The effects of lower body compression on left ventricular rotational mechanics in lymphoedema (from the MAGYAR‐Path Study)

Abstract

Aims Lower body half compression of bilateral secondary leg lymphoedema (LE) without relevant cardiac insufficiency gives rise to whether external leg compression may influence left ventricular (LV) function. Patients with LE were subjected to baseline two-dimensional transthoracic echocardiography (2DTTE) for general assessment then three-dimensional speckle-tracking echocardiography (3DSTE) before and 1 h after lower body half external compression for LV torsion analysis. Methods and results Baseline 2DTTE was performed in the cohort of 25 LE patients, and the results were compared with those of age-and gender-matched 52 healthy controls (mean age: 47.8 ± 12.8 vs. 40.7 ± 14.0 years, 24 women/1 man vs. 49 women/3 men, respectively). 3DSTE was conducted for the assessment of LV rotational mechanics where apical (AR), and basal rotations (BR) were measured before and 1 h after the use of compression class 2 (ccl 2) flat-knitted medical compression pantyhoses (pressure range: 23-32 mmHg). 2DTTE showed significantly larger LV end-diastolic volume and ejection fraction among LE patients compared with control subjects (108.3 ± 20.1 vs. 98.5 ± 21.7 mL, 69.8 ± 4.8 vs. 65.5 ± 4.3%, respectively) and notably smaller LV end-systolic diameter and posterior wall thickness (28.9 ± 3.5 vs. 31.2 ± 3.4 mm, 8.1 ± 1.0 vs. 9.0 ± 1.7 mm, respectively). The results of 20 patients with LE were considered in 3DSTE examinations due to the drop-out of five probands with technical failures. The data of four LE patients showing significant LV rotational abnormalities were managed separately, and the rotational parameters of the remaining sixteen patients did not differ significantly from those of matched controls except significant reduction of LV BR following the application of medical compression stockings (MCS) (À2.70 ± 1.26 degrees after 1 h use of pantyhose in patient group vs. À4.28 ± 2.18 degrees of the control group; P < 0.05). Conclusions The application of compression pantyhoses moderately but significantly decreased LV BR without a remarkable impact on twisting mechanism in LE patients in the absence of LV rotational abnormalities.

Left ventricular deformation in patients with lymphedema before and after the use of medical compression stockings—detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

“…In this special LV movement, walls of the LV not only contract, but the basal LV segments rotate in clockwise direction, while the apical LV segments rotate in counterclockwise direction leading to a towel-wringing-like motion called LV twist ( 15 ). The results of this study should be considered in the context of LV rotational parameters using the same protocol as published in a recent study ( 8 ). At rest, significant abnormalities were seen in one-fifth of the patients without reduction/elevation of LV rotational parameters in the remaining cases.…”

“…At rest, significant abnormalities were seen in one-fifth of the patients without reduction/elevation of LV rotational parameters in the remaining cases. Following the use of MCS, reduction of basal LV rotation with preservation of LV twisting mechanism could be detected ( 8 ). According to these findings, changes in LV strains could be considered as a compensation mechanism designed to maintain LV pumping function at a certain level.…”

“…LE-related fluid retention affects LV mechanics, which could be analyzed in detail by recent three-dimensional speckle-tracking echocardiography (3DSTE) ( 4 - 7 ). In a recent study, moderate effects of MCS use on LV rotational mechanics could be demonstrated in LE patients after the use of compression stockings ( 8 ). However, LV strains, quantitative features of LV deformation were never investigated in relation with MCS use in LE patients ( 9 ).…”