Quantitative assessment of left ventricular regional wall motion in endomyocardial fibrosis

Abstract

To analyze left ventricular (LV) regional wall motion in patients with endomyocardial fibrosis (EMF). The study comprised 88 patients, 59 of the female sex, with a mean age of 39+/-13 years (range, 9 to 65) and with echocardiographic and angiographic evidence of left ventricular EMF. The intensity of fibrous tissue buildup on contrast cineventriculography was classified as mild, moderate, or severe. The overall left ventricular ejection fraction (LVEF) was determined by using the area-length method on ventriculography. The motion was measured in 100 equidistant chords perpendicular to the centerline drawn in the middle of the final diastolic and systolic contours and normalized to cardiac size. Five left ventricular segments were analyzed: A--apical; AL--anterolateral; AB--anterobasal; IA--inferoapical; IB--inferobasal. Abnormality was expressed in units of standard deviation of the mean motion in a normal population of reference, comprised of 103 patients with normal LV according to clinical and electrocardiographic data, and angiographic standards. Mean LVEF was 0.47+/-0.12. Fibrous tissue buildup in the left ventricle was mild in 12 patients, moderate in 40, and severe in 36. The regions with the poorest ventricular wall motion were A (-1.4+/-1.6 standard deviation/chords) and IA (-1.6+/-1.8 standard deviation/chords) compared with that in AB (-0.3+/-1.9 standard deviation/chords), AL (-0.5+/-1.8 standard deviation/chords) and IB (-0.9+/-1.3 standard deviation/chords). No relation was observed between the intensity of fibrous tissue buildup and regional ventricular wall motion. A change in LV regional wall motion exists in EMF, and it is independent of the intensity of fibrous tissue buildup qualitatively assessed. Nonuniform involvement of the LV should be considered when planning surgery for this disease.