Andrew K. Knutsen, PhD, Ningning Ma, BS, Ajay K. Taggar, MD, Beckah D

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Heterogeneous Distribution of Left Ventricular Contractile Injury in Chronic Aortic Insufficiency Andrew K. Knutsen, PhD, Ningning Ma, BS, Ajay K. Taggar, MD, Beckah D. Brady, BS, Brian P. Cupps, PhD, Michael K. Pasque, MD The Annals of Thoracic Surgery Volume 93, Issue 4, Pages 1121-1127 (April 2012) DOI: 10.1016/j.athoracsur.2011.12.067 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Image acquisition and postprocessing steps: Long-axis and short-axis anatomic and tagged magnetic resonance images of the left ventricle were acquired between (A) end-diastole and (B) end-systole. Myocardial boundaries and tag lines were identified in each image. (C) Displacement vectors were calculated in 3 dimensions. (D) A standard p-version finite-element mesh was registered to the individual's left ventricle geometry. The p-version finite-element analysis was used to fit the components of displacement over the entire left ventricle and calculate the strain. (E) The z scores relative to the normal strain database (N = 60) were calculated for three strain measures and combined into one multiparametric systolic strain z score. The Annals of Thoracic Surgery 2012 93, 1121-1127DOI: (10.1016/j.athoracsur.2011.12.067) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Mean and standard deviation of raw strain in normal controls of (A) circumferential strain (ECC), (B) longitudinal strain (ELL), and (C) minimum principal strain angle. More deviation is seen at the cap of the apex than the rest of the left ventricle. The model is divided into three levels, base, mid, and apex, and into six regions, comprising posterior (P), posterior lateral (PL), anterior lateral (AL), anterior (A), anterior septum (AS), and posterior septum (PS). The Annals of Thoracic Surgery 2012 93, 1121-1127DOI: (10.1016/j.athoracsur.2011.12.067) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Mean and standard deviation of multiparametric z scores are shown for the total (A) aortic insufficiency (AI) group, and the AI groups with (B) poor cardiac function and (C) normal cardiac function. Note the difference in the scale bars between the mean and standard deviation plots. The model is divided into three levels, base, mid, and apex, and into six regions, comprising posterior (P), posterior lateral (PL), anterior lateral (AL), anterior (A), anterior septum (AS), and posterior septum (PS). The Annals of Thoracic Surgery 2012 93, 1121-1127DOI: (10.1016/j.athoracsur.2011.12.067) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions