Cardiac rotation and relaxation in patients with aortic valve stenosis

Background Diastolic dysfunction with delayed relaxation and abnormal passive elastic properties has been described in patients with severe pressure overload hypertrophy. The purpose of this study was to evaluate the time course of rotational motion of the left ventricle in patients with aortic valve stenosis using myocardial tagging. Methods Myocardial tagging is a non-invasive method based on magnetic resonance which makes it possible to label (‘tag') specific myocardial regions. From the motion of the tag's cardiac rotation, radial displacement and translational motion can be determined. In 12 controls and 13 patients with severe aortic valve stenosis systolic and diastolic wall motion was assessed in an apical and basal short axis plane. Results The normal left ventricle performs a systolic wringing motion around the ventricular long axis with clockwise rotation at the base (−4·4±1·6°) and counterclockwise rotation at the apex (+6·8±2·5°) when viewed from the apex. During early diastole an untwisting motion can be observed which precedes diastolic filling. In patients with aortic valve stenosis systolic rotation is reduced at the base (−2·4±2·0°;P