title: Impact of longitudinal cardiac rotation on mitral and tricuspid atrioventricular annular diastolic motion.
abstract: BACKGROUND
  It is unknown whether longitudinal rotation (LR), often seen in cardiac resynchronization therapy candidates, may affect mitral annular early diastolic (E') velocities and tricuspid annular motion. We assessed whether (1) LR affects the amplitude and timing of septal and lateral mitral annular E' velocities and tricuspid annular systolic and E' velocities and (2) if systolic strain heterogeneity seen in cardiac resynchronization therapy patients with LR extends into diastole.
  
  
  RESULTS
  Ninety-nine cardiac resynchronization therapy candidates with suitable baseline echocardiograms were identified. Early diastolic (E') and systolic myocardial velocities of the tricuspid annulus and E' velocities of the septal and lateral part of the mitral annulus were analyzed from tissue Doppler images. Longitudinal rotation and basal systolic and diastolic strain rates were analyzed by speckle-tracking. LR correlated with lateral mitral annular E' (r= 0.45, P<0.001), tricuspid annular E' (r=-0.3, P=0.003), and with a difference between septal and lateral mitral annular E' velocities (r= -0.49, P<0.001) but not with septal mitral annular E' velocity. LR also correlated with tricuspid annular systolic velocity (r= 0.60, P<0.001). After categorizing the patients according to the quartiles of their LR, we showed that with decreasing quartile number, heterogeneity of systolic (P=0.003) but not diastolic (P>0.1) strain rates increased.
  
  
  CONCLUSIONS
  LR direction and magnitude correlates with the amplitude of, and relative differences between, diastolic velocities of tricuspid, lateral mitral, and septal mitral annulus, which are a cornerstone of diastolic function assessment. LR is associated with systolic but not with diastolic regional heterogeneity.
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors.forename: Zoran B
authors.initials: ZB
authors.lastname: Popovic
authors.forename: Chirapa
authors.initials: C
authors.lastname: Puntawangkoon
authors.forename: David
authors.initials: D
authors.lastname: Verhaert
authors.forename: Neil
authors.initials: N
authors.lastname: Greenberg
authors.forename: Allan
authors.initials: A
authors.lastname: Klein
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Richard A
authors.initials: RA
authors.lastname: Grimm
mesh_terms: D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D001795:Blood Pressure Determination; D002304:Cardiac Pacing, Artificial; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003971:Diastole / Q000502:physiology*; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D012399:Rotation; D013318:Stroke Volume; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020257:Ventricular Remodeling
chemical_list: D008055:Lipids