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Eur J Cardiothorac Surg 2006;29:S139-S144
© 2006 Elsevier Science NL

The sequence of regional ventricular motion

^a Department of Medicine, Faculty of Medicine, University of Lleida, Spain
^b Service of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
^c Consultant Cardiologist, Faculty of Medicine, University of Lleida, Spain
^d Hospital de Mataró, Barcelona, Spain
^e Cardiac Diagnostic Imaging Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
^f Hospital Royo Villanova, Zaragoza, Spain
^g Division of Cardiology, University of California, Irvine College of Medicine, CA, USA

Received 17 February 2006; accepted 27 February 2006.

^_* Corresponding author. Address: Catalunya 1, esc. A, 3-2, 08390 Montgat, Barcelona, Spain. Tel.: +34 639354201. (Email: mballesterr{at}comll.es).

Objective: The chronology of electrical events that mechanically activate the myocardium has been described as initiating at the level of the septum, spreading to the apex, then to the bodies of both ventricles and eventually to the base of the heart (apex-to base activation). It has recently been suggested that the myocardium is a single muscular band that conforms a double-loop helicoid. Contraction of the myocardium would follow the trajectory of the muscular fibers that originate at the pulmonary artery towards the body of the left ventricle and to the aorta (base-to apex contraction). This would explain the movements of the base of the heart and the twisting motion of the ventricles seen at magnetic resonance studies. Methods: Temporal Fourier analysis of equilibrium radionucleide angiocardiography, by studying the topography of the regional myocardial mechanical displacement corresponding to the wave front of electro-mechanical activation, provides information on the sequence of regional ventricular contraction was used in 29 normal individuals to observe the sequence of myocardial motion. Results: Analysis disclosed that the base of the heart first moves (right then left ventricle) and mechanical movement later descends to involve the apex and the septum. These findings are in concordance with the proposed activation of the helical myocardium and open the way to more complex studies. Conclusions: Although electrical activation of the myocardium (QRS complex) follows a septum–apex–body–base of the left ventricle sequence, mechanical activation follows a base-to-apex sequence. This is likely to be related to anisotropic propagation of the electromechanical stimulus throughout the myocardial band once the electrical stimulus has been delivered at the base of the heart.

Key Words: Radionucleide angiocardiography • Helical ventricular myocardial band • Excitation contraction coupling • Regional ventricular motion sequence

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