Factors Influencing the Twisting and Untwisting Properties of the Left Ventricle during Normal Pregnancy

Papadopoulou, Elektra; Kaladaridou, Anna; Agrios, John; Matthaiou, John; Pamboukas, Constantinos; Toumanidis, Savvas

doi:10.1111/echo.12345

Cited by 17 publications

(21 citation statements)

References 41 publications

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“…With afterload held constant, increasing preload (eg, by saline infusion and in pregnancy) augments LVT and untwist 12,13 ; and with preload held constant, increasing afterload, for example, isometric handgrip, decreases LVT and untwist 14 , whereas decreasing afterload, for example, using rotates the base in a clockwise direction and the apex in a counterclockwise direction, whereas the inner endocardial layer (in red) rotates the apex and base in exactly opposite directions. Because of the larger epicardial radius (r1) and the smaller endocardial radius (r2), the epicardial rotation dominates the overall LV rotational direction.…”

Section: Changes Of Loading and Contractilitymentioning

confidence: 99%

Left Ventricular Twist and Torsion

Omar

Vallabhajosyula

Sengupta

2015

Circ: Cardiovascular Imaging

105

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A 52-year-old white man visited his physician because he started experiencing shortness of breath on walking short distances at ground level. He had smoked half a packet of cigarettes daily for 40 years. Physical examination revealed a blood pressure of 147/95 mm Hg. Chest examination and chest x-ray were unremarkable, and ECG showed left atrial abnormality. The patient had normal serum electrolytes, blood sugar, and kidney function tests. A stress echocardiogram was ordered to exclude potential coronary artery disease. His resting echocardiography showed an ejection fraction (EF) of 60%, normal septal and posterior wall thickness, and mild diastolic dysfunction (septal early diastolic mitral annular velocity [e′] of 7 cm/s, early diastolic [E wave] to late diastolic [A wave] transmitral Doppler flow velocity ratio [E/A] of 1.4, E-wave deceleration time of 210 ms, E/e′ ratio of 9, and left atrial volume index of 44 mL/m 2 ; Figure 1A). There were no resting segmental wall motion abnormalities suggestive of ischemia. The patient exercised on a treadmill using Bruce protocol for 4 minutes and 43 s, and achieved 6.6 metabolic equivalent of task and maximum heart rate of 148 bpm (88% of his maximum age predicted heart rate). At peak exercise, the patient developed severe dyspnea and his blood pressure was 213/90 mm Hg. Post exercise echocardiography was acquired within 1 minute of exercise termination and showed EF of 69% and no segmental wall motion abnormalities, with Doppler recordings obtained at recovering heart rate of 125 bpm; showing a septal e′ velocity of 7.3 cm/s, E/A of 1.9, E-wave deceleration time of 110 ms, and E/e′ of 13.7, left atrial volume index of 35 mL/m 2 ( Figure 1B). Ten minutes into the recovery period, the blood pressure returned to basal level (145/80 mm Hg). Compared with resting levels, the increased E/A ratio, shortened E-wave deceleration time and relatively increased E/e′ ratio suggested post exercise worsening of diastolic function with elevation of left ventricular (LV) filling pressures. To investigate the mechanistic basis of diastolic dysfunction in this patient, LV deformation was assessed offline using speckletracking echocardiography (STE). Besides characterizing the longitudinal and circumferential shortening, and radial thickening, the LV rotational deformation, that resembles the wringing of a towel, was also measured (Figures 2 and 3). This wringing deformation, also referred to as LV twist (LVT) and the subsequent recoil that occurs in diastole, referred to as untwist, were abnormal in this patient (Figure 4). At rest, the patient had mild diastolic dysfunction, which was associated with a higher than normal LVT and untwist values, compared with the published age-related normal values, 1,2 and low global longitudinal strain. At peak exercise, there was a significant worsening of the patient's diastolic parameters, which was associated with worsening untwist values and further reduction of global longitudinal strain, whereas LVT remained same in magnitude. The following ...

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Section: Changes Of Loading and Contractilitymentioning

confidence: 99%

Left Ventricular Twist and Torsion

Omar

Vallabhajosyula

Sengupta

2015

Circ: Cardiovascular Imaging

105

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“…Recently, using this echocardiographic technique, a small decrease in LV segmental longitudinal systolic and diastolic function, as well as changes in torsion and peak LV twist velocity, in hearts of women with otherwise normal pregnancies were reported . Thus, in the current study we employed indexes derived from both TDI and speckle tracking techniques, in addition to the more traditional methods, to study cardiac function in a unique group of patients to whom these methods have not yet been applied: those with significant SOB with no other known systemic or obstetric problem and no obvious reason on clinical investigation.…”

Section: Discussionmentioning

confidence: 99%

“…Global longitudinal and circumferential strain did not differ significantly in our group of patients with SOB from the control group; however, increased rotation of the base and a trend for greater torsion in the former group is in accord with reports on similar findings in patients with diastolic dysfunction. 21,23 Fonseca et al 24 found greater LV torsion by magnetic resonance imaging in patients with type 2 diabetes mellitus with diastolic dysfunction and normal LVEF than in a control group. Tzemos et al 25 reported increased twist during pregnancy in women with bicuspid and stenotic aortic valves.…”

Section: Echocardiographymentioning

confidence: 98%

Shortness of Breath During Pregnancy: Could a Cardiac Factor Be Involved?

Goland

Perelman

Asalih

et al. 2015

Clinical Cardiology

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Background: Shortness of breath (SOB) is common among healthy women with normal pregnancies. However, when no overt cardiac or extra cardiac etiology is found, a subtle cardiac source must be excluded. Hypothesis: Pregnancy may induce or unmask myocardial dysfunction that may cause SOB. Methods: Healthy pregnant women with significant SOB were recruited for this study. We performed a comprehensive echocardiographic assessment including tissue Doppler imaging (TDI) and 2-dimensional strain imaging (2DS). The echocardiographic data obtained were compared with that of a control group of pregnant women without SOB. Results: Thirty pregnant women with SOB were enrolled in the study (age, 31.8 ± 4.9 years, and gestation, 38.2 ± 2.8 weeks) for whom no overt etiology for SOB was detected. Patients with SOB compared with controls had thicker hearts (septum: 10.1 ± 1.1 vs 8.9 ± 0.9 mm; P < 0.001; posterior wall: 9.4 ± 1.1 vs 8.9 ± 0.9 mm; P < 0.01), shorter E-wave deceleration time (158.0 ± 50.1 vs 187.1 ± 37.6 msec; P = 0.01), and higher pulmonary artery pressure (26.8 ± 6.2 vs 19.0 ± 6.5 mm Hg, P < 0.01). Women with SOB tended to have a lower S' velocity TDI (P = 0.05) and a trend toward increased torsion on 2DS (P = 0.09). Conclusions: Significant SOB during otherwise normal pregnancy is associated with significant echocardiographic findings that may suggest a subtle cardiac involvement. Further investigation is necessary to verify such an association, which may have therapeutic implications for treating SOB of pregnancy.

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“…Данные в группе контроля совпадают с данными, полученными у беременных другими исследователями [19][20][21][22][23][24].…”

Section: материал и методыunclassified

“…Сандрикова [3,12,13]. В них были определены критерии эффективности терапии у пациентов различных нозологических групп на основа-нии оценки динамики данных спекл-трекинг эхокардио-графии (Эхо-КГ) в режиме 2DT, была показана невысокая информативность ФВ, доказана целесообразность расче-та крайне актуальных для миокарда производных силы, времени и скорости с оценкой динамики сокращения миокардиальных волокон в продольном, циркулярном и радиальном направлениях [3,12,[14][15][16][17][18][19][20][21][22][23].…”

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