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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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M. Wonisch, P. Lercher, D. Scherr, R. Maier, R. Pokan, P. Hofmann, and S. P. von Duvillard
Influence of Permanent Right Ventricular Pacing on Cardiorespiratory Exercise Parameters in Chronic Heart Failure Patients With Implanted Cardioverter Defibrillators
Chest, March 1, 2005; 127(3): 787 - 793.
[Abstract] [Full Text] [PDF]

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 Am. J. Physiol. Heart Circ. Physiol.Home page
R. A. Garcia, K. L. Brown, R. S. Pavelec, K. V. Go, J. W. Covell, and F. J. Villarreal
Abnormal cardiac wall motion and early matrix metalloproteinase activity
Am J Physiol Heart Circ Physiol, March 1, 2005; 288(3): H1080 - H1087.
[Abstract] [Full Text] [PDF]

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 Eur Heart JHome page
O. Lindner, J. Vogt, A. Kammeier, P. Wielepp, J. Holzinger, D. Baller, B. Lamp, B. Hansky, R. Korfer, D. Horstkotte, et al.
Effect of cardiac resynchronization therapy on global and regional oxygen consumption and myocardial blood flow in patients with non-ischaemic and ischaemic cardiomyopathy
Eur. Heart J., January 1, 2005; 26(1): 70 - 76.
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 Eur Heart JHome page
K. Vernooy, X. A.A.M. Verbeek, M. Peschar, H. J.G.M. Crijns, T. Arts, R. N.M. Cornelussen, and F. W. Prinzen
Left bundle branch block induces ventricular remodelling and functional septal hypoperfusion
Eur. Heart J., January 1, 2005; 26(1): 91 - 98.
[Abstract] [Full Text] [PDF]

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 EuropaceHome page
O. S. Satish, K.-H. Yeh, M.-S. Wen, and C.-C. Wang
Cardiac resynchronisation therapy versus dual site right ventricular pacing in a patient with permanent pacemaker and congestive heart failure
Europace, January 1, 2005; 7(4): 380 - 384.
[Abstract] [Full Text] [PDF]

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 EuropaceHome page
N. Preumont, J.-L. Jansens, G. Berkenboom, P. van de Borne, E. Stoupel, and S. Goldman
Effects of right ventricular pacing on regional myocardial glucose metabolism
Europace, January 1, 2005; 7(6): 584 - 591.
[Abstract] [Full Text] [PDF]

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 Am. J. Physiol. Heart Circ. Physiol.Home page
D. J. C. Alders, A. B. J. Groeneveld, F. J. J. de Kanter, and J. H. G. M. van Beek
Myocardial O2 consumption in porcine left ventricle is heterogeneously distributed in parallel to heterogeneous O2 delivery
Am J Physiol Heart Circ Physiol, September 1, 2004; 287(3): H1353 - H1361.
[Abstract] [Full Text] [PDF]

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 Eur Heart J SupplHome page
O. A. Breithardt, L. Herbots, J. D'Hooge, P. Claus, B. Bijnens, C. Stellbrink, A. Franke, and G. R. Sutherland
Strain rate imaging in CRT candidates
Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D16 - D24.
[Abstract] [Full Text] [PDF]

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 Eur Heart J SupplHome page
D Baller, J Vogt, O Lindner, B Lamp, J Holzinger, A Kammeier, P Wielepp, W Burchert, and D Horstkotte
Myocardial oxygen consumption and perfusion before and after cardiac resynchronization therapy: experimental observations and clinical implications
Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D91 - D97.
[Abstract] [Full Text] [PDF]

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 Am. J. Physiol. Heart Circ. Physiol.Home page
B. Kirn and V. Starc
Contraction wave in axial direction in free wall of guinea pig left ventricle
Am J Physiol Heart Circ Physiol, August 1, 2004; 287(2): H755 - H759.
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D. G. Rabkin, S. E. Cabreriza, L. J. Curtis, S. P. Mazer, J. P. Kanter, A. D. Weinberg, A. J. Hordof, and H. M. Spotnitz
Load dependence of cardiac output in biventricular pacing: Right ventricular pressure overload in pigs
J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1713 - 1722.
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 Am. J. Physiol. Heart Circ. Physiol.Home page
H. Ashikaga, J. H. Omens, N. B. Ingels Jr., and J. W. Covell
Transmural mechanics at left ventricular epicardial pacing site
Am J Physiol Heart Circ Physiol, June 1, 2004; 286(6): H2401 - H2407.
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 CirculationHome page
F. W. Prinzen, K. Vernooy, and R. N. Cornelussen
Cardiac Memory and Cortical Memory
Circulation, May 25, 2004; 109(20): e226 - e226.
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 Am. J. Physiol. Heart Circ. Physiol.Home page
I. Libbus, X. Wan, and D. S. Rosenbaum
Electrotonic load triggers remodeling of repolarizing current Ito in ventricle
Am J Physiol Heart Circ Physiol, May 1, 2004; 286(5): H1901 - H1909.
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 Eur Heart JHome page
S. Ghio, C. Constantin, C. Klersy, A. Serio, A. Fontana, C. Campana, and L. Tavazzi
Interventricular and intraventricular dyssynchrony are common in heart failure patients, regardless of QRS duration
Eur. Heart J., April 1, 2004; 25(7): 571 - 578.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
J. Sundell, E. Engblom, J. Koistinen, A. Ylitalo, A. Naum, K. Q. Stolen, R. Kalliokoski, S. G. Nekolla, K. E. J. Airaksinen, J. J. Bax, et al.
The effects of cardiac resynchronization therapy on left ventricular function, myocardial energetics, and metabolic reserve in patients with dilated cardiomyopathy and heart failure
J. Am. Coll. Cardiol., March 17, 2004; 43(6): 1027 - 1033.
[Abstract] [Full Text] [PDF]

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 JNMHome page
B. Nowak, C. Stellbrink, W. M. Schaefer, A. M. Sinha, O. A. Breithardt, H.-J. Kaiser, P. Reinartz, P. Hanrath, and U. Buell
Comparison of Regional Myocardial Blood Flow and Perfusion in Dilated Cardiomyopathy and Left Bundle Branch Block: Role of Wall Thickening
J. Nucl. Med., March 1, 2004; 45(3): 414 - 418.
[Abstract] [Full Text]

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 Eur J Heart FailHome page
S. Lafitte, S. Garrigue, J.-M. Perron, P. Bordachar, S. Reuter, P. Jais, M. Haissaguerre, J. Clementy, and R. Roudaut
Improvement of left ventricular wall synchronization with multisite ventricular pacing in heart failure: a prospective study using Doppler tissue imaging
Eur J Heart Fail, March 1, 2004; 6(2): 203 - 212.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
C. Leclercq and J. M. Hare
Ventricular Resynchronization: Current State of the Art
Circulation, January 27, 2004; 109(3): 296 - 299.
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 CirculationHome page
A. Auricchio and W. T. Abraham
Cardiac Resynchronization Therapy: Current State of the Art: Cost Versus Benefit
Circulation, January 27, 2004; 109(3): 300 - 307.
[Full Text] [PDF]

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 J Am Coll CardiolHome page
A. Auricchio
Pacing the left ventricle: does underlying rhythm matter?
J. Am. Coll. Cardiol., January 21, 2004; 43(2): 239 - 240.
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 J Am Coll CardiolHome page
H. Bader, S. Garrigue, S. Lafitte, S. Reuter, P. Jais, M. Haissaguerre, J. Bonnet, J. Clementy, and R. Roudaut
Intra-left ventricular electromechanical asynchrony: A new independent predictor of severe cardiac events in heart failure patients
J. Am. Coll. Cardiol., January 21, 2004; 43(2): 248 - 256.
[Abstract] [Full Text] [PDF]

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 EuropaceHome page
M. Zoghi and S. Nalbantgil
Electrical stunning and hibernation: suggestion of new terms for short- and long-term cardiac memory
Europace, January 1, 2004; 6(5): 418 - 424.
[Abstract] [Full Text] [PDF]

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 Am. J. Physiol. Heart Circ. Physiol.Home page
Y. Yu, A. Kramer, J. Spinelli, J. Ding, W. Hoersch, and A. Auricchio
Biventricular mechanical asynchrony predicts hemodynamic effect of uni- and biventricular pacing
Am J Physiol Heart Circ Physiol, December 1, 2003; 285(6): H2788 - H2796.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
I. Hashimoto, X. Li, A. Hejmadi Bhat, M. Jones, A. D. Zetts, and D. J. Sahn
Myocardial strain rate is a superior method for evaluation of left ventricular subendocardial function compared with tissue Doppler imaging
J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1574 - 1583.
[Abstract] [Full Text] [PDF]


 
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