Background-Left ventricular (LV) torsion is due to oppositely directed apical and basal rotation and has been proposed as a sensitive marker of LV function. In the present study, we introduce and validate speckle tracking echocardiography (STE) as a method for assessment of LV rotation and torsion. Methods and Results-Apical and basal rotation by STE was measured from short-axis images by automatic frame-to-frame tracking of gray-scale speckle patterns. Rotation was calculated as the average angular displacement of 9 regions relative to the center of a best-fit circle through the same regions. As reference methods we used sonomicrometry in anesthetized dogs during baseline, dobutamine infusion, and apical ischemia, and magnetic resonance imaging (MRI) tagging in healthy humans. In dogs, the mean peak apical rotation was Ϫ3.7Ϯ1.2°(ϮSD) and Ϫ4.1Ϯ1.2°, and basal rotation was 1.9Ϯ1.5°and 2.0Ϯ1.2°by sonomicrometry and STE, respectively. Rotations by both methods increased (PϽ0.001) during dobutamine infusion. Apical rotation by both methods decreased during left anterior descending coronary artery occlusion (PϽ0.007), whereas basal rotation was unchanged. In healthy humans, apical rotation was Ϫ11.6Ϯ3.8°and Ϫ10.9Ϯ3.3°, and basal rotation was 4.

Speckle tracking echocardiography provides accurate and angle-independent measurements of LV dimensions and strains and has potential to become a clinical bedside tool for quantifying myocardial strain.

We recruited 51 patients with symptomatic, ECG-documented, nonpermanent AF who were referred for first AF ablation or to the outpatient Background-Exercise training is an effective treatment for important atrial fibrillation (AF) comorbidities. However, a high level of endurance exercise is associated with an increased AF prevalence. We assessed the effects of aerobic interval training (AIT) on time in AF, AF symptoms, cardiovascular health, and quality of life in AF patients. Methods and Results-Fifty-one patients with nonpermanent AF were randomized to AIT (n=26) consisting of four 4-minute intervals at 85% to 95% of peak heart rate 3 times a week for 12 weeks or to a control group (n=25) continuing their regular exercise habits. An implanted loop recorder measured time in AF continuously from 4 weeks before to 4 weeks after the intervention period. Cardiac function, peak oxygen uptake (V ⋅ o 2 peak), lipid status, quality of life, and AF symptoms were evaluated before and after the 12-week intervention period. Mean time in AF increased from 10.4% to 14.6% in the control group and was reduced from 8.1% to 4.8% in the exercise group (P=0.001 between groups). AF symptom frequency (P=0.006) and AF symptom severity (P=0.009) were reduced after AIT. AIT improved V ⋅ o 2 peak, left atrial and ventricular ejection fraction, quality-of-life measures of general health and vitality, and lipid values compared with the control group. There was a trend toward fewer cardioversions and hospital admissions after AIT. Conclusions-AIT for 12 weeks reduces the time in AF in patients with nonpermanent AF. This is followed by a significant improvement in AF symptoms, V The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl

Tocilizumab attenuated the inflammatory response and primarily PCI-related TnT release in NSTEMI patients.

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