Left ventricular untwisting during left atrial contraction: A marker for chronic left ventricular diastolic dysfunction?

Abstract

Left ventricular (LV) untwisting is commonly seen during left atrial (LA) contraction. The purpose of this study was to test the hypothesis that this characteristic motion is associated with chronic LV diastolic dysfunction. Ninety-two patients with cardiovascular risk factors and 36 age-matched normal individuals were included in the present study, and were examined by echocardiography, including conventional, tissue Doppler, and two-dimensional speckle tracking methods, to clarify the predictors related to late diastolic untwisting rate (LDUTR). There was no significant difference in LV ejection fraction between patient and control groups. The ratio of peak early diastolic transmitral flow velocity to peak early diastolic mitral annular motion velocity (E/e') and LA volume index in the patient group were significantly greater compared to the ratio of peak early to late diastolic transmitral flow velocity (E/A) ≥1 group of the controls. The LDUTR in the E/A <1 group of the controls was significantly greater compared to the E/A ≥1 group of the controls and patient group. The LDUTR correlated with end-diastolic LV diameter, LA volume index, peak A velocity, E/e', relative LV wall thickness, and mean peak systolic LV radial strain. Multivariate regression analysis indicated that LA volume index is defined as a strong predictor related to LDUTR. Late diastolic LV untwisting reduces with a gradual increase in the LA size in patients with cardiovascular risk factors, and may reflect the disease history of chronic LV diastolic dysfunction.