial Fibrillation After Atrioventricular Node Ablation
J. Am. Coll. Cardiol., October 17, 2006; 48(8): 1642 - 1648.
[Abstract] [Full Text] [PDF]

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J. E. Stelzer and R. L. Moss
Contributions of Stretch Activation to Length-dependent Contraction in Murine Myocardium
J. Gen. Physiol., October 1, 2006; 128(4): 461 - 471.
[Abstract] [Full Text] [PDF]

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 EuropaceHome page
E. C. Stecker, M. Zargarian, V. Dogra, B. T. John, J. Kron, J. H. McAnulty, and S. S. Chugh
Native QRS duration predicts the occurrence of arrhythmic events in ICD recipients
Europace, October 1, 2006; 8(10): 859 - 862.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
W. Y. Vanagt, R. N. Cornelussen, Q. P. Poulina, E. Blaauw, K. Vernooy, J. P. Cleutjens, M. van Bilsen, T. Delhaas, and F. W. Prinzen
Pacing-Induced Dys-Synchrony Preconditions Rabbit Myocardium Against Ischemia/Reperfusion Injury
Circulation, July 4, 2006; 114(1_suppl): I-264 - I-269.
[Abstract] [Full Text] [PDF]

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 EuropaceHome page
H. Wieneke, K. Sattler, C. von Birgelen, D. Bose, M. Haude, W. Rechenberg, S. Sack, N. Dagres, and R. Erbel
Impact of intraventricular conduction delay on coronary haemodynamics: a study with intracoronary Doppler in patients with bundle branch blocks and normal coronary arteries.
Europace, March 1, 2006; 8(3): 151 - 156.
[Abstract] [Full Text] [PDF]

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 Am. J. Physiol. Heart Circ. Physiol.Home page
X. A. A. M. Verbeek, A. Auricchio, Y. Yu, J. Ding, T. Pochet, K. Vernooy, A. Kramer, J. Spinelli, and F. W. Prinzen
Tailoring cardiac resynchronization therapy using interventricular asynchrony. Validation of a simple model
Am J Physiol Heart Circ Physiol, March 1, 2006; 290(3): H968 - H977.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
M. O. Sweeney and F. W. Prinzen
A New Paradigm for Physiologic Ventricular Pacing
J. Am. Coll. Cardiol., January 17, 2006; 47(2): 282 - 288.
[Abstract] [Full Text] [PDF]

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M. R. Rosen and I. S. Cohen
Cardiac memory ... new insights into molecular mechanisms
J. Physiol., January 15, 2006; 570(2): 209 - 218.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
O. A. Smiseth and E. W. Remme
Regional Left Ventricular Electric and Mechanical Activation and Relaxation
J. Am. Coll. Cardiol., January 3, 2006; 47(1): 173 - 174.
[Full Text] [PDF]

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 EuropaceHome page
P. Dilaveris, A. Pantazis, G. Giannopoulos, A. Synetos, J. Gialafos, and C. Stefanadis
Upgrade to biventricular pacing in patients with pacing-induced heart failure: can resynchronization do the trick?
Europace, January 1, 2006; 8(5): 352 - 357.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
J. J.M. Zwanenburg, M. J.W. Gotte, J. T. Marcus, J. P.A. Kuijer, P. Knaapen, R. M. Heethaar, and A. C. van Rossum
Propagation of Onset and PeakTime of Myocardial Shortening in Time of Myocardial Shortening in Ischemic Versus Nonischemic Cardiomyopathy: Assessment by Magnetic Resonance Imaging Myocardial Tagging
J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2215 - 2222.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
A. C. Lardo, T. P. Abraham, and D. A. Kass
Magnetic Resonance Imaging Assessment of Ventricular Dyssynchrony: Current and Emerging Concepts
J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2223 - 2228.
[Abstract] [Full Text] [PDF]

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 Am. J. Physiol. Heart Circ. Physiol.Home page
R. C. P. Kerckhoffs, O. P. Faris, P. H. M. Bovendeerd, F. W. Prinzen, K. Smits, E. R. McVeigh, and T. Arts
Electromechanics of paced left ventricle simulated by straightforward mathematical model: comparison with experiments
Am J Physiol Heart Circ Physiol, November 1, 2005; 289(5): H1889 - H1897.
[Abstract] [Full Text] [PDF]

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 Eur Heart J Cardiovasc ImagingHome page
T. Szili-Torok, M. Bountioukos, A. J.Q.M. Muskens, D. A.M.J. Theuns, D. Poldermans, J. R.T.C. Roelandt, and L. J. Jordaens
The presence of contractile reserve has no predictive value for the evolution of left ventricular function following atrio-ventricular node ablation in patients with permanent atrial fibrillation
Eur Heart J Cardiovasc Imaging, October 1, 2005; 6(5): 344 - 350.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
G. Berberian, T. A. Quinn, J. P. Kanter, L. J. Curtis, S. E. Cabreriza, A. D. Weinberg, and H. M. Spotnitz
Optimized Biventricular Pacing in Atrioventricular Block After Cardiac Surgery
Ann. Thorac. Surg., September 1, 2005; 80(3): 870 - 875.
[Abstract] [Full Text] [PDF]

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 Cardiovasc ResHome page
D. D. Spragg, F. G. Akar, R. H. Helm, R. S. Tunin, G. F. Tomaselli, and D. A. Kass
Abnormal conduction and repolarization in late-activated myocardium of dyssynchronously contracting hearts
Cardiovasc Res, July 1, 2005; 67(1): 77 - 86.
[Abstract] [Full Text] [PDF]


 
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