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J Thorac Cardiovasc Surg 2007;134:888-896
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Left ventricular torsional mechanics after left ventricular reconstruction surgery for ischemic cardiomyopathy

Randolph M. Setser, DSca,*, Nicholas G. Smedira, MDb, Michael L. Lieber, MSc, Eric D. Saboa, Richard D. White, MDa,b,*

a Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio
b Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
c Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.

Received for publication January 24, 2007; revisions received April 17, 2007; accepted for publication May 11, 2007.

* Address for reprints: Randolph M. Setser, DSc, Division of Radiology, Desk Hb6, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195. (Email: setserr{at}ccf.org).

Objectives: Surgical left ventricular reconstruction improves symptoms and potentially prognosis in patients with ischemic cardiomyopathy; however, the effects of reconstruction on myocardial mechanics are not well defined. Therefore, we have computed left ventricular rotation and torsion in patients undergoing left ventricular reconstruction to determine its effects on these quantitative measures of myocardial mechanics.

Methods: Magnetic resonance imaging with tissue grid-tagging was performed in 26 patients (19 male/7 female, 62 ± 11 years) (mean ± standard deviation) before (23 ± 29 days) and after (231 ± 106 days) left ventricular reconstruction, as well as in 7 healthy volunteers (5 male/2 female, 34 ± 7 years). Left ventricular rotation was computed at basal and apical short-axis levels; torsion was defined as the difference between apical and basal rotation.

Results: Before left ventricular reconstruction, maximal apical rotation was significantly impaired relative to that of healthy volunteers (P = .001), although maximal basal rotation was preserved (P = .84). After reconstruction, maximal torsion did not change significantly: torsion was 6° ± 3° both before and after reconstruction (P = .84). However, the rate of early diastolic untwist improved significantly after reconstruction (–18°/s ± 13°/s vs –23°/s ± 14°/s; P = .04). Furthermore, patients with relatively worse torsion before reconstruction demonstrated more improved function after reconstruction; patients with torsion of less than 6° (n = 12) showed greater improvement in ejection fraction (15% vs 6%; P = .005), torsion (1° vs –1°; P = .01), and diastolic untwist (–9°/s vs –25°/s; P < .001) than did patients with torsion of 6° or more (n = 14).

Conclusions: Torsional mechanics were severely impaired by ischemic cardiomyopathy. On average, left ventricular reconstruction did not affect systolic torsion generation significantly; however, patients with relatively worse torsion did show improvement. Furthermore, the rate of untwist improved after surgery, suggesting that diastolic function was improved.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; EDV = end-diastolic volume; EF = ejection fraction; FOV = field of view; ICM = ischemic cardiomyopathy; LV = left ventricle(ular); LVR = left ventricular reconstruction; MRI = magnetic resonance imaging; MVR = mitral valve replacement/repair; SV = stroke volume; TE = echo time; TR = repetition time






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