Non Invasive Imaging

A1190JACC April 1, 2014

Volume 63, Issue 12

coMpensaTory Basal hyperroTaTion in paTienTs wiTh ischeMic cardioMyopaThy as deMonsTraTed By Three-diMensional speckle Tracking echocardiography

Poster ContributionsHall CSunday, March 30, 2014, 3:45 p.m.-4:30 p.m.

Session Title: Non Invasive Imaging: Myocardial Strain, Cardiac Mechanics and Diastolic FunctionAbstract Category: 15. Non Invasive Imaging: EchoPresentation Number: 1210-45

Authors: Haroon Yousaf, Mirza Nubair Ahmad, Bijoy K. Khandheria, Timothy E. Paterick, A. Jamil Tajik, Khawaja Afzal Ammar, Aurora Cardiovasc Svcs, Aurora Sinai/St. Luke’s Med Ctrs, Univ Wisconsin Sch Med and Public Health, Milwaukee, WI, USA

Background: Compensatory hyperkinesia is a well-known phenomenon in ischemic cardiomyopathy, wherein the walls opposite to the infarcted akinetic walls undergo hyperkinesia in order to maintain normal cardiac output. With the advent of three-dimensional speckle tracking echocardiography (3DSTE), twist mechanics can be studied in detail. We hypothesized that similar compensatory properties exist when it comes to twist mechanics in ischemic cardiomyopathy.

Methods: We studied 170 consecutive patients referred to the echocardiography laboratory of a tertiary care center from January 2012 to December 2012 and identified patients with ischemic cardiomyopathy (n=16) and compared them to a control group (n=19); each group was defined by medical record review, electrocardiography and echocardiography. These patients underwent 3DSTE (Artida platform, Toshiba Medical Systems Corp., Tokyo, Japan). Apical and basal rotation were measured in degrees, and time to peak apical rotation and time to peak basal rotation were measured in milliseconds.

results: In comparison to controls, left ventricular ejection fraction was significantly lower in patients with ischemic cardiomyopathy (43.4% vs. 61.9%, p<0.0001). Time to peak basal rotation was more prolonged in ischemic cardiomyopathy patients than in controls (374.6 ± 106.9 vs. 345.2 ± 133.8, p=0.484). Similarly, time to peak apical rotation was prolonged in ischemic cardiomyopathy patients (414.3 ± 100.7 vs. 363.3 ± 93.4, p=0.130) but did not reach statistical significance. Apical rotation was significantly reduced in those with ischemic cardiomyopathy (0.33 ± 7.72 vs. 5.38 ± 6.51, p=0.044), whereas basal rotation was significantly increased compared with controls (0.46 ± 4.52 vs. -2.4 ± 3.96, p=0.057).

conclusion: This is the first study to demonstrate the phenomenon of compensatory basal hyperrotation in patients with ischemic cardiomyopathy. This study furthers our understanding of altered twist mechanics in these patients.