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Congenital Heart Disease (ASD, PDA, PFO, VSD)
The Angle of the Heart Rotation in Normal and Pathological Contexts; Its Assessment During Coronary Angiography
Liliia Zulfatovna Usmanova1, Alexander Grigoryevich Osiev2, Irina Evgenievna Nikolaeva1, Igor V. Buzaev1, Lev Khadyevich Yuldybaev3
Republican Centre of Cardiovascular Diseases, Russian Federation1, MEDSI Clinical and Diagnostic Centre, Russian Federation2, Ufa State Oil Technical University, Russian Federation3
For the last three centuries, mechanical heart performance has remained one of the most enigmatic phenomena for the physiologists and clinicians studying this organ. R. Lower described the unique motion of the left ventricle (LV) twisting back in 1669. The British doctors, William Harvey (1578-1657) and Richard Lower (1631-1691) were first to describe the LV motion as ¡°... the wringing of a linen cloth to squeeze out the water¡±, and the physiological significance of this is increasingly recognized only nowadays. Experimental and clinical research on the left ventricle twisting involved the use of multiple methods such as implanted radiopaque markers, bipolar film-screen angiography, sonometry, optical instruments, gyro sensors, magnetic resonance imaging, and echocardiography. Furthermore, the increasing interest in quantitative evaluation of the LV bend under clinical conditions resulted in the development of innovative methods, which can easily identify LV bend in the patient¡¯s presence by ultrasound heart images in shades of gray. The growing data volume argues for the potential of LV rotation and twisting evaluation under clinical conditions [Takeuchi M., et al. 2006; Popescu B.A., et al.,2009; Mondillo S., et al., 2011; Victor Mor-Avi et al., 2015; Pavlyukova E.N. 2015].
The study includes 90 patients, aged from 30 to 71, for the parameters¡¯ evaluation of heart rotation mechanics. The subjects were divided into groups with dilated cardiomyopathy (DCM, n=30), left ventricular aneurysm (LVA, n=30), and patients with autonomic nervous system disorder (ANSD, n = 30) without heart failure (control group). The mechanics of heart rotation were studied using our method for early heart failure diagnosis. The method involves angiographic examination of coronary vessels and is distinguished by performing the coronary angiography in two projections. In the obtained images the following dot coordinates in systole and diastole are selected: 1) the coordinates of relatively fixed dots on the heart and on oblique projections; 2) the coordinates of the dots on the heart apex and on oblique projections; 3) the coordinates of the dots on the heart vessel at the initial and final moments (t1 and t2) on oblique projections. Then a heart rotation angle ϕ is calculated as the angle between two vectors, each of the vectors corresponding to the distance from B1 to O1A1 and the distance from B2 to O2A2, respectively.
The study revealed that statistically the DCM and LVA patients with chronic heart failure have a significantly lower heart rotation angle than the ANSD patients without heart diseases (p<0.05). The statistical comparison of the DCM and LVA groups displayed no significant differences in the rotation angle values (P=0.42). The normal values of heart rotation parameters were established: if =10.1¡¾1.9¡Æ (control norm in the range: 8.2¡Æ-12.0¡Æ), then myocardial dysfunction absence is determined; if <8.2¡Æ, then the presence of myocardial dysfunction is determined.
An evaluation technique of the heart rotational movement mechanics, based on mathematical calculations of the rotation angle by the dots movement on the heart surface, determined on the coronary angiogram in two projections, was developed. The left ventricle rotation angle, measured by our formula, decreases for patients with dilated cardiomyopathy and for patients with left ventricle aneurysm. Calculations of the left ventricle rotation angle changes can be potentially applied as an additional diagnostic criterion to determine the presence or absence of myocardium contractile dysfunction and to monitor the disease progression.
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