A New Coding System for the Identification of Left Ventricular Rotation Patterns and Their Relevance to Myocardial...

Area of Science:

• Cardiology
• Medical Imaging
• Biomechanical Engineering

Background:

• Left ventricular ejection fraction (LVEF) is crucial for cardiac function assessment.
• Current clinical coding systems lack specificity in differentiating left ventricular (LV) rotational patterns.
• Understanding LV rotational mechanics is key to evaluating myocardial function.

Purpose of the Study:

• To introduce and validate an alternative coding system for identifying distinct LV rotational patterns.
• To correlate these identified rotational patterns with myocardial function, specifically transmural global longitudinal strain (tGLS) and LVEF.
• To assess the clinical applicability of the proposed system in healthy subjects and patients with LV hypertrophy (LVH).

Main Methods:

• Utilized echocardiographic imaging and speckle tracking to derive tGLS and rotational parameters.
• Defined a rotational gradient to quantify twist (positive value) and rigid rotation (negative value).
• Evaluated 87 healthy subjects and 248 patients with LVH, categorizing them based on rotational patterns and myocardial function.

Main Results:

• The proposed system successfully distinguished between twist and rigid rotation patterns.
• Twist was prevalent in healthy controls and LVH patients with normal myocardial function (tGLS ≥ 17%).
• In LVH patients with myocardial dysfunction (tGLS < 17%), twist occurred in 83.3% and rigid rotation in 16.7%; all rigid rotation cases had LVEF < 50%.
• Rotational gradient values showed a strong correlation with LVEF (r = 0.73, p < 0.001).

Conclusions:

• The novel coding system effectively identifies specific LV rotational patterns.
• This system provides a valuable tool for relating rotational mechanics to myocardial function and LVEF.
• It offers potential for improved diagnostic and prognostic capabilities in cardiovascular assessments.