The effect of myocardial fibrosis on left ventricular torsion and twist in patients with non-ischemic dilated cardiomyopathy

Abstract

Background: Left ventricular (LV) rotation, twist, and torsion are important aspects of thecardiac performance. Myocardial fibrosis can be identified as the late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR). In this study, we investigated the associationbetween myocardial fibrosis and LV rotational parameters in patients with nonischemic dilated cardiomyopathy (NDC).

Methods: Twenty-two NDC patients were enrolled. LV dimensions, volumes and ejection fraction (EF) were measured, conventional tissue Doppler imaging data was acquired. Speckletracking imaging was performed to measure LV deformation, LV rotational parameters. Bloodsamples were obtained for NT-proBNP. Late gadolinium enhanced cardiac magnetic resonance (LGE-CMR) was used to assess cardiac fibrosis index.

Results: Myocardial deformation was similar between LGE+ and LGE– groups. LGE+patients have significantly higher basal and lower apical systolic rotation, lower twist andtorsion when compared to LGE– patients. However, untwisting rate was similar between thegroups. Torsion was significantly correlated with LVEF and MR-index. Patients with reversedapical systolic rotation had significantly greater NT-proBNP values, basal systolic rotation andsignificantly lower apical systolic rotation, torsion, and MR-index.

Conclusions: Cardiac fibrosis index is closely related with myocardial torsion and LV systolicfunction and may be used for the evaluation of cardiac condition. Reversed apical systolicrotation indicated more extensive cardiac fibrosis as it may reflect severe LV dyssynchrony andpoor LV performance.