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

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish (US)
Article number101
JournalJournal of Cardiovascular Magnetic Resonance
Volume19
Issue number1
DOIs
StatePublished - Dec 14 2017

Fingerprint

Ebstein Anomaly
Mechanics
Magnetic Resonance Spectroscopy
Heart Failure
Tricuspid Valve
Brain Natriuretic Peptide
Left Ventricular Dysfunction
Disease Progression
Heart Diseases
Software

Keywords

  • CMR feature tracking
  • Congenital heart disease
  • Dyssynchrony
  • Ebstein anomaly
  • Heart failure
  • Left ventricle
  • Torsion and recoil

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Left ventricular synchrony, torsion, and recoil mechanics in Ebstein's anomaly : Insights from cardiovascular magnetic resonance. / Steinmetz, Michael; Usenbenz, Simon; Kowallick, Johannes Tammo; Hösch, Olga; Staab, Wieland; Lange, Torben; Kutty, Shelby; Lotz, Joachim; Hasenfuß, Gerd; Paul, Thomas; Schuster, Andreas.

In: Journal of Cardiovascular Magnetic Resonance, Vol. 19, No. 1, 101, 14.12.2017.

Research output: Contribution to journalArticle

Steinmetz, M, Usenbenz, S, Kowallick, JT, Hösch, O, Staab, W, Lange, T, Kutty, S, Lotz, J, Hasenfuß, G, Paul, T & Schuster, A 2017, 'Left ventricular synchrony, torsion, and recoil mechanics in Ebstein's anomaly: Insights from cardiovascular magnetic resonance', Journal of Cardiovascular Magnetic Resonance, vol. 19, no. 1, 101. https://doi.org/10.1186/s12968-017-0414-y
Steinmetz, Michael ; Usenbenz, Simon ; Kowallick, Johannes Tammo ; Hösch, Olga ; Staab, Wieland ; Lange, Torben ; Kutty, Shelby ; Lotz, Joachim ; Hasenfuß, Gerd ; Paul, Thomas ; Schuster, Andreas. / Left ventricular synchrony, torsion, and recoil mechanics in Ebstein's anomaly : Insights from cardiovascular magnetic resonance. In: Journal of Cardiovascular Magnetic Resonance. 2017 ; Vol. 19, No. 1.
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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 < 0.01) 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.",
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T1 - Left ventricular synchrony, torsion, and recoil mechanics in Ebstein's anomaly

T2 - Insights from cardiovascular magnetic resonance

AU - Steinmetz, Michael

AU - Usenbenz, Simon

AU - Kowallick, Johannes Tammo

AU - Hösch, Olga

AU - Staab, Wieland

AU - Lange, Torben

AU - Kutty, Shelby

AU - Lotz, Joachim

AU - Hasenfuß, Gerd

AU - Paul, Thomas

AU - Schuster, Andreas

PY - 2017/12/14

Y1 - 2017/12/14

N2 - 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.

AB - 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.

KW - CMR feature tracking

KW - Congenital heart disease

KW - Dyssynchrony

KW - Ebstein anomaly

KW - Heart failure

KW - Left ventricle

KW - Torsion and recoil

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