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New parameters to evaluate left ventricle torsion allow to understand the preservation of left ventricle ejection fraction in cardiac amyloidosis

Session Poster session 1

Speaker Valentina Faga

Event : EuroEcho 2018

  • Topic : imaging
  • Sub-topic : Tissue Doppler, Speckle Tracking and Strain Imaging
  • Session type : Poster Session

Authors : V Faga (Valencia,ES), V Mora (Valencia,ES), I Roldan (Valencia,ES), R Arbucci (Buenos Aires,AR), MM Perez-Gil (Valencia,ES), J Bertolin (Valencia,ES), C Nunez (Valencia,ES), A Saad (Buenos Aires,AR), E Romero (Valencia,ES), J Lowenstein (Buenos Aires,AR)

V Faga1 , V Mora1 , I Roldan1 , R Arbucci2 , MM Perez-Gil1 , J Bertolin1 , C Nunez1 , A Saad2 , E Romero1 , J Lowenstein2 , 1Hospital Dr. Peset - Valencia - Spain , 2 Investigaciones medicas de Buenos Aires, Servicio de cardiodiagnóstico - Buenos Aires - Argentina ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 1 ), i185

Introduction: Left ventricle ejection fraction (LVEF) is the result of the coordinated action of both longitudinal and circunferencial contraction, basal and apical rotation, and radial thickening. The contribution of the left ventricle (LV) rotational mechanics to preserve LVEF might be crucial in some cardiomyopathies. 

Aim: To quantify the parameters that contribute to LV contractile function through the study of myocardial strain in cardiac amyloidosis (CA).

Methods: Comparative study between 15 patients (p) affected by CA with preserved LVEF (>50%), and 15 healthy volunteers (control group). Twist, radial strain (RS), circunferential strain (CS) and longitudinal strain (LS) were determined using 2D speckle-tracking echocardiography, along with mitral annulus plane systolic excursion (MAPSE) and basal-apex distance (B-A). The first ones were obtained from LV basal and apical transverse planes, while MAPSE, B-A and LS were assessed from apical 4,3 and 2 chambers views. The following indexes were calculated: Twist (apical rotation+basal rotation,º); Classic Torsion (twist/B-A,º/cm); Torsion Index (Tor-I) (twist/MAPSE,º/cm), Deformation Index (Def-I) (twist/LS,º/%). We propose the Tor-I and the Def-I as new parameters that allow for a more realistic assessment of LV torsion, since they include longitudinal shortening measures such as MAPSE and LS, describing in a more complete and physiological way the global LV torsion movement.

Results: No significative differences were observed in age (67,1 ± 11,5 vs 63,7 ± 2,8; p=0,29). MAPSE was significantly lower in the CA group (0,8 ± 0,2 vs 1,3 ± 0,1; p<0,001). LVEF was preserved in both groups although LS, CS and RS were significantly lower in the CA group (table). No significative difference was observed neither in twist (20,2 ± 8,4 vs 21,7 ± 6,1; p=0,57) nor in classic torsion (2,5±1,1 vs 2,7±0,8, p=0,59), while both Tor-I and Def-I were significantly increased in the CA group (table).

Conclusions: LVEF is preserved in p with CA thanks to an increase in LV torsion understood as a complex movement that includes both apical and basal rotation along with the contemporary LV longitudinal shortening (MAPSE or LS). In our study, it is reflected by the increase of the Tor-I and Def-I. Moreover twist and classic torsion, that do not take into account LV longitudinal shortening, fail to identify such changes.

LVEF(%) LS(%) CS (%) RS (%) Tor-I (º/cm) Def-I (º/%)

Amyloidosis (n=15)

59.5 ± 6.1

-12.6 ± 4.3

-18.1 ± 4.6

21.5 ± 7.6

27.0 ± 13.8 -1.7 ± 0.9
Controls (n=15)

68.2 ± 6.3

-20.6 ± 2.5

-22.7 ± 4.9

32.2 ± 11.9 16.4 ± 4.7 -1.0 ± 0.3
p 0.001 < 0.001 0.01 0.01 0.01 0.01
Abbreviations shown in the text.

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