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Abstract:The left ventricular (LV) twist is defined as the wringing motion of the heart around its longaxis in systole caused by oppositely directed counterclockwise apical and clockwise basal rotations resulted from the movement of two orthogonally oriented muscular bands. In some clinical circumstances, rotation at both basal and apical levels of the LV occurred in the same clockwise or counterclockwise direction during systole resulting the near absence of LV twist as called left ventricular "rigid body rotation" (LV-RBR). Hereby we present that LV-RBR normalization of LV rotational mechanics could be demonstrated at maximum hyperaemia during dipyridamole-induced stress by three-dimensional (3D) speckle tracking echocardiography in a patient with stable angina.Keywords: Three-dimensional (3D); stress; speckle tracking; echocardiography; myocardial; mechanics; rigid body rotation Submitted Feb 25, 2016. Accepted for publication Mar 13, 2016Mar 13, . doi: 10.21037/qims.2016 (Motion Analysis of the heart and Great vessels bY threedimensionAl speckle-tRacking echocardiography during Stress protocols), in which among others drug-induced stress-related pathophysiologic consequences were aimed to be examined ('magyar' means 'Hungarian' in Hungarian language). Informed consent was obtained from the patient and the study protocol was approved by the institution's human research committee.Following complete two-dimensional (2D) Doppler echocardiography 3DSTE was performed with the same Toshiba Artida TM echocardiography equipment (Toshiba, Tokyo, Japan) using a 1-4 MHz matrix phased-array PST-25SX transducer (15). Six wedge-shaped subvolumes were acquired within a single breath-hold from the apical window to create full-volume 3D datasets at rest and at peak hyperaemia. Dipyridamole was used as a vasodilator stress agent using standard international protocols. During chamber quantifications 3D Wall Motion Tracking software version 2.7 was used. The apical two-(AP2CH) and four-chamber (AP4CH) views and three short-axis views at different LV levels from the LV base to apex were automatically selected from the 3D echocardiographic pyramidal dataset at end-diastole by the software. Two points of the LV endocardium at the edges of the mitral valve and one at the LV apex were marked manually on the AP2CH and AP4CH views. Then, the 3D endocardial surface was automatically reconstructed and tracked in 3D space throughout the cardiac cycle. Manual adjustments were also performed, if needed. Curves were generated by the software for quantification of global peak apical, midventricular and basal LV rotations at rest and at peak hyperaemia ( Figure 1). No wall motion abnormalities could be detected both in resting conditions and at peak hyperaemia by visual assessment suggesting a negative stress test result. Interestingly, apical and basal LV rotations were in the same counterclockwise direction suggesting LV-RBR at rest. At peak hyperaemia basal LV rotation become clockwisedirected, while apical rotation remained counterclock...

A patient with previous coronary stenting presented with stable angina and positive exercise treadmill test. Echocardiography with three-dimensional speckle-tracking demonstrated left ventricular rigid body rotation (near absence of left ventricular twist), whose characteristics changed dramatically during dipyridamole-induced vasodilatation. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:152-156, 2018.

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