Abstract
Aims2D speckle tracking echocardiography allows for assessment of left ventricular (LV) torsional deformation as a composite function of the radial, longitudinal and circumferential fibres. We test the hypothesis that post-exercise LV torsional dynamics are more sensitive markers for myocardial dysfunction than resting measures, and better predictors for exercise capacity compared to post-exercise LV diastolic filling pressure (E/e’).MethodsWe studied 88 patients referred for stress echocardiogram. Treadmill exercise was performed using Bruce protocol, and echo images were acquired using GE Vivid 7. LV rotational dynamics were analysed by speckle tracking method using the GE ECHOPAC software. Tertiles were defined according to exercise capacity measured by the achieved metabolic equivalents (METS) adjusted for age and gender. Comparison was made between LV torsional dynamics and E/e’ to correlate with METS to predict exercise capacity.ResultsMean age of the study population was 58 years, 48% females. Patients with systolic dysfunction or evidence of ischaemia were excluded from the analysis. No significant correlation was found between METS and LV torsion measures at rest. There was statistically significant correlation between METS and post-exercise LV torsion (r=0.34, p=0.001), twist velocity increase (r=0.27, p=0.01), and incremental change in torsion (r=0.22, p<0.05). In addition, a correlation was also shown between post-exercise E/e’ and METS (r=-0.33, p=0.002).ConclusionPost-exercise LV torsional dynamics correlate with exercise capacity and may be a useful tool for assessing LV myocardial function in subjects with normal LVEF.
Highlights
Diagnosing and monitoring of left ventricular (LV) dysfunction can be a challenge at early stages of the myocardial disease before a reduction in the LV contractility measured using the conventional measures or blood pool information for ejection faction (EF). 2D speckle tracking is a newer technique that enables quantification of function of myocardial fibres at the local level taking account the rotational motion of the myocardium in different directions
We examined LV torsional dynamics pre- and post-exercise and compared to post-exercise E/e’ to test the hypothesis that post-exercise LV torsional dynamics are more sensitive markers for myocardial dysfunction than resting measures, and better predictors for exercise capacity and myocardial dysfunction compared to postexercise LV diastolic filling pressure (E/e’)
Exclusion criteria included a prior history of myocardial infarction or known coronary artery disease, ischaemic ECG changes or anginal symptoms during the test, induced or fixed wall motion abnormality on echocardiogram, systolic dysfunction defined as ejection fraction (EF) of less than 50%, significant valvular heart disease, conditions requiring electric pacemaker or defibrillator, atrial fibrillation (AF), inability to walk on treadmill, or history of significant respiratory disease
Summary
Diagnosing and monitoring of left ventricular (LV) dysfunction can be a challenge at early stages of the myocardial disease before a reduction in the LV contractility measured using the conventional measures or blood pool information for ejection faction (EF). 2D speckle tracking is a newer technique that enables quantification of function of myocardial fibres at the local level taking account the rotational motion of the myocardium in different directions. 2D speckle tracking is a newer technique that enables quantification of function of myocardial fibres at the local level taking account the rotational motion of the myocardium in different directions. It has been validated non-invasively against magnetic resonance imaging (MRI) tagging and invasively using sonomicrometry [1,2,3,4]. LV diastolic filling pressure (E/e’) estimated with Doppler echocardiography becomes elevated during exercise It has been well validated with cardiac catheterisation findings and been shown to predict exercise capacity [6]. Rapid untwisting during diastole causes a suction effect and contributes to the ventricular filling. We examined LV torsional dynamics pre- and post-exercise and compared to post-exercise E/e’ to test the hypothesis that post-exercise LV torsional dynamics are more sensitive markers for myocardial dysfunction than resting measures, and better predictors for exercise capacity and myocardial dysfunction compared to postexercise LV diastolic filling pressure (E/e’)
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