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Longitudinal Rotation: An Unrecognized Motion Pattern in Patients with Dilated Cardiomyopathy
  1. Zoran B Popovic (popoviz{at}ccf.org)
  1. Cleveland Clinic, United States
    1. Richard A Grimm (grimmr{at}ccf.org)
    1. Cleveland Clinic, United States
      1. Ali Ahmad (ahmada{at}ccf.org)
      1. Cleveland Clinic, United States
        1. Deborah Agler (aglerd{at}ccf.org)
        1. Cleveland Clinic, United States
          1. Miguel Favia (faviam{at}ccf.org)
          1. Cleveland Clinic, United States
            1. George Dan (dang{at}ccf.org)
            1. Cleveland Clinic, United States
              1. Pascal Lim (limp{at}ccf.org)
              1. Cleveland Clinic, United States
                1. Fernando Casas (casasf{at}ccf.org)
                1. Cleveland Clinic, United States
                  1. Neil L Greenberg (greenbn{at}ccf.org)
                  1. Cleveland Clinic, United States
                    1. James D Thomas (thomasj{at}ccf.org)
                    1. The Cleveland Clinic, United States

                      Abstract

                      Background Heart failure patients who are candidates for CRT frequently display longitudinal rotation (LR)-a swinging motion of the heart when imaged in a horizontal long-axis plane.

                      Objectives To identify the magnitude and predictors of LR in patients with ischemic (ICM) and idiopathic dilated (DCM) cardiomyopathy, and to assess predictive value of LR in patients undergoing cardiac resynchronization therapy (CRT). Design and setting: a retrospective study in a tertiary heart care setting

                      Methods We performed echocardiography in 45 ICM and 41 DCM patients who were CRT candidates and 16 control subjects. Global LR, segmental strains and segmental LR were assessed from echocardiograms using speckle tracking. Repeat echocardiography >40 days after the beginning of CRT was performed in 64 patients.

                      Results While DCM patients with QRS duration of both <130 ms and (3)130 ms displayed significant clockwise LR (p <0.001 for both vs. 0), ICM patients and control subjects had LR that did not differ from 0. Most significant LR predictor was end-diastolic volume (P<0.0001) followed by the absence of ischemia (p<0.0001) and QRS duration (p=0.05). DCM patients with prominent clockwise LR had lower septal but higher lateral strains than DCM patients with minimal LR, or ICM patients with counterclockwise LR. LR correlated with decrease of end-systolic volume in DCM (r = 0.49, p = 0.004), while no relationship was observed in ICM.

                      Conclusion Clockwise LR is linked to presence of DCM, with the small impact of QRS duration. LR is moderately strong predictor of end-systolic volume decrease during CRT in DCM.

                      • Left ventricular function
                      • dilated cardiomyopathy
                      • echocardiography

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                      • web only appendices 94/3/e11

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