Synchronicity of LV contraction as a determinant of LV twist mechanics: serial speckle-tracking analyses in WPW syndrome before and after radiofrequency catheter ablation

Myung-Ki Seo, Sung-A Chang, Hyung-Kwan Kim, Dong-Ho Shin, Eue-Keun Choi, Yong-Jin Kim, Seil Oh, Goo-Yeong Cho, Dae-Won Sohn, Byung-Hee Oh, Young-Bae Park
JACC. Cardiovascular Imaging 2011, 4 (4): 338-47

OBJECTIVES: This study set out to investigate the isolated impact of synchronous patterns of left ventricular (LV) contraction (i.e., LV synchronicity) on LV twist behavior.

BACKGROUND: Although the relationships between LV loading status/LV contractility and twist are well-established, no data are available regarding the relation between LV twist and LV synchronicity, without any interference by changes in LV pre-load, afterload, and contractility. Serial assessment of patients with Wolff-Parkinson-White syndrome before and after radiofrequency catheter ablation (RFCA) allows this to be explored.

METHOD: Of the 40 Wolff-Parkinson-White patients initially screened, 34 were enrolled. Two-dimensional and Doppler echocardiography along with speckle tracking-derived LV twist mechanics, apical-basal rotation delay, and left ventricular dyssynchrony index (LVdys) were obtained before and after RFCA. The LVdys was defined as the maximal delay in time-to-peak radial strain of different LV segments at the papillary muscle level.

RESULTS: Overall, no significant changes were demonstrated in LV volumes, systolic and diastolic function, and end-systolic wall stress before versus after RFCA. After RFCA, median value of LVdys was attenuated from 33.5 (interquartile range [IQR]: 14.0 to 84.3) to 14.0 (IQR: 11.5 to 21.8) (p = 0.002), which was accompanied by a reduction in apical-basal rotation delay from 9.7% (IQR: 3.5 to 23.7) to 3.3% (IQR: 1.3 to 8.0) (p = 0.004). In contrast, LV twist increased from 14.2° (IQR: 9.1° to 18.4°) before to 19.7° (IQR: 15.0° to 22.6°) after RFCA (p = 0.002). Delta LV twist pre- to post-RFCA displayed a significant inverse correlation with changes in apical-basal rotation delay (r = -0.42, p = 0.01) and Delta LVdys (r = -0.39, p = 0.02).

CONCLUSIONS: The LV synchronous contraction is significantly related to LV twist.

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