Longitudinal rotation: an unrecognised motion pattern in patients with dilated cardiomyopathy

Abstract

Clockwise LR is linked to presence of DCM, with the small impact of QRS duration. LR is a moderately strong predictor of end-systolic volume decrease during CRT in DCM.

Impact of Longitudinal Cardiac Rotation on Mitral and Tricuspid Atrioventricular Annular Diastolic Motion

“…1 In brief, the region of interest is applied over the LV myocardium in an apical 4-chamber view. The software automatically tracks down rotational rate of myocardial motion with reference to the center of gravity of the region of interest (Supplemental Video 1B).…”

“…1,2 To assess interobserver and intraobserver variability of measurements of TA TDI velocities and systolic and EЈ longitudinal strain rates, we assessed data of 10 randomly selected subjects. Data were measured in a 4-chamber view twice by a same observer and independently by a second observer.…”

“…Indeed, we have shown that LR affects the amplitude of basal septal and lateral systolic myocardial velocities, with blunting of the velocity of the wall in the direction of LR (depressed long-axis systolic velocities of the lateral wall in patients with clockwise LR as opposed to depressed septal wall velocities in patients with counterclockwise LR). 1 …”

“…ongitudinal cardiac rotation (LR) 1 is a rocking motion of the heart that can best be appreciated in a horizontal (4-chamber) long-axis view, where the heart silhouette exhibits a clockwise or counterclockwise rotation during systole. This motion is frequently seen in heart failure patients and is typically clockwise in subjects with nonischemic cardiomyopathy (Supplemental Video 1A) but sometimes may be counterclockwise in ischemic cardiomyopathy.…”

“…The degree of clockwise LR has been linked to decreased septal and increased lateral deformation and is predictive of reverse remodeling in patients undergoing cardiac resynchronization therapy. 1,2 Obviously, this kind of motion should affect measures that assess left ventricular (LV) function by quantifying up-and-down, piston-like, movement of the LV base. Indeed, we have shown that LR affects the amplitude of basal septal and lateral systolic myocardial velocities, with blunting of the velocity of the wall in the direction of LR (depressed long-axis systolic velocities of the lateral wall in patients with clockwise LR as opposed to depressed septal wall velocities in patients with counterclockwise LR).…”