Myocardial acceleration during isovolumic contraction: relationship to contractility.

BACKGROUND: Acceleration of the mitral ring during isovolumic contraction has been proposed as a load-independent index of global left ventricular (LV) contractility. This study investigates whether myocardial isovolumic acceleration (IVA) reflects regional contractility.

METHODS AND RESULTS: In acutely instrumented, anesthetized dogs, we measured LV pressure, myocardial long-axis velocities, and IVA by tissue Doppler imaging (TDI) and sonomicrometry at different levels of global LV contractility and preload and during regional myocardial ischemia (reduced flow in the left anterior descending coronary artery). Dobutamine caused dose-dependent increments in IVA from 3.6+/-0.6 (mean+/-SEM) to a maximum of 7.1+/-1.4 m/s2 (P<0.01) by TDI, and there were parallel increments in LV dP/dt(max) (P<0.01). However, volume loading decreased IVA from 3.6+/-0.6 to 2.5+/-0.4 m/s2 (P<0.05), whereas LV dP/dt(max) was unchanged, and LV pressure-segment length loop analysis confirmed unchanged regional contractility. During myocardial ischemia, sonomicrometry indicated severely depressed regional function, whereas IVA remained unchanged. These findings were confirmed when IVA was measured by sonomicrometry. In contrast to peak ejection velocity that increased from apex toward the LV base, peak IVC velocity was maximum midway between apex and base. The onset of IVA coincided with onset of the first heart sound by phonocardiography. Peak IVA occurred at a LV pressure of 14+/-1 mm Hg, ie, close to end-diastole.

CONCLUSIONS: There was no consistent relationship between peak IVA and regional myocardial contractility. Peak IVA was markedly load dependent and did not reflect impaired myocardial function during ischemia. Peak IVA may reflect late-diastolic events and possibly wall oscillations that are related to global LV function. Peak IVA seems to have limited potential in the assessment of regional myocardial function.