Left ventricular remodelling and torsional dynamics in dilated cardiomyopathy: reversed apical rotation as a marker of disease severity

Abstract

AimsDecreased left ventricular (LV) rotation and torsion and even reversed systolic apical rotation have been described in patients with dilated cardiomyopathy (DCM). We sought to test in patients with DCM whether reversed apical rotation with loss of LV torsion is related to the extent of LV remodelling and to the severity of LV dysfunction. Methods and resultsFifty consecutive patients with DCM (aged 49 + 13 years) were enrolled prospectively. Forty-seven healthy volunteers served as controls. All subjects underwent clinical examination, 12-lead electrocardiography, and a comprehensive echocardiogram. Basal and apical LV rotation and LV torsion were quantified by speckle tracking echocardiography. Left ventricular systolic rotation and torsion were reduced in patients, compared with controls (P , 0.001). Normally directed (counterclockwise) apical rotation was found in 24 patients (group 1), whereas 26 had reversed (clockwise) apical rotation (group 2). Patients in group 2 had larger LV volume, increased LV sphericity (P 0.02), more severe systolic dysfunction (ejection fraction 26 + 7 vs. 33 + 12%), and higher filling pressures (E/E 0 ratio 19 + 10 vs. 14 + 6; P , 0.05). The main correlates of LV apical rotation were LV volume, sphericity index, and QRS duration. ConclusionReversed apical rotation and loss of LV torsion in patients with DCM is associated with significant LV remodelling, increased electrical dyssynchrony, reduced systolic function, and increased filling pressures, indicating a more advanced disease stage.--

The effect of myocardial fibrosis on left ventricular torsion and twist in patients with non-ischemic dilated cardiomyopathy

“…1). LV [19]. On the other hand, particular attention was paid to the direction of systolic apical rotation: normal (counterclockwise) or reversed (clockwise), which was documented for each patient.…”

New insights in LV torsion for the selection of cardiac resynchronisation therapy candidates

“…Popescu et al [20] also found a relation between disease severity and rigid body rotation. In their study, in 50 patients with non-ischaemic dilated cardiomyopathy, rotation and torsion were analysed by ultrasound speckle tracking.…”

“…Following their results, the authors suggested rigid body rotation as a marker for non-compaction cardiomyopathy, and speculate that in other studies describing rigid body rotation this diagnosis might have been overlooked. However, in the study by Popescu et al [20], non-compaction cardiomyopathy was an exclusion criterion. Likely, no rigid body rotation was found in the dilated cardiomyopathy groups because the number of patients was limited.…”

Роль Спекл-Трекінг Ехокардіографії В Діагностиці Та Лікуванні Серцево-Судинних Захворювань

“…У боль-ных с хронической сердечной недостаточностью (ХСН) отмечается снижение стрейна миокарда в продольном, радиальном и циркулярном направ-лениях, что может быть обусловлено изменением ориентации волокон на фоне ремоделирования миокарда [39]. Обнаружено, что более выражен-ное нарушение стрейна миокарда наблюдается у пациентов с ХСН III-IV функциональных клас-сов NYHA [40].…”