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Apical transverse motion is associated with speckle-tracking radial dyssynchrony in patients with non-ischemic dilated cardiomyopathy [Anatol J Cardiol]
Anatol J Cardiol. 2015; 15(8): 620-625 | DOI: 10.5152/akd.2014.5607  

Apical transverse motion is associated with speckle-tracking radial dyssynchrony in patients with non-ischemic dilated cardiomyopathy

Emre Gürel1, Kürşat Tigen2, Tansu Karaahmet3, Cihan Dündar4, Ahmet Güler5, Yelda Başaran2
1Department of Cardiology, Ordu State Hospital; Ordu-Turkey
2Department of Cardiology, Faculty of Medicine, Marmara University Hospital; İstanbul-Turkey
3Department of Cardiology, Faculty of Medicine, Acıbadem University; İstanbul-Turkey
4Department of Cardiology, Samsun Atasam Hospital; Samsun-Turkey
5Department of Cardiology, Kartal Koşuyolu Heart and Research Hospital; İstanbul-Turkey

Objective: Apical transverse motion (ATM) is a new parameter for assessing left ventricular (LV) dyssynchrony. Speckle-tracking radial strain analysis seems to be the best method to identify potential responders to cardiac resynchronization therapy. The aim of our study was to investigate the association between ATM and radial dyssynchrony assessed by speckle-tracking echocardiography in patients with non-ischemic dilated cardiomyopathy (NDC). Methods: We examined 35 NDC patients (mean age 49.2±28.1 years; 21 males). Cardiac dimension and ejection fraction (EF) were measured. Speckle-tracking analysis was performed on two-dimensional greyscale images in the mid-LV short axis view and apical views to calculate global radial, circumferential, and longitudinal strain (GRS, GCS, GLS), as well as rotational indexes (LV twist and torsion). Radial dyssynchrony was defined as a difference in time to peak systolic radial strain between the anteroseptal and posterior segments with a cut-off value of 130 ms. ATM was estimated using motion traces of 2 opposite apical segments. Results: Radial dyssynchrony was significantly correlated with ATMloop (r=0.78, p<0.001), ATM4CV (r=0.71, p=0.001), ATM3CV (r=0.67, p=0.003), GRS (r=-0.51, p=0.04), GCS (r=-0.55, p=0.03), LV twist (r=-0.58, p=0.02), and LV torsion (r=-0.56, p=0.03). The receiver operating characteristics analysis for ATMloop to distinguish between patients with and without radial dyssynchrony revealed an area under the curve value of 0.88 (CI: 0.73-1.04, p=0.005). The best cut-off value was 2.5 mm for ATMloop (85% sensitivity and 86% specificity). Conclusion: Apical transverse motion is closely associated with radial dyssynchrony assessed by speckle-tracking echocardiography. Quantitative measure of apical rocking has the potential for clinical applications.

Keywords: speckle tracking, tissue Doppler, dyssynchrony


Noniskemik dilate kardiyomiyopatili hastalarda apikal transvers hareket, benek-takibi radiyal dissenkroni ile ilişkilidir

Emre Gürel1, Kürşat Tigen2, Tansu Karaahmet3, Cihan Dündar4, Ahmet Güler5, Yelda Başaran2
1Department of Cardiology, Ordu State Hospital; Ordu-Turkey
2Department of Cardiology, Faculty of Medicine, Marmara University Hospital; İstanbul-Turkey
3Department of Cardiology, Faculty of Medicine, Acıbadem University; İstanbul-Turkey
4Department of Cardiology, Samsun Atasam Hospital; Samsun-Turkey
5Department of Cardiology, Kartal Koşuyolu Heart and Research Hospital; İstanbul-Turkey

Amaç: Apikal transvers hareket (ATH) sol ventrikül (SV) dissenkronisini değerlendirmede yeni bir parametredir. Benek-takibi radiyal strain analizi, kardiyak resenkronizasyon tedavisine yanıt verme potansiyeli olanları tanımlamada en iyi yöntem olarak gözükmektedir. Çalışmamızın amacı, noniskemik dilate kardiyomiyopatili (NDK) hastalarda ATH ve benek-takibi ekokardiyografi ile değerlendirilmiş radiyal dissenkroni arasındaki ilişkinin araştırılmasıdır. Yöntemler: Otuz beş NDK’li hastayı inceledik (ortalama yaş 49,2±28,1 yıl; 21 erkek). Kardiyak çaplar ve ejeksiyon fraksiyonu (EF) ölçüldü. Rotasyon indekslerinin yanı sıra (SV twist ve torsiyon), global radiyal, sirkumferensiyal ve longitüdinal straini (GRS, GSS, GLS) hesaplamak için, benek-takibi analizi orta-SV kısa aks görüntüsü ve apikal görüntülere uygulandı. Radiyal dissenkroni, 130 ms cut-off değerine göre, anteroseptal ve posteriyor segmentler arasında, tepe sistolik radiyal strain zamanlamasındaki farklılık olarak tanımlandı. ATH, karşılıklı 2 apikal segmentin hareket trasesi kullanılarak hesaplandı. Bulgular: Radiyal dissenkroni; ATHloop (r=0,78, p<0,001), ATH4CV (r=0,71, p=0,001), ATH3CV (r=0,67, p=0,003), GRS (r=-0,51, p=0,04), GSS (r=-0,55, p=0,03), SV twist (r=-0,58, p=0,02) ve SV torsion (r=-0,56, p=0,03) ile anlamlı olarak koreleydi. ATHloop için, radiyal dissenkronisi olan ve olmayan hastaları ayırt etmek üzere uygulanan ROC analizi, eğri altında kalan alanın 0,88 olduğunu gösterdi (CI: 0,73-1,04, p=0,005). ATHloop için en iyi cut-off değeri 2,5 mm idi (%85 duyarlılık, %86 özgüllük). Sonuç: Apikal transverse hareket, benek-takibi ekokardiyografi ile değerlendirilmiş radiyal dissenkroni ile yakından ilişkilidir. Apikal çalkalanmanın sayısal ölçümü klinik uygulamalar için potansiyele sahiptir.

Anahtar Kelimeler: benek takibi, doku Doppler, dissenkroni


Emre Gürel, Kürşat Tigen, Tansu Karaahmet, Cihan Dündar, Ahmet Güler, Yelda Başaran. Apical transverse motion is associated with speckle-tracking radial dyssynchrony in patients with non-ischemic dilated cardiomyopathy. Anatol J Cardiol. 2015; 15(8): 620-625


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