Heart rotation angle as an assessment criterion of the contractile function of the myocardium for cardiac surgery patients

Introduction. Chronic heart failure (CHF) is one of the most severe and prognostically unfavorable complications of cardiovascular diseases. Modern pharmacological treatment improves prognosis, but loses its efficiency at a certain stage. Hence the key role is given to surgical methods of CHF treatment, which determine the further prognosis and patient’s quality of life. The main indication for CHF patients’ surgical treatment is the clinical picture of progressing heart failure. In this regard, assessment of myocardial contractility based on mathematical analysis of cardiac mechanics parameters during cardiac cycle using angiographic images of coronary arteries may become a decisive moment for choosing further tactics of diagnosis and treatment of this pathology. Materials and Methods. A retrospective study included 120 patients aged 30 to 71 years to assess the indexes of cardiac rotation mechanics. The patients were divided into four groups: 1) patients with dilated cardiomyopathy (DCMP, n = 30); 2) patients with left ventricular aneurysm (LVA, n = 30); 3) patients who underwent cardiac surgery (heart valve replacement, (n = 30); 4) patients without structural and functional heart disease (control group, n = 30). Heart rotation mechanics was studied using our developed method of mathematical calculation of cardiac rotation angle according to coronary angiography (CAG) data. Results. In cardiac surgery patients with DCMP and LVA, heart rotation angle is statistically significantly lower than in patients without structural and functional changes of the heart (p<0.001). A strong direct correlation was revealed between the heart rotation angle and LV EF (r = 0.8, p<0.001). When comparing the parameters of heart rotation angle in patients with DCMP and LVA with each other, no statistically significant differences (p = 0.59). Patients with prosthetic heart valves, with normal values of LV EF (64 [51; 66.8]), revealed low values of heart rotation angle (5.09 [2.7; 8.7]), which was statistically significantly lower than in control group patients (p<0.001). Insignificant inverse correlation (r = -0.29) was found between the heart rotation angle and LV EF, not reaching statistical significance level (p = 0.12). Conclusion. A new technique to assess the mechanics of cardiac rotational motion based on mathematical calculations of the cardiac rotation angle according to coronary angiography makes it possible to determine the presence or absence of myocardial contractility abnormalities in cardiac surgery patients depending on the results obtained. Heart rotation angle calculated during CAG can serve as a predictor of early diagnosis of impaired contractile function of the myocardium in patients urgently admitted to cardiology centers with presentation of ACS, which will accelerate the determination of further tactics of pre-treatment and treatment. In patients with prosthetic heart valves, the index of cardiac rotation angle will enable to assess the recovery of contractile function of the myocardium in the postoperative period.