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Methods of measurement of mechanical events of the left ventricle
Voltme Nwnzber
81 5
Diaginosis
Letters to the Editor
of posterior
infarction
To the Editor: I read with interest the clinical pathologic conference (AMER. HEART J. 80:562, 1970) in which Prof. Shillingford anaIyzes the unusual case in a splendid way. Nevertheless, I was confused by the diagnosis of posterior infarction in the presence of a manifest Q wave with a negative T wave in Leads II, III, and aVF which, in electrocardiography, means classical inferior wall infarction (pars diaphragmatica cordis). Posterior infarction is characterized on the ECG by tall R waves and T waves in Vi and Vz and in the horizontal projection of the vectorcardiogram by the 45 msec. vector situated anteriorly and the maximal anterior Z orthogonal greater than the maxima1 posterior Z comp0nent.i Vectorcardiographically inferior infarction is determined by a clockwise superior loop of at least 25 msec. in the frontal projection. Some authors have called posterior infarction, to differentiate it “true” posterior infarction. from inferior infarction, I believe this is superfluous because it may suggest that other infarctions are not true. Anatomically, posterior wall infarction is the opposite of anterior wall infarction of the left ventricle; the opposite of inferior wall infarction, if such there be, shoud be left atria1 infarction. Of course, this correction of nomenclature does not change the logic of Prof. Shillingford’s analysis. Although Shakespeare2 wrote, “What’s in a name?“, we must clarify this nomenclature now for us, for our colleagues, and for our students. Koen J. J. Bruyneel, M.D. Cardiac Clinic University of Ghent Ghent, Be&&z*
Methods of measurement mechanical events of the left ventricle
725
of
To the Editor: I have some remarks to make concerning the paper by Drs. S. Kumar and D. Spodick, entitled “Study of the mechanical events of the left ventricle by atraumatic techniques: Comparison of methods of measurement and their significance” (AMER.
HEARTJ. 80:401,1970). In a previous paper (AMER.HEART
J. 76:498, 1968) the same authors discussed six methods for indirect measurement of isovolumetric contraction time (IVCT) and came to the conclusion that Calculation 2, suggested by me (“Indirect measurement of isovolumic contraction time on the basis of polygraphic tracing,” Cardiologia 47:315, 1965), appeared to be the optimum method for measuring IVCT by atraumatic techniques. In the present paper by Drs. Kumar and Spodick (AMER. HEART J. 80:401, 1970, p. 404, second column) the same six methods for indirect measurement of IVCT are discussed in the same order as in the previous paper but the authors of the methods are not mentioned. The reader would therefore be under the false impression that Drs. Kumar and Spodick originally suggested these methods. Five out of the six papers in question, including mine (Cardiologia 47:315, 1965), were quoted by Drs. Kumar and Spodick, but concerning other problems or matters of secondary importance. I wonder whether you would care to rectify this situation by publishing a word in the AMERICAN HEART JOURNAL. I presume this has been a very involuntary lapse on the part of my colleagues, Drs. Kumar and Spodick.
REFERENCES
Vesselin Higher
1. Bruschke, A. V. G.: The diagnostic significance of the coronary arteriogram, Thesis, 1969, Groningen, The Neth.erlands. 2. Shakespeare, W.: Romeo and Juliette, 2:2.
I. Oreshkov, M.D. Medical Institute Sofia 31, Bulgaria
R@PlY *Present address: Groote Schuur Observatory, Cape Town, South
Hospital, Africa.
Cardiac
clinic,
Rerhf To the Editor: Thank you for your letter and the copy of the one from Dr. Bruyneel. He is, of course, right and “posterior” should read “inferior.” I must ayolo&e for any confusion so caused. At the same time I-should like to thank Dr. Bruyneel for pointing out the mistake in the text. J. P. Shillingjord Royal Postgraduate Medical School Hammersmith Hospital London WIZ, England
To the Editor: In our review of atraumatic techniques Dr. Kumar and I considered a number of methods of determining not only IVCT, but LVET, IRP, RFP, and other intervals, including comparative evaluations of them made by us and by others.’ For IVCT we cited our own comparison of six methods,2 with no implication of origination by us of any of them. Indeed, applications of noninvasive measurements represent a synthesis of work by many investigators, notably Blumberger and others of the German School and later Weissler and Benchimol in the United States and Van Bogaert in Belgium. With regard to Dr. Oreshkov’s claim, we became aware of his report only during our search of the literature after we began to write up our completed work (we rarely see copies of Curdiologia, a Swiss journal). In fact, our stimulus to include the calculation, IVCT = CAR, minus PTT came from the work of Tafur, Cohen, and Levine,2 published one
81 5
Diaginosis
Letters to the Editor
of posterior
infarction
To the Editor: I read with interest the clinical pathologic conference (AMER. HEART J. 80:562, 1970) in which Prof. Shillingford anaIyzes the unusual case in a splendid way. Nevertheless, I was confused by the diagnosis of posterior infarction in the presence of a manifest Q wave with a negative T wave in Leads II, III, and aVF which, in electrocardiography, means classical inferior wall infarction (pars diaphragmatica cordis). Posterior infarction is characterized on the ECG by tall R waves and T waves in Vi and Vz and in the horizontal projection of the vectorcardiogram by the 45 msec. vector situated anteriorly and the maximal anterior Z orthogonal greater than the maxima1 posterior Z comp0nent.i Vectorcardiographically inferior infarction is determined by a clockwise superior loop of at least 25 msec. in the frontal projection. Some authors have called posterior infarction, to differentiate it “true” posterior infarction. from inferior infarction, I believe this is superfluous because it may suggest that other infarctions are not true. Anatomically, posterior wall infarction is the opposite of anterior wall infarction of the left ventricle; the opposite of inferior wall infarction, if such there be, shoud be left atria1 infarction. Of course, this correction of nomenclature does not change the logic of Prof. Shillingford’s analysis. Although Shakespeare2 wrote, “What’s in a name?“, we must clarify this nomenclature now for us, for our colleagues, and for our students. Koen J. J. Bruyneel, M.D. Cardiac Clinic University of Ghent Ghent, Be&&z*
Methods of measurement mechanical events of the left ventricle
725
of
To the Editor: I have some remarks to make concerning the paper by Drs. S. Kumar and D. Spodick, entitled “Study of the mechanical events of the left ventricle by atraumatic techniques: Comparison of methods of measurement and their significance” (AMER.
HEARTJ. 80:401,1970). In a previous paper (AMER.HEART
J. 76:498, 1968) the same authors discussed six methods for indirect measurement of isovolumetric contraction time (IVCT) and came to the conclusion that Calculation 2, suggested by me (“Indirect measurement of isovolumic contraction time on the basis of polygraphic tracing,” Cardiologia 47:315, 1965), appeared to be the optimum method for measuring IVCT by atraumatic techniques. In the present paper by Drs. Kumar and Spodick (AMER. HEART J. 80:401, 1970, p. 404, second column) the same six methods for indirect measurement of IVCT are discussed in the same order as in the previous paper but the authors of the methods are not mentioned. The reader would therefore be under the false impression that Drs. Kumar and Spodick originally suggested these methods. Five out of the six papers in question, including mine (Cardiologia 47:315, 1965), were quoted by Drs. Kumar and Spodick, but concerning other problems or matters of secondary importance. I wonder whether you would care to rectify this situation by publishing a word in the AMERICAN HEART JOURNAL. I presume this has been a very involuntary lapse on the part of my colleagues, Drs. Kumar and Spodick.
REFERENCES
Vesselin Higher
1. Bruschke, A. V. G.: The diagnostic significance of the coronary arteriogram, Thesis, 1969, Groningen, The Neth.erlands. 2. Shakespeare, W.: Romeo and Juliette, 2:2.
I. Oreshkov, M.D. Medical Institute Sofia 31, Bulgaria
R@PlY *Present address: Groote Schuur Observatory, Cape Town, South
Hospital, Africa.
Cardiac
clinic,
Rerhf To the Editor: Thank you for your letter and the copy of the one from Dr. Bruyneel. He is, of course, right and “posterior” should read “inferior.” I must ayolo&e for any confusion so caused. At the same time I-should like to thank Dr. Bruyneel for pointing out the mistake in the text. J. P. Shillingjord Royal Postgraduate Medical School Hammersmith Hospital London WIZ, England
To the Editor: In our review of atraumatic techniques Dr. Kumar and I considered a number of methods of determining not only IVCT, but LVET, IRP, RFP, and other intervals, including comparative evaluations of them made by us and by others.’ For IVCT we cited our own comparison of six methods,2 with no implication of origination by us of any of them. Indeed, applications of noninvasive measurements represent a synthesis of work by many investigators, notably Blumberger and others of the German School and later Weissler and Benchimol in the United States and Van Bogaert in Belgium. With regard to Dr. Oreshkov’s claim, we became aware of his report only during our search of the literature after we began to write up our completed work (we rarely see copies of Curdiologia, a Swiss journal). In fact, our stimulus to include the calculation, IVCT = CAR, minus PTT came from the work of Tafur, Cohen, and Levine,2 published one