title: Left ventricular shape and mass impact torsional dynamics in asymptomatic patients with chronic aortic regurgitation and normal left ventricular ejection fraction.
abstract: Chronic aortic regurgitation (AR) is associated with a unique pattern of left ventricular (LV) volume and pressure overload, leading to LV remodelling. LV torsional motion, a key component of LV performance, can be altered in this setting. We aimed to assess the impact of LV remodelling on LV torsional dynamics parameters using speckle-tracking echocardiography (STE) in asymptomatic AR patients. We prospectively enrolled 60 patients with chronic AR and LVEF > 50% and 55 healthy controls. LV rotation, twisting and untwisting were assessed using STE. Patients with AR had higher LV diameters, volumes and mass, a more spherical LV shape than controls, but similar LVEF. In AR patients we found reduced peak LV apical rotation and decreased (2.1 ± 0.8 vs 2.9 ± 0.9°/cm, p < 0.001) and delayed (time to peak LV twist: 0.94 ± 0.12 vs 0.99 ± 0.09, p = 0.004) peak LV torsion. Also, peak LV untwisting velocity was decreased (-123.5 ± 41.5 vs -152.3 ± 55.0°/s, p = 0.002) due to lower peak LV apical diastolic rotation rate. LV shape influenced LV torsional dynamics, a more spherical LV displaying reduced peak LV apical rotation and diastolic rotation rate and decreased LV twist. A more hypertrophied LV had a lower peak LV torsion, peak LV apical diastolic rotation rate and peak LV untwisting velocity. LV apical rotation and torsion are decreased and LV twist is delayed in patients with chronic AR and normal LVEF, detecting early subclinical LV dysfunction before LVEF declines. Also, LV untwisting is reduced in these patients. LV remodelling impairs LV torsional dynamics parameters in this setting.
authors.affiliation: Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania. roxenache@gmail.com.|"Prof. Dr. C. C. Iliescu" Emergency Institute of Cardiovascular Diseases, Sos. Fundeni, No 258, Bucharest, 022328, Romania. roxenache@gmail.com.
authors.forename: Roxana
authors.initials: R
authors.lastname: Enache
authors.affiliation: Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.|"Prof. Dr. C. C. Iliescu" Emergency Institute of Cardiovascular Diseases, Sos. Fundeni, No 258, Bucharest, 022328, Romania.
authors.forename: Bogdan A
authors.initials: BA
authors.lastname: Popescu
authors.affiliation: Cardiology Department, S. Maria degli Angeli Hospital, Pordenone, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Piazza
authors.affiliation: Department of Cardiac, Thoracic and Vascular Science, School of Medicine, University of Padua, Padua, Italy.
authors.forename: Denisa
authors.initials: D
authors.lastname: Muraru
authors.affiliation: Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.|"Prof. Dr. C. C. Iliescu" Emergency Institute of Cardiovascular Diseases, Sos. Fundeni, No 258, Bucharest, 022328, Romania.
authors.forename: Andreea
authors.initials: A
authors.lastname: Călin
authors.affiliation: Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.|"Prof. Dr. C. C. Iliescu" Emergency Institute of Cardiovascular Diseases, Sos. Fundeni, No 258, Bucharest, 022328, Romania.
authors.forename: Carmen C
authors.initials: CC
authors.lastname: Beladan
authors.affiliation: Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.|"Prof. Dr. C. C. Iliescu" Emergency Institute of Cardiovascular Diseases, Sos. Fundeni, No 258, Bucharest, 022328, Romania.
authors.forename: Monica
authors.initials: M
authors.lastname: Roşca
authors.affiliation: Cardiology Department, S. Maria degli Angeli Hospital, Pordenone, Italy.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Nicolosi
authors.affiliation: Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.|"Prof. Dr. C. C. Iliescu" Emergency Institute of Cardiovascular Diseases, Sos. Fundeni, No 258, Bucharest, 022328, Romania.
authors.forename: Carmen
authors.initials: C
authors.lastname: Ginghină
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D058070:Asymptomatic Diseases; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014102:Torsion Abnormality / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D054159:Torsion, Mechanical; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left; D017725:Ventricular Pressure; D020257:Ventricular Remodeling
keywords: 2D strain echocardiography; Aortic regurgitation; Left ventricular function; Left ventricular mass; Left ventricular mechanics; Left ventricular shape