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At least 991 records · Page 55Linked to original sources
PubMed2003

New insights into septal anterior wall motion velocities at end-systole in normal and hypertrophied left ventricles.

AIMS: It was two-fold (1) to define tissue Doppler echocardiographic characteristics of the end-systolic septal anterior motion: passive due to heart translation, or active motion free of translational effects, substantiated by a myocardial velocity gradient. (2) to specify the temporal features of this septal anterior motion on normal and hypertrophied left ventricles since it occurs while the posterior wall contracts during late ejection. METHODS AND RESULTS: Myocardial velocity gradient was calculated during the anterior motion in simultaneously colour M-mode imaged septal and posterior walls of 21 controls (49+/-12 years) and 17 patients (49+/-13 years) with left ventricle hypertrophy. Timings of septal motion were compared with flow and posterior wall motion. In controls, septal anterior motion started prior to, and overlapped the end of subaortic flow and that of the posterior wall anterior motion. Myocardial velocity gradient was found, exceeding that at the posterior wall (2.5+/-1.6 vs 0.9+/-0.5s(-1), P=0.001). In patients, septal myocardial velocity gradient was lower than in controls (1.2+/-1.04 s(-1)P=0.006). The anterior motion had a longer duration than in controls (75+/-37 vs 50+/-17ms, P=0.003). Myocardial velocity gradient and duration were correlated with septal thickness (P=<0.01). CONCLUSIONS: The septal anterior motion was active. Patients showed a decreased myocardial velocity gradient, while wall asynchrony increased. Unusual higher septal than posterior wall systolic velocities at tissue Doppler echocardiography may suggest a relaxation pattern, in spite of its end-systolic onset.

Adult↗
PubMed2001

Modeling the vertical motion of a soft contact lens.

PURPOSE: The motion of a soft contact lens in the up-down or vertical (inferior-superior) and in-out (anterior-posterior) directions drives mixing in the post lens tear film. Thus, it is important to obtain an accurate assessment of lens motion. The commonly used experimental technique to measure the vertical motion, video microscopy, only gauges motion during the interblink period. Since most of the eyelid force, which drives the motion, is exerted during the blink, it is reasonable to assume that the majority of the lens motion in the up-down direction takes place during the blink and is, therefore, hidden from view. Thus, experimentally measured values of vertical lens travel are currently underpredicted. METHODS: In this paper, we use a simple mechanical force balance on the lens to predict its motion in the vertical direction. The forces included in our model are due to the upper and the lower eyelids, gravity, elasticity, and viscous stresses. We input the lens physical parameters, the various tear film thicknesses, and the upper eyelid velocity. Then we integrate a macroscopic force balance to obtain the lens vertical position as a function of time. RESULTS: The proposed model predicts that the downward lens motion during a blink is about 2--3 times the downward motion during the interblink (centration). CONCLUSIONS: The up-down motion observable during the interblink period is only a small fraction of the total lens vertical travel.

Biomechanical Phenomena↗
PubMed1952

Some aspects of protoplasmic motion.

In Nitella the protoplasm forms a layer about 15 microns thick surrounding a large central vacuole. The outer part of the protoplasm is a gel, the inner layer is a sol which is in continual motion travelling the entire length of the cell in opposite directions on opposite sides and thus making a complete circuit (cyclosis). If we have a cell devoid of motion and if we regard the protoplasm in any region as made up of successive portions, A, B, C, D, etc., as we pass from left to right) we may suppose that a reaction starts in B which results in a temporary loss of volume by electrostriction, so that liquid moves from A to B to fill the void thus created. The same reaction then occurs at C causing liquid to flow from B to C and so on. The protoplasmic movement can be controlled by agents which affect the viscosity of the protoplasm or the reactions which cause the flow. Certain reagents such as lead acetate stop the flow temporarily. When the motion is stopped in any region by killing or by applying lead acetate, the motion goes on for a time in adjoining regions. When motion stops in all of the cell or in certain parts, it resumes in the same direction as it had before stoppage occurred. Under normal conditions each of the two sides of the cell (on opposite sides of the white line) has its own characteristic direction of motion which remains unchanged after a temporary stoppage of motion in all parts of the cell. Hence the two sides differ and we have what may be called lateral polarity. There is also longitudinal polarity as the opposite ends of the cell are unlike since shoots grow out at one end and roots at the opposite end. The explanation suggested to account for motion in Nitella may apply to other kinds of motion including the motion of cilia and of flagella.

Cell Physiological Phenomena↗
PubMed2006

Quantifying the effect of respiratory motion on lung tumour dosimetry with the aid of a breathing phantom with deforming lungs.

The contribution of organ and tumour motion to the degradation of planned dose distributions during radiotherapy to the breathing lung has been experimentally investigated and quantified. An anthropomorphic, tissue-equivalent breathing phantom with deformable lungs has been built, in which the lung tumour can be driven in any arbitrary 3D trajectory. The trajectory is programmed into a motion controller connected to a high-precision moving platform that is connected to the tumour. The motion controller is connected to the accelerator's dose counter and the speed of motion is scaled to the dose rate. This ensures consistent delivery despite variation in either the dose rate or inter-segment timing. For this study, the phantom was made to breathe by a set of periodic equations representing respiratory motion by an asymmetric, trigonometric function. Several motion amplitudes were selected to be applied in the primary axis of motion. Five three-dimensional, geometrically conformal (3DCRT) fractions with different starting phases (spaced uniformly in the breathing cycle) were delivered to the phantom and compared to a delivery where the phantom was static at the end-expiration position. A set of intensity-modulated radiotherapy plans (IMRT) was subsequently delivered in the same manner. Bigger amplitudes of motion resulted in a higher degree of dose blurring. Severe underdosages were observed when deliberately selecting the PTV wrongly, their extent being correlated with the degree of margin error. IMRT motion-averaged dose distributions exhibited areas of high dose in the gross tumour volume (GTV) which were not present in the static irradiations, arising from booster segments that the optimizer was creating to achieve planning target volume (PTV) homogeneity during the inverse-planning process. 3DCRT, on the other hand, did not demonstrate such effects. It has been concluded that care should be taken to control the delivered fluence when delivering IMRT to the breathing lung, even when the PTV margin has been adequately chosen to include the extent of the breathing motion.

Humans↗
PubMed1999

The effects of motion on parametric fMRI analysis techniques.

Subject motion during the time course of functional activation studies has been shown to cause spurious signals which can mimic 'true' activation. Therefore, the importance of motion correction has been widely recognized. Correction with post-processing using image registration software is common practice in functional imaging and analysis. Many image registration algorithms, developed for analysis requirements other than fMRI, assume rigid body motion. Although these techniques are now routinely used by a number of groups, rigid body coregistration has not yet been shown to reduce the effects of motion to an acceptable level in fMRI analysis, i.e. the effects on resulting correlation analysis directly. In this paper we have used volume data to assess rigid body co-registration in terms of motion artefacts for the different correlation approaches used in fMRI. We have developed a new way of visualizing motion effects in correlation analysis based on generating a scatter plot of correlation score against local image gradient. This technique has been tested on fMRI data sets from a functional paradigm suffering from motion correlated artefacts, with and without rigid body motion correction. Although we do not attempt to estimate the actual residual motion, this technique can be used to verify the results of analysis and select regions of relatively unambiguous activation. This paper assesses directly the rigid body assumption and proves the need for, and effectiveness of, co-registration for all correlation based analysis techniques. The specific differences between the popular correlation forms used are investigated and explained. We show that for certain forms of correlation analysis the effects of motion, while not removed altogether, are effectively statistically eliminated.

Adult↗
PubMed1995

Effects of systolic anterior motion of the mitral valve on haemodynamics. Evaluation by a direct method.

We evaluated the effects of systolic anterior motion systolic anterior motion of the mitral valve on cardiac haemodynamics. Seven adult mongrel dogs in which systolic anterior motion-septal contact was observed after dobutamine administration were used. To exclude the effects of left ventricular function and morphology, a stone removal basket catheter was placed in the left ventricular outflow tract, and haemodynamics were compared with the basket closed and opened. The basket was opened five times in three dogs not showing systolic anterior motion-septal contact, but the basket itself did not effect the haemodynamics. In the seven dogs that showed systolic anterior motion-septal contact without left ventricular hypertrophy, the basket was opened a total of 33 times in the presence of various degrees of systolic anterior motion-septal contact. After opening the basket, systolic anterior motion was reduced echocardiographically, and significant (P<0.01) changes were observed in the left ventricle-aorta pressure gradient (from 68 +/- 22 to 25 +/- 15 mm Hg), the systolic ejection period (from 146 +/- 19 to 135 +/- 16 ms), and the stroke volume (SV; from 9.4 +/- 2.9 to 10.1 +/- 3.3 ml). After basket inflation, aortic pressure and aortic flow waveforms changed but the peak pressure and flow velocity did not. The temporal distribution of left ventricular ejection also definitely changed after the basket was opened. No changes were observed in the peak dp/dt, peak negative dp/dt, time constant, left ventricular end-diastolic pressure, or left atrial pressure. These observations in this animal model of systolic anterior motion without left ventricular hypertrophy suggest that: (1) there is no potential for generation of an intra-cavity gradient in the absence of systolic anterior motion of the mitral valve, so that (2) systolic anterior motion narrowed the left ventricular outflow tract and, consequently, produced the systolic ejection period, and affected the left ventricular ejection dynamics, and that (3) the basket catheter is useful because it allows these assessments in the same heart with a nearly fixed left ventricular contractility, at least in our animal model.

Animals↗
PubMed2002

Segmental wall motion abnormalities during telerobotic totally endoscopic coronary artery bypass grafting.

UNLABELLED: In addition to single-lung ventilation (SLV), intrathoracic CO2 insufflation is mandatory for adequate exposure during totally endoscopic coronary artery bypass grafting. With transesophageal echocardiography, we investigated biventricular myocardial wall motion in 25 patients with isolated disease of the left anterior descending coronary artery who underwent totally endoscopic coronary artery bypass grafting with the "Da Vinci" robotic surgical system. At distinct time points during the operation, a cine loop of both ventricles was registered from a transgastric mid-short-axis view. Myocardial wall motion analysis was performed according to an established segmentation model of the left ventricle and to an established five-point scale for wall motion (1, normal; 5, dyskinesia). Significant alterations from preoperative baseline wall motion were visible in the septal, inferior, and anterior segments of the left ventricle at some time during the prebypass period, combined with a markedly decreased PaO2 under SLV and increased intrathoracic pressure. The same findings applied to the right ventricle; however, wall motion abnormalities were more pronounced here. After myocardial revascularization, weaning from cardiopulmonary bypass, CO2 deflation, and return to double-lung ventilation, myocardial wall motion recovered to baseline values. Clinically significant hemodynamic instability did not occur. The data suggest that robot-assisted coronary artery bypass grafting leads to significant prebypass alterations of biventricular segmental wall motion. On the basis of our data, it cannot be definitively stated whether the observed results were due to reduced oxygenation during SLV and thus "real" myocardial ischemia, intrathoracic CO2 insufflation with positive pressure leading to mechanical compromise of the heart, absolute or relative hypovolemia, or a combination of these factors. However, in this cohort, which consisted of patients with single-vessel disease and good ventricular function, these changes were of limited clinical relevance. IMPLICATIONS: Segmental myocardial wall motion was evaluated with transesophageal echocardiography during robot-assisted totally endoscopic coronary artery bypass grafting. Significant biventricular segmental wall motion abnormalities occurred before cardiopulmonary bypass under single-lung ventilation and carbon dioxide insufflation. The changes in myocardial wall motion were of limited clinical relevance.

Carbon Dioxide↗
PubMed2001

Coronary artery motion during the cardiac cycle and optimal ECG triggering for coronary artery imaging.

RATIONALE AND OBJECTIVES: Our purpose was to investigate the motion characteristics of the coronary arteries and determine optimal electrocardiographic (ECG) trigger time during the cardiac cycle to minimize motion artifacts. METHODS: Contrast-enhanced multislice movie studies of electron beam tomography (EBT) images were performed on 70 subjects. The EBT datasets, which covered an entire cardiac cycle at 58-ms intervals, were acquired for a short-axis view of the heart with ECG triggering. The pixel values along x and y axes were measured at multiple intervals during the cardiac cycle to establish the motion distance and velocity of three major coronary arteries. RESULTS: Coronary artery motion varied greatly throughout the cardiac cycle in three major coronary arteries and increased with the patient's baseline heart rate. The greatest and lowest velocities of coronary arterial movement during the cardiac cycle were determined. Based on the lowest velocity of right coronary artery movement during the cardiac cycle, the optimal ECG trigger times were located at approximately 35% (31.4%-37.6%) or 70% (68.7%-71.4%) of the R-R interval in patients whose resting heart rate was < or =70 beats per minute (bpm); at 50% (47.2%-61.1%) of the R-R interval in the 71- to 100-bpm group; and at 55% (52.8%-59.1%) of the R-R interval in the >100-bpm group. Our data demonstrated that the motion characteristics of the left circumflex artery were quite similar to those of the right coronary artery and that the left anterior descending coronary artery had no significant differences in motion throughout the cardiac cycle. A minimum scan speed of 35.4 to 75.5 ms per slice is needed to completely diminish cardiac motion artifacts (in-plane coronary artery motion with <1-mm displacement). CONCLUSIONS: For coronary artery screening, the optimal ECG trigger time should be determined according to the patient's heart rate, thus greatly reducing motion and motion artifacts during 100-ms acquisitions.

Adult↗
PubMed2006

Automated detection of videotaped neonatal seizures based on motion tracking methods.

This study was carried out during the second phase of the project "Video Technologies for Neonatal Seizures" and aimed at the development of a seizure detection system by training neural networks, using quantitative motion information extracted by motion tracking methods from short video segments of infants monitored for seizures. The motion of the infants' body parts was quantified by temporal motion trajectory signals extracted from video recordings by robust motion trackers, based on block motion models. These motion trackers were developed to autonomously adjust to illumination and contrast changes that may occur during the video frame sequence. The computational tools and procedures developed for automated seizure detection were evaluated on short video segments selected and labeled by physicians from a set of 240 video recordings of 54 patients exhibiting myoclonic seizures (80 segments), focal clonic seizures (80 segments), and random infant movements (80 segments). This evaluation provided the basis for selecting the most effective strategy for training neural networks to detect neonatal seizures as well as the decision scheme used for interpreting the responses of the trained neural networks. The best neural networks exhibited sensitivity and specificity above 90%. The best among the motion trackers developed in this study produced quantitative features that constitute a reliable basis for detecting myoclonic and focal clonic neonatal seizures. The performance targets of the second phase of the project may be achieved by combining the quantitative features described in this paper with those obtained by analyzing motion strength signals produced by motion segmentation methods.

Diagnosis, Computer-Assisted↗
PubMed2003

Increased sagittal plane segmental motion in the lower cervical spine in women with chronic whiplash-associated disorders, grades I-II: a case-control study using a new measurement protocol.

STUDY DESIGN: Case-control study comparing sagittal plane segmental motion in women (n = 34) with chronic whiplash-associated disorders, Grades I-II, with women (n = 35) with chronic insidious onset neck pain and with a normal database of sagittal plane rotational and translational motion. OBJECTIVE: To reveal whether women with chronic whiplash-associated disorders, Grades I-II, demonstrate evidence of abnormal segmental motions in the cervical spine. SUMMARY OF BACKGROUND DATA: It is hypothesized that unphysiological spinal motion experienced during an automobile accident may result in a persistent disturbance of segmental motion. It is not known whether patients with chronic whiplash-associated disorders differ from patients with chronic insidious onset neck pain with respect to segmental mobility. METHODS: Lateral radiographic views were taken in assisted maximal flexion and extension. A new measurement protocol determined rotational and translational motions of segments C3-C4 and C5-C6 with high precision. Segmental motion was compared with normal data as well as among groups. RESULTS: In the whiplash-associated disorders group, the C3-C4 and C4-C5 segments showed significantly increased rotational motions. Translational motions within each segment revealed a significant deviation from normal at the C3-C4 segment in the whiplash-associated disorders and insidious onset neck pain groups and at the C5-C6 segment in the whiplash-associated disorders group. Significantly more women in the whiplash-associated disorders group (35.3%) had abnormal increased segmental motions compared to the insidious onset neck pain group (8.6%) when both the rotational and the translational parameters were analyzed. When the translational parameter was analyzed separately, no significant difference was found between groups, or 17.6% (whiplash-associated disorders group) and 8.6% (insidious onset neck pain group), respectively. CONCLUSION: Hypermobility in the lower cervical spine segments in 12 out of 34 patients with chronic whiplash-associated disorders in this study point to injury caused by the accident. This subgroup, identified by the new radiographic protocol, might need a specific therapeutic intervention.

Adult↗
PubMed2003

Quantification and clinical relevance of head motion during computed tomography.

OBJECTIVE: To quantify the 3-dimensional translation and rotation components of head motion during computed tomography and to analyze the influence of such motion on perceptible artifacts and distortion of volume image data sets. METHODS: Using high-precision optoelectronic motion-capture technology, changes in patient head position during axial CT scanning were registered in 20 cases and 2 phantoms with a spatial relative resolution better than 0.003 cm. Statistical analysis was performed on a base of 6-dimensional measurement-vectors, each with 3 translation and 3 rotation values. Because of the recording frequency of the tracking system, more than 80000 values were included in a statistical analysis. RESULTS: All 20 patients had head motion during the CT scanning, with only 4 of 20 patients showing perceptible motion artifacts. The frequency, the extent, and the direction of the movements did not correlate with either the observations made by the radiologic staff or with the patient's subjective estimation of comfort. Translation movements of the head during CT accounted for a maximum of 0.5 cm and rotations of more than 2 degrees without perceptible motion artifacts. The extent of positional changes of the head was found to correlate with the duration of scanning (Pearson's correlation coefficient: 0.647 for translation shifts, 0.453 for rotation shifts). The mean direction of head motion could be characterized predominantly as a rotation around the longitudinal axis of the body (xy plane) at a significance level of 0.01. CONCLUSION: Computed tomography evaluations of the head performed without rigid fixation suffer a spatial distortion of the volume image data sets, caused by interimage motion. The absence of motion artifacts is not correlated with the absence of motion.

Adolescent↗
PubMed2001

Organ motion detection in CT images using opposite rays in fan-beam projection systems.

Motion artifacts have been identified as a problem in medical tomography systems. While computed tomography (CT) imaging has been getting faster, there remains a need to detect and compensate for motions in clinical follow-up of neurological patients (multiple sclerosis, tumors, stroke, etc.), in cardiac imaging, and in any area in which failing to detect a motion artifact may lead to misdiagnosis. We have developed a novel algorithm to detect motion in brain images. The algorithm deals with detecting and isolating motion in the object domain using only the information available in the sinogram domain. The new "opposite ray algorithm" (ORA) addresses the issue of motion in the interior elements of the object. The ORA combines information from projections that are opposite in space and separated in time to isolate and identify the motion. A sinogram of motion is created, integrated and reconstructed to isolate the moving component. The algorithm can be used with conventional clinical scanners employing quarter-detector offset. The significant effect of quarter-detector offset on the ORA is investigated. The effects that a finite beamwidth and noise have on the ORA are also investigated. Both the similarity index and a correlation coefficient are used to evaluate the algorithm. The algorithm is successful when applied to cases exhibiting translational and translational-rotational motion. A similarity index of 0.88 is obtained in a typical case with both translational and rotational motion. Further development is recommended in the deformation case.

Algorithms↗
PubMed2006

Discriminative analysis of lip motion features for speaker identification and speech-reading.

There have been several studies that jointly use audio, lip intensity, and lip geometry information for speaker identification and speech-reading applications. This paper proposes using explicit lip motion information, instead of or in addition to lip intensity and/or geometry information, for speaker identification and speech-reading within a unified feature selection and discrimination analysis framework, and addresses two important issues: 1) Is using explicit lip motion information useful, and, 2) if so, what are the best lip motion features for these two applications? The best lip motion features for speaker identification are considered to be those that result in the highest discrimination of individual speakers in a population, whereas for speech-reading, the best features are those providing the highest phoneme/word/phrase recognition rate. Several lip motion feature candidates have been considered including dense motion features within a bounding box about the lip, lip contour motion features, and combination of these with lip shape features. Furthermore, a novel two-stage, spatial, and temporal discrimination analysis is introduced to select the best lip motion features for speaker identification and speech-reading applications. Experimental results using an hidden-Markov-model-based recognition system indicate that using explicit lip motion information provides additional performance gains in both applications, and lip motion features prove more valuable in the case of speech-reading application.

Algorithms↗
PubMed2005

An information-theoretic criterion for intrasubject alignment of FMRI time series: motion corrected independent component analysis.

A three-dimensional image registration method for motion correction of functional magnetic resonance imaging (fMRI) time-series, based on independent component analysis (ICA), is described. We argue that movement during fMRI data acquisition results in a simultaneous increase in the joint entropy of the observed time-series and a decrease in the joint entropy of a nonlinear function of the derived spatially independent components calculated by ICA. We propose this entropy difference as a reliable criterion for motion correction and refer to a method that maximizes this as motion-corrected ICA (MCICA). Specifically, a given motion-corrupted volume may be corrected by determining the linear combination of spatial transformations of the motion-corrupted volume that maximizes the proposed criterion. In essence, MCICA consists of designing an adaptive spatial resampling filter which maintains maximum temporal independence among the recovered components. In contrast with conventional registration methods, MCICA does not require registration of motion-corrupted volumes to a single reference volume which can introduce artifacts because corrections are applied without accounting for variability due to the task-related activation. Simulations demonstrate that MCICA is robust to activation level, additive noise, random motion in the reference volumes and the exact number of independent components extracted. When the method was applied to real data with minimal estimated motion, the method had little effect and, hence, did not introduce spurious changes in the data. However, in a data series from a motor fMRI experiment with larger motion, preprocessing the data with the proposed method resulted in the emergence of activation in primary motor and supplementary motor cortices. Although mutual information (MI) was not explicitly optimized, the MI between all subsequent volumes and the first one was consistently increased for all volumes after preprocessing the data with MCICA. We suggest MCICA represents a robust and reliable method for preprocessing of fMRI time-series corrupted with motion.

Algorithms↗
PubMed2002

Motion artifacts of pulse inversion-based tissue harmonic imaging.

Motion artifacts of the pulse inversion technique were studied for finite amplitude distortion-based harmonic imaging. Motion in both the axial and the lateral directions was considered. Two performance issues were investigated. One is the harmonic signal intensity relative to the fundamental intensity and the other is the potential image quality degradation resulting from spectral leakage. A one-dimensional (1-D) correlation-based correction scheme also was used to compensate for motion artifacts. Results indicated that the tissue harmonic signal is significantly affected by tissue motion. For axial motion, the tissue harmonic intensity decreases much more rapidly than with lateral motion. The fundamental signal increases for both axial and lateral motion. Thus, filtering is still required to remove the fundamental signal, even if the pulse inversion technique is applied. The motion also potentially decreases contrast resolution because of the uncancelled spectral leakage. Also, it was indicated that 1-D motion correction is not adequate if nonaxial motion is present.

Artifacts↗
PubMed2003

Diaphragm motion affects flow patterns in an artificial heart.

In the sac-driven artificial heart, the flow characteristics are coupled to the dynamics of the sac motion. The opening dynamics of the sac wall can, for example, strongly affect the chamber flow characteristics during diastole by directing or impeding the inflow. Poor sac motion can reduce the volume output of the pump and may increase the potential for thrombus formation within the ventricular chamber. It is particularly important for laboratory studies of the flow fields in artificial hearts that the diaphragm motion properly simulates the sac motion observed in vivo. In the present study, flow visualization was performed to investigate the relationship between the chamber flow characteristics of a Penn State artificial heart and the motion of the diaphragm during the filling phase during in vitro experimentation. The chamber flow pattern and diaphragm motion were recorded as a function of time, using high-speed videography. Experiments were conducted to determine the influence of diaphragm motion on the flow characteristics by altering the filling pressure, diaphragm thickness, and fluid density. Diaphragm motion was quantified by tracking the position of three surface points over the cardiac cycle. The alignment of these three surface trajectories can be used to quantify the uniformity of diaphragm motion. As a result, diaphragm motion was determined to be nonuniform under most operating conditions with the diaphragm opening in a wave-like pattern starting at the bottom of the chamber and propagating toward the inflow/outflow ports. This opening pattern simulates the opening pattern observed in an in vitro study of the clinical blood sac used in the Lionheart LVAD.

Blood Circulation↗
PubMed1986

Asynchronous left ventricular wall motion early after coronary thrombosis.

To study regional wall motion early in the development of acute myocardial infarction, left ventriculograms performed in 24 patients before thrombolysis and within 3.5(1.2) (mean (SD] hours of the onset of pain were digitised frame by frame. Isometric and contour plots of regional wall motion were constructed. In 19 patients (seven with anterior descending, eight with right, and four with circumflex disease) thrombosis was demonstrated on an underlying stenosis. In 10 patients the two remaining coronary arteries were normal, and in nine, one or both showed important disease. Mean values of global indices of left ventricular function, including end diastolic volume, ejection fraction, peak ejection and filling rates, and cavity shape changes were all within normal limits, though end systolic volume was significantly raised. Total systolic amplitude of wall motion was normal in the affected area in all but seven patients (four with anterior descending, two with right, and one with circumflex thrombosis). Dyskinesis of more than 2 mm was seen in only three patients, all with thrombosis of the anterior anterior descending coronary artery, and hyperkinesis was present in four. The commonest abnormality of wall motion was hypokinesis during ejection followed by prolonged inward motion during isovolumic relaxation, which was seen in four patients with anterior descending, seven with right, and three with circumflex artery thrombosis. This was preceded by outward motion during isovolumic contraction and delayed inward motion during ejection in eight with right or circumflex thrombosis. Five of six patients without thrombosis had simple hypokinesis or dyskinesis without asynchrony. Disease of other coronary arteries did not affect the pattern of wall motion seen after right or circumflex coronary artery occlusion but it reduced the incidence of delayed inward motion along the free wall after thrombosis of anterior descending artery. Thus early after acute coronary thrombosis asynchronous wall motion is commoner than simple hypokinesis or dyskinesis. Its persistence suggests that in the setting of coronary artery thrombosis in man, residual contractile activity may persist for up to six hours after the onset of symptoms.

Acute Disease↗
PubMed1982

Mechanism of abnormal interventricular septal motion during delayed left ventricular activation.

To evaluate the mechanism of the abnormal motion of the interventricular septum (IVS) seen echocardiographically in some patients with relatively delayed ventricular activation, we simultaneously recorded high-fidelity left and right ventricular pressures and electrograms and echocardiograms of the IVS in nine open-chest dogs. During sinus rhythm and during left IVS pacing, the IVS was activated from left to right, preejection left ventricular pressure exceeded right ventricular pressure, and IVS motion was normal. During right ventricular pacing from the outflow tract, apex, free wall or right IVS was activated from right to left, right ventricular pressure increased before left ventricular pressure and simultaneously there was an abrupt posterior IVS motion. Simultaneous pacing from the right IVS and left ventricular free wall activated the IVS from right to left and produced a normal transseptal preejection pressure gradient and normal IVS motion. Simultaneous pacing from the left IVS and right ventricular free wall activated the IVS from left to right, and produced abrupt preejection posterior IVS motion coincident with an altered transseptal pressure gradient. During right ventricular pacing, IVS motion after the abrupt preejection posterior movement was variable. Anterior motion was associated with a greater asynchrony of right and left ventricular contraction than was normal posterior motion. We conclude that abrupt preejection posterior IVS motion seen with delayed left ventricular activation from right ventricular pacing is due to passive IVS displacement from an altered transseptal pressure gradient, and subsequent IVS motion depends on the degree of asynchrony between right and left ventricular contraction.

Animals↗