Influence of cardiac shape on left ventricular twist

Dalen, Bas van; Kauer, Floris; Vletter, Wim B.; Soliman, Osama Ibrahim Ibrahim; Zwaan, Heleen van der; Cate, Folkert J. ten; Geleijnse, Marcel L.

doi:10.1152/japplphysiol.00419.2009

Cited by 81 publications

(80 citation statements)

References 36 publications

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“…17 Interestingly, in the same study, a parabolic relationship between these parameters was found in healthy subjects, suggesting that either decreased or increased angle of fibre orientation might be detrimental to LV torsional mechanics. The changes in subepicardial and subendocardial fibre orientation in our patients secondary to RV dilation might perhaps explain the observed differences in torsional mechanics compared with controls, although this remains speculative.…”

Section: Discussionmentioning

confidence: 68%

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: 68%

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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“…7 The influence of LV mass index on parameters of LV torsional dynamics: peak LV apical diastolic rotation rate (A) and peak LV untwisting velocity (B). LV left ventricle previously found in patients with dilated cardiomyopathy [30,31]. Unlike patients with dilated cardiomyopathy and systolic LV dysfunction, in our study all AR patients had a normal LVEF.…”

Section: Systolic Left Ventricular Torsional Mechanics In Aortic Regucontrasting

confidence: 40%

Left ventricular shape and mass impact torsional dynamics in asymptomatic patients with chronic aortic regurgitation and normal left ventricular ejection fraction

Enache

Popescu

Piazza

et al. 2015

Int J Cardiovasc Imaging

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Chronic aortic regurgitation (AR) is associated with a unique pattern of left ventricular (LV) volume and pressure overload, leading to LV remodelling. LV torsional motion, a key component of LV performance, can be altered in this setting. We aimed to assess the impact of LV remodelling on LV torsional dynamics parameters using speckle-tracking echocardiography (STE) in asymptomatic AR patients. We prospectively enrolled 60 patients with chronic AR and LVEF > 50% and 55 healthy controls. LV rotation, twisting and untwisting were assessed using STE. Patients with AR had higher LV diameters, volumes and mass, a more spherical LV shape than controls, but similar LVEF. In AR patients we found reduced peak LV apical rotation and decreased (2.1 ± 0.8 vs 2.9 ± 0.9°/cm, p < 0.001) and delayed (time to peak LV twist: 0.94 ± 0.12 vs 0.99 ± 0.09, p = 0.004) peak LV torsion. Also, peak LV untwisting velocity was decreased (-123.5 ± 41.5 vs -152.3 ± 55.0°/s, p = 0.002) due to lower peak LV apical diastolic rotation rate. LV shape influenced LV torsional dynamics, a more spherical LV displaying reduced peak LV apical rotation and diastolic rotation rate and decreased LV twist. A more hypertrophied LV had a lower peak LV torsion, peak LV apical diastolic rotation rate and peak LV untwisting velocity. LV apical rotation and torsion are decreased and LV twist is delayed in patients with chronic AR and normal LVEF, detecting early subclinical LV dysfunction before LVEF declines. Also, LV untwisting is reduced in these patients. LV remodelling impairs LV torsional dynamics parameters in this setting.

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“…It is well established that the longer lever arm of the subepicardium compared with the subendocardium dominates the direction of rotation because of its larger radius [31]. Other work has associated increased wall thickness with greater apical rotation and thus LV twist [75]; amplifying the distance between the two contour layers as a result of thicker walls could cause even greater dominance of epicardial rotation and potentially explain the increased twist in highly static low-dynamic athletes.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Speckle Tracking-Derived Cardiac Strain and Cardiac Twist Mechanics in Athletes: A Systematic Review and Meta-Analysis of Controlled Studies

et al. 2016

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BackgroundThe athlete’s heart is associated with physiological remodeling as a consequence of repetitive cardiac loading. The effect of exercise training on left ventricular (LV) cardiac strain and twist mechanics are equivocal, and no meta-analysis has been conducted to date.ObjectiveThe objective of this systematic review and meta-analysis was to review the literature pertaining to the effect of different forms of athletic training on cardiac strain and twist mechanics and determine the influence of traditional and contemporary sporting classifications on cardiac strain and twist mechanics.MethodsWe searched PubMed/MEDLINE, Web of Science, and ScienceDirect for controlled studies of aged-matched male participants aged 18–45 years that used two-dimensional (2D) speckle tracking with a defined athlete sporting discipline and a control group not engaged in training programs. Data were extracted independently by two reviewers. Random-effects meta-analyses, subgroup analyses, and meta-regressions were conducted.ResultsOur review included 13 studies with 945 participants (controls n = 355; athletes n = 590). Meta-analyses showed no athlete–control differences in LV strain or twist mechanics. However, moderator analyses showed greater LV twist in high-static low-dynamic athletes (d = –0.76, 95% confidence interval [CI] –1.32 to –0.20; p < 0.01) than in controls. Peak untwisting velocity (PUV) was greater in high-static low-dynamic athletes (d = –0.43, 95% CI –0.84 to –0.03; p < 0.05) but less than controls in high-static high-dynamic athletes (d = 0.79, 95% CI 0.002–1.58; p = 0.05). Elite endurance athletes had significantly less twist and apical rotation than controls (d = 0.68, 95% CI 0.19–1.16, p < 0.01; d = 0.64, 95% CI 0.27–1.00, p = 0.001, respectively) but no differences in basal rotation. Meta-regressions showed LV mass index was positively associated with global longitudinal (b = 0.01, 95% CI 0.002–0.02; p < 0.05), whereas systolic blood pressure was negatively associated with PUV (b = –0.06, 95% CI –0.13 to –0.001; p = 0.05).ConclusionEchocardiographic 2D speckle tracking can identify subtle physiological differences in adaptations to cardiac strain and twist mechanics between athletes and healthy controls. Differences in speckle tracking echocardiography-derived parameters can be identified using suitable sporting categorizations.

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Influence of cardiac shape on left ventricular twist

Cited by 81 publications

References 36 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

Left ventricular shape and mass impact torsional dynamics in asymptomatic patients with chronic aortic regurgitation and normal left ventricular ejection fraction

Left Ventricular Speckle Tracking-Derived Cardiac Strain and Cardiac Twist Mechanics in Athletes: A Systematic Review and Meta-Analysis of Controlled Studies

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