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European Heart Journal Advance Access originally published online on October 19, 2007
European Heart Journal 2007 28(22):2756-2762; doi:10.1093/eurheartj/ehm440
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Published on behalf of the European Society of Cardiology. All rights reserved.© The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org.

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

Masaaki Takeuchi1,*, William B. Borden2, Hiromi Nakai1, Tomoko Nishikage1, Michiko Kokumai1, Toshiki Nagakura1, Shinichiro Otani1 and Roberto M Lang2

1 Department of Cardiology and Internal Medicine, Tane General Hospital, 1-2-31 Sakaigawa, Nishi-ku, Osaka 550-0024, Japan
2 Noninvasive Cardiac Imaging Laboratory, Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA

Received 11 May 2006; revised 6 July 2007; accepted 13 September 2007; online publish-ahead-of-print 19 October 2007.

* Corresponding author. Tel: +81 6 6581 1071; fax: +81 6 6581 2520. E-mail address: masaaki_takeuchi{at}hotmail.com

Aims: Newly developed two-dimensional ultrasound speckle tracking imaging allows measurements of left ventricular (LV) rotation and twist. Because LV untwisting predominantly occurs during the isovolumic relaxation period, its assessment reflects the process of LV relaxation. The aim of this study was to examine whether LV hypertrophy (LVH) adversely affects LV untwisting and abnormalities in LV untwisting could become a novel marker in assessing LV relaxation abnormalities.

Methods and results: We acquired basal and apical LV short-axis images in 49 hypertensive patients. Using two-dimensional strain software, a time-domain speckle tracking was performed, and the mean value of LV rotation was obtained at each plane. LV twist was defined as apical rotation relative to the base. In order to adjust for inter-subject differences in heart rate, the time sequence was normalized to the percentage of systolic and diastolic duration. The degree of LV untwisting was calculated as the percentage of systolic twist : untwisting = (TwistES–Twistt/TwistES) x 100, where Twistt is twist at time t and TwistES is twist at end-systole. Although peak systolic twist was not different, early diastolic LV untwisting and untwisting rate during isovolumic relaxation period was significantly delayed and reduced in parallel to the severity of LVH, as assessed by LV mass index.

Conclusion: The observed delayed and reduced diastolic untwisting during the isovolumic relaxation period noted in hypertensive patients with LVH may contribute towards the LV relaxation abnormality. Two-dimensional speckle tracking imaging is a novel tool which can be used for the non-invasive assessment of LV relaxation.

Key Words: Two-dimensional speckle tracking • Untwisting • Relaxation • Left ventricular hypertrophy


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