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( A ) Normal apical rotation in control patients. Tracking points at the left ventricular apical level. The left ventricular rotation– time curve ( x -axis: time in ms; y -axis: left ventricular apical rotation in degrees). An electrocardiogram is displayed at the bottom. ( B ) Normal basal rotation in control patients. Tracking points at the left ventricular basal level. The left ventricular rotation– time curve ( x -axis: time in ms; y -axis: left ventricular basal rotation in degrees). An electrocardiogram is displayed at the bottom (arrow indicates peak global basal rotation at time of aortic valve closure).
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Aims:
Speckle-tracking echocardiography (STE) has emerged as a quantitative technique to assess left ventricular (LV) function via twist mechanics. Hypertension-associated changes in LV twist have not been previously evaluated in African patients with LV systolic dysfunction. This study evaluates LV twist dynamics in hypertensive patients with a l...
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Citations
... Hypertensive heart disease includes a number of complications due to high blood pressure including LV hypertrophy, heart failure, etc. In hypertensive cardiomyopathy patients with reduced LV-EF, 32% of subjects showed predominantly Cw LV-RBR suggesting compromised LV apical rotation similarly to NCCM/DCM/NICM patients [25]. ...
... At the time of 3DSTE, these subjects had no abnormality, pathologic state, drug use, symptoms, electrocardiographic or echocardiographic findings, which could explain LV-RBR. Theoretically, these subjects had subclin- [25] 2D-STE 41 (32%) Cw -85% ...
... [17,[36][37][38][39][40][43][44][45][46][47][48][49]). Interestingly, while most cardiomyopathy patients showed Cw LV-RBR [11,12,15,18,19,22,23,25], patients with non-cardiac disorders without obvious cardiac involvement (lymphedema, acromegaly, following kidney transplantation) most likely had CCw LV-RBR [37,40,46]. ...
Left ventricular (LV) twist is defined as the wringing motion of the LV around
its long-axis during systole generated by rotation of the LV apex in a
counterclockwise direction, as viewed from the apex, while the LV base moves in a
clockwise direction. In several cases, the LV apex and base move in the same
direction during ejection demonstrating a special condition called as LV ‘rigid
body rotation’. The present review aimed to summarize our knowledge about this
rare but not fully understood entity demonstrating its theoretic pathophysiologic
background, clinical significance, associated diseases, and reversibility based
on available literature.
... The LV rotation, represented as twist and torsion, is shown to be a marker of LV systolic [28,29] and diastolic function [30]. This indicates that LV myocardial Multiple recent studies have demonstrated that STE represents a clinically feasible alternative to TDI in evaluation of myocardial rotation and twist mechanics in the majority of patients [25,31]. ...
Background
The aim of this study was to examine left ventricular (LV) function in untreated, newly diagnosed hypertensive patients with morning blood pressure surge (MBPS) status using three-dimensional (3D) speckle tracking echocardiography (STE).
Methods
In this study, 163 newly diagnosed hypertensive patients were included, and all patients underwent 24-h ambulatory blood pressure monitoring (ABPM). According to ABPM, participants were divided into a MBPS group and a non-MBPS group. The entire study population was examined by complete two-dimensional (2D) transthoracic echocardiography (TTE) and 3D STE.
Result
The results of this study showed that 3D LV longitudinal strain was significantly decreased in the MBPS group compared with the non-MBPS group (− 30.1 ± 2.0 vs. -31.1 ± 2.7, p = 0.045). Similar trends were observed for 3D twist (9.6 ± 6.1 vs. 12.1 ± 4.8, p = 0.011) as well as for 3D torsion (1.23 ± 0.78 vs. 1.49 ± 0.62, p = 0.042). The LV principal strain was decreased in the MBPS group (− 33.9 ± 1.7 vs. -35.5 ± 2.8, p < 0.001). The 3D LV global longitudinal strain (GLS) and principal strain were significantly associated with quartile of MBPS as measured by systolic blood pressure (SBP).
Conclusion
The 3D STE revealed that LV mechanics were more impaired in the MBPS group than in the non-surge newly diagnosed, untreated hypertensive patients; even the 2D TTE parameters showed no difference.
... Of note, the RBR pattern was found in 53.3% of patients, remarkably close to our findings (44.9%). On the other hand, we found that RBR pattern was associated with worse LV remodeling and lower LVEF, increased ventricular volumes and mass, which is more consistent with previous studies in other cardiomyopathies [21,22]. Interestingly, our matrix correlation and AI model recognized that RBR was correlated with 5 relevant echocardiographic parameters: LVEF, diastolic dysfunction twist, NC/C ratio and torsion. ...
Aims
Noncompaction cardiomyopathy (NCC) is considered a genetic cardiomyopathy with unknown pathophysiological mechanisms. We propose to evaluate echocardiographic predictors for rigid body rotation (RBR) in NCC using a machine learning (ML) based model.
Methods and results
Forty-nine outpatients with NCC diagnosis by echocardiography and magnetic resonance imaging (21 men, 42.8±14.8 years) were included. A comprehensive echocardiogram was performed. The layer-specific strain was analyzed from the apical two-, three, four-chamber views, short axis, and focused right ventricle views using 2D echocardiography (2DE) software. RBR was present in 44.9% of patients, and this group presented increased LV mass indexed (118±43.4 vs. 94.1±27.1g/m ² , P = 0.034), LV end-diastolic and end-systolic volumes ( P < 0.001), E/e’ (12.2±8.68 vs. 7.69±3.13, P = 0.034), and decreased LV ejection fraction (40.7±8.71 vs. 58.9±8.76%, P < 0.001) when compared to patients without RBR. Also, patients with RBR presented a significant decrease of global longitudinal, radial, and circumferential strain. When ML model based on a random forest algorithm and a neural network model was applied, it found that twist, NC/C, torsion, LV ejection fraction, and diastolic dysfunction are the strongest predictors to RBR with accuracy, sensitivity, specificity, area under the curve of 0.93, 0.99, 0.80, and 0.88, respectively.
Conclusion
In this study, a random forest algorithm was capable of selecting the best echocardiographic predictors to RBR pattern in NCC patients, which was consistent with worse systolic, diastolic, and myocardium deformation indices. Prospective studies are warranted to evaluate the role of this tool for NCC risk stratification.
... In the study of Dragulescu et al.,19 of 50 young cTOF patients had reversed (counterclockwise) LV basal rotation (5). According to the literature, LV-RBR was found to be a frequent phenomenon in several disorders with the largest ratio in non-compaction (50-100%) (12), dilated (50%) (13) and hypertensive cardiomyopathies (32%) (14), cardiac amyloidosis (60%) (15) and acromegaly (20%) (16). Some case reports showed LV-RBR in some CHDs as well including Ebstein's anomaly (17), univentricular heart (18) and hypoplastic right-heart syndrome (19). ...
Background:
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease (CHD). Abnormal aortic dimensions and elasticity parameters have been long described for corrected TOF (cTOF) together with left ventricular (LV) rotational abnormalities, but results are conflicting. The present study focuses on investigating LV rotational mechanics in cTOF, and possible correlation of these parameters with aortic elasticity. It was also aimed to be examined whether different surgical strategies have any effect on these results.
Methods:
The study involved 26 adult cTOF patients, from which 14 had palliative surgery first and a late total correction (pcTOF), while early total correction was the treatment of choice in 12 patients (etrTOF). Their results were compared to those of 37 age- and gender-matched healthy adults. Routine transthoracic two-dimensional Doppler echocardiography extended with assessment of aortic elastic properties and three-dimensional speckle-tracking echocardiography (3DSTE) was performed in all cTOF patients and controls.
Results:
Sixteen out of 26 cTOF patients showed normally directed LV rotational mechanics, while apical or basal LV rotations were in the same clockwise or counterclockwise directions in 7 and 3 cTOF cases, respectively (LV 'rigid body rotation', RBR). Significantly reduced LV apical rotation and twist could be demonstrated in all cTOF patients with preserved LV basal rotation regardless of previous procedure. pcTOF patients showed significantly reduced LV apical rotation as compared to that of etrTOF cases. Significant correlations could be demonstrated between LV apical rotation and aortic stiffness index (r=-0.55, P=0.03) and aortic distensibility (r=0.52, P=0.04).
Conclusions:
Significant LV rotational abnormalities could be demonstrated in cTOF with the high prevalence of LV-RBR. pcTOF patients showed significantly reduced LV apical rotation as compared to that of etrTOF cases. Unexpected abnormal physiologic response of LV rotational mechanics to increased aortic stiffness can be detected in cTOF patients without LV-RBR.
... however, it has also been demonstrated in several other disorders, e.g., dilated and hypertensive cardiomyopathy, amyloidosis or different types of congenital heart diseases (9,(45)(46)(47). In our study population, a mainly clockwise-directed RBR was found in the patients with reduced EF. ...
... In our study population, a mainly clockwise-directed RBR was found in the patients with reduced EF. Some studies have shown that patients with a clockwise RBR have higher volumes and more severely reduced EF and LV remodeling, which leads to a decrease in apical rotation and can eventually result in reversed apical rotation and clockwise RBR (43,45,48,49). These findings are in accordance with our own results. ...
Background
There is a lack of cardiac MRI information on left ventricular (LV) strain and rotational parameters of left ventricular noncompaction (LVNC) patients with reduced ejection fraction (EF). Thus, we sought to use feature tracking (FT) to describe these changes at different levels of EF deterioration.
Methods
We included 31 adult LVNC patients with reduced LV EF (Group B, EF < 50%) without any comorbidities or concomitant cardiac diseases, 31 age- and sex-matched LVNC patients with good EF (Group A, EF > 50%) and 31 healthy controls. Group B was divided according to LV EF into two subgroups (Group B-1: EF 35–50%, Group B-2: EF < 35%). Their global longitudinal, circumferential (GCS), and radial (GRS) strains; LV segmental strains; LV apical and basal rotation values; and patterns and degree of LV dyssynchrony were measured.
Results
All of the global and mean segmental strain parameters were significantly worse in Groups B, B-1 and B-2 than in Group A and in the controls. The LV mechanical dispersion increased as LV EF decreased. The degree of apical rotation was the highest in the control group, almost the same in Group A and the lowest and in the reverse direction in Group B-2. A rotational pattern, clockwise-directed rigid body rotation (RBR), was found in 39% of the Group B patients, and a counterclockwise-directed RBR was found in 26% of the Group A patients.
Conclusions
The strain values and rotational parameters changed as the EF decreased. These changes affected the global LV, and we did not identify an LVNC-specific strain pattern.
... A second reason for the variability of results is the nonuniformity of LVNC criteria used. Not only do the studies mentioned vary with regard to the criteria used, but, since the publication of Kohli et al. in 2008, the individual criterion themselves have been modified-including those utilised by Jenni et al. and Stollberger et al [5,[16][17][18]21]. Thus, the current criteria are more similar, more encompassing, and stricter. ...
Background
Several large, prospective screening studies of predominantly Caucasian patients have suggested that hypertrabeculation may not necessarily be pathologic unless there is concomitant left ventricular (LV) dysfunction, LV dilatation, history of arrhythmia, family history, or characteristic gene mutations. This conundrum may be magnified in blacks, in whom hypertrabeculation and LV hypertrophy is more common. We therefore investigated the frequency of hypertrabeculation/isolated LV noncompaction (ILVNC) phenotype in normal black Africans and evaluated LV function using sensitive measures of deformation and twist.
Methods
Two hundred and fifty-three volunteers were recruited and evaluated according to strict inclusion and exclusion criteria. Their mean age was 36.3 ± 12.2 years.
Results
Trabeculations were found in 12 (4.74%) participants. Three (1.2%) subjects had ≥ 4 LV trabeculations. The LV apex was the most common anatomical site for the location of trabeculations. Subjects with trabeculations were more likely to be males of a younger age, and had greater LV end-diastolic and end-systolic parameters and lateral e’. However, 0.8% of the population fulfilled the Stollberger criteria, and none fulfilled the Jenni, Milwaukee, or Baragwanath criteria. All subjects in this study had normal rotation patterns with no differences in rotational parameters or net twist.
Conclusions
Trabeculations may be found as a normal variant in black Africans. Assessing trabeculations alone may infer ILVNC; however, utilizing the more comprehensive ILVNC criteria enables differentiation of a possible LVNC phenotype. Normal individuals with hypertrabeculation have normal LV function and normal rotation patterns, with no differences in rotational parameters or net twist.
... Previous studies have shown that in patients with systemic hypertension, LV twist could be preserved [18,27] or increased [1,5] but decreased when LV ejection fraction was impaired [14]. However, LV untwist was always decreased whatever the LV ejection fraction [5,15,18,27]. ...
The mechanical and cellular relationships between systole and diastole during left ventricular (LV) dysfunction remain to be established. LV contraction-relaxation coupling was examined during LV hypertrophy induced by chronic hypertension. Chronically instrumented pigs received angiotensin II infusion for4weeks to induce chronic hypertension (133 ± 7 mmHg vs 98 ± 5 mmHg for mean arterial pressure at Day 28 vs 0, respectively) and LV hypertrophy. LV function was investigated with the instrumentation and echocardiography for LV twist-untwist assessment before and after dobutamine infusion. The cellular mechanisms were investigated by exploring the intracellular Ca2+ handling. At Day 28, pigs exhibited LV hypertrophy with LV diastolic dysfunction (impaired LV isovolumic relaxation, increased LV end-diastolic pressure, decreased and delayed LV untwisting rate) and LV systolic dysfunction (impaired LV isovolumic contraction and twist) although LV ejection fraction was preserved. Isolated cardiomyocytes exhibited altered shortening and lengthening. Interestingly, contraction-relaxation coupling remained preserved both in vivo and in vitro during LV hypertrophy. LV systolic and diastolic dysfunctions were associated to post-translational remodeling and dysfunction of the type 2 cardiac ryanodine receptor/Ca2+ release channel (RyR2), i.e., PKA hyperphosphorylation of RyR2, depletion of calstabin 2 (FKBP12.6), RyR2 leak and hypersensitivity of RyR2 to cytosolic Ca2+ during both contraction and relaxation phases. In conclusion, LV contraction-relaxation coupling remained preserved during chronic hypertension despite LV systolic and diastolic dysfunctions. This implies that LV diastolic dysfunction is accompanied by LV systolic dysfunction. At the cellular level, this is linked to sarcoplasmic reticulum Ca2+ leak through PKA-mediated RyR2 hyperphosphorylation and depletion of its stabilizing partner.
... Moreover, the real prevalence of LV-RBR in different clinical scenarios is not known. Regarding the literature, several studies confirmed LV-RBR in noncompaction, [4] hypertensive, [5] and dilated [6] cardiomyopathies with decreased LV function. Moreover, some reports found LV-RBR in congenital heart diseases and in infiltrative disorders such as cardiac amyloidosis. ...
Under normal physiological conditions, the direction of systolic rotation of the left ventricular (LV) base is clockwise, and that of the LV apex is counterclockwise resulting in the wringing motion of the LV around its long axis called as LV twist. The present study was designed to present a patient with significant coronary artery disease in whom near absence of LV twist called as LV rigid body rotation could be induced during dipyridamole stress as assessed noninvasively by three-dimensional speckle-tracking echocardiography. © 2019 Journal of Cardiovascular Echography | Published by Wolters Kluwer - Medknow.
... Similarly, 26 age-and gender-matched individuals were recruited from healthy volunteers with no known underlying medical conditions among unrelated staff members at Chris Hani Baragwanath Hospital and local churches around the Soweto, Johannesburg area. 22 Ethics approval for this study was obtained from the University of the Witwatersrand human research ethics committee. Written informed consent was obtained from all patients, and the study protocol (approval number M10510) conformed to the 1975 Declaration of Helsinki. ...
... CKD patients were evaluated before and within an hour of a single haemodialysis session. According to a standardised protocol used by our institution, [22][23][24][25] a comprehensive echocardiographic examination was performed in the lateral decubitus position using a commercially available system (iE33 xMATRIX, Philips Healthcare, Andover, MA, USA) equipped with an S5-1 transducer (frequency transmitted 1.7 MHz, frequency received 3.4 MHz). Measurements obtained were averaged from three heartbeats. ...
... Basal rotation was measured at a time isochronous to peak apical systolic rotation, in keeping with a standard protocol used by our institution, which has previously been published. 22,24,25 Net instantaneous twist was calculated as peak apical rotation minus the isochronous basal rotation. ...
Background:
The most commonly used parameter of cardiac function in the chronic kidney disease (CKD) patient is ejection fraction (EF), using transthoracic echocardiography (TTE). EF is a highly load-dependent measurement, which varies considerably in CKD patients undergoing haemodialysis. The aim of this pilot study was to evaluate a novel measure of myocardial function, left ventricular twist, which is defined as the 'wringing action of the heart', using speckletracking echocardiography in CKD patients before and after haemodialysis.
Methods:
Twenty-six patients were recruited from the Chris Hani Baragwanath Hospital haemodialysis unit. TTE was performed according to a detailed standardised protocol before and after a single haemodialysis session. Echocardiography was also performed on 26 age- and gendermatched healthy subjects.
Results:
The mean age of the control versus CKD group was 44 ± 11.4 and 43.4 ± 12.2 years, respectively; 46% were male. Apical rotation was diminished in CKD patients compared to controls (4.83 ± 2.3 vs 6.31 ± 1.6 °; p = 0.01) despite no difference in EF (61.7 ± 6.2 vs 58.8 ± 13; p = 0.68). There were no differences in the components of twist: apical rotation, basal rotation and net twist before and after dialysis, despite an increase in EF (58.8 ± 13.7 vs 61.2 ± 13.6; p = 0.02) following dialysis.
Conclusion:
Unlike EF, the components of twist are relatively independent of changes in haemodynamic load seen during dialysis. The decrease in apical rotation may represent an early marker of cardiac pathology in the late-stage CKD patient.
... In adults with hypertension, left ventricular twist and torsion are impaired. 8 As indicated by Navarini et al, 7 this may reflect the likely relatively short duration of hypertension in young patients. ...
