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AJR 2002; 178:953-958
© American Roentgen Ray Society

Cardiac Systolic Rotation and Contraction Before and After Valve Replacement for Aortic Stenosis

A Myocardial Tagging Study Using MR Imaging

Joern J. W. Sandstede1, Thorsten Johnson1, Kerstin Harre2, Meinrad Beer1, Siegfried Hofmann1, Thomas Pabst1, Werner Kenn1, Wolfram Voelker2, Stefan Neubauer1,2 and Dietbert Hahn1

1 Institut für Röntgendiagnostik & Medizinische Klinik, Universität Würzburg, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany.
2 Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, United Kingdom.

OBJECTIVE. Aortic stenosis leads to the derangement of cardiac function and contraction mode because of chronic pressure overload that is relieved after surgical valve replacement. The purpose of this study was to determine the changes in left ventricular systolic rotation and contraction using MR tagging in patients with aortic stenosis before and after surgical valve replacement compared with age-matched healthy volunteers.

MATERIALS AND METHODS. Twelve patients with aortic stenosis were examined with an electrocardiographically triggered two-dimensional tagging sequence at 1.5 T before and 12 months after surgical valve replacement for the evaluation of wall function of the apical, mid ventricular, and basal levels. Eight healthy volunteers in the same age group served as the control group.

RESULTS. Before surgery, all patients showed a significant increase of apical rotation (22.2° ± 5.9° vs 10.3° ± 2.5°, p < 0.0001) and overall left ventricular torsion (25.1° ± 6.6° vs 14.5° ± 3.7°, p < 0.001); basal rotation was not significantly different (-2.9° ± 2.1° vs -4.2° ± 1.9°, p = not significant) compared with the volunteer group. Apical rotation and torsion were negatively correlated with left ventricular mass (r = -0.73, p < 0.01, and r = -0.61, p < 0.05, respectively) and end-diastolic volume (r = -0.73, p < 0.01 and r = -0.64, p < 0.03, respectively). One year after surgery, basal rotation was reduced in the patients with aortic stenosis compared with the patients in the control group (-1.9° ± 1.8°, p < 0.01). In comparison with preoperative values, apical rotation (14.2° ± 3.6°, p < 0.01) also decreased but was still elevated, and this resulted in a normalization of left ventricular torsion (16.1° ± 3.7°, p < 0.01).

CONCLUSION. Surgical valve replacement for aortic stenosis leads to normalization of the left ventricular torsion 1 year after surgery. Pressure overload before surgery is associated with an increase of systolic left ventricular wringing motion, possibly serving as a compensatory mechanism. This mechanism declines with increasing left ventricular hypertrophy and dilatation.


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