Journal of Cardiovascular Magnetic Resonance (Dec 2017)

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

  • Michael Steinmetz,
  • Simon Usenbenz,
  • Johannes Tammo Kowallick,
  • Olga Hösch,
  • Wieland Staab,
  • Torben Lange,
  • Shelby Kutty,
  • Joachim Lotz,
  • Gerd Hasenfuß,
  • Thomas Paul,
  • Andreas Schuster

DOI
https://doi.org/10.1186/s12968-017-0414-y
Journal volume & issue
Vol. 19, no. 1
pp. 1 – 9

Abstract

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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 0.05) 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.

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