Uznańska Barbara, Chrzanowski Lukasz, Plewka Michał, Lipiec Piotr, Krzemińska-Pakuła Maria, Kasprzak Jarosław D
Medical University, Łódź, Poland.
Kardiol Pol. 2008 Jul;66(7):740-7; discussion 748-9.
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.
我们使用斑点追踪超声心动图研究了乳头肌（PM）水平的左心室（LV）扭转和旋转（ROT）及其与标准超声心动图和人口统计学参数的相关性。
评估左心室短轴ROT的支点在心肌疾病中是否发生移位。
研究组由33例患者组成（年龄54±13岁，女性18例）。6例患者左心室收缩功能正常，其余患者存在不同程度的室壁运动异常[左心室射血分数（LVEF）49±15，室壁运动评分指数（WMSI）1.43±0.38]。离线分析基底、PM和心尖水平的短轴图像。ROT方向从心尖切面确定，以度表示：顺时针（CW）为负值，逆时针为正值。扭转是心尖和基底ROT之间的算术差。
左心室扭转范围为0.4 - 27.5（14±7）度，与左心室收缩末期直径（LVS）相关，r = -0.46，95%置信区间为-0.69至-0.13，p <0.
