Impaired systolic torsion in dilated cardiomyopathy: Reversal of apical rotation at mid-systole characterized with magnetic resonance tagging method

Left ventricular (LV) torsion plays an important role in squeezing the blood out of the heart. To characterize the systolic torsion in LV dysfunction, we studied using magnetic resonance imaging myocardial tagging method in 26 subjects: 17 patients with dilated cardiomyopathy (DCM, LV ejection fraction [EF], 27 +/- 8%) and 9 healthy control subjects. Grid-tagged LV short-axis cine images were acquired at base, mid and apex levels. Tag-intersections were tracked during the systole, thereby determining rotation angle (positive indicated clockwise from the apex). Peak torsion was defined as the maximum difference in rotation angle between the base and apex. Time to peak torsion was expressed as % systole by dividing the time by a total systolic time. Amplitude of the rotation at peak was less in DCM than in controls at both the base (0.1 +/- 2.9 vs. 2.6 +/- 1.6 degrees, P < 0.05) and apex (-5.9 +/- 5.3 vs. -11.2 +/- 2.5 degrees, P < 0.01). Amplitude of peak torsion was then less in DCM than in controls (6.1 +/- 3.4 vs. 13.6 +/- 2.5 degrees, P < 0.001), and the timing of peak was earlier (66 +/- 22 vs. 104 +/- 16% systole, P < 0.001). The amplitude of peak torsion was correlated with LVEF (r=0.74, P < 0.001). In conclusion, amplitude of systolic torsion was impaired in proportion to LV function. Systolic torsion in LV dysfunction was characterized by the discontinuing counter-rotation of the apex to the base before end-systole.