Leftt ventricular shape and mass impact torsional dynamics in patients with chronic aortic regurgitation and normal left ventricular ejection fraction

Introduction: Chronic aortic regurgitation (AR) is associated with a unique pattern of left ventricular (LV) volume and pressure overload, leading to LV remodeling. Due to this adaptation, AR patients remain asymptomatic and have a preserved LV ejection fraction (LVEF) for a long time. LV torsional motion, a key component of an efficient systolic performance, can be altered in this setting. Purpose: To assess LV torsional dynamics parameters using speckle tracking echocardiography (STE) in patients with chronic asymptomatic AR and to determine the influence of LV shape and mass on these parameters. Methods: We prospectively enrolled 60 patients (46 ± 16 years, 50 males) with moderate-to-severe and severe AR and LVEF > 50% and 40 age- and gender-matched healthy subjects (43 ± 15 years, 26 males). Rotation was measured from 2D greyscale LV parasternal basal and apical short-axis views by STE using a dedicated soft ware (2D strain, EchoPac, GE Healthcare). LV twist was defined as the net difference in opposite rotations of LV apex and base. LV torsion was calculated as LV twist normalized to LV end-diastolic longitudinal length. LV untwisting was assessed by measuring peak untwisting velocity on the torsional velocity curve. A LV sphericity index was defined as LV end-diastolic volume divided by the volume of a sphere with the same diameter as the LV end-diastolic longitudinal length. Results: LVEF was similar in both groups. AR patients had higher LV diameters, volumes and mass (p < 0.001) and a more spherical LV. LV torsional dynamics parameters were reduced in AR patients: LV apical rotation (14.5 ± 7.4 vs 18.8 ± 6.0°, p = 0.003), twist (18.4 ± 7.2 vs 23.5 ± 6.9°, p = 0.001), torsion (2.1 ± 0.8 vs 2.9 ± 0.9°/ cm, p < 0.001), apical diastolic rotation rate (-82.5 ± 38.9 vs -116.0 ± 51.1°/s, p < 0.001), untwisting velocity (-123.5 ± 41.5 vs -152.9 ± 58.0°/s, p = 0.008). LV sphericity index correlated with LV apical rotation (r = -0.34, p = 0.008), diastolic rotation rate (r = 0.37, p = 0.004) and twist (r = -0.27, p = 0.036). LV mass correlated with LV torsion (r = -0.27, p = 0.039), apical diastolic rotation rate (r = 0.34, p = 0.008) and untwisting velocity (r = 0.31, p = 0.018). Conclusions: LV apical rotation and torsion are reduced in patients with significant AR and normal LVEF, thus detecting early subclinical LV dysfunction before LVEF declines. Also, LV untwisting is reduced in these patients. LV shape and mass both impacts parameters of LV torsional dynamics in this setting.

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