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

• Published in: The International Journal of Cardiovascular Imaging Vol. 31; no. 7; pp. 1315 - 1326
• Main Authors: Enache, Roxana, Popescu, Bogdan A., Piazza, Rita, Muraru, Denisa, Călin, Andreea, Beladan, Carmen C., Roşca, Monica, Nicolosi, Gian Luigi, Ginghină, Carmen
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01-10-2015; Springer Nature B.V
• Subjects: Adult; Aortic Valve Insufficiency - complications; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - physiopathology; Asymptomatic Diseases; Biomechanical Phenomena; Cardiac Imaging; Cardiology; Case-Control Studies; Chronic Disease; Echocardiography, Doppler; Female; Humans; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - etiology; Hypertrophy, Left Ventricular - physiopathology; Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Predictive Value of Tests; Prospective Studies; Radiology; Torsion Abnormality - diagnostic imaging; Torsion Abnormality - etiology; Torsion Abnormality - physiopathology; Torsion, Mechanical; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left; Ventricular Pressure; Ventricular Remodeling; Left ventricular shape; Left ventricular mass; Left ventricular mechanics; Aortic regurgitation; 2D strain echocardiography; Left ventricular function
• ISSN: 1569-5794; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-015-0684-0

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.