Skip to main content
SpringerLink
Log in

Left ventricular remodeling in chronic aortic regurgitation

  • Articles
  • Published:
The International Journal of Cardiac Imaging Aims and scope Submit manuscript

Abstract

Left ventricular (LV) shape in chronic volume overload due to aortic regurgitation is commonly described as rounder than in normal subjects. This statement derives from observations of qualitative nature or based on the measure of eccentricity index. We analyzed LV shape and function in 16 normal subjects (N) and in 24 patients with chronicpure aortic regurgitation (AR), without coronary artery disease or associated mitral regurgitation. LV cavity geometry was quantitatively evaluated from end-diastolic and end-systolic outlines obtained in 30° RAO angiographic projection, by calculating: 1. the eccentricity and circularity indexes, 2. the regional curvature at 90 equidistant points using a windowed Fourier series approximation of contours, in which the number of harmonics and filter-window were locally chosen in order to minimize the reconstruction errors and to maximize the smoothness of the curve, 3. by measuring the length of the anterior and posterior hemi-perimeter of LV outlines and 4. by performing a Fourier analysis of LV contours.

Neither eccentricity nor circularity indexes were adequate to differentiate shape abnormalities, whereas Fourier geometric analysis indicated abnormalities of shape in AR. Regional curvature showed that diastolic outline of AR had a greater curvature of the anterobasal, anterolateral and inferoapical regions and a lower curvature of the anteroapical one. Systolic outline showed a greater curvature of the inferoapical region and a lower curvature of the anteroapical one. The angiographic apex, i.e. the point of the greatest curvature, was shifted towards the mitral plane (at end-diastole from point 48.4 in N to 51.5 in AR; p < 0.001, at end-systole from point 46.3 in N to 49.1 in AR; p=0.007), owing to a greater length of the anterior hemi-perimeter in respect to N. The increase in anterior hemi-perimeter length was significantly related to the decrease in pump function (increase in end-systolic volume index and decrease in ejection fraction).

Conclusion

in respect to normal subjects LV shape in aortic regurgitation is not simply more globular, but it definitely appears to be asymmetric because of the prevailing elongation of the anterior hemi-perimeter from the aortic corner to the apex suggesting a remodeling of the left ventricle with a prevailing expansion of the anterolateral regions. These alterations in cavity geometry correlate to the decrease in pump function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Fishl SJ, Gorlin R, Herman MV. Cardiac shape and function in aortic valve disease: Physiologic and clinical implications. Am J Cardiol 1977; 39: 170–6.

    PubMed  Google Scholar 

  2. Hood WD Jr, Rolett EL. Patterns of contraction in the human left ventricle (abstract). Circulation 1969; 40 Suppl II: II-109.

    Google Scholar 

  3. Rackley CE, Frimer M, Porter CM, Dodge HT. Relationship between left ventricular shape, size and function in heart disease. Clin Res 1970; 18: 71–5.

    Google Scholar 

  4. McCullogh WH, Covell JW, Ross JJR. Left ventricular dilation and diastolic compliance changes during chronic volume overload. Circulation 1972; 65: 1518–21.

    Google Scholar 

  5. Mancini GBJ, LeFree MT, Vogel RA. Curvature analysis of normal ventriculograms: Fundamental framework for the assessment of shape changes in man. IEEE Comput Cardiol 1985: 141–6.

  6. Eugene M, Drobinsky G, Teillac A, Grosgogeat Y. Etude de la contraction segmentaire ventriculaire par analyse du rayon de courbure. Arch Mal Coeur 1986; 79: 1413–8.

    PubMed  Google Scholar 

  7. Mancini GBJ, DeBoe SF, Anselmo E, LeFree MT. A comparison of traditional wall motion assessment and quantitative shape analysis: A new method for characterizing left ventricular function in humans. Am Heart J 1987; 114: 1183–91.

    PubMed  Google Scholar 

  8. Baroni M, Barletta G, Fantini F. Left ventricular wall motion: From quantitative analysis to knowledge-based understanding. IEEE Comput Cardiol 1989: 99–102.

  9. Fantini F, Barletta G, Voegelin MR, Maioli M, Di Donato M. Abnormalities of left ventricular shape in patients with stable angina. Int J Cardiol 1990; 27: 107–16.

    PubMed  Google Scholar 

  10. Kass DA, Traill TA, Altieri PI, Maugham WL. Abnormalities of dynamic ventricular shape change in patients with aortic and mitral valvular regurgitation: Assessment by Fourier shape analysis and global geometric indexes. Circulation Res 1988; 62: 127–38.

    PubMed  Google Scholar 

  11. Yang SS, Bentivoglio LG, Maranhao V, Goldberg H. From cardiac catheterization data to hemodynamic parameters. 3rd Ed. Philadelphia, FA Davis, 1988.

    Google Scholar 

  12. Chapman CB, Baker O, Reynolds J, Bonte FJ. Use of biplane cinefluorography for measurement of ventricular volume. Circulation 1958; 18: 1105–17.

    PubMed  Google Scholar 

  13. Sheehan FH, Bolson EL, Dodge HT, Mathey DG, Schofer J, Woo H. Advantages and applications of the centerline method for characterizing regional ventricular function. Circulation 1986; 74: 293–305.

    PubMed  Google Scholar 

  14. Gibson DG, Brown DJ. Continuous assessment of left ventricular shape in man. Br Heart J 1975; 37: 904–10.

    PubMed  Google Scholar 

  15. Baroni M, Barletta G. Digital curvature estimation for left ventricular shape analysis. Image & Vision Comput J 1992; 10: 485–94.

    Google Scholar 

  16. Grossman W, Jones D, McLaurin LP. Wall stress and pattern of hypertrophy in the human left ventricle. J Clin Invest 1975; 56: 56–64.

    PubMed  Google Scholar 

  17. Fantini F, Barletta G, Baroni M, Fantini A, Maioli M, Sabatier M, Rossi P, Dor V, Di Donato M. Quantitative evalution of left ventricular shape in anterior aneurysm. Cathet Cardiovasc Diagn 1993; 28: 295–300.

    PubMed  Google Scholar 

  18. Fantini F, Barletta G, Di Donato M, Fantini A, Baroni M. Left ventricular shape abnormalities in inferior wall myocardial infarction. Am J Cardiol 1992; 70: 1081–5.

    PubMed  Google Scholar 

  19. Osbakken MD, Bove AA, Spann JE Left ventricular regional wall motion and velocity of shortening in chronic mitral and aortic regurgitation. Am J Cardiol 1981; 47: 193–8.

    PubMed  Google Scholar 

  20. Di Donato M, Barletta G, Mori F, Fantini F. Regional left ventricular wall motion abnormalities in chronic volume overload. Cathet Cardiovasc Diagn 1983; 9: 453–62.

    PubMed  Google Scholar 

  21. Di Donato M, Barletta GA, Mori F, Dabizzi RP, Fantini F. Apical left ventricular asynergy in chronic aortic regurgitation. Clin Cardiol 1985; 8: 283–9.

    PubMed  Google Scholar 

  22. Gould KL, Lipscomb K, Hamilton GW, Kennedy JW. Relation of left ventricular shape, functon and wall stress in man. Am J Cardiol 1974; 34: 627–34.

    PubMed  Google Scholar 

  23. Fuster V, Danielson MA, Robb RA, Broadbent JC, Brown AL, Elveback LR. Quantization of left ventricular myocardial fiber hypertrophy and interstitial tissue in human hearts with chronically increased volume and pressure overload. Circulation 1977; 55: 504–8.

    PubMed  Google Scholar 

  24. Schoen FJ, Lawrie GM, Titus JL. Left ventricular cellular hypertrophy in pressure and volume-overload valvular heart disease. Hum Pathol 1984; 15: 860–5.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Electronic Engineering, University of Florence, Italy

    Maurizio Baroni

  2. Institute of Internal Medicine, Section of Cardiology, University of Florence, Italy

    Giuseppe Barletta, Marisa Di Donato, Maurizio Baroni, Andrea Fantini & Fabio Fantini

Authors
  1. Giuseppe Barletta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marisa Di Donato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maurizio Baroni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea Fantini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fabio Fantini
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barletta, G., Di Donato, M., Baroni, M. et al. Left ventricular remodeling in chronic aortic regurgitation. Int J Cardiac Imag 9, 185–193 (1993). https://doi.org/10.1007/BF01145320

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01145320

Key words

Search

Navigation