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Torsion / Twist

Key Reference Library

Non-Invasive Imaging

Last update: September 2012



Left ventricular torsional dynamics in aortic stenosis: relationship between left ventricular untwisting and filling pressures. A two-dimensional speckle tracking study.
Popescu BA, Calin A, Beladan CC, Muraru D, Rosca M, Deleanu D, Lancellotti P, Antonini-Canterin F, Nicolosi GL, Ginghina C.
Comment:
In patients with severe AS and preserved LVEF, there is a significant relationship between LV untwisting and LV filling pressures, suggesting a role for impaired LV untwisting in the pathophysiology of diastolic dysfunction in this setting.
Reference:
Eur J Echocardiogr. 2010 Jan 6

Normal Rotational, Torsion and Untwisting Data in Children, Adolescents and Young Adults. 
Takahashi K, Al Naami G, Thompson R, Inage A, Mackie AS, Smallhorn JF.
Comment:
The present study investiguated the effect of age on LV torsion and rotation rate. The heart maintains a constant LV torsion and LV rotation profile when normalized by length and cardiac cycle. Younger hearts tend to twist, untwist, and deform faster.
Reference:
J Am Soc Echocardiogr. 2010 jan

The pathophysiology of heart failure with normal ejection fraction: exercise echocardiography reveals complex abnormalities of both systolic and diastolic ventricular function involving torsion, untwist, and longitudinal motion. 
Tan YT, Wenzelburger F, Lee E, et al.
Comment:
In heart failure with normal ejection fraction (HFNEF) exercise limitation is due to combined systolic and diastolic abnormalities, particularly involving ventricular twist and deformation (strain) leading to reduced ventricular suction, delayed untwisting, and impaired early diastolic filling. Therefore, In HFNEF there are widespread abnormalities of both systolic and diastolic function that become more apparent on exercise. HFNEF is not an isolated disorder of diastole.
Reference:
J Am Coll Cardiol 2009;54:36-46

Role of left ventricular twist mechanics in the assessment of cardiac dyssynchrony in heart failure. 
Bertini M, Sengupta PP, Nucifora G, Delgado V, Ng AC, Marsan NA, Shanks M, van Bommel RR, Schalij MJ, Narula J, Bax JJ.
Comment:
The incremental value of assessing left ventricular (LV) twist mechanics in patients with heart failure (HF) and its potential usefulness in characterizing response to cardiac resynchronization therapy (CRT) is discussed, as the critical relationship between LV lead position and changes in LV twist after CRT.
Reference:
JACC Cardiovasc Imaging. 2009 Dec;2(12):1425-35

Apical rotation assessed by speckle tracking echocardiography as an index of global left ventricular contractility. 
Kim WJ, Lee BH, Kim YJ, et al.

Comment:
LV twist gives additional information to LV ejection fraction. In the present study the authors have shown that apical torsion is an accurate index of global LV contractility estimated noninvasively by speckle 2D-tracking and is more closely related to dP/dt(max) than LV ejection fraction.
Reference:
Circ Cardiovasc Imaging 2009;2:123-131

Comprehensive evaluation of left ventricular strain using speckle tracking echocardiography in normal adults: comparison of three-dimensional and two dimensional approaches. 
Saito K, Okura H, Watanabe N, et al.
Comment:
2-dimensional speckle tracking echocardiography has some limitations for the assessment of LV twist mainly related to the acquisition of LV apical short-axis images and presence of through-plane motion, particularly at the basal level, which may affect the accuracy of the measurement of LV rotational parameters. Recently developed 3-dimensional speckle tracking analysis may partially overcome these limitations and may provide even more global characterization of LV twist mechanics.
Reference:
J Am Soc Echocardiogr 2009;22:1025-1030

Assessment of regional rotation patterns improves the understanding of the systolic and diastolic left ventricular function: an echocardiographic speckle-tracking study in healthy individuals. 
Gustafsson U, Lindqvist P, Morner S, Waldenstrom A.
Comment:
In 40 healthy volunteers with structurally normal hearts and no history of hypertension, ‘regional’ LV rotation was studied for the first time with speckle tracking echocardiography. Systolic rotation at the basal level (but not at the apical level) is increased in the posterior segments and there is a temporal dispersion in apical and basal de-rotation during diastole.
Reference:
Eur J Echocardiogr 2009 Jan;10(1):56-61

Left ventricular torsion by two-dimensional speckle tracking echocardiography in patients with diastolic dysfunction and normal ejection fraction. 
Park SJ, Miyazaki C, Bruce CJ, Ommen S, Miller FA, Oh JK.
Comment:
Systolic torsion and diastolic untwisting are significantly increased in patients with mild diastolic dysfunction. In patients with advanced diastolic dysfunction with increased filling pressure, they are normalized or reduced.
Reference:
J Am Soc Echocardiogr 2008;21:1129-1137

Twist Mechanics of the Left Ventricle: Principles and Application. 
Sengupta P, Tajik J, Chandrasekaran K, Khandheria B.
Comment:
This review presents an algorithm for routine application of left ventricular (LV) twist in clinical differentiation of patterns of LV dysfunction encountered in day-to-day practice. Left ventricular twist during ejection predominantly deforms the subendocardial fiber matrix, resulting in storage of potential energy. Subsequent recoil of twist deformation is associated with the release of restoring forces, which contributes to LV diastolic relaxation and early diastolic filling. Noninvasive techniques such as magnetic resonance imaging and echocardiography are useful for understanding LV twist dynamics in clinical settings, and data regarding their relative merits and pitfalls are rapidly accumulating.
Reference:
JACC: Cardiovascular Imaging, Volume 1, Issue 3, May 2008, Pages 366-376

Importance of transducer position in the assessment of apical rotation by speckle tracking echocardiography. 
van Dalen BM, Vletter WB, Soliman OI, ten Cate FJ, Geleijnse ML.
Comment:
Caveat and pitfalls in the assessment of twist by speckle tracking echocardiography.
Reference:
J Am Soc Echocardiogr (2008) 21:895–8

Prior D.Doin' the twist: new tools for an old concept of myocardial function. 
Burns AT, McDonald IG, Thomas JD, Macisaac A
Comment:
An extensive review on twist.
Reference:
Heart. 2008 Aug;94(8):978-83

Ventricular untwisting: a temporal link between left ventricular relaxation and suction. 
Notomi Y, Popovic ZB, Yamada H, Wallick DW, Martin MG, Oryszak SJ, et al.
Comment:
LV twist plays a pivotal role in the mechanical efficiency of the heart and untwist plays a crucial role in diastolic suction.
Reference:
Am J Physiol Heart Circ Physiol (2008) 294:H505–13

Regional left ventricular electric and mechanical activation and relaxation 
O.A. Smiseth and E.W. Remme.
Comment:
Torsion occurs in the normal heart because the orientation of the myocardial fibers varies across the wall. The subendocardial fibers have an approximately longitudinal orientation with and angle of 80° relative to the circumferential plane. This angle decreases toward the mid-wall, where the fibers are circumferentially oriented (0°), and decreases further to an oblique orientation of approximately 60° at the subepicardium.
Reference:
J Am Coll Cardiol. 2006 Jan 3;47(1):173-4.

Enhanced ventricular untwisting during exercise: a mechanistic manifestation of elastic recoil described by Doppler tissue imaging 
Y. Notomi, M.G. Martin-Miklovic and S.J. Oryszak et al
Comment:
Diastolic recoil or “untwisting” is related to the systolic compression of elastic proteins and elastic recoil contributes to the development of the intracavitary gradient that precedes mitral valve opening (diastolic suction).
Reference:
Circulation. 2006 May 30;113(21):2524-33.

Maturational and adaptive modulation of left ventricular torsional biomechanics: Doppler tissue imaging observation from infancy to adulthood 
Y. Notomi, G. Srinath and T. Shiota et al.
Comment:
Because cardiac cellular structure and function change from infancy to adulthood, it is reasonable to ask whether torsional biomechanics also change. In a study of 45 normal subjects ranging in age from 9 days to 49 years, the authors observed by using DTI that LV torsion increased with age, owing primarily to the augmentation of basal clockwise rotation during childhood and apical counterclockwise rotation during adulthood. Although peak LV torsion and untwisting velocity showed age-related increases, when normalized by LV length, greater values were observed in infants and middle-aged patients. The proportion of untwisting during isovolumic relaxation was lowest during infancy and increased progressively being highest in middle age; however, peak normalized untwisting velocity (peak untwisting velocity normalized by peak LV torsion) showed a decrease in adulthood.
Reference:
Circulation 113 (2006), pp. 2534–2541

Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging 
Y. Notomi, P. Lysyansky and R.M. Setser et al.
Reference:
J Am Coll Cardiol 45 (2005), pp. 2034–2041.

Assessment of left ventricular torsional deformation by Doppler tissue imaging: validation study with tagged magnetic resonance imaging 
Y. Notomi, R.M. Setser and T. Shiota, et al.
Comment:
Two echocardiographic methods have been proposed to measure torsion: Doppler Tissue Imaging (DTI) and Speckle Tracking (STE), both of which have been shown to correlate with magnetic resonance imaging (MRI) when used in small groups of patients.
Reference:
Circulation 111 (2005), pp. 1141–1147

Age-related changes in left ventricular twist assessed by two-dimensional speckle-tracking imaging 
M. Takeuchi, H. Nakai and M. Kokumai et al.
Comment:
Age-related changes in left ventricular twist assessed by two-dimensional speckle-tracking imaging - This is a study of 118 adults, using STE, that similarly examined the effects of aging on torsion and untwisting. Patients were divided in 3 groups (young, <40 year [n = 57]; middle-aged, 40 to 60 years [n = 41]; and older subjects, >60 years [n = 15]). Torsion increased with age. Untwisting rates were significantly lower in middle age and older groups than in the young group. No gender differences were noted in peak twist or untwisting velocities.
Reference:
J Am Soc Echocardiogr 19 (2006), pp. 1077–1084.

Myocardial adaptation to short-term high-intensity exercise in highly trained athletes 
T.G. Neilan, T.T. Ton-Nu and D.S. Jassal et al.
Comment:
Myocardial adaptation to short-term high-intensity exercise in highly trained athletes - This study showed that torsion increased from baseline to the end of a 2,000-m world indoor rowing championship. The smaller increase in torsion after much more strenuous efforts may reflect the difference in measurements made during versus after exercise.
Reference:
J Am Soc Echocardiogr 19 (2006), pp. 1280–1285

New noninvasive method for assessment of left ventricular rotation: speckle tracking echocardiography 
T. Helle-Valle, J. Crosby and T. Edvardsen et al.
Comment:
New noninvasive method for assessment of left ventricular rotation: speckle tracking echocardiography - Validation study comparing STE to sonomicrometer measurements, authors found an excellent correlation between the 2 methods for apical rotation however, for basal rotation, the correlation decreased slightly. Conversely, the correlation of the time to peak rotation was better at the base than at the apex. They showed corresponding increases in rotation during dobutamine infusion and decreases in apical rotation after left anterior descending artery (LAD) ligation without affecting basal rotation. STE is dependent on the quality of the 2-dimensional images, and subendocardial speckles have been noted to be more easily identified than subepicardial echoes. Preferential subendocardial sampling may increase torsion values because subendocardial torsion is nearly twice that of the subepicardium. STE at the base may be complicated by through plane translation that may explain the poorer correlations for basal rotation when compared with reference standards. Peak rotation of the apex and base do not necessarily occur at the same time, with the result that instantaneous peak torsion may be smaller than the difference between peak apical and peak basal rotation.
Reference:
Circulation 112 (2005), pp. 3149–3156

Three-dimensional systolic strain patterns in the normal human left ventricle: characterization with tagged MR imaging 
R.E. Henson, S.K. Song and J.S. Pastorek et al.
Comment:
Three-dimensional systolic strain patterns in the normal human left ventricle: characterization with tagged MR imaging - Although absolute torsion in infants is less than in adults, LVtor normalized for ventricular length is greater in infants than in older children, adolescents, and adults, which is consistent with the higher contractility noted in infants. Likewise, the mouse heart has an apex to base angular deformity that is a fraction of the human value; however, when normalized for LV length, the 2 species become equal.
Reference:
Am J Physiol Heart Circ Physiol 278 (2000), pp. H1117–H1123.

Cardiac rotation and relaxation in patients with aortic valve stenosis 
E. Nagel, M. Stuber and B. Burkhard et al.
Comment:
Cardiac rotation and relaxation in patients with aortic valve stenosis - Torsion varies with changes in preload, afterload, and contractility. In the experimental model, torsion was shown to increase with increasing end-diastolic volume at constant end-systolic volumes and to decrease with increasing end-systolic volumes at constant end-diastolic volumes.
Reference:
Eur Heart J 21 (2000), pp. 582–589.

Three-dimensional left ventricular deformation in hypertrophic cardiomyopathy 
Akagawa E, Murata K, Tanaka N, Yamada H, Miura T, Kunichika H, et al.
Comment:
Alterations in the local myocardial motion pattern in patients suffering from pressure overload due to aortic stenosis - Three-dimensional left ventricular deformation in hypertrophic cardiomyopathy - Augmentation of LV rotation with inotropism was observed in the apical endocardium, thus causing increased LV endo-torsion and apical radial strain.
Reference:
Circ J (2007) 71:661–8