Left ventricular twist and untwist in aortic stenosis

Dalen, Bas van; Tzikas, Apostolos; Soliman, Osama Ibrahim Ibrahim; Kauer, Floris; Heuvelman, H. J.; Vletter, Wim B.; Cate, Folkert J. ten; Geleijnse, Marcel L.

doi:10.1016/j.ijcard.2009.11.022

Cited by 48 publications

(50 citation statements)

References 32 publications

(35 reference statements)

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“…ApRot is typically increased in patients with AS. 10,12,17 Our study population had a mean peak ApRot of 5.1 , which is consistent with previous studies that found ApRot to be lower in patients with normal LVEFs (Carasso et al, 18 3.2 6 2.0 ) and those who are symptomatic (Carasso et al, 14 2.9 6 1.7 ). Our study population all had normal LVEFs, and 63% were symptomatic.…”

Section: The Role Of Aprot In Systolic Function and Outcomessupporting

confidence: 90%

Increased Apical Rotation in Severe Aortic Stenosis is Associated with Reduced Survival: A Speckle-Tracking Study

Holmes

Taub

García

et al. 2015

Journal of the American Society of Echocardiography

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Section: The Role Of Aprot In Systolic Function and Outcomessupporting

confidence: 90%

Increased Apical Rotation in Severe Aortic Stenosis is Associated with Reduced Survival: A Speckle-Tracking Study

Holmes

Taub

García

et al. 2015

Journal of the American Society of Echocardiography

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“…However, untwist decreases and is associated with diastolic dysfunction and elevated LV enddiastolic filling pressures. 44 Aortic valve replacement either by surgery or by transcatheter (TAVI) in these patients normalizes the LVT, 43,45 although the development of significant aortic regurgitation post-TAVI abolishes this normalization. However, aortic stenosis patients with reduced EF have reduced LVT, signifying exhaustion of LVT compensatory mechanisms and LVT in these patients does not change post-TAVI.…”

Section: Valvular Heart Diseasementioning

confidence: 94%

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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“…Left ventricular torsion was investigated in two of the strongest quality articles; both showing an elevation as compared to healthy controls (Online Figure 2) [8,44]. Also, five moderate quality papers reported on the maximal apical rotation in those with aortic stenosis, all showing increased apical rotation as compared to healthy controls [8,44-47]. Of the four papers that reported individual basal rotation, three reported no change in basal rotation [8,45,47] while one of the lower quality articles showed a reduction [46].…”

Section: Resultsmentioning

confidence: 99%

Heart Disease and Left Ventricular Rotation – A Systematic Review and Quantitative Summary

Phillips

Coté

Bredin

2012

BMC Cardiovasc Disord

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BackgroundLeft ventricular (LV) rotation is increasingly examined in those with heart disease. The available evidence measuring LV rotation in those with heart diseases has not been systematically reviewed.MethodsTo review systematically the evidence measuring LV rotational changes in various heart diseases compared to healthy controls, literature searches were conducted for appropriate articles using several electronic databases (e.g., MEDLINE, EMBASE). All randomized-controlled trials, prospective cohort and case–controlled studies that assessed LV rotation in relation to various heart conditions were included. Three independent reviewers evaluated each investigation’s quality using validated scales. Results were tabulated and levels of evidence assigned.ResultsA total of 1,782 studies were found through the systematic literature search. Upon review of the articles, 47 were included. The articles were separated into those investigating changes in LV rotation in participants with: aortic stenosis, myocardial infarction, hypertrophic cardiomyopathy, dilated cardiomyopathy, non-compaction, restrictive cardiomyopathy/ constrictive pericarditis, heart failure, diastolic dysfunction, heart transplant, implanted pacemaker, coronary artery disease and cardiovascular disease risk factors. Evidence showing changes in LV rotation due to various types of heart disease was supported by evidence with limited to moderate methodological quality.ConclusionsDespite a relatively low quality and volume of evidence, the literature consistently shows that heart disease leads to marked changes in LV rotation, while rotational systolic-diastolic coupling is preserved. No prognostic information exists on the potential value of rotational measures of LV function. The literature suggests that measures of LV rotation may aid in diagnosing subclinical aortic stenosis and diastolic dysfunction.

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Left ventricular twist and untwist in aortic stenosis

Cited by 48 publications

References 32 publications

Increased Apical Rotation in Severe Aortic Stenosis is Associated with Reduced Survival: A Speckle-Tracking Study

Increased Apical Rotation in Severe Aortic Stenosis is Associated with Reduced Survival: A Speckle-Tracking Study

Left Ventricular Twist and Torsion

Heart Disease and Left Ventricular Rotation – A Systematic Review and Quantitative Summary

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