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European Heart Journal Advance Access originally published online on January 31, 2008
European Heart Journal 2008 29(6):825; doi:10.1093/eurheartj/ehn004
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. 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

Andrew T. Burns

Cardiac Investigation Unit
St Vincent's Hospital Melbourne
PO Box 2900, Fitzroy
VIC 3065
Australia
Tel: +61 3 92882211
Fax: +61 3 92884423
Email: andrew.burns{at}svhm.org.au

Andre La Gerche

Cardiac Investigation Unit
St Vincent's Hospital Melbourne
PO Box 2900, Fitzroy
VIC 3065
Australia

David L. Prior

Cardiac Investigation Unit
St Vincent's Hospital Melbourne
PO Box 2900, Fitzroy
VIC 3065
Australia
Department of Medicine
St Vincent's Hospital Melbourne
University of Melbourne
Mclbourne, VIC
Australia

Andrew I. MacIsaac

Cardiac Investigation Unit
St Vincent's Hospital Melbourne
PO Box 2900, Fitzroy
VIC 3065
Australia
Department of Medicine
St Vincent's Hospital Melbourne
University of Melbourne
Mclbourne, VIC
Australia

We read with interest the study by Takeuchi et al.1 which elegantly lends weight to the critical role of untwisting in normal and abnormal diastolic function.2 However, we would like to raise two important methodological issues in the use of speckle tracking imaging (STI) to assess torsion:

  1. The need for further interpolation of STI data. The STI algorithm includes cubic spline interpolation and provides estimation of rotation in the six predefined segments at each frame. Because current 2D echocardiography allows imaging only in one plane at a time, changes between acquisition of the apical and basal short-axis images in heart rate or frame rate, as documented by these authors, may result in the STI algorithm estimating rotation for frames at different time points at the apex and base. Although temporal normalization overcomes intersubject differences in heart rate, it does not prevent deduction of basal rotation from apical rotation values at different time points in the cardiac cycle which results in erroneous calculation of torsion or twist. A further cubic spline interpolation3,4 of the temporally normalized apical and basal rotation data overcomes this issue by ensuring data from the same time points can be deducted. Although this is potentially labour intensive, customized automated algorithms may facilitate this.4
  2. The measurement of untwisting and untwisting rate from end systole. Because peak torsion, which is the onset of untwisting, may be delayed beyond aortic valve closure, particularly, as these authors and others have shown, by increased LV mass,2 we believe that the untwisting should be measured from peak torsion rather than end systole. Measurement of untwisting from end systole may result in a significant underestimation of the gradient of untwisting (e.g. in this study, Table 3, untwisting at t = 5%, for the severe left ventricular hypertrophy group, a negative value does not represent true untwisting). Both timing and velocity of untwisting may be important in diastolic dysfunction and the parameter negative torsion acceleration3 incorporates both these aspects of torsional dynamics and may be a useful parameter of diastolic function. In the present study, because the authors have calculated untwisting as a percentage, the units of untwisting rate should be percentage per millisecond.
We commend the authors on this excellent work but emphasize the importance of consistent and reproducible methodology for the ongoing study of left ventricular torsion.

References

  1. Takeuchi M, Borden WB, Nakai H, Nishikage T, Kokumai M, Nagakura T, Otani S, Lang RM. Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy: a study using two-dimensional speckle tracking imaging. Eur Heart J (2007) 28:2756–2762.[Abstract/Free Full Text]
  2. Notomi Y, Martin-Miklovic MG, Oryszak SJ, Shiota T, Deserranno D, Popovic ZB, Garcia MJ, Greenberg NL, Thomas JD. Enhanced ventricular untwisting during exercise. A mechanistic manifestation of elastic recoil described by doppler tissue imaging. Circulation (2006) 113:2524–2533.[Abstract/Free Full Text]
  3. Burns AT, La Gerche A, MacIsaac AI, Prior DL. Augmentation of left ventricular torsion with exercise is attenuated with age. J Am Soc Echocardiogr (2007) (in press).
  4. Borg AN, Harrison JL, Argyle RA, Ray SG. Left ventricular torsion in primary chronic mitral regurgitation. Heart (2007) (in press).

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This article has been cited by other articles:


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