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1 Department of Surgery and the Harrison Department of Surgical Research and 2 Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104; and 3 Philips Medical Systems, Andover, Massachusetts 01810
After myocardial infarction (MI),
the border zone expands chronically, causing ventricular dilatation and
congestive heart failure (CHF). In an ovine model (n = 4) of anteroapical MI that results in CHF, contrast echocardiography
was used to image short-axis left ventricular (LV) cross sections and
identify border zone myocardium before and after coronary artery
ligation. In the border zone at end systole, the LV endocardial
curvature (K) decreased from 0.86 ± 0.33 cm
1 at baseline to 0.35 ± 0.19 cm1 at
1 h (P < 0.05), corresponding to a mean decrease
of 55%. Also in the border zone, the wall thickness (h)
decreased from 1.14 ± 0.26 cm at baseline to 1.01 ± 0.25 cm
at 1 h (P < 0.05), corresponding to a mean
decrease of 11%. By Laplace's law, wall stress is inversely proportional to the product
K · h. Therefore, a 55%
decrease in K results in a 122% increase in circumferential
stress; a 11% decrease in h results in a 12% increase in
circumferential stress. These findings indicate that after MI,
geometric changes cause increased dynamic wall stress, which likely
contributes to border zone expansion and remodeling.
congestive heart failure; remodeled myocardium; coronary artery disease; perfusion echocardiography
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