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European Heart Journal Advance Access published online on March 18, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp062
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Apical transverse motion as surrogate parameter to determine regional left ventricular function inhomogeneities: a new, integrative approach to left ventricular asynchrony assessment

Jens-Uwe Voigt1,*,{dagger}, Thomas-Michael Schneider2,{dagger}, Stephan Korder2, Mariola Szulik1, Emre Gürel1, Werner G. Daniel2, Frank Rademakers1 and Frank A. Flachskampf2

1 Department of Cardiology, University Hospital Gasthuisberg, Cath. University Leuven, Herestraat 49, 3000 Leuven, Belgium
2 Medical Clinic II, University Hopital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany

Received 26 June 2008; revised 22 January 2009; accepted 30 January 2009 * Corresponding author. Tel: +32 16 349 016, Fax: +32 16 344 240, Email: jens.uwe.voigt{at}gmx.net

Aims: Left ventricular (LV) asynchrony assessment is mostly based on delays between regional myocardial velocity peaks. Regional function is barely considered. We propose apical transverse motion (ATM) as a new parameter integrating both temporal and functional information, which was tested in different conduction delays.

Methods and results: We examined 67 patients, 11 patients with post-infarct ischaemic left bundle branch blocks (iLBBB) and 25 patients with non-ischaemic left bundle branch block (nLBBB), 12 patients with right bundle branch block (RBBB), and 19 normal healthy volunteers (NORM). Longitudinal colour tissue Doppler data were used to calculate the total transverse apex motion (ATM), the transverse motion in the four-chamber view plane alone (ATM4CV) as well as regional myocardial deformation and conventional LV asynchrony parameters. Median ATM was 1.8 mm in NORM, 1.5 mm in RBBB (P = 0.999), 2.4 mm in iLBBB (P = 0.183), and 4.3 mm in nLBBB (P < 0.001 vs. NORM and RSB). ATM4CV behaved similarly, showed a good correlation with regional deformation data, and distinguished well between NORM and LBBB (AUC = 0.87).

Conclusion: Apical transverse motion is a new and simple parameter integrating information on both regional and temporal function inhomogeneities of the LV. It has a potential role in assessing LV asynchrony in the clinical context.

Key Words: Myocardial function • Dyssynchrony • Conduction delay

This paper was guest edited by Dr Michael H. Picard, Department of Cardiology, Massachusetts General Hospital, Boston, USA

{dagger} The first two authors contributed equally to the study.


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