Cardiac rotation and relaxation in patients with aortic valve stenosis

E. Nagel, M. Stuber, B. Burkhard, S. E. Fischer, M. B. Scheidegger, P. Boesiger, O. M. Hess

Research output: Contribution to journalArticle

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 counter-clockwise 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 ± 1.1 s-1) when compared to controls (-10.7 ± 2.2 s-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. (C) 2000 The European Society of Cardiology.

Original languageEnglish (US)
Pages (from-to)582-589
Number of pages8
JournalEuropean heart journal
Volume21
Issue number7
DOIs
StatePublished - Apr 1 2000

Keywords

  • Aortic valve stenosis
  • Cardiac torsion
  • Diastolic dysfunction
  • Left ventricular hypertrophy
  • Magnetic resonance
  • Myocardial tagging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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