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Left ventricular shape and mass impact torsional dynamics in asymptomatic patients with chronic aortic regurgitation and normal left ventricular ejection fraction

The International Journal of Cardiovascular Imaging volume 31, pages 1315–1326 (2015)Cite this article

Abstract

Chronic aortic regurgitation (AR) is associated with a unique pattern of left ventricular (LV) volume and pressure overload, leading to LV remodelling. LV torsional motion, a key component of LV performance, can be altered in this setting. We aimed to assess the impact of LV remodelling on LV torsional dynamics parameters using speckle-tracking echocardiography (STE) in asymptomatic AR patients. We prospectively enrolled 60 patients with chronic AR and LVEF > 50 % and 55 healthy controls. LV rotation, twisting and untwisting were assessed using STE. Patients with AR had higher LV diameters, volumes and mass, a more spherical LV shape than controls, but similar LVEF. In AR patients we found reduced peak LV apical rotation and decreased (2.1 ± 0.8 vs 2.9 ± 0.9°/cm, p < 0.001) and delayed (time to peak LV twist: 0.94 ± 0.12 vs 0.99 ± 0.09, p = 0.004) peak LV torsion. Also, peak LV untwisting velocity was decreased (−123.5 ± 41.5 vs −152.3 ± 55.0°/s, p = 0.002) due to lower peak LV apical diastolic rotation rate. LV shape influenced LV torsional dynamics, a more spherical LV displaying reduced peak LV apical rotation and diastolic rotation rate and decreased LV twist. A more hypertrophied LV had a lower peak LV torsion, peak LV apical diastolic rotation rate and peak LV untwisting velocity. LV apical rotation and torsion are decreased and LV twist is delayed in patients with chronic AR and normal LVEF, detecting early subclinical LV dysfunction before LVEF declines. Also, LV untwisting is reduced in these patients. LV remodelling impairs LV torsional dynamics parameters in this setting.

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Acknowledgments

This work was supported by a Grant of the University of Medicine and Pharmacy ‘Carol Davila’ (RE, contract 28484/2012) and by a Grant of the Romanian Ministry of National Education, CNCS—UEFISCDI, Project Numbers PN-II-ID-PCE-2012-4-0560 (contract 21/2013).

Conflict of interest

B.A.P and D.M received research support and lecture honoraria from GE Healthcare.

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Affiliations

  1. Cardiology Department, University of Medicine and Pharmacy “Carol Davila”, Euroecolab, Bucharest, Romania

    Roxana Enache, Bogdan A. Popescu, Andreea Călin, Carmen C. Beladan, Monica Roşca & Carmen Ginghină

  2. “Prof. Dr. C. C. Iliescu” Emergency Institute of Cardiovascular Diseases, Sos. Fundeni, No 258, Bucharest, 022328, Romania

    Roxana Enache, Bogdan A. Popescu, Andreea Călin, Carmen C. Beladan, Monica Roşca & Carmen Ginghină

  3. Cardiology Department, S. Maria degli Angeli Hospital, Pordenone, Italy

    Rita Piazza & Gian Luigi Nicolosi

  4. Department of Cardiac, Thoracic and Vascular Science, School of Medicine, University of Padua, Padua, Italy

    Denisa Muraru

Authors
  1. Roxana Enache
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  2. Bogdan A. Popescu
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  3. Rita Piazza
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  4. Denisa Muraru
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  5. Andreea Călin
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  6. Carmen C. Beladan
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  7. Monica Roşca
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  8. Gian Luigi Nicolosi
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  9. Carmen Ginghină
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Correspondence to Roxana Enache.

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Enache, R., Popescu, B.A., Piazza, R. et al. Left ventricular shape and mass impact torsional dynamics in asymptomatic patients with chronic aortic regurgitation and normal left ventricular ejection fraction. Int J Cardiovasc Imaging 31, 1315–1326 (2015). https://doi.org/10.1007/s10554-015-0684-0

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  • DOI: https://doi.org/10.1007/s10554-015-0684-0

Keywords

  • Aortic regurgitation
  • Left ventricular function
  • Left ventricular shape
  • Left ventricular mass
  • Left ventricular mechanics
  • 2D strain echocardiography