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LETTER TO THE EDITOR

The following is the abstract of the article discussed in the subsequent letter:

Wall stress, although commonly used as an index of afterload, fails to take into account forces generated within the wall of the left ventricle (LV) that oppose systolic fiber shortening. Wall stress may, therefore, misrepresent fiber stress, the force resisting fiber shortening, particularly in the presence of an abnormal LV thickness-to-dimension ratio (h/D). M-mode LV echocardiograms were obtained from 207 patients with a wide range of values for LV mass and/or h/D. Diagnoses were valvar aortic stenosis, coarctation repair, anthracycline treated, and severe aortic and/or mitral regurgitation. End-systolic wall stress (WS_es) and fiber stress (FS_es) were expressed as age-corrected Z scores relative to a normal population. The difference between WS_es and FS_es was extreme when h/D was elevated or reduced [WS_es Z score – FS_es Z score = 0.14 x (h/D)^–1.47 – 2.13; r = 0.78, P < 0.001], with WS_es underestimating FS_es when h/D was increased and overestimating FS_es when h/D was decreased. Analyses of myocardial mechanics based on wall stress have limited validity in patients with abnormal ventricular geometry.

REPLY

Department of Pediatrics
University of Auckland and Pediatric and Congenital Cardiac Service
Starship Children’s Hospital
1001 Auckland, New Zealand
E-mail: TomG{at}adhb.govt.nz

Steven D. Colan

Department of Cardiology, Children’s Hospital and Department of Pediatrics
Harvard Medical School
Boston, Massachusetts 02115

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