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Additive value of torsion to global longitudinal left ventricular strain in patients with reduced ejection fraction

Background Torsional and longitudinal deformations are essential components of left ventricular (LV) performance. A precise assessment of LV function must take into account both LV torsion (LVtor) and global longitudinal strain (LVε). We compared a new 2D-strain parameter, LVtor × LVε, with several...

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Bibliographic Details
Published in:Acta Cardiologica 2011-10, Vol.66 (5), p.565-572
Main Authors: Mornoş, Cristian, Ruşinaru, Dan, Ionac, Adina, Petrescu, Lucian, Cozma, Dragoş, Pescariu, Sorin, Drăgulescu, ştefan Iosif
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Language:English
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Summary:Background Torsional and longitudinal deformations are essential components of left ventricular (LV) performance. A precise assessment of LV function must take into account both LV torsion (LVtor) and global longitudinal strain (LVε). We compared a new 2D-strain parameter, LVtor × LVε, with several other echocardiographic parameters, with respect to their strength of association with N-terminal pro-brain natriuretic peptide (NTproBNP) in patients with reduced LV ejection fraction (LVEF). Methods Echocardiography was performed simultaneously with NTproBNP determination in 78 consecutive patients with reduced LVEF (< 50%) in sinus rhythm. Early diastolic transmitral velocity/early mitral annular diastolic velocity ratio (E/E') and systolic mitral annular velocity (S') were measured. LVtor was defi ned as the ratio between LV twist (LVtw) and LV end-diastolic longitudinal length. LVtw (net diff erence between rotation angles at base and apex) was obtained from parasternal apical and basal short-axis planes. LV εwas obtained by averaging longitudinal peak systolic strain of all 17 LV-segments (from apical planes). Results Log-transformed NTproBNP correlated signifi cantly with LV ε(r = 0.57, P < 0.001), myocardial performance index (r = 0.56, P < 0.001), systolic pulmonary artery pressure (r = 0.47, P < 0.001), E/E'(r = 0.41, P< 0.001), LVtor (r = -0.37, P= 0.001), E-velocity deceleration time (r = -0.37, P= 0.003), S' (r = -0.36, P= 0.002), LVtw (r = -0.34, P= 0.003), LVEF (r = -0.34, P= 0.003), E/A (A = late diastolic transmitral velocity, r = 0.30, P= 0.01) and E (r = 0.28, P= 0.03). LVtor × LV εhad the strongest correlation with log-NTproBNP (r = 0.70, P< 0.001). LVtor × LV εwas a better predictor of NTproBNP > 900 pg/ml (sensitivity = 82%, specifi city = 84%) than other investigated parameters (each P< 0.05). Conclusions In patients with reduced LVEF, LVtor × LV εis a promising parameter that deserves research to establish its clinical meaning and prognostic value.
ISSN:0001-5385
0373-7934
DOI:10.1080/AC.66.5.2131080