Jones C J, Raposo L, Gibson D G
Cardiac Department, Brompton Hospital, London.
Br Heart J. 1990 Apr;63(4):215-20. doi: 10.1136/hrt.63.4.215.
The role of longitudinally and circumferentially oriented fibres in left ventricular wall motion was examined by digitising echocardiograms of the mitral ring (whose motion reflects long axis change) and of the standard minor axis in 36 healthy individuals, 36 patients with coronary artery disease, 16 with left ventricular hypertrophy, 44 with mitral valve disease (24 of whom had undergone mitral valve replacement). In the controls long axis shortening significantly preceded minor axis shortening (mean (1 SD) difference 25 (40) ms) so that the minor axis increased more during isovolumic contraction (0.25 v 0.09 cm), indicating that the left ventricle became more spherical. Changes in the long and short axes were synchronous at end ejection and in early diastole in the controls. Epicardial excursion preceded endocardial excursion by 50 (20) ms at its peak. These time relations were consistently disturbed in all patient groups, irrespective of the extent of fractional shortening of the minor axis. The onset of long axis shortening was delayed, and this was often associated with premature shortening of the minor axis, the normal spherical shape change during isovolumic contraction was lost, and peak epicardial and endocardial changes became more synchronous. In patients with coronary disease these changes are the expected consequence of ischaemic injury to longitudinally orientated subendocardial fibres. In left ventricular hypertrophy their presence consistently showed systolic dysfunction when orthodox measures were still normal. They were more pronounced after mitral valve replacement when the papillary muscles had been sectioned; long axis shortening was reduced during systole and prolonged into early diastole, while normal shortening of the minor axis was maintained only by abnormal epicardial excursion. Relations between long and short axis motion in healthy individuals are characteristic, and their loss is an early index of systolic ventricular disease. These disturbances precede changes in orthodox measures such as fractional shortening or peak velocity of circumferential fibre shortening.
通过对36名健康个体、36名冠心病患者、16名左心室肥厚患者、44名二尖瓣疾病患者（其中24名已接受二尖瓣置换术）的二尖瓣环（其运动反映长轴变化）和标准短轴的超声心动图进行数字化处理，研究纵向和周向纤维在左心室壁运动中的作用。在对照组中，长轴缩短明显先于短轴缩短（平均（1标准差）差异为25（40）毫秒），因此在等容收缩期短轴增加更多（0.25对0.09厘米），表明左心室变得更接近球形。在对照组中，长轴和短轴在射血末期和舒张早期同步变化。心外膜偏移在其峰值时比心内膜偏移提前50（20）毫秒。在所有患者组中，这些时间关系均受到持续干扰，与短轴缩短分数的程度无关。长轴缩短的起始延迟，且常伴有短轴过早缩短，等容收缩期正常的球形变化消失，心外膜和心内膜变化的峰值变得更加同步。在冠心病患者中，这些变化是纵向排列的心内膜下纤维缺血损伤的预期后果。在左心室肥厚患者中，当传统指标仍正常时，这些变化始终表明存在收缩功能障碍。在二尖瓣置换术后，当乳头肌被切断时，这些变化更为明显；收缩期长轴缩短减少，并延长至舒张早期，而短轴的正常缩短仅通过异常的心外膜偏移来维持。健康个体中长轴和短轴运动之间的关系具有特征性，其丧失是心室收缩期疾病的早期指标。这些干扰先于传统指标的变化，如缩短分数或周向纤维缩短峰值速度的变化。
