Left ventricular synchrony, torsion, and recoil mechanics in Ebstein’s anomaly: insights from cardiovascular magnetic resonance

Journal of Cardiovascular Magnetic Resonance

Research

Gerd Hasenfuß¹  Torben Lange¹  Andreas Schuster²  Olga Hösch³  Simon Usenbenz⁴  Thomas Paul⁴  Michael Steinmetz⁴  Wieland Staab⁵  Johannes Tammo Kowallick⁵  Joachim Lotz⁵  Shelby Kutty⁶ 

[1] Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099, Götttingen, Germany;DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany;Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099, Götttingen, Germany;DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany;Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Nothern Clinical School, University of Sydney, Sydney, Australia;Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099, Göttingen, Germany;Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099, Göttingen, Germany;DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany;Institute for Diagostic and Interventional Radiology, Georg-August-University Göttingen, University Medical Center, Göttingen, Germany;DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany;University of Nebraska Medical Center/ Children’s Hospital and Medical Center, Omaha, NE, USA;

关键词: Ebstein anomaly;    CMR feature tracking;    Left ventricle;    Dyssynchrony;    Torsion and recoil;    Heart failure;    Congenital heart disease;   

DOI  :  10.1186/s12968-017-0414-y

 received in 2017-03-16, accepted in 2017-11-23,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundDisease progression and heart failure development in Ebstein’s Anomaly (EA) of the tricuspid valve is characterized by both right and left ventricular (LV) deterioration. The mechanisms underlying LV dysfunction and their role in heart failure development are incompletely understood. We hypothesized that LV dyssynchrony and impaired torsion and recoil mechanics induced by paradoxical movement of the basal septum may play a role in heart failure development.Methods31 EA patients and 31 matched controls underwent prospective cardiovascular magnetic resonance (CMR). CMR feature tracking (CMR-FT) was performed on apical, midventricular and basal short-axis and 4D–volume analysis was performed using three long-axis views and a short axis cine stack employing dedicated software. Circumferential uniformity ratio estimates (CURE) time-to-peak-based circumferential systolic dyssynchrony index (C-SDI), 4D volume analysis derived SDI (4D–SDI), torsion (Tor) and systolic (sysTR) and diastolic torsion rate (diasTR) were calculated for the LV. QRS duration, brain natriuretic peptide, NYHA and Total R/L-Volume Index (R/L Index) were obtained.ResultsEA patients (31.5 years; controls 31.4 years) had significantly longer QRS duration (123.35 ms ± 26.36 vs. 97.33 ms ± 11.89 p < 0.01) and showed more LV dyssynchrony (4D–SDI 7.60% ± 4.58 vs. 2.54% ± 0.62, p < 0.001; CURE 0.77 ± 0.05 vs. 0.86 ± 0.03, p < 0.001; C-SDI 7.70 ± 3.38 vs. 3.80 ± 0.91, p = 0.001). There were significant associations of LV dyssynchrony with heart failure parameters and QRS duration. Although torsion and recoil mechanics did not differ significantly (p > 0.05) there was an association of torsion and recoil mechanics with dyssynchrony parameters CURE (sysTR r = −0.426; p = 0.017, diasTR r = 0.419; p = 0.019), 4D–SDI (sysTR r = 0.383; p = 0.044) and C-SDI (diasTR r = −0.364; p = 0.044).ConclusionsEA is characterized by LV intra-ventricular dyssynchrony, which is associated with heart failure and disease severity parameters. Markers of dyssynchrony can easily be quantified from CMR-FT, and may have a role in the assessment of altered cardiac function, carrying potential management implications for EA patients.

【 授权许可】

CC BY   
© The Author(s). 2017

【 图 表 】

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