Left Ventricular Twist Research Articles

Ventricular twist in isolated left ventricular noncompaction

The study aimed at assessing the rotational motion of the left ventricle around the long axis in patients affected by isolated left ventricular noncompaction (LVNC) and comparing their results with those of healthy volunteers. Patients and methodsThe study comprised eight patients with LVNC confirmed by echocardiography and magnetic resonance imaging (mean age 41±19 years; four males; left ventricular ejection fraction [LVEF] 45±25%). The patients were divided into Group A with an LVEF above 50% (four patients; one male) and Group B with an LVEF below 50% (four patients; three males). For both groups, age- and sex-matched volunteers were found. The focus was on myocardial twist, rotation of the LV apex and base, times to reach maximal apical and maximal basal rotation and myocardial twist, as well as correlations between systolic function, rotation of individual planes and LV twist. ResultsWhen comparing LVNC patients with healthy volunteers, there were statistically significantly decreased systolic function (p=0.004), larger diastolic dimension (p=0.045) and decreased apical rotation (p=0.01). Left ventricular twist was significantly decreased in the group of patients with LVNC and systolic dysfunction (p=0.04). A statistically significant correlation was found between systolic function and LV apical rotation. ConclusionThe study showed a significant decrease in apical rotation and twist mechanism of the LV as measured using two-dimensional speckle tracking in patients with LVNC and decreased LV systolic function. Measuring these parameters could contribute to more accurate diagnosis and risk stratification of patients affected by this condition.

Relationship between Left Ventricular Twist and Circulating Biomarkers of Collagen Turnover in Hypertensive Patients with Heart Failure

Left ventricular (LV) twist may be a compensatory mechanism to preserve ejection fraction (EF). In patients with hypertension, twist varies depending on the left ventricle's degree of remodeling and systolic function; it is increased in those with hypertension with normal EF (HTNEF) and diminished in those with hypertension with low EF (HTLEF). The ratio of collagen-degradation biomarkers in patients with hypertension is higher in those with low EFs than those with preserved EFs and may contribute to remodeling and systolic dysfunction. The aim of this study was to evaluate the relationship between these biomarkers and LV twist in 82 patients with hypertension, 41 with EFs < 50% (HTLEF group) and 41 with EFs ≥ 50% (HTNEF group). Net LV twist was measured using speckle-tracking echocardiography. Markers of collagen turnover, including serum concentrations of matrix metalloproteinase-1 (MMP1), tissue inhibitor of MMP1 (TIMP1), and the ratio of MMP1 to TIMP1, were measured. Log TIMP1, log MMP1, and log MMP1/TIMP1 ratio levels were higher in the HTLEF group than the HTNEF group (12.3 ± 0.3 vs 11.8 ± 0.1 [P < .0001], 9.1 ± 0.3 vs 8.0 ± 0.2 [P < .0001], and -3.3 ± 0.3 vs -3.8 ± 0.2 [P < .0001], respectively). Net LV twist was lower in the HTLEF group than the HTNEF group (3.3 ± 1.1 vs 11.7 ± 0.7, P < .0001). An inverse correlation existed between log MMP1/TIMP1 and net LV twist after adjusting for age, EF, duration of heart failure, systolic blood pressure, LV mass index, and LV sphericity index at end-diastole (r= -0.43, P < .0001). This inverse correlation between twist and loss of myocardial collagen scaffolding in patients with hypertension with heart failure suggests that the integrity of the extracellular matrix may play an important role in preserving myocardial deformation.

High-normal blood pressure, functional capacity and left heart mechanics: Is there any connection?

Objective. To evaluate the relationship between functional capacity and left ventricular (LV) and left atrial (LA) myocardial deformation, assessed by two- and three-dimensional (2DE and 3DE) strain analysis, in subjects with high-normal blood pressure (BP). Methods. This cross-sectional study included 64 subjects with optimal BP and 75 subjects with high-normal BP of similar gender and age. All the subjects underwent a complete 2DE and 3DE examination and cardiopulmonary exercise testing. Results. 3DE global longitudinal strain was significantly lower in the group with high-normal BP than in the optimal BP group (− 20.1 ± 2.4 vs − 18.5 ± 2.3%, p < 0.001). Similar results were obtained for 3DE global circumferential strain (− 21.8 ± 2.6 vs − 19.3 ± 2.4%, p < 0.001), as well as for 3DE global radial strain (45.1 ± 8.8 vs 42.3 ± 7.2%, p = 0.042), and 3DE global area strain (− 30.1 ± 4.2 vs − 28.1 ± 3.8%, p < 0.001). LV twist was similar between the observed groups, whereas untwisting rate was significantly decreased in the subjects with high-normal BP (− 123 ± 30 vs − 112 ± 26°/s, p = 0.023). Peak VO2 was significantly lower in the high-normal BP group (30.8 ± 4 vs 28.3 ± 3.7 ml/kg/min, p < 0.001). 2DE LV ejection fraction (β = 0.38, p = 0.014), 2DE global longitudinal strain (β = 0.35, p = 0.019) and 3DE global longitudinal strain (β = 0.27, p = 0.042) were independently associated with peak VO2. Conclusion. LV and LA mechanics, as well as functional capacity are significantly impaired in the subjects with high-normal BP. LV and LA myocardial deformations are associated with peak oxygen uptake.

119 Cardiovascular Magnetic Resonance Evaluation of Change in Myocardial Strain following Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR)

BackgroundTAVI is the treatment of choice for patients with severe symptomatic aortic stenosis (AS) who are at high surgical risk. AS results in changes in myocardial strain and twist. Myocardial...

Andersen-Tawil syndrome (LQT7) is associated with alterations in left ventricular rotational mechanics

E-mail: nemes.attila@med.u-szeged.hu The goal: Andersen-Tawil syndrome (ATS), also called Andersen Syndrome and Long QT Syndrome 7 (LQT7) is a rare condition. ATS is characterized by episodic flaccid muscle weakness, distinctive dysmorphic features, ventricular arrhythmias and prolonged QT interval in the presence of normal conventional left ventricular (LV) structural and functional parameters. In the normal heart, the LV base rotates clockwise, while the apex rotates counterclockwise during systole, producing a towel-wringing motion of the heart. The difference between the LV base and LV apex is called net twist angle. The present study was designed to assess LV rotational mechanics in ATS by three-dimensional speckle-tracking echocardiography (3DSTE). Patients and Methods: The study comprised 6 patients with ATS, their results were compared to 20 healthy volunteers. Complete two-dimensional Doppler echocardiography and 3DSTE were performed in all cases. 3DSTE was used to measure apical and basal LV rotations and LV twist. Results: During 3DSTE, apical LV rotation proved to be 8.43 ± 1.54 degree, while basal LV rotation was -2.31 ± 1.31 degree, therefore LV twist was 11.12 ± 5.32 degree in healthy subjects. In 3 out of 6 ATS patients, LV basal and LV apical rotation were in the same direction resulting in the near absence of LV twist showing „rigid body rotation”. In the remaining 3 ATS patients, LV apical rotation (2.06 ± 1.30 degree, p <0.05) together with LV twist (6.51 ± 1.28 degree, p <0.05) were significantly decreased as compared to controls. Mean basal rotation showed no significant difference compared to the values of controls (-4.45 ± 1.87 degree, p =NS). Conclusions: Significant alterations in LV rotational mechanics could be demonstrated in ATS by 3DSTE.

Echocardiographic Assessment of Left Ventricular Twisting and Untwisting Rate in Normal Subjects by Tissue Doppler and Velocity Vector Imaging: Comparison of Two Methods

Echocardiographic Assessment of Left Ventricular Twisting and Untwisting Rate in Normal Subjects by Tissue Doppler and Velocity Vector Imaging: Comparison of Two Methods

Echocardiographic Assessment of Left Ventricular Twisting and Untwisting Rate in Normal Subjects by Tissue Doppler and Velocity Vector Imaging: Comparison of Two Methods

I have read Echocardiographic Assessment of Left Ventricular Twisting and Untwisting Rate in Normal Subjects by Tissue Doppler and Velocity Vector Imaging: Comparison of Two Methods with great interest and congratulate the authors on their comprehensive and very balanced overview of recent studies on the left ventricular (LV) deformation analysis (1). However, there are three incorrect aspects that in my opinion needs clarification. Frist, the authors calculated the LV rotation by integrating the rotational velocity, determined from the DTI velocities of the septal and lateral regions, and correcting [R (t)] for the LV radius over time. R (t) is incorrect in Equation 1; it should be improved to:

Evaluation of left ventricular rotation and twist by speckle tracking echocardiography in heart transplant recipients

Objective To evaluate the left ventricular rotation and twist in the cardiac allograft by speckle tracking echocardiography.Methods Twenty-six heart transplant recipients underwent echocardiographic studies at 1st,3rd,6th and 12th month after heart transplantation.Twenty-six healthy subjects served as controls.Parasternal basal and apical short-axis images of left ventricle were recorded and then were analyzed using EchoPAC software.The curves of basal and apical rotation and left ventricular twist were obtained,Peak values of basal and apical rotation and left ventricular twist were measured and then statistically analyzed.Results There were no significant differences in left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) between heart transplant recipients and controls (P ＞0.05).The left ventricular twist,apical rotation were significantly lower in heart transplant recipients at 1 st,3rd,6th and 12th month after surgery than those in controls (P ＜0.05) ;while basal rotation in heart transplant recipients had no significant difference when compared with controls (P ＞0.05).The left ventricular twist,apical and basal rotation in heart transplant recipients among 1 st,3rd,6th and 12th month after surgery had no significant difference (P ＞ 0.05).Conclusions Although the LVEF and LVFS of cardiac allograft seemed normal,the left ventricular twist,apical rotation were still significantly lower in heart transplant recipients than those in controls.Speckle tracking echocardiography can be used for accurate assessment of left ventricular twist in heart transplant recipients. Key words: Echocardiography; Heart transplantation; Ventricular function, left; Speckle tracking imaging

Associations between N-terminal pro-B-type natriuretic peptide and cardiac function in adults with corrected tetralogy of Fallot

BackgroundAmino-terminal B-type natriuretic peptide (NT-proBNP) may detect early cardiac dysfunction in adults with tetralogy of Fallot (ToF) late after corrective surgery. We aimed to determine the value of NT-proBNP in adults with ToF and establish its relationship with echocardiography and exercise capacity. Methods and resultsNT-proBNP measurement, electrocardiography and detailed 2D-echocardiography were performed on the same day in 177 consecutive adults with ToF (mean age 34.6±11.8years, 58% male, 89% NYHA I, 29.3±8.5years after surgical correction). Thirty-eight percent of the patients also underwent a cardiopulmonary-exercise test. Median NT-proBNP was 16 [IQR 6.7–33.6] pmol/L, and was elevated in 55%. NT-proBNP correlated with right ventricular (RV) dilatation (r=0.271, p<0.001) and RV systolic dysfunction (r=−0.195, p=0.022), but more strongly with LV systolic dysfunction (r=−0.367, p<0.001), which was present in 69 patients (39%). Moderate or severe pulmonary regurgitation was not associated with higher NT-proBNP. Tricuspid and pulmonary regurgitation peak velocities correlated with NT-proBNP (r=0.305, p<0.001 and r=0.186, p=0.045, respectively). LV twist was measured with speckle-tracking echocardiography in 71 patients. An abnormal LV twist (20 patients, 28%) was associated with elevated NT-proBNP (p=0.030). No relationship between NT-proBNP and exercise capacity was found. ConclusionsNT-proBNP levels are elevated in more than 50% of adults with corrected ToF, while they are in stable clinical condition. Higher NT-proBNP is most strongly associated with elevated pulmonary pressures, and with LV dysfunction rather than RV dysfunction. NT-proBNP has the potential to become routine examination in patients with ToF to monitor ventricular function and may be used for timely detection of clinical deterioration.

Normal Left Ventricular Mechanics by Two-dimensional Speckle-tracking Echocardiography. Reference Values in Healthy Adults

Introduction and objectivesTwo-dimensional speckle-tracking echocardiography is a novel tool to assess myocardial function. The purpose of this study was to evaluate left ventricular myocardial strain and rotation parameters by two-dimensional speckle-tracking echocardiography in a large group of healthy adults across a wide age range to establish their reference values and to assess the influence of age, sex, and hemodynamic factors. MethodsTransthoracic echocardiograms were acquired in 247 healthy volunteers (139 women, 44 years [standard deviation, 16 years old] (range, 18-80 years). We measured longitudinal, circumferential, and radial peak systolic strain values, and left ventricular rotation and twist. ResultsAverage values of global longitudinal, radial, and circumferential strain were –21.5% (standard deviation, 2.0%), 40.1% (standard deviation, 11.8%) and –22.2% (standard deviation, 3.4%), respectively. Longitudinal strain was significantly more negative in women, whereas radial and circumferential strain and rotational parameters were similar in both sexes. Accordingly, lower limits of normality for the strain components were –16.9% in men and –18.5% in women for longitudinal strain, and –15.4% for circumferential and 24.6% for radial strain, irrespective of sex. Longitudinal strain values were more negative at the base than at apical segments. Mean rotational values were –6.9° (standard deviation, 3.5°) for the base, 13.0° (standard deviation, 6.5°) for apical rotation, and 20.0° (standard deviation, 7.3°) for net twist. ConclusionsWe report the comprehensive assessment of normal myocardial deformation and rotational mechanics in a large cohort of healthy volunteers. We found that women have more negative longitudinal strain, accounting for their higher left ventricular ejection fraction. Availability of reference values for these parameters may foster their implementation in the clinical routine.

Mecánica ventricular izquierda normal mediante ecocardiografía speckle tracking bidimensional. Valores de referencia para adultos sanos

Introduction and objectivesTwo-dimensional speckle-tracking echocardiography is a novel tool to assess myocardial function. The purpose of this study was to evaluate left ventricular myocardial strain and rotation parameters by two-dimensional speckle-tracking echocardiography in a large group of healthy adults across a wide age range to establish their reference values and to assess the influence of age, sex, and hemodynamic factors. MethodsTransthoracic echocardiograms were acquired in 247 healthy volunteers (139 women, 44 years [standard deviation, 16 years old] (range, 18-80 years). We measured longitudinal, circumferential, and radial peak systolic strain values, and left ventricular rotation and twist. ResultsAverage values of global longitudinal, radial, and circumferential strain were –21.5% (standard deviation, 2.0%), 40.1% (standard deviation, 11.8%) and –22.2% (standard deviation, 3.4%), respectively. Longitudinal strain was significantly more negative in women, whereas radial and circumferential strain and rotational parameters were similar in both sexes. Accordingly, lower limits of normality for the strain components were –16.9% in men and –18.5% in women for longitudinal strain, and –15.4% for circumferential and 24.6% for radial strain, irrespective of sex. Longitudinal strain values were more negative at the base than at apical segments. Mean rotational values were –6.9° (standard deviation, 3.5°) for the base, 13.0° (standard deviation, 6.5°) for apical rotation, and 20.0° (standard deviation, 7.3°) for net twist. ConclusionsWe report the comprehensive assessment of normal myocardial deformation and rotational mechanics in a large cohort of healthy volunteers. We found that women have more negative longitudinal strain, accounting for their higher left ventricular ejection fraction. Availability of reference values for these parameters may foster their implementation in the clinical routine.Full English text available from:www.revespcardiol.org/en

Left Ventricular Twisting Modifications in Patients with Left Ventricular Concentric Hypertrophy at Increasing After‐Load Conditions

Left ventricular hypertrophy (LVH) develops as a result of several clinical conditions, such as intensive training, hypertension, aortic valve stenosis. Aim of this study was to analyze the left ventricular twist (LVT) modifications in LVH patients with increasing after-load conditions. A total of 131 patients were enrolled: 17 healthy sedentary people (Hg), without concentric LVH; 45 water polo players (ATg); 22 patients with hypertensive cardiopathy (HPg); 47 patients with different degrees of aortic stenosis (ASg); all patients had concentric LVH, ejection fraction (EF) >54%, and were age-matched. The left ventricular end-systolic wall stress (LV-ESWS) was used as index of after-load. Left ventricular twist value showed a progressive increase from ATg to ASg, according to increasing after-load. Longitudinal left ventricular function by tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) was reduced in HPg and ASg. There was a negative correlation between LVT and longitudinal systolic function at TDI and STE (r = -0.4; P < 0.001; -0.23; P < 0.05). E/A ratio was lower in HPg and ASg than ATg and Hg. LVT was linearly related to LV-ESWS (r = 0.36; P < 0.01), E/A ratio (r = -0.59; P < 0.001), E/E' ratio (r = 0.43; P < 0.001), age (r = 0.5; P < 0.001), relative wall thickness (RWT) (r = 0.38; P < 0.01), heart rate (HR) (r = 0.3; P < 0.05), maximum (G. max), and mean transvalvular gradient (G. mean) in ASg (r = 0.37; P < 0.01, r = 0.4; P < 0.01). RWT, E/A ratio, and HR were independent predictor of LVT (β = 0.23; P = 0.007; -0.44; P = 0.001; 0.17; P = 0.049). Only in ASg, G. mean was independent predictor of LVT (β = 0.44; P = 0.01). Left ventricular twist showed a linear trend at increasing after-load values to compensate the reduction in systolic longitudinal function in pathological LVH patients.

Left Ventricular Twist and Ventricular–Arterial Coupling in Hypertensive Patients

Left ventricular (LV) twist is usually influenced by LV hypertrophy resulting from hypertension or vascular stiffness. Vascular stiffness would increase arterial elastance (Ea), whereas LV end-systolic stiffness (Ees) could be influenced by LV hypertrophy. Therefore, in hypertensive patients, we assessed the extent to which ventricular-arterial coupling (VAC; Ea/Ees) affects LV twist, which may be a compensatory mechanism for systolic dysfunction. Hypertensive patients (n = 128) and healthy controls (n = 40) underwent conventional and speckle tracking echocardiography including LV twist. Ea and Ees were estimated noninvasively by echocardiography. Patients were divided into 3 tertiles according to the twist angle. Univariate and multivariate regression analyses were performed to test the influence of VAC on twist. Patients in the lowest LV twist tertile had larger LV end-systolic volume, lower ejection fraction, lesser mid-wall fractional shortening (MWFS), and higher LV mass index (LVMI), compared to those with the highest tertile. They showed the lower septal tissue Doppler velocity, and global longitudinal and circumferential strain. With regard to VAC, Ea was similar among 3 groups, but Ees was significantly decreased in patient with lower tertile, resulting in increased VAC (1.1 ± 0.2 vs. 0.9 ± 0.1 vs. 0.7 ± 0.1, P < 0.001). While LV twist showed significant correlations with Ees, MWFS, and LVMI, VAC (β = -14.92, P < 0.001) was most associated with twist in a multivariate analysis. LV twist was significantly associated with VAC in accordance with LV function; LV twist and VAC decreased progressively as LV systolic function deteriorated, while being enhanced during the well-compensated phase.

Myocardial Mechanics in Cardiomyopathies

Cardiomyopathies are a heterogeneous group of diseases that can be phenotypically recognized by specific patterns of ventricular morphology and function. The authors summarize recent clinical observations that mechanistically link the multidirectional components of left ventricular (LV) deformation with morphological phenotypes of cardiomyopathies for offering key insights into the transmural heterogeneity of myocardial function. Subendocardial dysfunction predominantly alters LV longitudinal shortening, lengthening and suction performance and contributes to the phenotypic patterns of heart failure (HF) with preserved ejection fraction (EF) seen with hypertrophic and restrictive patterns of cardiomyopathy. On the other hand, a more progressive transmural disease results in reduction of LV circumferential and twist mechanics leading to the phenotypic pattern of dilated cardiomyopathy and the clinical syndrome of HF with reduced (EF). A proper characterization of LV transmural mechanics, energetics, and space-time distributions of pressure and shear stress may allow recognition of early functional changes that can forecast progression or reversal of LV remodeling. Furthermore, the interactions between LV muscle and fluid mechanics hold the promise for offering newer mechanistic insights and tracking impact of novel therapies.

Different contribution of extent of myocardial injury to left ventricular systolic and diastolic function in early reperfused acute myocardial infarction

BackgroundWe sought to investigate the influence of the extent of myocardial injury on left ventricular (LV) systolic and diastolic function in patients after reperfused acute myocardial infarction (AMI).MethodsThirty-eight reperfused AMI patients underwent cardiac magnetic resonance (CMR) imaging after percutaneous coronary revascularization. The extent of myocardial edema and scarring were assessed by T2 weighted imaging and late gadolinium enhancement (LGE) imaging, respectively. Within a day of CMR, echocardiography was done. Using 2D speckle tracking analysis, LV longitudinal, circumferential strain, and twist were measured.ResultsExtent of LGE were significantly correlated with LV systolic functional indices such as ejection fraction (r = -0.57, p < 0.001), regional wall motion score index (r = 0.52, p = 0.001), and global longitudinal strain (r = 0.56, p < 0.001). The diastolic functional indices significantly correlated with age (r = -0.64, p < 0.001), LV twist (r = -0.39, p = 0.02), average non-infarcted myocardial circumferential strain (r = -0.52, p = 0.001), and LV end-diastolic wall stress index (r = -0.47, p = 0.003 with e’) but not or weakly with extent of LGE. In multivariate analysis, age and non-infarcted myocardial circumferential strain independently correlated with diastolic functional indices rather than extent of injury.ConclusionsIn patients with timely reperfused AMI, not only extent of myocardial injury but also age and non-infarcted myocardial function were more significantly related to LV chamber diastolic function.

The impact of high-normal blood pressure on left ventricular mechanics: a three-dimensional and speckle tracking echocardiography study

To assess the presence of subclinical left ventricular myocardial dysfunction in subjects with high-normal blood pressure (BP) and untreated arterial hypertension, using three-dimensional (3D) echocardiography strain analysis. This cross-sectional study included 49 subjects with optimal BP, 50 subjects with high-normal BP, and 50 newly diagnosed untreated hypertensive patients matched by gender and age. All the subjects underwent 24 h blood pressure monitoring and complete two-dimensional and 3D echocardiography examination. The enrolled subjects were grouped according to 24 h systolic BP values, dividing the subjects with optimal BP from those with high-normal BP and the hypertensive patients (cut-off values were 120 and 130 mmHg, respectively). 3D global longitudinal strain was significantly lower in the high-normal BP group and the hypertensive patients, in comparison with the optimal BP group (-20.5 ± 3.3 vs. -18.7 ± 2.8 vs. -17.6 ± 2.7%, p < 0.001). Similar results were obtained for 3D global circumferential strain (-18.6 ± 3 vs. -17.1 ± 2.9 vs. -16 ± 2.5 %, p < 0.001), as well for 3D global radial strain (49.4 ± 9.5 vs. 44.7 ± 8.1 vs. 43.5 ± 7.8%, p = 0.002), and global area strain (-31.2 ± 4.8 vs. -28.7 ± 4.2 vs. -27.1 ± 4.5%, p < 0.001). LV twist was increased in the hypertensive patients in comparison with the high-normal and the optimal BP groups (10.1° ± 2.4° vs. 10.8° ± 2.6° vs. 13.8° ± 3.1°, p < 0.01), whereas untwisting rate significantly and gradually decreased from the optimal BP group, across the high-normal BP group, to the hypertensive patients (-135 ± 35 vs. -118 ± 31 vs. -102 ± 27°/s, p < 0.001). 3D echocardiography revealed that the subjects with high-normal BP suffered subclinical impairment of LV mechanics similar as the hypertensive patients.

Association between Multilayer Left Ventricular Rotational Mechanics and the Development of Left Ventricular Remodeling after Acute Myocardial Infarction

The identification of patients at risk for developing left ventricular (LV) remodeling after acute myocardial infarction (AMI) has crucial prognostic implications. The aims of this study were (1) to investigate the relationship between peak subepicardial and subendocardial twist and infarct transmurality, as assessed using contrast-enhanced magnetic resonance imaging, and (2) to evaluate the association between peak subepicardial and subendocardial twist and LV remodeling 6 months after AMI. A total of 213 patients with ST-segment elevation AMIs who underwent three-dimensional echocardiography for LV volumes and functional assessment and two-dimensional speckle-tracking analysis for the evaluation of LV twist (subendocardial vs subepicardial) were retrospectively included. A subgroup of 40 patients underwent magnetic resonance imaging within 2 months for infarct size quantification. Peak subepicardial twist was strongly related to infarct size (number of segments with transmural scar: r(2) = 0.526, P < .001; total scar score: r(2) = 0.515, P < .001) compared with peak subendocardial twist (number of segments with transmural scar: r(2) = 0.379, P < .001; total scar score: r(2) = 0.331, P < .001). In the overall population, 44 patients (21%) developed significant LV remodeling at 6-month follow-up (LV end-systolic volume increase ≥ 15%). These patients showed significantly more impaired peak subepicardial and subendocardial twist at baseline compared with patients without LV remodeling (4.5 ± 1.3° vs 9.4 ± 3.5°, P < .001; 7.0 ± 3.2° vs 12.9 ± 5.8°, P < .001, respectively). Importantly, peak subepicardial twist (odds ratio, 0.241; 95% confidence interval, 0.134-0.431; P < .001) and peak troponin T (odds ratio, 1.152; 95% confidence interval, 1.006-1.320; P = .041) were independently associated with the development of LV remodeling. Peak subepicardial twist strongly reflects infarct transmurality as assessed with magnetic resonance imaging and is independently associated with LV remodeling after AMI.

Geometric and functional change of both ventricles after atrial ventricular septal defect closure.

REFER TO THE PAGE 182-188 The secundum type atrial septal defect (ASD) is a relatively common congenital heart defect. The long-standing left to right shunt causes right ventricular (RV) volume overload and pulmonary vascular changes resulting in later RV pressure overload. Also it causes and results in reduced left ventricular (LV) preload, leading to a decrease in cardiac output. Therefore, in patients with significant ASD shunts, the RV chamber distends and the septum deviates toward the LV, resulting in a compressed LV. Transcatheter or surgical closure of the defect causes reverse remodeling of the both ventricles. However, such adaptation may take long time and can be in completion in adult patients. Standard echocardiographic studies in ASD patients showed higher RV dimensions with lower LV dimensions.1) Also higher global RV systolic function indices such as tricuspid annular plane systolic excursion (TAPSE) and RV ejection fraction (EF) were reported in ASD patients. After ASD closure, the RV shrink and the LV expand dramatically in 24 hours and show further change slowly after that time. Neither show further significant diameter change after 1 month.2) All of the RV systolic functional parameters including TAPSE, RVEF RV fractional area change and RV myocardial performance index were worsened immediately after the closure, and improved again at first month follow-up. This biphasic change by time may be due to a delayed change in RV mass in the face of acute volume reduction. Assessment of the RV function in ASD patients remained difficult as conventional echocardiographic parameters such as EF, which may not represent the contractility of a dilated, volume and pressure overloaded RV. Myocardial deformation parameters such as strain and strain rate are closely related to the intrinsic myocardial contractility and allow regional function analysis.3) Interestingly, previous studies shows that there are some regional differences regarding the extent and the time course of deformational changes.2) The regional heterogeneity in RV wall thickness and curvature may explain some of the variance in RV regional deformation. In ASD patients, RV lateral longitudinal strain is higher and RV septal strain is similar (or slightly higher) compared with healthy controls.2),4),5) The difference between the septal and lateral wall deformation can be explained with the fact that 2 dimensional speckle tracking could not distinguish between right sided and left sided component of the septum. However, there is no difference of strain rate in ASD patients compared with healthy controls and this finding has demonstrated in some studies,3),6),7) that systolic strain rate is mainly related to the change in contractility, whereas systolic strain primarily determined by the stroke volume and more dependent on volume overload. After the closure, strain and strain rate of most segments excluding apical lateral segment decrease immediately. Transcatheter device closure, an attractive alternative to cardiac surgery, has been increasingly performed and offered as a primary therapy for the secundum ASD. Also it is good for evaluation the pure effect excluding cardiopulmonary bypass effect regarding to volume unloading after ASD closure. Lower apical strain values shows strong correlation with systolic pulmonary arterial pressure and global RV systolic function indices. The prognostic value of changes in systolic strain over time was notable especially in patients with severe pulmonary arterial hypertension.8) An individual improvement > 5% in RV strain at follow-up was correlated with better pulmonary hemodynamics, improved clinical status, and less evidence of right heart failures, and it also predicted greater long-term survival that was incremental over clinical factors and choice of therapy. Rare data are available on the impact of ASD closure on LV deformation. LV systolic twist was significantly reduced in patients with ASD mainly due to the heterogonous basal rotation. LV basal rotation improved significantly while apical rotation remained unchanged after transcatheter ASD closure.9) Since the LV twist is defined as the LV apical rotation relative to the basal rotation, and the basal rotation was improved, it is observed a significant increased LV twist after ASD closure. This study also showed similar findings that the lateral longitudinal strain of RV was higher in ASD patients and decreased after ASD closure.10) However, in terms of regional difference, there were somewhat different compared with previous studies.

Atrioventricular Left Ventricular Apical Pacing Improves Haemodynamic, Rotational, and Deformation Variables in Comparison to Pacing at the Lateral Wall in Intact Myocardium: Experimental Study

Aim. To assess the effect on left ventricular (LV) function of atrioventricular (AV) and ventricular pacing at the LV apical or lateral wall and to compare the normal torsional and deformation pattern of the intact LV myocardium with those created by the aforementioned LV pacing modes and sites. Methods. Experiments were conducted in pigs (n = 21) with normal LV function to investigate the acute hemodynamic effects of epicardial AV and ventricular LV pacing at the LV apical or lateral wall. Torsional and deformation indices of LV function were assessed using speckle tracking echocardiography. Results. AV pacing at the apex revealed a significant reduction in the radial strain of the base (P < 0.03), without affecting significantly the ejection fraction and the LV torsion or twist. In contrast, AV pacing at the lateral wall produced, in addition to the reduction of the radial strain of the base (P < 0.01), significant reduction of the circumferential and the radial strain of the apex (both P < 0.01) as well as of the ejection fraction (P < 0.002) and twist (P < 0.05). Conclusions. In pig hearts with intact myocardium, LV function is maintained at sinus rhythm level when AV pacing is performed at the LV apex.

Endurance and Strength Athlete's Heart: Analysis of Myocardial Deformation by Speckle Tracking Echocardiography.

BackgroundIntensive training induces two morphological myocardial typologies of athlete's heart. Endurance training (ET) induces eccentric remodeling, bradycardia and better diastolic filling. Strength training (ST) determines concentric chamber remodelling maintaining a normal heart rate (HR). Aim of the study was to compare ET and ST athletes' heart using speckle tracking echocardiography (STE).Methods33 professional ET, 36 ST athletes, and 17 healthy controls (CT) were enrolled. All subjects underwent standard transthoracic echocardiography at rest and STE.ResultsIn ET group, HR was lower than ST group and CT group (p < 0.001; p < 0.01). ET group had higher E/A ratio than ST group and CT group (p < 0.01; p < 0.001). The left ventricular apical circumferential strain in ET group was lower than ST group and CT group (-21.6 ± 4.1% vs. -26.8 ± 7.7%, p < 0.05; vs. -27.8 ± 5.6%, p < 0.01). ET group had lower left ventricular twist (LVT) and untwisting (UTW) than ST group (6.2 ± 0.1° vs. 12.0 ± 0.1°, p < 0.01; -67.3 ± 22.9°/s vs. -122.5 ± 52.8°/s, p < 0.01) and CT group (10.0 ± 0.1°, p < 0.01; -103.3 ± 29.3°/s, p < 0.01). The univariate analysis showed significant correlation between E/A ratio and HR (r = -0.54; p < 0.001), LVT (r = -0.45; p < 0.01), UTW (r = 0.24; p < 0.05). At the multivariate analysis only HR was confirmed as independent predictor of diastolic function in all groups (Beta -0.52; p < 0.001).ConclusionIn ET there was a better global systolic and diastolic functional reserve at rest observed with strain analysis and it maybe depended on autonomic modulation.