© 2004 European Society of Cardiology
Cardiac rotation and relaxation in patients with chronic heart failure
Swiss Cardiovascular Center and Institute of Diagnostic Radiology, Debis Systemhaus Health Care Services, University Hospital Freiburgstrasse, Bern CH-3010, Switzerland
* Corresponding author. Tel.: +41-31-632-96-53; fax: +41-31-632-47-71. E-mail address: otto.martin.hess{at}insel.ch
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Abstract |
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Background: The normal left ventricle shows a systolic wringing motion with clockwise rotation at the base and counterclockwise rotation at the apex.
Purpose: The aim of the present study was (1) to assess left ventricular (LV) contraction and relaxation in patients with chronic heart failure (CHF), and (2) to evaluate the effect of medical therapy on LV contraction–relaxation behavior.
Methods: Magnetic resonance was used to examine LV motion by labeling specific LV regions in three planes (myocardial tagging). Twenty-three subjects were included, nine healthy controls and 14 CHF patients. Cardiac motion was determined from the deformation of a rectangular grid in a basal and apical plane. CHF patients were put on triple therapy with ACE-inhibitors, β-blockers and spironolactone. Follow-up examination (n=9) was performed after 6 months.
Results: In controls, systolic rotation was –9.5±2° at the base and +3.3±1° at the apex. In CHF patients, rotation was reduced both at the base (–3.4±2°, P<0.01) and the apex (+0.9±3°, P<0.05). Similarly, regional ejection fraction (REF) was reduced in CHF patients both at the base and the apex. Medical therapy was associated with an improvement in REF, but systolic rotation improved only at the base (–4.6±2°, P<0.05).
Conclusions: Systolic wringing motion with clockwise rotation at the base and counterclockwise rotation at the apex is maintained in CHF although reduced. Heart failure treatment is associated with an improvement in REF, whereas rotation improved only at the base, but not at the apex. Thus, there is an uncoupling between regional shortening and rotation in CHF patients.
Key Words: Abbreviations • CHF, chronic heart failure • LV, left ventricular • MR, magnetic resonance • C, controls • NS, not significant • ACE, angiotensin-converting enzyme
Received June 5, 2003; Revised September 13, 2003; Accepted December 23, 2003
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