Left ventricular rotational dyssynchrony before cardiac resynchronization therapy: a step forward into ventricular...

Area of Science:

• Cardiology
• Echocardiography
• Heart Failure Research

Background:

• Heart failure patients exhibit impaired left ventricular rotation and twist.
• The significance of pre-implant left ventricular rotational timing in cardiac resynchronization therapy (CRT) responders is not well understood.

Purpose of the Study:

• To evaluate baseline left ventricular rotational mechanics and segmental rotational timing in CRT-eligible patients.
• To investigate the association between rotational dyssynchrony and echocardiographic response to CRT.

Main Methods:

• Two-dimensional speckle-tracking echocardiography was used to assess baseline rotation, twist, and time-related parameters in 55 CRT patients and 11 healthy controls.
• Analysis included peak apical and basal rotation, peak twist, and delays between opposite segments at base and apex.

Main Results:

• 54% of CRT patients were echocardiographic responders at 6 months.
• While overall rotation and twist did not correlate with response, altered time-related parameters were observed in CRT patients.
• Longer basal and apical segment delays, and anteroseptal-posterior delays, were significant in responders.
• Apical anteroseptal-posterior delay independently predicted response (OR: 1.022) and was linked to reverse remodeling.

Conclusions:

• Left ventricular rotational timing is altered in heart failure patients eligible for CRT.
• Specific patterns of rotational dyssynchrony, notably apical anteroseptal-posterior delay, are associated with CRT response and reverse remodeling, independent of LBBB.
• Rotational mechanics provide valuable insights into CRT outcomes.