Quantitative assessment of the rotation and twist of the left ventricle during dobutamine stress echocardiography: a comparison of patients with and without significant coronary artery disease

Abstract

BACKGROUND The rotation and twist of the left ventricle (LV) have been comprehensively evaluated at rest. However, little is known about rotational mechanics during dobutamine stress echocardiography (DSE). AIMS We aimed to quantify and compare the basal and apical rotation and twist of the LV at rest as well as at the peak and recovery stages of DSE in patients with and without coronary artery disease (CAD). METHODS We enrolled 91 patients, including 48 patients with CAD and 43 patients without CAD (mean [SD] age, 62 [9] years and 61 [10] years, respectively). Coronary artery disease was defined as the presence of stenoses of 50% or more in the left main coronary artery and/or stenoses of 70% or more in other epicardial arteries. Rotation was measured by 2-dimensional speckle-tracking echocardiography, and twist was calculated as the difference between the basal and apical rotation. RESULTS Neither rotation nor twist differed between patients with and without CAD at rest, although apical rotation was significantly greater in the CAD group at peak DSE (mean [SD], 5.43° [3.45°] vs 3.71° [3.52°], P = 0.01) and at recovery (mean [SD], 5.05° [3.65°] vs 2.87° [2.73°], P <0.01). On the contrary, the absolute value for basal rotation at recovery was higher in patients without CAD (mean [SD], 3.87° [3.37°] vs 2.63° [2.43°], P = 0.03). In both groups, the rotation and twist did not change significantly during the dobutamine challenge. CONCLUSIONS During DSE, we observed differences in LV rotation between patients with and without CAD, revealing the effect of ischemia on deformation parameters.

Global Longitudinal Strain at Rest as an Independent Predictor of Mortality in Liver Transplant Candidates: A Retrospective Clinical Study

“…To calculate the LV twist, apical heart rotation (i.e., circumferential strain) was subtracted from the basal rotation as described by Mielczarek et al [32].…”

“… * p ≤ 0.05, ** p ≤ 0.01, *** p ≤ 0.001 vs. cALD. Abbreviations: cALD, compensated advanced liver disease; CSPH, compensated advanced liver disease with clinically significant portal hypertension; dALD, decompensated advanced liver disease; Diast dysf, diastolic dysfunction; DT, deceleration time; E, mitral valve early diastolic velocity; E’, mitral annulus early diastolic velocity; ED, end diastolic; E/A, ratio of early transmitral flow velocity to late diastolic filling velocity caused by atrial contraction; E/E’, ratio of the mitral valve early diastolic flow velocity to the mitral annulus early diastolic flow velocity; GCS, global circumferential strain; GLS, global longitudinal strain; GRS, global radial strain; LA vol index, maximum left atrial volume index; LV twist, left ventricular twist according to [ 32 ]; LVEDD, left ventricular end-diastolic diameter; LVESD, left ventricular end-systolic diameter; LVEF, left ventricular ejection fraction; TAPSE, tricuspid annular plane systolic excursion; TR velocity, tricuspid regurgitation peak velocity. …”

Reduced Left Ventricular Twist Early after Acute ST-Segment Elevation Myocardial Infarction as a Predictor of Left Ventricular Adverse Remodelling

“…LV torsion early after reperfusion can predict LV remodelling at the 3-month follow-up [ 46 ]. Future studies may assess these rotational parameters after the acute phase, taking into consideration stress echocardiography, as little is known about rotational mechanics during dobutamine stress echocardiography [ 47 ].…”

The impact of chronic alcohol overuse on heart function and prognosis: layer-specific longitudinal strain and mid-term outcome analysis

“…Layer-specific strain in cardiac damage LV function can be more precisely evaluated in different clinical settings, e.g., in ischemia detection, by including deformation parameters [13]. Layer-specific strain was found to be a marker of cardiac muscle dysfunction associated with arterial hypertension and LV hypertrophy [14,15].…”

“…Deformation parameters have demonstrated diagnostic and prognostic utility in a wide range of cardiac and non-cardiac conditions, such as ischemic heart disease [13], aortic stenosis [24], diabetes type 2 [25], acute hyperglycaemia [26] or pre-eclampsia [27]. Both GLS and layer-specific strains (GLSendo, GLSepi) have been found to have predictive significance for adverse outcomes following acute coronary syndrome [28].…”