Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy: a study using two-dimensional speckle tracking imaging

Takeuchi, Masaaki; Borden, William B.; Nakai, Hiromi; Nishikage, Tomoko; Kokumai, Michiko; Nagakura, Toshiki; Otani, Shinichiro; Lang, Roberto M.

doi:10.1093/eurheartj/ehm440

Cited by 174 publications

(122 citation statements)

References 25 publications

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“…(2016) in healthy populations confirm data from clinical populations, where a decrease in cardiac mechanics is associated with an increase in LV after‐load (Takeuchi et al. 2007), which is an important finding when considering the continuum of hypertensive heart disease from raised after‐load to adverse LV remodeling to cardiac failure. It is conceivable that had Weiner et al.…”

Section: Discussionmentioning

confidence: 99%

Acute cardiac functional and mechanical responses to isometric exercise in prehypertensive males

et al. 2017

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Isometric exercise (IE) training has been shown to reduce resting arterial blood pressure (ABP) in hypertensive, prehypertensive, and normotensive populations. However, the acute hemodynamic response of the heart to such exercise remains unclear. We therefore performed a comprehensive assessment of cardiac structure, function, and mechanics at rest and immediately post a single IE session in 26 male (age 44.8 ± 8.4 years) prehypertensive participants. Conventional echocardiography recorded standard and tissue Doppler measures of left ventricular (LV) structure and function. Speckle tracking echocardiography was used to measure LV global longitudinal, circumferential, and radial strain and strain rate. From this data, apical and basal rotation and rotational velocities, LV twist, systolic twist velocity, untwist velocity, and torsion were determined. IE led to a significant post exercise reduction in systolic (132.6 ± 5.6 vs. 109.4 ± 19.6 mmHg, P < 0.001) and diastolic (77.6 ± 9.4 vs. 58.8 ± 17.2 mmHg, P < 0.001) blood pressure, with no significant change in heart rate (62 ± 9.4 vs. 63 ± 7.5b·min−1, P = 0.63). There were significant reductions in LV end systolic diameter (3.4 ± 0.2 vs. 3.09 ± 0.3 cm, P = 0.002), LV posterior wall thickness (0.99 ± 0.1 vs. 0.9 ± 0.1 cm, P = 0.013), relative wall thickness (0.4 ± 0.06 vs. 0.36 ± 0.05, P = 0.027) estimated filling pressure (E/E' ratio 6.08 ± 1.87 vs. 5.01 ± 0.82, P = 0.006) and proportion of participants with LV concentric remodeling (30.8% vs. 7.8%, P = 0.035), and significant increases in LV ejection fraction (60.8 ± 3 vs. 68.3 ± 4%, P < 0.001), fractional shortening (31.6 ± 4.5 vs. 39.9 ± 5%, P < 0.001), cardiac output (4.3 ± 0.7 vs. 6.1 ± 1L·min−1, P < 0.001), and stroke volume (74.6 ± 11 vs. 96.3 ± 13.5 ml, P < 0.001). In this setting, there were significant increases in global longitudinal strain (−17.8 ± 2.4 vs. −20 ± 1.8%, P = 0.002) and strain rate (−0.88 ± 0.1 vs. −1.03 ± 0.1%, P < 0.001), basal rotation (−5 ± 3.5 vs. −7.22 ± 3.3°, P = 0.047), basal systolic rotational velocity (−51 ± 21.9 vs. −79.3 ± 41.3°·s−1, P = 0.01), basal diastolic rotational velocity (48.7 ± 18.9 vs. 62.3 ± 21.4°·s−1, P = 0.042), LV twist (10.4 ± 5.8 vs. 13.8 ± 5°, P = 0.049), systolic twist velocity (69.6 ± 27.5 vs. 98.8 ± 35.8°·s−1, P = 0.006), and untwist velocity (−64.2 ± 23 vs. −92.8 ± 38°·s−1, P = 0.007). These results suggest that IE improves LV function and mechanics acutely. This may in turn be partly responsible for the observed reductions in ABP following IE training programs and may have important implications for clinical populations.

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Section: Discussionmentioning

confidence: 99%

Acute cardiac functional and mechanical responses to isometric exercise in prehypertensive males

et al. 2017

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“…The onset of untwisting was significantly delayed in both systolic and diastolic HF. Takeuchi, et al 158 , demonstrated in hypertensive patients that while twist was similar among groups of patients with or without LVH, diastolic LV untwisting and untwisting rates were delayed and reduced in parallel to the severity of LVH. Of note, DD associated with normal aging does not cause a reduction in diastolic untwist as studies have shown normal twist mechanics in elderly individuals 159 , 160 .…”

Section: Torsion/twist Mechanicsmentioning

confidence: 99%

Echocardiographic evaluation of diastolic heart failure

Thomas

2010

Australas J Ultrason Med

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“…[14][15][16] It has been shown that delayed and reduced diastolic untwisting during the diastolic phase may be an early indicator of an LV relaxation abnormality for hypertensive patients with LV hypertrophy. 17 Bansal et al 5 found that resting global LVrot and regional LVrot were significantly reduced in patients with myocardial infarction compared to those without previous myocardial infarction, and LVrot was most impaired in patients with multiple areas of infarction. Therefore, LVrot assessment represents an interesting approach for quantifying LV function and may provide important clinical information about cardiac function.…”

Section: Left Ventricular Rotation and Clinical Implicationsmentioning

confidence: 99%

Three-Dimensional Speckle-Tracking Imaging for Left Ventricular Rotation Measurement

Zhou

Ashraf

et al. 2010

Journal of Ultrasound in Medicine

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Objective. Left ventricular (LV) twist is manifested in oppositely directed apical and basal rotation. We studied a new 3-dimensional (3D) echocardiography program (wall motion tracking; Toshiba America Medical Systems, Inc, Tustin, CA) for left ventricular rotation. Methods. We used a rotation model with a variable-speed motor to rotate hearts in a water bath. We studied 10 freshly harvested pig hearts, which were mounted on the rotary actuator of our twist phantom with the heart base rotating and the apex held fixed to avoid translational motion, at rotations of 0°, 15°, 20°, and 25°. Full-volume 3D image loops were acquired on a Toshiba Aplio Artida ultrasound system at a maximized frame rate. Results. As the actual heart rotation increased, computed segmental and global rotation also increased accordingly, with the measured rotations of the basal and middle segments greater than that of the apex (both P < .001). Segmental and global rotation at all 3 levels correlated well with the actual rotation (base: r = 0.93; middle: r = 0.92; apex: r = 0.82; global: r = 0.95; all P < .001). Conclusions. The new 3D program tracked LV rotation accurately. Key words: left ventricular rotation; speckle tracking; 3-dimensional imaging. esearch in clinical deformation cardiac mechanics has recently been focused on 2-dimensional (2D) left ventricular (LV) deformation studies, including LV twist and LV rotation (LVrot). 1 Left ventricular twist may be related to the helical fiber orientation of the LV, which results in opposing rotational directions of the apex and the base and which determines the magnitude of this torsional deformation. 2,3 It has been proposed that LV twist is a sensitive marker of changes in both regional and global LV function. [4][5][6] Recently, efforts have focused on 2D speckle-tracking imaging (STI) to assess LVrot. [7][8][9] Several studies have shown that 2D STI gives equivalent results when compared to magnetic resonance imaging (MRI) or Doppler tissue imaging (DTI) for measuring LVrot. 9 However, because of the 3-dimensional (3D) nature of cardiac deformation, 2D STI based on 2D imaging may not be robust enough for LVrot measurement because of speckle decorrelation or the loss of some speckles due to elevational

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Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy: a study using two-dimensional speckle tracking imaging

Cited by 174 publications

References 25 publications

Acute cardiac functional and mechanical responses to isometric exercise in prehypertensive males

Acute cardiac functional and mechanical responses to isometric exercise in prehypertensive males

Echocardiographic evaluation of diastolic heart failure

Three-Dimensional Speckle-Tracking Imaging for Left Ventricular Rotation Measurement

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