Correlation between Left Ventricular End Diastolic Pressure and Torsion Dynamics in Patients with Diastolic Dysfunction, Speckle Tracking Imaging Study

Abstract

Background: Invasive measuring of LV end diastolic pressure (LVEDP) provides reliable assessment of LV diastolic dysfunction, but its invasive nature limits its use in daily practice. Accurate noninvasive assessment of LV diastolic dysfunction is highly desirable, and the relationship between the degree of LVEDP and LV torsion dynamics assessed by 2D speckle tracking is not clearly assessed; here in our study we aimed to assess the relation between the degree of LVEDP and torsion dynamics of left ventricle. Methods: The study included sixty patients divided equally into 3 groups according to the degree of LVEDP, group I: 18 mmHg; complete conventional echo-Doppler study includes also annular septal E wave peak velocity, E/E’ ratio and 2D-speckle tracking including parameters of LV global longitudinal strain (GLS), peak and time to peak of twist ratio (TR & TT respectively), peak and time to peak of untwist ratio (UTR & UTT respectively). Results: There was significant progressive decrease in GLS with progressive increase in LVEDP from I to III. Untwist ratio increased in group II and decreased in significant degree in group III; Twist ratio did not differ with different grades of LVEDP. LA diameter and E/E’ increase from group I to III. The LVEDP is negatively correlated with the UTR and GLS is positively correlated with UTT, E/E & LA diameter. The E/E’ ratio is correlated negatively with the UTR, GLS and positively with LVEDP & UTT and LA diameter. Conclusions: Noninvasive assessment of LV torsion and untwisting was feasible in patients with various grades of LVEDP and diastolic dysfunction; the peak untwist ratio increased in mild degree of increased LVEDP then decreased again with more increase in LVEDP; LVEDP wasnegatively correlated with the peak untwist ratio and GLS was positively correlated with UTT and E/E’.