Reversal of left ventricular “rigid body rotation” during dipyridamole-induced stress in a patient with stable angina: a case from the three-dimensional speckle tracking echocardiographic MAGYAR-Stress Study

Abstract

Abstract:The left ventricular (LV) twist is defined as the wringing motion of the heart around its longaxis in systole caused by oppositely directed counterclockwise apical and clockwise basal rotations resulted from the movement of two orthogonally oriented muscular bands. In some clinical circumstances, rotation at both basal and apical levels of the LV occurred in the same clockwise or counterclockwise direction during systole resulting the near absence of LV twist as called left ventricular "rigid body rotation" (LV-RBR). Hereby we present that LV-RBR normalization of LV rotational mechanics could be demonstrated at maximum hyperaemia during dipyridamole-induced stress by three-dimensional (3D) speckle tracking echocardiography in a patient with stable angina.Keywords: Three-dimensional (3D); stress; speckle tracking; echocardiography; myocardial; mechanics; rigid body rotation Submitted Feb 25, 2016. Accepted for publication Mar 13, 2016Mar 13, . doi: 10.21037/qims.2016 (Motion Analysis of the heart and Great vessels bY threedimensionAl speckle-tRacking echocardiography during Stress protocols), in which among others drug-induced stress-related pathophysiologic consequences were aimed to be examined ('magyar' means 'Hungarian' in Hungarian language). Informed consent was obtained from the patient and the study protocol was approved by the institution's human research committee.Following complete two-dimensional (2D) Doppler echocardiography 3DSTE was performed with the same Toshiba Artida TM echocardiography equipment (Toshiba, Tokyo, Japan) using a 1-4 MHz matrix phased-array PST-25SX transducer (15). Six wedge-shaped subvolumes were acquired within a single breath-hold from the apical window to create full-volume 3D datasets at rest and at peak hyperaemia. Dipyridamole was used as a vasodilator stress agent using standard international protocols. During chamber quantifications 3D Wall Motion Tracking software version 2.7 was used. The apical two-(AP2CH) and four-chamber (AP4CH) views and three short-axis views at different LV levels from the LV base to apex were automatically selected from the 3D echocardiographic pyramidal dataset at end-diastole by the software. Two points of the LV endocardium at the edges of the mitral valve and one at the LV apex were marked manually on the AP2CH and AP4CH views. Then, the 3D endocardial surface was automatically reconstructed and tracked in 3D space throughout the cardiac cycle. Manual adjustments were also performed, if needed. Curves were generated by the software for quantification of global peak apical, midventricular and basal LV rotations at rest and at peak hyperaemia ( Figure 1). No wall motion abnormalities could be detected both in resting conditions and at peak hyperaemia by visual assessment suggesting a negative stress test result. Interestingly, apical and basal LV rotations were in the same counterclockwise direction suggesting LV-RBR at rest. At peak hyperaemia basal LV rotation become clockwisedirected, while apical rotation remained counterclock...

Change of left ventricular “rigid body rotation” during dipyridamole‐induced vasodilation: A case from the three‐dimensional speckle tracking echocardiographic MAGYAR‐Stress Study

“…Peteiro et al found that LV torsion decreased with ischemia due to worsening of basal rotation in CAD patients, whereas LV apical rotation was not impaired, suggesting the existence of an apical compensatory mechanism . In a recent case report, reversal of LV‐RBR could be detected in a patient without significant CAD during dipyridamole‐induced stress in which basal LV rotation became normally clockwise oriented at peak hyperemia, but returned to LV‐RBR at the recovery phase …”

“…3 In a recent case report, reversal of LV-RBR could be detected in a patient without significant CAD during dipyridamole-induced stress in which basal LV rotation became normally clockwise oriented at peak hyperemia, but returned to LV-RBR at the recovery phase. 8 3DSTE is a new noninvasive clinical tool with the ability to create a three-dimensional model of the LV and atria along the cardiac cycle. Over accurate volumetric measurements, 9,10 uni-and multidirectional strains and parameters characterizing LV rotational mechanics can be calculated at the same time from the same digitally acquired three-dimensional datasets.…”

Dipyridamole-induced Left ventricular “Rigid Body Rotation” (A case from the three-dimensional speckle tracking echocardiographic MAGYAR-stress study)

“…Moreover, some reports found LV-RBR in congenital heart diseases and in infiltrative disorders such as cardiac amyloidosis. [78] In a case report, a pair of identical twins was presented to have LV-RBR (clockwise and counterclockwise), the twins had twin-to-twin transfusion syndrome in the past medical history. [9] In addition to these results, two reports have found reversal of LV-RBR.…”

“…Following the recovery phase of the stress protocol, all these changes in rotational mechanics returned back to LV-RBR. [8]…”

Real-time three-dimensional speckle tracking echocardiography: technical aspects and clinical applications

“…38 New initial experiences with 3D-derived STE highlight the potential usefulness of this technique during stress echo, in both animals and humans. 39,40 However, this kind of application is still far from being of current clinical practice.…”