Apical Rotation Assessed by Speckle-Tracking Echocardiography as an Index of Global Left Ventricular Contractility

Kim, Won-Jang; Lee, Byeong Han; Kim, Yun Jeong; Kang, Jee Hye; Jung, Yoo Jin; Song, Jong–Min; Kang, Duk-Hyun; Song, Jae‐Kwan

doi:10.1161/circimaging.108.794719

Cited by 61 publications

(41 citation statements)

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“…26 Importantly, there is increasing evidence to suggest that LV torsion might be superior to LV ejection fraction in the characterization of abnormal haemodynamics in patients with heart failure. 27 Furthermore, abnormal systolic LV torsion has been shown to be related to diastolic dysfunction. As shown in this and previous studies, 28,29 the magnitude of LV systolic torsion is related inversely to the rate of untwisting during diastole.…”

Section: Discussionmentioning

confidence: 99%

Torsional Mechanics of the Left Ventricle in Patients After Surgical Repair of Tetralogy of Fallot

Cheung

Wong

Liang

et al. 2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp hile right ventricular (RV) dysfunction has been the main concern in patients after repair of tetralogy of Fallot (TOF), 1-3 the importance of left ventricular (LV) dysfunction as a risk factor of long-term adverse outcomes is increasingly acknowledged. 1,4,5 Dysfunction of the left ventricle is characterized by reduced ejection fraction, 1,4 altered systolic myocardial deformation, 6,7 and systolic mechanical dyssynchrony. 1,7,8 These LV functional abnormalities have been attributed to suboptimal ventricular-ventricular interaction, 1,4 although the nature of this interaction remains to be defined.Assessment of cardiac mechanics has extended from evaluation of linear to torsional deformation, which might provide new mechanistic insights. Twisting motion of the left ventricle during the ejection phase is important in the Frank-Starling mechanism, 9 while untwisting contributes to LV diastolic relaxation and early diastolic filling. 10 Interaction between LV subendocardial and subepicardial helical myocardial fibres has been proposed to explain the phenomenon of torsional deformation. 11 Alteration of septal geometry and changes in LV shape due to volume overloading of the right ventricle might potentially distort this interaction and impair torsional deformation. In the present study, we tested the hypothesis that alteration of LV torsional mechanics occurs in postoperative TOF patients and is associated with RV volume overload and changes in LV configuration. Methods SubjectsFifty-five patients who had undergone surgical repair of TOF with transannular patch enlargement of the RV outflow were recruited consecutively from the cardiac clinic of Queen Mary Hospital. From the case records, the following data were retrieved: age at operation, types of surgical procedure, and duration of follow up since total repair. Twenty-seven healthy subjects, including those followed up for non-specific chest pain and palpitation but without documented cardiac arrhythmias and healthy siblings, were recruited as controls. The weight and height of all subjects were measured and the body surface area was calculated accordingly. The Institutional Review Board approved the study and all of the subjects gave

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Section: Discussionmentioning

confidence: 99%

Torsional Mechanics of the Left Ventricle in Patients After Surgical Repair of Tetralogy of Fallot

Cheung

Wong

Liang

et al. 2011

Circ J

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“…A wide range of LV inotropy status was achieved by pharmacological modulation of ␤-adrenergic receptors (14). Each animal was treated with dobutamine (5, 10, and 20 g·kg Ϫ1 ·min…”

Section: Methodsmentioning

confidence: 99%

“…Although S= has been found to show significant correlation with EF, a widely used clinical index of LV systolic function, the accuracy of S= relative to EF under a wide range of contractility conditions and RWMA has not been investigated extensively. Moreover, the relationship between S=, a measure of LV longitudinal movement, and LV rotation, a new index of LV contractility (9,14), has not been established. Using an open-chest canine model with and without coronary artery ligation, we sought to determine whether S= measured by pulsed TDI could be used as a noninvasive quantitative index of contractility under various conditions, including a wide range of LV inotropic status, including RWMA.…”

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Peak systolic velocity of mitral annular longitudinal movement measured by pulsed tissue Doppler imaging as an index of global left ventricular contractility

Seo

Kim

et al. 2010

American Journal of Physiology-Heart and Circulatory Physiology

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Seo JS, Kim DH, Kim WJ, Song JM, Kang DH, Song JK. Peak systolic velocity of mitral annular longitudinal movement measured by pulsed tissue Doppler imaging as an index of global left ventricular contractility. Am J Physiol Heart Circ Physiol 298: H1608 -H1615, 2010. First published March 5, 2010; doi:10.1152/ajpheart.01231.2009.-We sought to test whether the peak systolic velocity of mitral annular longitudinal movement (S=) measured by pulsed tissue Doppler imaging technique is useful to assess global left ventricular (LV) contractility under various LV inotropic conditions, including regional wall motion abnormality. In addition, the accuracy of S= relative to LV ejection fraction (EF), a conventional index of LV contractility, and its association with apical rotation, a new index of LV contractility, were also evaluated. We measured S= at the medial mitral annulus and apical rotation in 11 open-chest anesthetized dogs at eight inotropic stages before and after ligation of either the left anterior descending or circumflex coronary artery. Maximal positive dP/dt (dP/dt peak) was monitored using a high-fidelity pressure catheter and used as the standard measure of LV contractility. S= showed dose-dependent increases and decreases after dobutamine and esmolol infusion, respectively. There was a stronger association between dP/dt peak and S= (R 2 ϭ 0.665, P Ͻ 0.001) than between dP/dtpeak and EF (R 2 ϭ 0.408, P Ͻ 0.001), and this trend was more apparent with coronary ligation, regardless of the ligation site. The strength of association between dP/dt peak and S= (R 2 ϭ 0.665) was not different from that between dP/dt peak and apical rotation (R 2 ϭ 0.726) (P ϭ 0.350). The association between LV EF and S= was modest (R 2 ϭ 0.472, P Ͻ 0.001), whereas a good association between S= and apical rotation was observed both with (R 2 ϭ 0.552, P Ͻ 0.001) and without (R 2 ϭ 0.674, P Ͻ 0.001) coronary ligation. S= is a more sensitive index of global LV contractility than is LV EF, reflecting both LV longitudinal shortening and torsional deformation. contractility; echocardiography; longitudinal movement; ventricular rotation DESPITE EARLY RECOGNITION of abundant longitudinal cardiac muscle fibers (31), the function of these longitudinal fibers could not be extensively investigated before successful clinical introduction of echocardiography. Initial M-mode recording of mitral annular descent or excursion reflecting left ventricular (LV) longitudinal shortening during ejection was reported to be a sensitive measure of LV systolic function, and the amplitude of long-axis motion during systole also correlates well with LV ejection fraction (EF) (12,23,28). Later, the development of tissue Doppler imaging (TDI) provided an easier way to measure peak systolic velocity of mitral annular longitudinal movement (S=), with S= found useful in diagnosing global LV systolic dysfunction in many cardiac diseases (2,4,8,16,20,27). Moreover, the prognostic implication of S= has been documented in patients with heart failure, mitral regurgitati...

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“…9 Twist motion and apical rotation are sensitive markers for changes in the state of cardiac function and contractility. 10, 11 However, as with all 2D speckle-tracking techniques used for quantification of the LV, deformation and twist are affected by incorrect acquisition. 12 Cardiac motion is three-dimensional and myocardial speckles move in 3 dimensions.…”

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confidence: 99%

Three-Dimensional Left Ventricular Torsion in Patients With Dilated Cardiomyopathy　― A Marker of Disease Severity ―

Sveric

Ulbrich

Rady

et al. 2017

Circ J

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mental exercise. 9 Twist motion and apical rotation are sensitive markers for changes in the state of cardiac function and contractility. 10, 11 However, as with all 2D speckle-tracking techniques used for quantification of the LV, deformation and twist are affected by incorrect acquisition. 12 Cardiac motion is three-dimensional and myocardial speckles move in 3 dimensions. Hence, only a portion of the real myocardial motion can be detected with a 2D method. 3D speckletracking echocardiography (STE) is a novel tool to noninvasively quantify myocardial deformation and LV rotation. It has been validated against sonomicrometry, showing agreement with magnetic resonance imaging. 3D-STE allows efficient single-time acquisition of all LV segments in the same 3D data set. 13- 16 Until now, no systematic studies have been able to elucidate the relationship between peak V O2 and LV torsion in patients with DCM. The clinical relevance of LV torsion in treatment guidance for DCM is still unclear. Therefore, Idiopathic non-ischemic dilated cardiomyopathy (DCM) is characterized by progressive left ventricular (LV) dilatation that is accompanied by reduced myocardial contractility. Cardiopulmonary exercise testing (CPET), along with an abnormal peak oxygen uptake (peak V O2 <20 mL/kg/min), is a strong predictor of death and disease progression in these patients. 1-3 In daily practice, therapy is most commonly assessed echocardiographically by changes in LV ejection fraction (EF). The validity of LV EF in predicting clinical outcome and peak V O2 is questionable in chronic systolic heart failure. 4,5 LV twist, induced by systolic apical counterclockwise (positive angulation in echocardiography) and basal clockwise rotation, results in a LV wringing motion, which was first described in 1628 by Harvey. 6 The counterdirectional helical layer architecture of the LV provides the anatomical basis of the twist motion. 7,8 A normalized twist, called torsion, makes measurements of the LV wringing motion more comparable among differently sized hearts. LV twist/ torsion, together with longitudinal and circumferential deformation, indicates an effective LV performance, which is necessary for adequate stroke volume (SV) during incre- Editorial p 440Received Background: LV twist has a key role in maintaining left ventricular (LV) contractility during exercise. The purpose of this study was to investigate LV torsion instead of twist as a surrogate marker of peak oxygen uptake (peak V O2) assessed by cardiopulmonary exercise testing (CPET) in patients with non-ischemic dilated cardiomyopathy (DCM).

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Apical Rotation Assessed by Speckle-Tracking Echocardiography as an Index of Global Left Ventricular Contractility

Cited by 61 publications

References 41 publications

Torsional Mechanics of the Left Ventricle in Patients After Surgical Repair of Tetralogy of Fallot

Torsional Mechanics of the Left Ventricle in Patients After Surgical Repair of Tetralogy of Fallot

Peak systolic velocity of mitral annular longitudinal movement measured by pulsed tissue Doppler imaging as an index of global left ventricular contractility

Three-Dimensional Left Ventricular Torsion in Patients With Dilated Cardiomyopathy　― A Marker of Disease Severity ―

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Apical Rotation Assessed by Speckle-Tracking Echocardiography as an Index of Global Left Ventricular Contractility

Cited by 61 publications

References 41 publications

Torsional Mechanics of the Left Ventricle in Patients After Surgical Repair of Tetralogy of Fallot

Torsional Mechanics of the Left Ventricle in Patients After Surgical Repair of Tetralogy of Fallot

Peak systolic velocity of mitral annular longitudinal movement measured by pulsed tissue Doppler imaging as an index of global left ventricular contractility

Three-Dimensional Left Ventricular Torsion in Patients With Dilated Cardiomyopathy ― A Marker of Disease Severity ―

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Three-Dimensional Left Ventricular Torsion in Patients With Dilated Cardiomyopathy　― A Marker of Disease Severity ―