Left ventricular synchrony, torsion, and recoil mechanics in Ebstein’s anomaly: insights from cardiovascular magnetic resonance
Abstract Background Disease 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 underst...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2017-12-01
|
| Series: | Journal of Cardiovascular Magnetic Resonance |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12968-017-0414-y |
| _version_ | 1797204022358179840 |
|---|---|
| author | Michael Steinmetz Simon Usenbenz Johannes Tammo Kowallick Olga Hösch Wieland Staab Torben Lange Shelby Kutty Joachim Lotz Gerd Hasenfuß Thomas Paul Andreas Schuster |
| author_facet | Michael Steinmetz Simon Usenbenz Johannes Tammo Kowallick Olga Hösch Wieland Staab Torben Lange Shelby Kutty Joachim Lotz Gerd Hasenfuß Thomas Paul Andreas Schuster |
| author_sort | Michael Steinmetz |
| collection | DOAJ |
| description | Abstract Background Disease 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. Methods 31 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. Results EA 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). Conclusions EA 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. |
| first_indexed | 2024-04-24T08:28:37Z |
| format | Article |
| id | doaj.art-f3705815c6404e8d8109850a00cc66c9 |
| institution | Directory Open Access Journal |
| issn | 1532-429X |
| language | English |
| last_indexed | 2024-04-24T08:28:37Z |
| publishDate | 2017-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj.art-f3705815c6404e8d8109850a00cc66c92024-04-16T21:14:12ZengElsevierJournal of Cardiovascular Magnetic Resonance1532-429X2017-12-011911910.1186/s12968-017-0414-yLeft ventricular synchrony, torsion, and recoil mechanics in Ebstein’s anomaly: insights from cardiovascular magnetic resonanceMichael Steinmetz0Simon Usenbenz1Johannes Tammo Kowallick2Olga Hösch3Wieland Staab4Torben Lange5Shelby Kutty6Joachim Lotz7Gerd Hasenfuß8Thomas Paul9Andreas Schuster10Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, University Medical CenterDepartment of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, University Medical CenterInstitute for Diagostic and Interventional Radiology, Georg-August-University Göttingen, University Medical CenterDepartment of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, University Medical CenterInstitute for Diagostic and Interventional Radiology, Georg-August-University Göttingen, University Medical CenterDepartment of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical CenterUniversity of Nebraska Medical Center/ Children’s Hospital and Medical CenterInstitute for Diagostic and Interventional Radiology, Georg-August-University Göttingen, University Medical CenterDepartment of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical CenterDepartment of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, University Medical CenterDepartment of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical CenterAbstract Background Disease 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. Methods 31 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. Results EA 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). Conclusions EA 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.http://link.springer.com/article/10.1186/s12968-017-0414-yEbstein anomalyCMR feature trackingLeft ventricleDyssynchronyTorsion and recoilHeart failure |
| spellingShingle | Michael Steinmetz Simon Usenbenz Johannes Tammo Kowallick Olga Hösch Wieland Staab Torben Lange Shelby Kutty Joachim Lotz Gerd Hasenfuß Thomas Paul Andreas Schuster Left ventricular synchrony, torsion, and recoil mechanics in Ebstein’s anomaly: insights from cardiovascular magnetic resonance Journal of Cardiovascular Magnetic Resonance Ebstein anomaly CMR feature tracking Left ventricle Dyssynchrony Torsion and recoil Heart failure |
| title | Left ventricular synchrony, torsion, and recoil mechanics in Ebstein’s anomaly: insights from cardiovascular magnetic resonance |
| title_full | Left ventricular synchrony, torsion, and recoil mechanics in Ebstein’s anomaly: insights from cardiovascular magnetic resonance |
| title_fullStr | Left ventricular synchrony, torsion, and recoil mechanics in Ebstein’s anomaly: insights from cardiovascular magnetic resonance |
| title_full_unstemmed | Left ventricular synchrony, torsion, and recoil mechanics in Ebstein’s anomaly: insights from cardiovascular magnetic resonance |
| title_short | Left ventricular synchrony, torsion, and recoil mechanics in Ebstein’s anomaly: insights from cardiovascular magnetic resonance |
| title_sort | left ventricular synchrony torsion and recoil mechanics in ebstein s anomaly insights from cardiovascular magnetic resonance |
| topic | Ebstein anomaly CMR feature tracking Left ventricle Dyssynchrony Torsion and recoil Heart failure |
| url | http://link.springer.com/article/10.1186/s12968-017-0414-y |
| work_keys_str_mv | AT michaelsteinmetz leftventricularsynchronytorsionandrecoilmechanicsinebsteinsanomalyinsightsfromcardiovascularmagneticresonance AT simonusenbenz leftventricularsynchronytorsionandrecoilmechanicsinebsteinsanomalyinsightsfromcardiovascularmagneticresonance AT johannestammokowallick leftventricularsynchronytorsionandrecoilmechanicsinebsteinsanomalyinsightsfromcardiovascularmagneticresonance AT olgahosch leftventricularsynchronytorsionandrecoilmechanicsinebsteinsanomalyinsightsfromcardiovascularmagneticresonance AT wielandstaab leftventricularsynchronytorsionandrecoilmechanicsinebsteinsanomalyinsightsfromcardiovascularmagneticresonance AT torbenlange leftventricularsynchronytorsionandrecoilmechanicsinebsteinsanomalyinsightsfromcardiovascularmagneticresonance AT shelbykutty leftventricularsynchronytorsionandrecoilmechanicsinebsteinsanomalyinsightsfromcardiovascularmagneticresonance AT joachimlotz leftventricularsynchronytorsionandrecoilmechanicsinebsteinsanomalyinsightsfromcardiovascularmagneticresonance AT gerdhasenfuß leftventricularsynchronytorsionandrecoilmechanicsinebsteinsanomalyinsightsfromcardiovascularmagneticresonance AT thomaspaul leftventricularsynchronytorsionandrecoilmechanicsinebsteinsanomalyinsightsfromcardiovascularmagneticresonance AT andreasschuster leftventricularsynchronytorsionandrecoilmechanicsinebsteinsanomalyinsightsfromcardiovascularmagneticresonance |