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Ventricular Torsion in Young Patients With Single-Ventricle Anatomy
Journal of the American Society of Echocardiography ( IF 6.5 ) Pub Date : 2018-10-17 , DOI: 10.1016/j.echo.2018.07.018
Michael Grattan , Luc Mertens , Lars Grosse-Wortmann , Mark K. Friedberg , Barbara Cifra , Andreea Dragulescu

Background

In normal left ventricles, clockwise basal rotation and counterclockwise apical rotation result in systolic torsion. Torsion is important for contractile efficiency and may be especially important in single-ventricle (SV) physiology. However, little is known about torsion in patients with SVs. The aim of this study was to measure torsion in SVs and to determine its relationship with other measures of ventricular function. The hypothesis was that torsion would be decreased in all SVs, most significantly in single right ventricles, and that it would correlate with other measures of ventricular function.

Methods

A prospective cross-sectional study was performed in 61 patients with SVs undergoing pre- or post-Fontan cardiac catheterization and 30 matched control subjects. Echocardiography, catheterization, and cardiac magnetic resonance imaging were performed under the same anesthetic. Torsion and strain were measured using speckle-tracking echocardiography. Intracardiac pressures, pulmonary vascular resistance, and cardiac magnetic resonance imaging–derived ventricular volume and ejection fraction were measured.

Results

Thirty-five patients were left ventricular dominant, 15 were right ventricular dominant, 10 were codominant, and one had indeterminate morphology. Thirty-seven patients were pre-Fontan and 24 were post-Fontan. Patients with SVs had similar overall torsion as control subjects (median, 1.7°/cm vs 1.65°/cm; P = NS); however, they had decreased or reversed basal rotation (−0.32°/cm vs −0.93°/cm, P < .0001) and increased apical rotation (1.45°/cm vs 1.06°/cm, P = .0065). There were no differences on the basis of ventricular dominance or palliative stage. Torsion did not significantly correlate with other echocardiographic, catheter-based, or cardiac magnetic resonance imaging measures of cardiac function.

Conclusions

Single left and right ventricles exhibit preserved torsion, mainly because of preserved or increased apical rotation. Possible mechanisms of torsion in single right ventricles include myofiber remodeling and altered ventricular-ventricular interactions. Understanding myocardial deformation in SVs will improve the ability to interpret ventricular function in this precarious population.



中文翻译:

单心室解剖的年轻患者的心室扭转

背景

在正常的左心室中,顺时针基础旋转和逆时针顶部旋转会导致收缩期扭转。扭转对于收缩效率很重要,在单心室(SV)生理学中尤其重要。但是,关于SV患者的扭转知之甚少。这项研究的目的是测量SVs的扭转并确定其与其他心室功能测量的关系。假设是所有SV的扭转都会减少,单个右心室的扭转最明显,并且它与其他心室功能指标相关。

方法

在61名接受Fontan心脏导管术前后的SV患者和30位匹配的对照受试者中进行了一项前瞻性横断面研究。在同一麻醉下进行超声心动图,导管插入术和心脏磁共振成像。使用斑点跟踪超声心动图测量扭力和应变。测量了心内压,肺血管阻力和心脏磁共振成像得出的心室容积和射血分数。

结果

35例为左室显性,15例为右室显性,10例为显性,1例形态不确定。Fontan前有37例,Fontan之后有24例。SVs患者的总体扭转与对照组相似(中位数为1.7°/ cm对1.65°/ cm;P  = NS)。然而,它们的基础旋转减少或逆转(-0.32°/ cm vs -0.93°/ cm,P  <.0001),而根尖旋转增加(1.45°/ cm vs 1.06°/ cm,P  = .0065)。根据心室优势或姑息阶段没有差异。扭转与其他超声心动图,基于导管或心脏功能的心脏磁共振成像测量结果没有显着相关性。

结论

左心室和右心室显示出扭转的保留,主要是因为保留或增加了根尖旋转。单个右心室扭转的可能机制包括肌纤维重塑和心室-心室相互作用改变。了解SVs中的心肌变形将提高这一不稳定人群的心室功能解释能力。

更新日期:2018-10-17
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