Deformation, rotation, and axial torsion of the left ventricle in coronary heart disease patients with its severe dysfunction


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Abstract

Aim. To evaluate global left ventricular (LV) systolic longitudinal and circumferential strain rates, rotation, and axial torsion in relation to the type of postinfarction LV remodeling in patients with coronary heart disease (CHD) and severe LV dysfunction. Subjects and methods. Studies were performed in 58 patients with sustained anterior myocardial infarction, an ejection fraction of less than 40%, and NYHA Functional Class III-IV heart failure. Three types of postinfarction LV remodeling were identified: 1) with LV apical aneurysm; 2) an intermediate type; 3) with ischemic cardiomyopathy. Global LV systolic longitudinal and circumferential strain rates, end-systolic basal (RotMV/RotMV) and apical (Rotapex/RotRapex) rotation, and axial torsion axis were estimated as an indicator of global LV systolic function. Results. No differences were found in the basal global LV longitudinal and circumferential strain rates, basal rotation, and rotation rate between the patients with 3 types of LV remodeling. In the patients with type 1 LV remodeling, the basal rotation was higher than the apical one (RotMV - Rotapex: -3.085±2.821 versus 2.293±1.021; p=0,002; RotRMV - RotRapex: -22.452±19.823/с-1 versus 13.641±10.745/с-1; p=0.003). In type 2 postinfarction LV remodeling, the basal and apical rotation values did not differ statistically significantly. Impaired apical rotation (in a clockwise direction) was identified in 5 of the 16 patients with type 3 LV remodeling (Rotapex: -1.477±0.392; RotRapex: -30.572±13.735/с-1). There were no differences in the value of LV axial torsion between types 1 and 2 LV postinfarction remodeling (Type 1, 6.714±3.017; Type 2, 7.463±5.416). Conclusion. It was shown for the first time that there were no differences in global LV longitudinal and circumferential strain rates and end-systolic LV rotation between the patients with types 1 and 2 postinfarction LV remodeling.

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Деформация, ротация и поворот по оси левого желудочка у больных ишемической болезнью сердца с тяжелой левожелудочковой дисфункцией. - Резюме. Цель исследования. Оценить глобальную деформацию левого желудочка (ЛЖ) в продольном направлении и по окружности в систолу, ротацию и поворот по оси ЛЖ в зависимости от типа постинфарктного ремоделирования ЛЖ у больных ИБС и тяжелой левожелудочковой дисфункцией. Материалы и методы. Исследования выполнены у 58 пациентов с перенесенным передним инфарктом миокарда, фракцией выброса менее 40% и сердечной недостаточностью III-IV функционального класса по классификации NYHA. Выделены 3 типа постинфарктного ремоделирования ЛЖ: I - с аневризмой верхушки ЛЖ; II - промежуточный вариант; III - с ишемической кардиомиопатией. В качестве показателя глобальной систолической функции ЛЖ оценивали глобальную деформацию в продольном направлении (Global Longitudinal Stain/Strain Rate) и по окружности (Global Circumferential Strain/Strain Rate), ротацию в конце систолы на базальном (RotMV/RotRMV), верхушечном уровне (Rotapex/RotRapex,) и поворот по оси ЛЖ (Torsion).Результаты. Не выявлено различий по величине глобальной деформации ЛЖ в продольном направлении и по окружности, ротации и скорости ротации ЛЖ на базальном уровне между пациентами c 3 типами ремоделирования ЛЖ. У больных с I типом ремоделирования ротация на базальном уровне была выше ротации на уровне верхушки (RotMV - Rotapex: -3,085±2,821 против 2,293±1,021; p=0,002; RotRMV - RotRapex: -22,452±19,823/с-1 против 13,641±10,745/с-1; p=0,003). При II типе постинфарктного ремоделирования значения ротации на базальном и верхушечном уровне статистически значимо не различались. Обнаружено нарушение ротации верхушки (движение по часовой стрелке) у 5 из 16 больных с III типом ремоделирования ЛЖ (Rotapex: -1,477±0,392; RotRapex: -30,572±13,735/с-1). Не выявлено различий по величине поворота по оси ЛЖ между пациентами с I и II типами постинфарктного ремоделирования ЛЖ (I тип: 6,714±3,017; II тип: 7,463±5,416). Заключение. Впервые показано отсутствие различий по глобальной деформации ЛЖ по длинной оси, окружности, ротации ЛЖ в конце систолы между больными с I и II типами постинфарктного ремоделирования.
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About the authors

E N Pavliukova

Email: pavlyuk@cardio.tsu.ru

R S Karpov

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