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Published on: December 22, 2023
[Assessment of cardiac twist in dilated cardiomyopathy using echocardiography velocity vector imaging]
1Department of Ultrasonography, Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Dilated cardiomyopathy (DCM) impairs cardiac twist function, a key indicator of global heart health. Velocity Vector Imaging (VVI) effectively assesses these changes in DCM patients.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- Assessing left ventricular function in DCM is crucial for patient management.
- Cardiac twist, a complex motion, plays a vital role in ventricular efficiency.
Purpose of the Study:
- To evaluate cardiac twist in dilated cardiomyopathy (DCM) patients using echocardiography Velocity Vector Imaging (VVI).
- To explore the clinical utility of VVI in assessing cardiac twist in DCM.
Main Methods:
- Echocardiographic data from 33 healthy subjects and 30 DCM patients were analyzed.
- Velocity Vector Imaging (VVI) software was used to measure rotation, velocity, and strain parameters.
- Measurements included systolic rotation, peak rotation velocity, circumferential strain, and time to peak rotation velocity.
Main Results:
- DCM patients exhibited significantly reduced cardiac twist parameters compared to controls, particularly at the apical level.
- Abnormal cardiac twist patterns were observed in some DCM patients.
- Apical time to peak rotation velocity was prolonged in DCM, indicating rotational dyssynchrony.
Conclusions:
- Cardiac twist function is diffusely impaired in DCM, contributing to global cardiac dysfunction.
- VVI provides an objective method for evaluating cardiac twist in DCM patients.
- Assessing cardiac twist with VVI holds clinical value for understanding DCM pathophysiology.
Objective:
To assess cardiac twist in dilated cardiomyopathy (DCM) patients using echocardiography velocity vector imaging (VVI) and to explore the clinical application value of VVI in evaluating cardiac twist.
Methods:
Thirty-three normal subjects and 30 DCM patients were enrolled. Echocardiographs of parasternal left ventricle basal, papillary muscle level and apical short axis plane, apical four-, two-chamber plane were obtained respectively. Systolic maximal rotation degree, peak rotation velocity, circumferential strain (CS), time to peak rotation velocity (TPRV), peak un-rotation velocity of end diastole and end isovolumic relaxation period in subendocardium were measured by VVI software.
Results:
(1) In the normal group, left ventricle performed systolic wring motion with counterclockwise rotation at the apex and clockwise rotation at the base as seen from the apex, while with transient counterclockwise rotation at the base and clockwise rotation at the apex in isovolumic relaxation period. The papillary level rotation form was not constant For the dominant rotation action of the apex, the whole cardiac twist form was counterclockwise. (2) Compared with the control group, 4 DCM patients cardiac twist pattern changed: two showed both counterclockwise rotation of the base and the apex, one represented both clockwise rotation of the base and the apex, another performed the base rotated counterclockwise and the apex rotated clockwise. (3) All rotation and twist parameters of other 26 DCM patients decreased, especially at the apical level: LVtw:7.34 degrees +/- 3.65 degrees vs. 17.01 degrees +/- 4.81 degrees, LVtor: (0.09 +/- 0.04) degrees/mm vs. (0.23 +/- 0.06) degrees/mm, torsion rate: (60.23 +/- 23.67) degrees/s vs. (148.24 +/- 56.23) degrees/s, untwisting rate (0.37 +/- 0.19) degrees/m vs. (0.59 +/- 0.33%)/m, basal CS: (-8.09 +/- 2.73)% vs. (-19.49 +/- 5.51)% (P = 0.013), apical CS: (-8.94 +/- 5.90)% vs. (-27.49 +/- 9.53)% (P = 0.000), basal rotation angle: (-3.60 +/- 2.38) vs. (-6.28 +/- 3.05) (P = 0.014), apical rotation angle: (5.80 +/- 3.55) degrees vs. (11.02 +/- 3.33) degrees (P = 0.001). (4) The apical TPRV in DCM group were longer than the control group represented rotational dyssynchrony in DCM patients (400.26 ms +/- 70.15 ms vs 328.13 ms +/- 66.95 ms, P = 0.008). LVtw correlated positively well with EF (r = 0.489, P < 0.05).
Conclusion:
(1) Cardiac twist function was diffusely impaired in DCM patients and it contributed to the global cardiac dysfunction. (2) Cardiac twist pattern changed in some of DCM patients. (3) VVI can objectively reflect cardiac twist function in DCM patients.
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