Assessment of Left Ventricular Rotation and Torsion with Two-dimensional Speckle Tracking Echocardiography

• DOI: 10.1016/j.echo.2006.07.007
• Publication Date: 2007-01-11T12:58:45Z
• Authors: Hyung-Kwan Kim; Dae-Won Sohn; Sang-Eun Lee; Su-Yeon Choi; Jin-Shik Park; Yong-Jin Kim; Byung-Hee Oh; Young-Bae Park; Yun-Shik Choi
• Keywords: Adult; Male; Torsion Abnormality; Heart Ventricles; Age Factors; Middle Aged; Sensitivity and Specificity; Ventricular Function, Left; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Echocardiography; Reference Values; Image Processing, Computer-Assisted; Feasibility Studies; Humans; Female; Echocardiography, Transesophageal; Probability

Speckle tracking echocardiography (STE) has a unique feature of angle independence and, thus, may provide a powerful means of assessing left ventricular (LV) torsion (LVtor). The aims of this study were to assess: (1) the feasibility of 2-dimensional STE in the measurement of LVtor; and (2) the relationship of LVtor with age and conventional echocardiographic parameters.We consecutively recruited 160 healthy volunteers. After obtaining conventional echocardiographic parameters, apical and basal short-axis rotations were assessed with STE. LVtor was defined as the net difference between rotation angles in the two short-axis planes normalized for LV longitudinal length.Reliable LVtor measurement was possible only in 56 volunteers (35%). This low feasibility was largely a result of the failure to obtain reliable basal rotation values. In 56 volunteers who were finally enrolled in this study, a significant correlation was found between LV ejection fraction and LVtor (r = 0.56, P < .001) and this correlation was attributed to apical (r = 0.47, P < .001) but not basal (P = .14) rotation. There was no significant change in LVtor with aging. However, initial counterclockwise motion (r = -0.51, P = .001) and its interval (r = -0.44, P = .001) in the basal rotation gradually decreased with aging, and correlated with early transmitral inflow velocity (r = 0.44 and 0.49, respectively) and its deceleration time (r = -0.43 and -0.48, respectively) (all P < .001). In contrast, such correlations were not found for initial clockwise motion and its interval in the apical rotation.Currently, STE has limited feasibility in the measurement of LVtor. There was no significant age-related change in LVtor. In LV rotations, basal rotation was affected by the age-related changes in the LV early diastolic filling, whereas apical rotation was mainly related to LV systolic performance.