Increase in left ventricular torsion-to-shortening ratio in children with valvular aortic stenosis

Perfusion of left ventricular (LV) subendocardium in valvular aortic stenosis (AS) patients is impaired. It was expected that this may lead to a reduction of subendocardial fiber contraction and, consequently, to an increase of LV torsion per amount of ejection. Using MR tagging (MRT), it was investigated whether the torsionto-shortening ratio (TSR) is elevated in valvular AS patients. Six asymptomatic children with valvular AS were investigated using echo Doppler, ECG, exercise test, and MRT. LV torsion and natural strain of the inner diameter were determined from measured tag displacements in two short-axis slices of the LV. In all AS patients TSR was similar to40% increased (0.62 +/- 0.04 rad; mean +/-SD) as compared to pediatric (0.44 +/- 0.08 rad; n = 5) and adult controls (0.46 +/- 0.08 rad; n = 9), indicating subendocardial contractile dysfunction. With other techniques hitherto used this type of dysfunction could not be detected. (C) 2003 Wiley-Liss, Inc.