Left ventricular remodelling and torsional dynamics in dilated cardiomyopathy: reversed apical rotation as a marker of disease severity

Aims Decreased left ventricular (LV) rotation and torsion and even reversed systolic apical rotation have been described in patients with dilated cardiomyopathy (DCM). We sought to test in patients with DCM whether reversed apical rotation with loss of LV torsion is related to the extent of LV remodelling and to the severity of LV dysfunction. Methods and results Fifty consecutive patients with DCM (aged 49 +/- 13 years) were enrolled prospectively. Forty-seven healthy volunteers served as controls. All subjects underwent clinical examination, 12-lead electrocardiography, and a comprehensive echocardiogram. Basal and apical LV rotation and LV torsion were quantified by speckle tracking echocardiography. Left ventricular systolic rotation and torsion were reduced in patients, compared with controls (P < 0.001). Normally directed (counterclockwise) apical rotation was found in 24 patients (group 1), whereas 26 had reversed (clockwise) apical rotation (group 2). Patients in group 2 had larger LV volume, increased LV sphericity (P <= 0.02), more severe systolic dysfunction (ejection fraction 26 +/- 7 vs. 33 +/- 12%), and higher fitting pressures (E/E' ratio 19 +/- 10 vs. 14 +/- 6; P < 0.05). The main correlates of LV apical rotation were LV volume, sphericity index, and QRS duration. Conclusion Reversed apical rotation and loss of LV torsion in patients with DCM is associated with significant LV remodelling, increased electrical dyssynchrony, reduced systolic function, and increased filling pressures, indicating a more advanced disease stage.