Left ventricular torsion in paced patients

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BackgroundIn healthy people the left ventricle presents a counter-clockwise apical rotation and a clockwise basal rotation ending in late systole. In early systole (during isovolumic contraction) there is a fast and inverse rotation (counter-clockwise at the base and clockwise at the apex). This opposite rotation between apex and base produces the systolic torsion of the left ventricle. The effect of permanent conventional pacing on this torsion is little known.ObjectivesThe aim of this study was to assess, by speckle tracking echocardiography, left ventricular rotation and torsion in patients conventionally paced at the apex of the right ventricle.MethodsLeft ventricular apical and basal rotation and the consequent torsion were evaluated by means of speckle tracking echocardiography, in 13 paced patients, without ischemic or valvular disease, and in 17 healthy participants. Left ventricular dyssynchrony was evaluated by means of temporal uniformity of strain.ResultsIn the paced group there was a significant reduction in early-systolic clockwise torsion (−0.4° ± 1.2 vs. −1.5° ± 1.6; P = 0.04), and in late-systolic counter-clockwise torsion (15.1° ± 4.3 vs. 19.1° ± 5.5; P = 0.03). Circumferential temporal uniformity of strain averaged significantly lower in paced patients.ConclusionsConventional pacing from the apex of the right ventricle alters both the torsional mechanic and the synchrony of the left ventricle.

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