Abstract 964: Effect of Volume Overload on Left Ventricular Torsion and Extra Cellular Matrix

Background: Muscle fibers are arranged in a spiral network and are connected by extracellular matrix (ECM). LV torsion is increased in the pressure overloaded heart where there is an increase in ECM. However, torsion and its relation to ECM have not been systematically studied in the volume overloaded heart. Hypothesis: The volume overloaded heart has a decrease in LV torsion due a loss of ECM. Methods: Primary mitral regurgitation (MR) (n=29), resistant hypertension (HTN) (n=77) and normal volunteers (NL) (n±37) were studied. Comprehensive cardiac magnetic resonance imaging (MRI) with tissue tagging was performed and analyzed using three-dimensional data set. Torsion was computed by fitting a B-spline deformation model in prolate-spheroidal coordinates to the tag line data. A subset of MR subjects had LV collagen assessed by picric acid Sirius red from biopsy samples taken at the time of surgery. Results: LV ejection fraction was 65% in MR and 70% in HTN. MR demonstrated eccentric remodeling and HTN demonstrated concentric remodeling. HTN had significantly higher torsion angle and systolic twist compared to NL and MR. This was associated with a simultaneous decrease in longitudinal strain. In contrast, MR patients had similar torsion indices, circumferential and longitudinal strains compared to NL. LV biopsy in MR demonstrated a decrease in interstitial collagen compared to NL. Conclusions: As opposed to the pure volume overloaded heart, LV torsional forces are increased in the pressure overloaded heart. This difference may be related to a rearrangement of the laminar structure due to a differential effect on ECM in the volume overloaded versus the pressure overloaded heart.

Download Full-text

Three-Dimensional Left Ventricular Torsion in Patients With Dilated Cardiomyopathy　― A Marker of Disease Severity ―

Circulation Journal ◽

10.1253/circj.cj-16-0965 ◽

2017 ◽

Vol 81 (4) ◽

pp. 529-536 ◽

Cited By ~ 6

Author(s):

Krunoslav Michael Sveric ◽

Stefan Ulbrich ◽

Mohamed Rady ◽

Tobias Ruf ◽

Heda Kvakan ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

Disease Severity ◽

Three Dimensional ◽

Left Ventricular ◽

Left Ventricular Torsion ◽

Ventricular Torsion

Download Full-text

Left ventricular torsion, energetics, and diastolic function in normal human aging

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00985.2011 ◽

2012 ◽

Vol 302 (4) ◽

pp. H885-H892 ◽

Cited By ~ 46

Author(s):

Kieren G. Hollingsworth ◽

Andrew M. Blamire ◽

Bernard D. Keavney ◽

Guy A. MacGowan

Keyword(s):

Ventricular Volume ◽

Normal Aging ◽

Left Ventricular ◽

Diastolic Filling ◽

Strongly Correlated ◽

Left Ventricular Torsion ◽

Tissue Tagging ◽

Diastolic Left Ventricular Function ◽

Ventricular Torsion ◽

Effects Of Aging

This study determined, for the first time, whether the effects of normal aging on systolic and diastolic left ventricular function in subjects without cardiovascular disease are related to underlying energetic defects. Cardiac magnetic resonance imaging with tissue tagging and 31P spectroscopy was used to determine global structure, function, myocardial strains, and the phosphocreatine-to-ATP ratio (PCr/ATP) in 49 healthy subjects aged 20–69 yr. The three major abnormalities that developed with increasing age were the early filling percentage (EFP, the left ventricular volume increase from end systole to mid-diastole divided by stroke volume × 100), which decreased with age, indicating impaired early diastolic filling ( r = −0.72, P < 0.0001), the torsion-to-shortening ratio (TSR, measure of subepicardial torsion exerting mechanical advantage over subendocardial shortening), which increased with age indicating relative subendocardial dysfunction ( r = 0.44, P < 0.02), and the PCr/ATP (decreased with increasing age, r = −0.52, P < 0.003). EFP and TSR were strongly correlated ( r = −0.63, P < 0.0001), although they were not related to PCr/ATP [EFP vs. PCr/ATP: r = 0.34, not significant (NS) and TSR vs. PCr/ATP: r = −0.3, P = NS]. In normal aging, changes in EFP and TSR likely share the same pathophysiology, although it is unlikely that energetics have a major role in the functional effects of aging.

Download Full-text

Abstract 14645: Three Dimensional Ejection Fraction is More Strongly Determined by Strain Than by Torsion in a Cohort of Breast Cancer Patients Undergoing Anthracycline-Based Chemotherapy

Circulation ◽

10.1161/circ.132.suppl_3.14645 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Gaurav Gulati ◽

Benjamin French ◽

Kathleen W Zhang ◽

Hari K Narayan ◽

Akinyemi Bajulaiye ◽

...

Keyword(s):

Breast Cancer ◽

Ejection Fraction ◽

Risk Prediction ◽

Three Dimensional ◽

Left Ventricular ◽

Principal Strain ◽

Left Ventricular Ejection ◽

Left Ventricular Torsion ◽

Deformation Parameters ◽

Ventricular Torsion

Introduction: Anthracycline cardiotoxicity affects approximately 10-20% of treated individuals, representing a significant health burden. Three dimensional (3D) echocardiographic measures of myocardial mechanics have the potential to improve our understanding of the functional changes that occur with anthracyclines, and may play an important role in cardiotoxicity risk prediction. Our objective was to define the relationships between 3D myocardial deformation parameters and left ventricular ejection fraction (LVEF) in a longitudinal, prospective cohort of patients with breast cancer. Methods: We performed 3D echocardiograms at standardized intervals in a longitudinal cohort of women with breast cancer undergoing doxorubicin therapy with or without trastuzumab. We acquired all 3D images at a minimum of 22 frames per second and excluded from analysis all images that had poor tracking of greater than 3 myocardial segments, dropout of the apex, or stitch artifact. Two readers used a vendor-independent analysis platform (TomTec Cardiac Performance Analyses, Unterschleissheim, Germany) to measure 3D LVEF and the following 3D deformation parameters: principal strain, global longitudinal strain (GLS), global circumferential strain (GCS), and left ventricular torsion. Spearman correlation analyses were performed to understand the relationships amongst these parameters. Results: We analyzed 270 total echocardiograms from 87 women (mean age 49). Conventional 3D strain parameters were highly correlated with 3D LVEF (principal strain, r=-0.95, p<0.001; GLS, r=-0.85, p<0.001; GCS r=-0.97, p<0.001). In contrast, left ventricular torsion was only modestly correlated with 3D LVEF (r=0.51, p<0.001). Conclusions: Three dimensional principal strain, GLS, and GCS were all strongly correlated with 3D LVEF. However, left ventricular torsion was only weakly correlated to LVEF, suggesting that LVEF is determined less by torsion than by 3D strain. With further study, 3D strain may play an important role in chemotherapy cardiotoxicity risk prediction.

Download Full-text

Assessment of swine left ventricular torsion after left coronary artery occlusion using 2-D speckle tracking imaging

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(08)60346-x ◽

2008 ◽

Vol 7 ◽

pp. 124-124 ◽

Cited By ~ 1

Author(s):

W RUAN ◽

Y SUN ◽

M CAO ◽

Q ZHANG ◽

L LU ◽

...

Keyword(s):

Coronary Artery ◽

Speckle Tracking ◽

Left Coronary Artery ◽

Coronary Artery Occlusion ◽

Artery Occlusion ◽

Left Ventricular ◽

Speckle Tracking Imaging ◽

Left Ventricular Torsion ◽

Ventricular Torsion

Download Full-text

The Improvement of Torsion Assessed by Cardiovascular Magnetic Resonance Feature Tracking after Coronary Artery Bypass Grafting: A Sensitive Index of Cardiac Function

The Heart Surgery Forum ◽

10.1532/hsf.1655 ◽

2017 ◽

Vol 20 (1) ◽

pp. 026 ◽

Cited By ~ 2

Author(s):

Nan Cheng ◽

Liuquan Cheng ◽

Rong Wang ◽

Lin Zhang ◽

Changqing Gao

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Ejection Fraction ◽

Cardiac Function ◽

Feature Tracking ◽

Artery Bypass ◽

Left Ventricular ◽

Rapid Acquisition ◽

Left Ventricular Torsion ◽

Ventricular Torsion

Objective: The aim of this study was to quantify left ventricular torsion by newly applied cardiovascular magnetic resonance feature tracking (CMR-FT), and to evaluate the clinical value of the ventricular torsion as a sensitive indicator of cardiac function by comparison of preoperative and postoperative torsion.Methods: A total of 54 volunteers and 36 patients with previous myocardial infarction (MI) and LV ejection fraction (EF) between 30%-50% were screened preoperatively or postoperatively by MRI. The patients’ short axis views of the whole heart were acquired, and all patients had a scar area >75% in at least one of the anterior or inferior segments. Their apical and basal rotation values were analyzed by feature tracking, and the correlation analysis was performed for the improvement of LV torsion and ejection fraction after CABG. The intra- and inter-observer reliabilities of torsion measured by CMR-FT were assessed.Results: In normal hearts, the apex rotated counterclockwise in the systolic period with the peak rotation as 10.2 ± 4.8°, and the base rotated clockwise as the peak value was 7.0 ± 3.3°. There was a timing hiatus between the apex and base untwisting, during which period the heart recoils and its suction sets the stage for the following rapid filling period. The postoperative torsion and rotation significantly improved compared with preoperative ones. However, the traditional indicator of cardiac function, ejection fraction, didn’t show significant improvement.Conclusion: Left ventricular torsion derived from CMR-FT, which does not require specialized CMR sequences, was sensitive to patients with low ejection fraction whose cardiac function significantly improved after CABG. The rapid acquisition of this measurement has potential for the assessment of cardiac function in clinical practice.

Download Full-text