Cardiac rotation and relaxation in patients with chronic heart failure.
BACKGROUND
The normal left ventricle shows a systolic wringing motion with clockwise rotation at the base and counterclockwise rotation at the apex.


OBJECTIVE
The aim of the present study was (1) to assess left ventricular (LV) contraction and relaxation in patients with chronic heart failure (CHF), and (2) to evaluate the effect of medical therapy on LV contraction-relaxation behavior.


METHODS
Magnetic resonance was used to examine LV motion by labeling specific LV regions in three planes (myocardial tagging). Twenty-three subjects were included, nine healthy controls and 14 CHF patients. Cardiac motion was determined from the deformation of a rectangular grid in a basal and apical plane. CHF patients were put on triple therapy with ACE-inhibitors, beta-blockers and spironolactone. Follow-up examination (n=9) was performed after 6 months.


RESULTS
In controls, systolic rotation was -9.5+/-2 degrees at the base and +3.3+/-1 degrees at the apex. In CHF patients, rotation was reduced both at the base (-3.4+/-2 degrees , P<0.01) and the apex (+0.9+/-3 degrees , P<0.05). Similarly, regional ejection fraction (REF) was reduced in CHF patients both at the base and the apex. Medical therapy was associated with an improvement in REF, but systolic rotation improved only at the base (-4.6+/-2 degrees , P<0.05).


CONCLUSIONS
Systolic wringing motion with clockwise rotation at the base and counterclockwise rotation at the apex is maintained in CHF although reduced. Heart failure treatment is associated with an improvement in REF, whereas rotation improved only at the base, but not at the apex. Thus, there is an uncoupling between regional shortening and rotation in CHF patients.
Fuchs
Esther
E
Swiss Cardiovascular Center and Institute of Diagnostic Radiology, Debis Systemhaus Health Care Services, University Hospital, Freiburgstrasse, Bern CH-3010, Switzerland.
Müller
Markus F
MF
Oswald
Helmut
H
Thöny
Harriet
H
Mohacsi
Paul
P
Hess
Otto M
OM
D000328:Adult; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D012399:Rotation; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*