Ventricular Motion Research Articles

902 Bileaflet mitral valve orientation — is it associated with obstructive valve thrombosis? A transesophageal echocardiographic study

2 , 2 Institute for Cardiovascular Diseases, Belgrade, Yugoslavia Objective: Preservation of the posterior leaflet during mitral valve replacement in patients (pts) with mitral regurgitation has been proven beneficial for postoperative left ventricular performance. Some authors have been stating that posterior leaflet preservation during every mitral valve replacement was highly beneficial both post- operatively as well as long-term. The aim of our study was to investigate long-term effect of this technique in pts with rheumatic mitral stenosis. Patients and Methods: We studied 20 pts with mitral valve replacement for rheumatic mitral stenosis operated from 1989-1990. In all pts a Carbomedics valve was inserted. In group A (10 pts) the posterior leaflet was preserved, while group B (10 pts) underwent excision of both leaflets with corresponding chordas. In both groups hemodynamic characteristic of the valve and the left ventricle, based on echocardiographic findings 12 years later, were compared. We determined maxi- mal (PG) and mean (MG) transmitral valvular gradients, as well as the effective area of inserted valvular opening (AREA), telediastolic (TDV) and telesystolic (TSV) left ventricular volume, stroke volume (SV), ejection fraction (EF), fractional shortening (FS) and segmental left ventricular motion. Results: The mean size of inserted valve was 27.4 in group A and 26.6 in group B. We found no difference between the two groups according to hemodynamic data: PG (10.4 vs 11.1mmHg), MG (4.0 vs 3.5 mmHg), AREA (2.3 vs 2.37cm2), TDV (114.5 vs 133.7ccm), TSV (36.6 vs 46.2ccm), SV (53.7 vs 83.7ccm), EF (67.1 vs 63.7%), FS (38.2 vs 33.7%). Dyskinesis of the corresponding segments was found in 3 patiens in group A and in one patient in group B. Conclusion: In pts with rheumatic mitral stenosis and valve replacement, posterior leaflet preservation has not been shown beneficial for left ventricular function during long-term follow-up. Adequate preservation of the posterior mitral leaflet did not change the properties of the inserted valve in long-term follow-up.

Defining normal left ventricular wall motion from contrast ventriculograms

Sources of variability in defining the normal range for left ventricular (LV) motion from contrast ventriculograms were assessed by comparing the function of 183 normal patients from six sites in three countries. Wall motion was measured using the centreline method at seven regions around the LV contour. The influence of institution, heart rate, age, end diastolic volume, body surface area and gender was evaluated using univariate analysis, and then compared using multivariate regression analysis. Wall motion varied significantly but weakly (|r| < 0.32 for all) with site, gender and body surface area in some regions. Variability was greater within sites than between sites. Wall motion was most similar in the two sites with the largest patient populations (N = 49 and N = 52). Normal LV wall motion is influenced by many factors. The reliable definition of the normal range requires analysis of a large number of subjects. For wall motion, the normal population should comprise closer to 50 subjects than the 10–20 that are commonly referenced.

Clinically suspected constrictive pericarditis: MR imaging assessment of ventricular septal motion and configuration in patients and healthy subjects.

To assess ventricular septal motion and quantify the septal configuration in patients clinically suspected of having constrictive pericarditis (CP), and to compare these patients with healthy subjects and with patients who have other diastolic heart abnormalities such as restrictive cardiomyopathy (RCM). In 41 patients clinically suspected of having CP and 12 healthy subjects, magnetic resonance (MR) imaging yielded information about cardiac morphology and function. On short-axis cine MR images, septal motion was assessed, and the septal and left ventricular free wall (LVFW) radii of curvature were quantified and normalized to end systole. Abnormal diastolic septal motion was expressed in terms of the largest difference in normalized radius between the septum and the LVFW. Analysis of variance was used to identify significant differences in septal shape among subject groups. Left-sided septal flattening was identified in 17 of the 21 patients with surgically proven CP, in none of the 20 patients without CP, and in none of the healthy subjects. CP without septal flattening was present on the left side (n = 1), on the right side (n = 1), and at the atrioventricular grooves (n = 2). Abnormal septal motion yielded a sensitivity of 81% (17 of 21 patients), specificity of 100% (20 of 20 patients), accuracy of 90% (37 of 41 patients), positive predictive value of 100% (17 of 17 patients), and negative predictive value of 83% (20 of 24 patients) in the detection of CP. The maximal difference in normalized radius of curvature between the septum and the LVFW in the patients with CP was significantly different from that in the patients without CP (P <.001) and that in the healthy subjects (P <.001). Abnormal diastolic septal motion is a frequent phenomenon of CP. If present in patients suspected of having CP, this finding is helpful in distinguishing CP from RCM.

Colour encoded endocardial tracking: the current state of play.

Colour encoded endocardial tracking is a new echocardiographic technique designed to track ventricular wall endocardial motion and thus help in assessing both regional and global ventricular function. It is an extension of automatic boundary detection, a technique based on integrated backscatter analysis. By utilizing automated boundary detection, colour encoded endocardial tracking automatically tracks endocardial motion on a frame by frame basis. Colour overlays are then superimposed on the grey-scale images. These colour overlays are updated in real time, providing an integrated display of the magnitude and timing of endocardial wall motion. With further post-processing analysis, this technique can provide quantitative information on both global and regional ventricular systolic and diastolic function.

Noninvasive coronary artery imaging by multislice spiral computed tomography.

Although the excellent spatial resolution of multislice spiral computed tomography (MSCT) enables the coronary arteries to be visualized, its limited temporal resolution results in poor image reproducibility because of cardiac motion artifact (CMA) and hence limits its widespread clinical use. A novel retrospectively ECG-gated reconstruction method has been developed to minimize CMA. In 88 consecutive patients, the scan data were reconstructed using 2 retrospectively ECG-gated reconstruction methods. Method 1: the end of the reconstruction window (250 ms) was positioned at the peak of the P wave on ECG, which corresponded to the end of the slow filling phase during diastole immediately before atrial contraction. Method 2 (conventional method): relative retrospective gating with 50% referred to the R-R interval was performed so that the beginning of the reconstruction window (250 ms) was positioned at the halfway point between the R-R intervals of the heart cycle. The quality of the coronary artery images was evaluated according to the presence or absence of CMA. The assessment was applied to the left main coronary artery (LMCA), the left anterior descending artery (LAD, segments #6, #7 and #8), the left circumflex artery (LCx, segments #11 and #13) and the right coronary artery (RCA, segments #1, #2 and #3). The first diagonal artery (#9-1), the obtuse marginal artery (#12-1), the posterior descending artery (#4-PD), the atrioventricular node branch (#4-AV) and the first right ventricular branch (RV) were also evaluated. Of the 88 patients, 85 were eligible for image evaluation. Method 1 allowed visualization of the major coronary arteries without CMA in the majority of patients. The LCA system (segments #5-7, #11 and #13) and the proximal portion of the RCA were visualized in more than 94% of patients. Artifact-free visualization of the distal portion of the LAD (segment #8) and RCA (#4PD and #4AV), and side branches (#9-1, #12-1 and RV) was also achieved in more than 80% of patients. On the other hand, CMA occurred frequently on images obtained by Method 2. The LCx and RCA systems were the most affected by CMA, revealing only 41% artifact-free visualization of the segment #13, 39% of #1, 15% of #2 and 32% of #3. Thus, Method 1, which avoids the ventricular motion occurring during the rapid filling and atrial contraction phases, gives superior image quality over the conventional ECG-gated reconstruction method.

Development of an electrostatic generator for a cardiac pacemaker that harnesses the ventricular wall motion

A variable-capacitance-type electrostatic (VCES) generator that harnesses ventricular motion was developed with the aim of driving a cardiac pacemaker permanently without a battery. The developed model of the VCES generator was handmade, but it was too large to implant into the thoracic cavity of a laboratory animal. For this reason, to demonstrate its feasibility, a somewhat complicated method that measured the left ventricular wall motion by means of the accelerometer module put on the free wall and reproduced the motion in real time with a vibration mode simulator was used. The VCES generator was vibrated on the simulator, and its generated power was supplied to the cardiac pacemaker, which then stimulated the heart. A mean power of approximately 36 μW was generated, which was enough to drive the cardiac pacemaker. Continuous electric generation and cardiac pacing were performed successfully for more than 2 h in the animal experiment.

Tissue Doppler imaging for the assessment of left ventricular systolic and diastolic functions.

Doppler tissue imaging is a technique that allows recording of the low Doppler shift frequencies of high energy generated by the ventricular walls motion that are purposely filtered out in standard Doppler blood flow studies. Doppler tissue imaging can be performed with the use of pulsed Doppler, color two-dimensional Doppler, and color M-mode Doppler. Pulsed Doppler tissue imaging offers a high temporal resolution and therefore can be appropriately used for analysis of temporal relation between myocardium systolic and diastolic velocity waves. Color two-dimensional Doppler provides a good spatial resolution that permits differentiation of the velocity profiles between subendocardial and subepicardial layers but is limited by its poor temporal resolution. M-mode color-coded tissue imaging is characterized by a high spatiotemporal resolution, but sampling is only performed on a single line. Both two-dimensional and M-mode color-coded tissue imaging require specific modification of the current ultrasound machines. The present article reviews how Doppler tissue imaging may contribute to the noninvasive assessment of systolic and diastolic myocardial functions.

Nonlinear dynamics of the left ventricle

The cnoidal method is applied to solve the set of nonlinear dynamic equations of the left ventricle. By using the theta-function representation of the solutions and a genetic algorithm, the ventricular motion can be described as a linear superposition of cnoidal pulses and additional terms, which include nonlinear interactions among them.

Left ventricular 4D echocardiogram motion and shape analysis

The article describes the methodology and the processes of modeling the function and the motion of left ventricle using trans-esophageal echocardiograph. The parameters can be used in studying the functionality of left ventricle, the status of abnormality of myocardial, and the geometric and morphological of left ventricle in shape analysis. The parameters describes the motion of left ventricle are the left ventricular (LV) floating long axis, the morphological parameters. The LV morphological parameters describe the wall motion, the LV chamber cavity variation, the effective R-ratio of endomyocardial chamber of LV, the area surface curvature, and the global surface curvature circularity. The parameters such as stroke volume, ejection fraction used in evaluation of LV functions are also extracted.

Atypical Stunned Myocardium Caused by Severe Pulmonary Dysfunction

We present the case of a 71-year-old Japanese man suffering from severe dyspnea who showed abnormal left ventricular motion in cardiac echogram with ST-T elevation in electrocardiogram, which at first was misdiagnosed as an acute myocardial infarction. Coronary angiography showed neither coronary obstructions nor spasms. The symptoms were transient and the patient soon recovered. We speculate that it is a specific type of atypical stunned myocardium caused by the great stress of severe pulmonary dysfunction.

A typical Stunned Myocardium Caused by Severe Pulmonary Dysfunction

We present the case of a 71-year-old Japanese man suffering from severe dyspnea who showed abnormal left ventricular motion in cardiac echogram with ST-T elevation in electrocardiogram, which at first was misdiagnosed as an acute myocardial infarction. Coronary angiography showed neither coronary obstructions nor spasms. The symptoms were transient and the patient soon recovered. We speculate that it is a specific type of atypical stunned myocardium caused by the great stress of severe pulmonary dysfunction.

Post-endsystolic active shortening in the non-ischemic region impairs left ventricular pressure fall in acute ischemic heart.

To investigate the relation between the impairment of isovolumic relaxation and the regional wall motion in acute ischemia, the left ventricular pressure fall and regional myocardial motion were examined in the relaxation phase in dogs during both acute coronary artery occlusion (n = 12) and a regional coronary flow reduction (n = 6). Fifteen to 40 seconds after complete coronary artery occlusion or in the stable state after a regional coronary flow reduction by 70 to 90% of the control state, a shortening of the non-ischemic region at the early isovolumic relaxation phase (the post-endsystolic shortening) appeared, combined with lengthening of the ischemic region. In these situations, the logarithmic plots of the left ventricular pressure fall was composed of two components (time constant of early part [Ta] and at latter part [Tb]). Ta was greater than Tb (64.3 +/- 13.8 milliseconds vs. 36.6 +/- 10.4 milliseconds at 15 seconds after coronary occlusion, p < 0.01; 67.6 +/- 22.9 milliseconds vs. 45.1 +/- 17.5 milliseconds at flow reduction, p < 0.01) and the time constant at control (p < 0.01). These findings suggested that post-endsystolic shortening in the non-ischemic region played a role in a the non-uniformity of the left ventricular contraction and contributed to the impairment of the left ventricular pressure fall in acute regional ischemia, especially in early isovolumic relaxation.

Speed of normalization of right ventricular volume overload after transcatheter closure of atrial septal defect in children and adults

Right ventricular (RV) volume overload occurs in patients with significant atrial septal defect (ASD) shunt, which can impair left ventricular (LV) filling and ejection fraction. 1 Louie E.K Lin S.S Reynertson S.I Brundage B.H Levitsky S Rich S Pressure and volume loading of the right ventricle have opposite effects on left ventricular ejection fraction. Circulation. 1995; 92: 819-824 Crossref PubMed Scopus (149) Google Scholar RV dilation and abnormal ventricular septal motion are characteristic echocardiographic features of RV volume overload. Transcatheter closure of secundum ASD was first attempted >25 years ago, and it is being increasingly used in recent years with promising closure results. 2 Rome J.J Keane J.F Perry S.B Spevak P.J Lock J.E Double-umbrella closure of atrial septal defects initial clinical applications. Circulation. 1990; 82: 751-758 Crossref PubMed Scopus (278) Google Scholar , 3 Das G.S Voss G Jarvis G Wyche K Gunther R Wilson R.F Experimental atrial septal defect closure with a new, transcatheter, self-centering device. Circulation. 1993; 88: 1754-1764 Crossref PubMed Scopus (204) Google Scholar , 4 Prieto L.R Foreman C.K Cheatham J.P Latson L.A Intermediate-term outcome of transcatheter secundum atrial septal defect closure using the Bard Clamshell Septal Umbrella. Am J Cardiol. 1996; 78: 1310-1312 Abstract Full Text PDF PubMed Scopus (78) Google Scholar , 5 Rao P.S Berger F Rey C Haddad J Meier B Walsh K.P Chandar J.S Lloyd T.R de Lezo J.S Zamora R Sideris E.B Results of transvenous occlusion of secundum atrial septal defects with the fourth generation buttoned device comparison with first, second and third generation devices. International Buttoned Device Trial Group. J Am Coll Cardiol. 2000; 36: 583-592 Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar , 6 Masura J Gavora P Formanek A Hijazi Z.M Transcatheter closure of secundum atrial septal defects using the new self-centering Amplatzer septal occluder initial human experience. Cathet Cardiovasc Diagn. 1997; 42: 388-393 Crossref PubMed Scopus (406) Google Scholar , 7 Thanopoulos B.D Laskari C.V Tsaousis G.S Zarayelyan A Vekiou A Papadopoulos G.S Closure of atrial septal defects with the Amplatzer occlusion device preliminary results. J Am Coll Cardiol. 1998; 31: 1110-1116 Abstract Full Text Full Text PDF PubMed Scopus (258) Google Scholar This study evaluates the change in RV volume overload after transcatheter closure of ASD by echocardiography and assesses the possible influencing factors.

Age-dependent changes in regional diastolic function evaluated by color doppler myocardial imaging: A comparison with pulsed doppler indexes of global function

The goals of this study were to evaluate possible normal age-related changes in regional myocardial relaxation as detected by color Doppler myocardial imaging (CDMI) velocities and to compare the extent of any such changes with age-induced changes in global diastolic function. In 80 healthy subjects (aged 21 to 72 years, equally subdivided by decades) the mitral flow velocities in early diastole (E) and atrial contraction (A) were recorded as were the velocities of left ventricular (LV) motion of early (EDV) and late diastole (LDV) in the 16 standard LV segments, and their ratios were calculated. In healthy persons younger than 40 years, all segments showed an EDV/LDV ratio > 1, whereas in healthy persons aged 40 years or older the mean EDV of all segments decreased, and the mean LDV increased, resulting in a significant decrease of the mean EDV/LDV ratio with age. Values of EDV/LDV ratios were higher than E/A ratios (P <.0001), but their changes with age correlated well with each other (r = 0.805). With increasing age, an EDV/LDV ratio <1 was observed more often in basal segments (P <.001, compared with mid and apical segments) and less often in segments of anteroseptal and posterior walls viewed from the parasternal window. The presence of >50% segments with an EDV/LDV ratio <1 was associated with an E/A ratio <1. Regional diastolic function indexes as evaluated by CDMI changed with increasing age in a heterogeneous way and influenced global diastolic function parameters.

Comparison of chronic biventricular pacing between epicardial and endocardial left ventricular stimulation using Doppler tissue imaging in patients with heart failure

In patients with a wide QRS, drug-resistant heart failure, and a coronary sinus that is unsuitable for transvenous biventricular pacing (BVP), a transseptal approach from the right to left atrium can allow endocardial left ventricular (LV) pacing (with permanent anticoagulant therapy) instead of epicardial pacing via the coronary sinus branches. We sought to compare the effects of endocardial pacing with those of epicardial LV pacing on regional LV electromechanical delay (EMD) and contractility. Twenty-three patients (68 ± 8 years) with severe heart failure and QRS ≥130 ms received a pacemaker for BVP. Fifteen patients underwent epicardial LV pacing, and 8 underwent endocardial LV pacing because of an unsuitable coronary sinus. All LV leads were placed at the anterolateral LV wall. Six months after implant, echocardiography and Doppler tissue imaging were performed. LV wall velocities and regional EMDs (time interval between the onset of the QRS and local ventricular systolic motion) were calculated for the 4 LV walls and compared for each patient between right ventricular (RV) and BVP. The amplitude of regional LV contractility was also assessed. Epicardial BVP reduced the septal wall EMD by 11% versus RV pacing (p = 0.05) and the lateral wall EMD by 41% versus RV pacing (p <0.01). With endocardial BVP, the septal and lateral EMDs were 21.3% and 54%, respectively (p <0.01, compared with epicardial BVP). The mitral time-velocity integral increased by 40% with endocardial BVP versus 2% with epicardial BVP (p <0.01). The amplitude of the lateral LV wall systolic motion increased by 14% with epicardial BVP versus 31% with endocardial BVP (p = 0.01). This resulted in a LV shorterning fraction increase of 25% in patients with endocardial BVP (p = 0.05). However, all patients were clinically improved at the end of follow-up. Thus, in heart failure patients with BVP, endocardial BVP provides more homogenous intraventricular resynchronization than epicardial BVP and is associated with better LV filling and systolic performance.

Recurrent Mitral Stenosis: Problems of Management

Abbreviation: TEE 5 transesophageal echocardiography A 44-year-old woman was evaluated for the primary complaint of the sensation of rapid and irregular beating of the heart, which was intensified by exertion. This sensation had been apparent for approximately 2 months and was associated with increased fatigability. Her previous history disclosed that elsewhere, 21 years previously, she had undergone aortic valve replacement combined with mitral valvotomy, but the records of this event were unavailable. She had never previously noted a rapid or irregular heart rhythm, and the remainder of the history and review of systems was completely negative. Three weeks previously, her referring physician had initiated regular oral treatment with digoxin and warfarin. On examination, the BP was 130/80 mm Hg, and the pulse rate was estimated at 85 beats/min and irregular. Physical findings included a displaced apical impulse to 1 cm lateral to the midclavicular line. An accentuated first heart sound and a soft mitral opening snap were audible. Opening and closing sounds were compatible with a mechanical aortic prosthetic valve. There was a grade 2/6 apical pansystolic murmur together with a grade 2/6 mid diastolic rumbling murmur consistent with combined mitral stenosis and regurgitation. A grade 3/6 early systolic ejection murmur was noted at the base together with a soft, high-pitched (blowing) diastolic decrescendo murmur (grade 1/6) heard maximally at the mid-left sternal border and consistent with aortic regurgitation. The lungs were clear to auscultation, and the findings of the remainder of the examination were normal. The ECG disclosed atrial fibrillation with a ventricular response rate of 75 beats/min; ST-T abnormalities were consistent with the effect of digitalis. An echocardiogram disclosed an enlarged left atrium (diameter, 4.8 cm). The mitral valve was thickened and stenotic, with a valve area estimated by both direct planimetric measurement and Doppler echocardiographic assessment to be approximately 1.1 cm 2 . Mild-to-moderate mitral regurgitation was demonstrated. A mechanical prosthetic valve in the aortic position was visualized, and peak systolic gradient of 47 mm Hg across this structure was derived by Doppler echocardiographic assessment. Mild regurgitation was noted across this orifice. The left ventricular size and systolic motion were normal. There was mild-to-moderate tricuspid regurgitation, from which the right ventricular systolic pressure was estimated to be in the range of 30 to 40 mm Hg. Chest radiography disclosed a cardiac silhouette indicative of left atrial enlargement, but the lung fields were clear. A mechanical prosthetic aortic valve was present together with evidence of a previous sternotomy.

Left ventricular hypertrophy demonstrated by four-dimensional myocardiography by helical computed tomography.

We present 4D images of hypertrophied myocardium in patients with essential hypertension, hypertrophic cardiomyopathy with asymmetrical septal hypertrophy, and apical hypertrophic cardiomyopathy using helical computed tomography (CT) ( Figures 1 through 4⇓⇓⇓⇓). Previously, we reported on 4D CT-ventriculography, which can assess right and left ventricular morphology and motion.1 In 4D ventriculography, we used only information about the inner cavities of the heart, and we discarded information regarding the myocardium. However, it is important to estimate the extent and function of the hypertrophied myocardium. Therefore, we retrieved and dealt with informa-tion about the myocardium as demonstrated in a 4D manner (4D myocardiography). Methods …

Ventricular motion during the ejection phase: a computational analysis.

In the present paper, the study of the ventricular motion during systole was addressed by means of a computational model of ventricular ejection. In particular, the implications of ventricular motion on blood acceleration and velocity measurements at the valvular plane (VP) were evaluated. An algorithm was developed to assess the force exchange between the ventricle and the surrounding tissue, i.e., the inflow and outflow vessels of the heart. The algorithm, based on the momentum equation for a transitory flowing system, was used in a fluid-structure model of the ventricle that includes the contractile behavior of the fibers and the viscous and inertial forces of the intraventricular fluid. The model calculates the ventricular center of mass motion, the VP motion, and intraventricular pressure gradients. Results indicate that the motion of the ventricle affects the noninvasive estimation of the transvalvular pressure gradient using Doppler ultrasound. The VP motion can lead to an underestimation equal to 12.4 +/- 6.6%.

Left ventricular motion reconstruction from planar tagged MR images: acomparison

Through recent development of MR techniques, it is now possible to assessregional myocardial wall function in a non-invasive way. Using MR tagging,space is marked with planes which deform with the tissue, providing markersfor tracking the local motion of the myocardium. Numerous methods toreconstruct the three-dimensional displacement field have been developed. Theaim of this article is to provide a framework to quantitatively compare theperformance of four methods the authors have developed. Five sets ofexperiments are described, and their results are reported. Instructions arealso provided to perform similar tests on any method using the same data.The experiments show that some characteristic properties of the methods, suchas sensitivity to noise or spatial resolution, can be quantitativelyclassified. Cross-comparison of performances show what range values for theseproperties can be considered acceptable.

Effect of systemic sclerosis on left ventricular long-axis motion and left ventricular mass assessed by magnetic resonance.

The aim of this study was to assess the effect of scleroderma on left ventricular mass and subendocardial function using cardiovascular magnetic resonance (CMR) to determine parameters reflecting early dysfunction from fibrosis. Fifteen patients with a history of scleroderma had left ventricular mass measured with standard techniques and regional subendocardial contractile function assessed using myocardial velocity mapping in the basal short-axis plane with long-axis sensitized velocity mapping. Peak myocardial velocities in systole and diastole were measured to reflect systolic and diastolic function. The variance in the regional myocardial velocity, was determined as a parameter of function heterogeneity around the ventricle. The results were compared with 19 healthy volunteers without a history of cardiovascular disease. In 10 patients, pulmonary transfer factor was measured using a single-breath helium dilution technique. The duration of scleroderma correlated with left ventricular mass (r = 0.7, p < 0.05), the coefficient of variation of velocity (r = 0.63, p < 0.05), and inversely with the mean left ventricular diastolic long-axis velocity (r = -0.63, p < 0.05). There was also a correlation between left ventricular diastolic long-axis velocity and the pulmonary transfer factor (r = 0. 7, p < 0.05). Trends suggested differences between control subjects and scleroderma patients for mean systolic (64 vs. 49 mm/sec, p = 0.09) and diastolic (90 vs. 72 mm/sec, p = 0.07) velocities, as well as velocity variance (26 vs. 33, p = 0.09). In conclusion, there is a relationship between duration of scleroderma and both left ventricular mass and diastolic function, which may result from increased myocardial fibrosis. Trends suggest absolute differences in functional values with control subjects that reflect impaired diastolic and systolic function, with greater regional heterogeneity that is consistent with nonuniform collagen deposition, but a larger sample size is required to confirm this. CMR should be explored further as a technique for monitoring myocardial involvement in scleroderma noninvasively.