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European Heart Journal 2000 21(7):582-589; doi:10.1053/euhj.1999.1736
Copyright © 2000 by the European Society of Cardiology.
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Cardiac rotation and relaxation in patients with aortic valve stenosis

E Nagela,f1, M Stuberb, B Burkhardb, S.E Fischerb, M.B Scheideggerb, P Boesigerb and O.M Hessa

a Cardiology, University Hospital Zurich, Zurich, Switzerland
b Institute of Biomedical Engineering and Medical Informatics, University and Federal Institute of Technology, Zurich, Switzerland

revised June 21, 1999; accepted June 23, 1999

Abstract

Background Diastolic dysfunction with delayed relaxation and abnormal passive elastic properties has been described in patients with severe pressure overload hypertrophy. The purpose of this study was to evaluate the time course of rotational motion of the left ventricle in patients with aortic valve stenosis using myocardial tagging.

Methods Myocardial tagging is a non-invasive method based on magnetic resonance which makes it possible to label (‘tag’) specific myocardial regions. From the motion of the tag’s cardiac rotation, radial displacement and translational motion can be determined. In 12 controls and 13 patients with severe aortic valve stenosis systolic and diastolic wall motion was assessed in an apical and basal short axis plane.

Results The normal left ventricle performs a systolic wringing motion around the ventricular long axis with clockwise rotation at the base (–4·4±1·6°) and counterclockwise rotation at the apex (+6·8±2·5°) when viewed from the apex. During early diastole an untwisting motion can be observed which precedes diastolic filling. In patients with aortic valve stenosis systolic rotation is reduced at the base (–2·4±2·0°;P<0·01) but increased at the apex (+12·0±6·0°;P<0·05). Diastolic untwisting is delayed and prolonged with a decrease in normalized rotation velocity (–6·9±1·1s–1) when compared to controls (–10·7±2·2s–1;P<0·001). Maximal systolic torsion is 8·0±2·1° in controls and 14·1±6·4° (P<0·01) in patients with aortic valve stenosis.

Conclusions Left ventricular pressure overload hypertrophy is associated with a reduction in basal and an increase in apical rotation resulting in increased torsion of the ventricle. Diastolic untwisting is delayed and prolonged. This may explain the occurrence of diastolic dysfunction in patients with severe pressure overload hypertrophy.

Key Words: Myocardial tagging, left ventricular hypertrophy, diastolic dysfunction, aortic valve stenosis, cardiac torsion, magnetic resonance

f1 Correspondence: Eike Nagel, MD, Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany.

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