Patients with Ebstein's anomaly exhibited significantly higher left ventricular dyssynchrony compared to healthy controls, as measured by 4D-SDI (7.60% vs 2.54%, p<0.001).
Case-Control (n=62)
No
Does Ebstein's Anomaly cause left ventricular dyssynchrony, impaired torsion, and recoil mechanics compared to matched controls as assessed by CMR?
Ebstein's anomaly is associated with significant left ventricular intra-ventricular dyssynchrony quantifiable by CMR feature tracking, which correlates with heart failure severity.
Absolute Event Rate: 7.6% vs 2.54%
p-value: p=<0.001
BACKGROUND: Disease progression and heart failure development in Ebstein's Anomaly (EA) of the tricuspid valve is characterized by both right and left ventricular (LV) deterioration. The mechanisms underlying LV dysfunction and their role in heart failure development are incompletely understood. We hypothesized that LV dyssynchrony and impaired torsion and recoil mechanics induced by paradoxical movement of the basal septum may play a role in heart failure development. METHODS: 31 EA patients and 31 matched controls underwent prospective cardiovascular magnetic resonance (CMR). CMR feature tracking (CMR-FT) was performed on apical, midventricular and basal short-axis and 4D-volume analysis was performed using three long-axis views and a short axis cine stack employing dedicated software. Circumferential uniformity ratio estimates (CURE) time-to-peak-based circumferential systolic dyssynchrony index (C-SDI), 4D volume analysis derived SDI (4D-SDI), torsion (Tor) and systolic (sysTR) and diastolic torsion rate (diasTR) were calculated for the LV. QRS duration, brain natriuretic peptide, NYHA and Total R/L-Volume Index (R/L Index) were obtained. RESULTS: EA patients (31.5 years; controls 31.4 years) had significantly longer QRS duration (123.35 ms ± 26.36 vs. 97.33 ms ± 11.89 p 0.05) there was an association of torsion and recoil mechanics with dyssynchrony parameters CURE (sysTR r = -0.426; p = 0.017, diasTR r = 0.419; p = 0.019), 4D-SDI (sysTR r = 0.383; p = 0.044) and C-SDI (diasTR r = -0.364; p = 0.044). CONCLUSIONS: EA is characterized by LV intra-ventricular dyssynchrony, which is associated with heart failure and disease severity parameters. Markers of dyssynchrony can easily be quantified from CMR-FT, and may have a role in the assessment of altered cardiac function, carrying potential management implications for EA patients.
Steinmetz et al. (2016) conducted a case-control in Ebstein's Anomaly (n=62). Cardiovascular magnetic resonance (CMR) vs. Healthy controls was evaluated on Left ventricular dyssynchrony (4D-SDI) (p=<0.001). Patients with Ebstein's anomaly exhibited significantly higher left ventricular dyssynchrony compared to healthy controls, as measured by 4D-SDI (7.60% vs 2.54%, p<0.001).