1. Severe aortic insufficiency and normal systolic function: determining regional left ventricular wall stress by finite-element analysis 
Brian P Cupps, PhD, Pavlos Moustakidis, MD, Benjamin J Pomerantz, MD, Giridhar Vedala, MD, Randall P Scheri, MD, Nicholas T Kouchoukos, MD, Victor G Davila-Roman, MD, Michael K Pasque, MD 
The Annals of Thoracic Surgery 
Volume 76, Issue 3, Pages (September 2003)
DOI: /S (03)

2. Fig 1
(A, C) End-diastolic image as determined by the largest ventricular diameter. (B, D) End-systolic image as determined by choosing the smallest ventricular size in the imaging sequence.
The Annals of Thoracic Surgery  , DOI: ( /S (03) )

3. Fig 2
(A) Carotid pulse tracings, recorded simultaneously with the magnetic resonance imaging triggering signals. (B) Calculation of left ventricular end-systolic pressure. End-systolic pressure (ESP) was estimated by linear interpolation to the level of the incisura according to the formula shown. (DBP = diastolic blood pressure; SBP = systolic blood pressure.)
The Annals of Thoracic Surgery  , DOI: ( /S (03) )

4. Fig 3
Midventricular representation of the division of the ventricle into elements incorporating the influence of variation of left ventricular wall curvature and thickness, providing an accurate stress estimation on a regional basis by means of finite-element analysis. Left: normal volunteer; right: AI patient. (A = anterior; AL = anterolateral; AS = anteroseptal; P = posterior; PL = posterolateral; PS = posteroseptal.)
The Annals of Thoracic Surgery  , DOI: ( /S (03) )

5. Fig 4
(A) The overall maximal principal end-systolic stress was significantly increased in patients with aortic insufficiency (AI) compared with normal control subjects (154,700 ± 31,711 versus 96,781 ± 23,185 dyne/cm2, *p < versus normal). (B) Gender differences between patients with aortic insufficiency and normal control subjects. In this subset analysis, women in both groups tended to have increased wall stress although the difference within each group was not significant (p > 0.05). Results expressed as mean ± standard deviation. (LV = left ventricular.)
The Annals of Thoracic Surgery  , DOI: ( /S (03) )

6. Fig 5
Regional wall stress distribution. Average regional maximal principal stress in each of the ventricular elements. Patients with aortic insufficiency (striped bars) differed significantly from normal subjects (open bars) in all regions (p < 0.001).
The Annals of Thoracic Surgery  , DOI: ( /S (03) )

7. Fig 6
Comparison of regional stress distribution among the different left ventricular wall areas. Examination of wall stress distribution among the various left ventricular wall segments did not demonstrate any statistically significant differences among any of the segments within each group (p > 0.05). Results expressed as mean ± standard deviation. (AI = aortic insufficiency; anterior = black squares; anterolateral = open triangles; anteroseptal = open diamonds; posterior = open circles; posterolateral = black triangles; posteroseptal = black circles.)
The Annals of Thoracic Surgery  , DOI: ( /S (03) )

8. Fig 7
Color-coded midventricular regional and transmural end-systolic stress maps of the myocardium in a normal volunteer (A) and a patient with aortic insufficiency (B). Stress was significantly increased in the patient with aortic insufficiency in all six left ventricular wall segments. End-systolic stress was also increased in the endocardium compared with the epicardium in both subjects. (A = anterior; AL = anterolateral; AS = anteroseptal; P = posterior; PL = posterolateral; PS = posteroseptal.)
The Annals of Thoracic Surgery  , DOI: ( /S (03) )