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STATE-OF-THE-ART PAPER

Left Ventricular Structure and Function

Basic Science for Cardiac Imaging

Partho P. Sengupta, MBBS, MD, DM^_*, Josef Korinek, MD^_*, Marek Belohlavek, MD, PhD, FACC, FESC^_*, Jagat Narula, MBBS, MD, DM, PhD, FACC, FAHA, Mani A. Vannan, MBBS, FACC, Arshad Jahangir, MD, FACC^_* and Bijoy K. Khandheria, MD, FESC, FASE, FACC^,_*

^_* Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
Division of Cardiology, University of California at Irvine, Irvine, California
Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona.

Manuscript received June 1, 2006; revised manuscript received August 29, 2006, accepted August 30, 2006.

^_* Reprint requests and correspondence: Dr. Bijoy K. Khandheria, Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, Arizona 85259. (Email: khandheria{at}mayo.edu).

The myofiber geometry of the left ventricle (LV) changes gradually from a right-handed helix in the subendocardium to a left-handed helix in the subepicardium. In this review, we associate the LV myofiber architecture with emerging concepts of the electromechanical sequence in a beating heart. We discuss: 1) the morphogenesis and anatomical arrangement of muscle fibers in the adult LV; 2) the sequence of depolarization and repolarization; 3) the physiological inhomogeneity of transmural myocardial mechanics and the apex-to-base sequence of longitudinal and circumferential deformation; 4) the sequence of LV rotation; and 5) the link between LV deformation and the intracavitary flow direction observed during each phase of the cardiac cycle. Integrating the LV structure with electrical activation and motion sequences observed in vivo provides an understanding about the spatiotemporal sequence of regional myocardial performance that is essential for noninvasive cardiac imaging.

Abbreviations and Acronyms   IVC = isovolumic contraction   IVR = isovolumic relaxation   LV = left ventricle/ventricular   MRI = magnetic resonance imaging

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