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CLINICAL STUDY: ECHOCARDIOGRAPHY

Myocardial contraction fraction: a volumetric index of myocardial shortening by freehand three-dimensional echocardiography

^* College of Physicians and Surgeons, Columbia University, New York, New York, USA.

Manuscript received February 13, 2002; revised manuscript received April 1, 2002, accepted April 17, 2002.

^* Reprint requests and correspondence: Dr. Donald L. King, 19 Searles Road, Darien, Connecticut 06820, USA.
dlathamking{at}yahoo.com

OBJECTIVES: This study sought to evaluate myocardial contraction fraction (MCF) as an index of myocardial shortening by comparison to conventional shortening indices in patients with hypertensive hypertrophy, athletes with physiologic hypertrophy and sedentary normal adult subjects.

BACKGROUND: A significant percentage of patients with hypertensive hypertrophy have "normal" or "preserved" left ventricular (LV) systolic function by conventional echocardiographic measures whereas their systolic function is depressed when measured by the two-dimensional echocardiographic mid-wall shortening fraction (MWSF). A three-dimensional echocardiographic measure of myocardial shortening analogous to MWSF has been lacking. We describe a volumetric measure of myocardial shortening, the MCF, as the ratio of stroke volume (SV) to myocardial volume (MV), and hypothesize that it may be useful to compare myocardial performance in patients with different degrees and types of hypertrophy.

METHODS: We compared the MCF using freehand three-dimensional echocardiographic reconstruction of the LV to conventional measures of LV function (ejection fraction [EF], endocardial shortening fraction [SF] and MWSF) in subjects with pathologic hypertensive hypertrophy, heart failure symptoms and preserved EF (n = 17), athletes with physiologic hypertrophy (n = 41) and normal sedentary adults (n = 80).

RESULTS: The EF was in the normal range for all three groups. The MCF was lower in hypertensive hypertrophy compared with normal subjects (0.33 ± 0.05 vs. 0.44 ± 0.07, p < 0.01). It also successfully differentiated physiologic hypertrophy from normal subjects (0.50 ± 0.05 vs. 0.44 ± 0.07, p < 0.01). The endocardial SF did not distinguish athletes from normal subjects and the MWSF did not distinguish hypertensive from physiologic hypertrophy.

CONCLUSIONS: The MCF, a volumetric measure of myocardial shortening, demonstrates that myocardial shortening is decreased in hypertensive hypertrophy and increased in physiologic hypertrophy. The MCF may be useful in assessing differences in myocardial performance in patients with similar degrees of hypertrophy.

Abbreviations and Acronyms   EF   ejection fraction   HF   heart failure   LV   left ventricle/ventricular   MCF   myocardial contraction fraction   MRI   magnetic resonance imaging   MV   myocardial volume   MWSF   mid-wall shortening fraction   SF   shortening fraction   SV   stroke volume   VO2max   maximal oxygen consumption

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