Using speckle tracking echocardiography we investigated left ventricular (LV) twist and rotation (ROT) at the papillary muscle (PM) level and their correlation with standard echocardiographic and demographic parameters.
To assess whether the fulcrum of LV short axis ROT is shifted in myocardial disease.
The study group consisted of 33 patients (54+/-13 years old, 18 women). Left ventricular systolic function was normal in 6, and various degrees of wall motion abnormalities were present in the others [LV ejection fraction (LVEF) 49+/-15, wall motion score index (WMSI) 1.43+/-0.38]. Short axis images at basal, PM and apical level were analysed offline. The direction of ROT was determined from the apical aspect and expressed in degrees: clockwise (CW) in negative values, counter CW in positive. Twist is the arithmetic difference between apical and basal ROT.
Left ventricular twist was in the range of 0.4-27.5 (14+/-7) degrees and correlated with LV systolic diameter (LVS), r=-0.46, 95% CI from -0.69 to -0.13, p <0.01; LV diastolic diameter (LVD), r=-0.40, 95% CI from -0.65 to -0.06, p=0.02; and systolic motion score index of 6 mid segments (6S-MSI), calculated as WMSI at PM level, r=-0.37, 95% CI from -0.63 to -0.03, p <0.04. Linear regression resulted in a model including interventricular septum systolic thickness (IVSS) and 6S-MSI, which predicted twist correctly in 21% of cases. Twist was independent of LVEF and overall WMSI. The PM ROT value correlated with: apical ROT, r=0.36, 95% CI 0.02-0.63, p <0,04; posterior wall systolic thickness (PWS), r=0.39, 95% CI 0.05-0.64, p <0.03. We distinguished Group A, n=14, with CW direction of PM ROT - negative values, range from -5.2 to -0.9; Group B, n=19, with counter CW, range 0.4-4.9. Apical ROT was 5 vs. 10 degrees, p <0.03; PWS 14 vs. 15 mm, p <0.03; diastolic posterior wall thickness 10 vs. 12 mm, p <0.04, respectively. In univariate logistic regression, we identified independent factors related to counter CW PM ROT: apical ROT (OR=1.15, 95% CI 1.00-1.33, p <0.05) and PWS (OR=1.71, 95% CI 1.03-2.84, p <0.04). Multiple logistic regression resulted in a model predicting counterCW rotation at PM (p <0.01) including: apical ROT (OR=1.18, 95% CI 1.00-1.38, p <0.05) and PWS (OR=1.77, 95% CI 1.02-3.08, p <0.05). ROC curves identified cut-off values of apical ROT >11.3 deg and PWS >13 mm. We found counterCW PM ROT in all patients with both conditions, 59% of patients with one, 22% with none.
Left ventricular twist is related to mid segments function and IVSS, while PM ROT value and its direction (associated with 'zero ROT level') is related to PWS and apical ROT, rather than to LVEF or WMSI. Thus twist and rotation may reflect novel aspects of LV function.
[Show abstract][Hide abstract] ABSTRACT: To investigate the effect of intracoronary injection of autologous mononuclear bone marrow stem cells (BMSCs) in patients with ST-elevation myocardial infarction (STEMI) on left ventricular (LV) systolic and diastolic function using standard echocardiography and 2-dimensional systolic strain. A total of 60 patients with first anterior wall STEMI and LV ejection fraction of <40%, treated with successful primary percutaneous coronary intervention were randomly assigned to the treatment group (BMSC group) or the control group in a 2:1 ratio. Transcatheter intracoronary injection of BMSCs into the infarct-related artery was performed 7 days after STEMI. Standard echocardiography and speckle tracking analysis was performed at baseline and 6 months after STEMI. No differences were found in the baseline echocardiographic parameters of LV systolic and diastolic dysfunction--the LV ejection fraction was 35 +/- 6% in the BMSC group, similar to that in the control group (33 +/- 7%, p = 0.42). After 6 months, the absolute change in the LV ejection fraction was significantly greater in the BMSC group than in the control group (10 +/- 9% versus 5 +/- 8%, p = 0.04). Significant improvement was seen in 2-dimensional systolic strain in all segments (12 +/- 4 vs 14 +/- 4; p = 0.0009) and in the infarcted area (5 +/- 2 vs 6 +/- 2; p = 0.0038) only in the BMSC group. Of the diastolic function parameters, we observed improvement in the early filling propagation velocity (30 +/- 8 cm/s vs 37 +/- 13 cm/s; p = 0.0008), early diastolic velocity - E' (4.5 +/- 1.5 vs 5.0 +/- 1.3, p = 0.02), and the E/E' ratio (17 +/- 7 vs 14 +/- 5; p = 0.03) in the BMSC group. In conclusion, intracoronary injection of unselected BMSCs in patients with STEMI improved both LV systolic and diastolic function at 6 months of follow-up.
The American journal of cardiology 11/2009; 104(10):1336-42. DOI:10.1016/j.amjcard.2009.06.057 · 3.28 Impact Factor
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