Effects of Cardiac Resynchronization Therapy on Left Ventricular Twist
Matteo Bertini, MD*, ,
Nina Ajmone Marsan, MD*,
Victoria Delgado, MD*,
Rutger J. van Bommel, MD*,
Gaetano Nucifora, MD*,
C. Jan Willem Borleffs, MD*,
Giuseppe Boriani, MD, PhD,
Mauro Biffi, MD,
Eduard R. Holman, MD, PhD*,
Ernst E. van der Wall, MD, PhD*, ,
Martin J. Schalij, MD, PhD* and
Jeroen J. Bax, MD, PhD*,*
* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Cardiology, University of Bologna, Bologna, Italy
Department of Cardiology, Interuniversity Cardiology Institute of the Netherlands Utrecht, Utrecht, the Netherlands
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Figure 1 Assessment of LV Twist
Examples of left ventricular (LV) twist in a normal control patient (A) and in a heart failure patient (B). The top 2 panels in A and B represent apical and basal rotations and the bottom panels represent LV twist calculation after exporting the data to a spreadsheet program (Excel 2003, Microsoft Corp., Redmond, Washington). AVC = aortic valve closure; AVO = aortic valve opening.
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Figure 2 LV Twist and LV Systolic Function
(A) Correlation between baseline peak left ventricular (LV) twist and left ventricular ejection fraction (LVEF) in heart failure (HF) patients (ischemic: open circles, and nonischemic: solid circles). (B) Correlation between  peak LV twist and LVEF immediately after cardiac resynchronization therapy in HF patients (ischemic: open circles, and nonischemic: solid circles).
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Figure 3 LV Twist in Responders and Nonresponders
Peak left ventricular (LV) twist in responders and nonresponders at baseline, immediately after cardiac resynchronization therapy (CRT), and at 6-month follow-up. ANOVA = analysis of variance.
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Figure 4 LV Twist and LVEF in Relation to LV Lead Position
(A) Peak LV twist at baseline and 6-month follow-up in patients with basal, midventricular, and apical LV lead position. Significant improvement was observed in patients with an apical or midventricular LV lead position but not in patients with basal LV lead position. (B) LVEF at baseline and 6-month follow-up in patients with basal, midventricular, and apical LV lead position. Significant improvement was observed in patients with an apical or midventricular LV lead position but not in patients with basal LV lead position. Abbreviations as in Figure 2.
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Figure 5 Example of a CRT Responder With LV Lead in an Apical Position
(A) Peak LV twist improved from 3.9° at baseline to 9.7° immediately after cardiac resynchronization therapy (CRT) implantation. Peak LV twist further improved at 6-month follow-up (peak LV twist 10.9°). (B) Biplane fluoroscopy: the left anterior oblique (LAO) view shows the LV lead in a posterolateral cardiac vein; in the postero-anterior (PA) view, the distance between the coronary sinus/mitral plane and the cardiac apex was divided (dotted lines) into 3 parts (basal, midventricular, and apical). LVEF = left ventricular ejection fraction; other abbreviations as in Figure 1.
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