Interleukin-8 as an independent predictor of long-term clinical outcome in patients with coronary artery disease

Left ventricular torsion is a measurement derived from the twisting or wringing motion of the heart around its long axis. The calculation is made by measuring the magnitude of rotation at the apex of the heart, and subtracting the rotation at the base. Although the phenomenon of left ventricular twisting was first described in the 17th Century, it wasn't until the 1960s that the first invasive method of measurement was demonstrated. Silver tantalum clips were sutured into the epicardium during cardiac surgery and viewed using cineradiography. Non-invasive torsion measurement has been subsequently developed, adopting Magnetic Resonance Imaging and 2D echocardiography. Interest in the changes of different components of torsion, during various cardiac disease states has developed with the advent of these non-invasive measurement techniques. This review article summarises the history of the development of torsion analysis and describes the known changes of torsion during different clinical circumstances.     

Left ventricular twisting and untwisting motion in childhood cancer survivors

Background: Anthracycline has been shown to degrade titin that plays a role in myocardial twisting and untwisting. This study aimed to test the hypothesis that left ventricular (LV) twisting and untwisting motion may be altered in children after anthracycline therapy. Methods: Thirty‐six childhood leukemia survivors aged 15.6 ± 5.5 years and 20 healthy controls aged 16.8 ± 7.7 years (P = 0.54) were studied. LV twisting and untwisting motion was determined using speckle tracking imaging, whereas LV ejection fraction and systolic and diastolic mitral annular velocities were determined respectively by three‐dimensional and tissue‐Doppler echocardiography. Results: Compared with controls, patients had significantly lower LV ejection fraction (P = 0.01) but similar systolic and diastolic mitral annular velocities (all P > 0.05). Their peak LV torsion (P = 0.003), systolic twisting velocity (P < 0.001), and diastolic untwisting velocity (P = 0.04) were significantly lower than controls, which could be attributable to their reduced apical rotation (P = 0.03) and apical untwisting rate (P = 0.002). For the whole cohort, LV systolic torsion and twisting velocity correlated significantly with apical untwisting rate (P < 0.001) and LV diastolic untwisting velocity (P < 0.001). In patients, none of the twisting or untwisting parameters were found to correlate with cumulative anthracycline dose (all P > 0.05). Twenty‐eight (78%) patients had LV ejection fractions ≥50%. Although their systolic and diastolic mitral annular velocities were similar to those of controls, their peak LV torsion (P = 0.005), apical untwisting rate (P = 0.01), and LV systolic twisting velocity (P = 0.001) remained significantly lower. Conclusion: Impairment of LV twisting and untwisting motion is evident in children after anthracycline therapy, even in those with “normal” LV ejection fractions. (Echocardiography 2011;28:738‐745)     

Use of velocity vector imaging technology to evaluate the motion of myocardial infarction

Background The velocity vector imaging is an ultrasound speckle imaging that was recently developed,which is based on the two-dimensional gray scale image,with more accurate tracking process and more convenient and time-saving operation method can quantitatively displays the varied curve of myocardial velocity and direction sampling taking from multiple parts in one cardiac cycle by tracking the space motion of echo spots of the cardiovascular tissue,and then analyze their movements,avoiding the angular dependence and the limitations of analysis section that could effect on Doppler technology.The technology provides a new auxiliary method for the diagnosis and treatment of cardiovascular disease and is valuable on clinical diagnosis and scientific research and a wide horizon of development.     

Unexpected Twists: A 61-Year-Old Male with Repeated HeartMate II Complications andSubsequent Replacement with HeartMate III

An outflow graft twist of a left ventricular assist device (LVAD) remains a challenging clinical diagnosis and may even be misdiagnosed for other outflow obstructions. We present a case of a patient with two LVAD exchanges due to suspected outflow graft twisting in both clinical scenarios. As new LVADs continue to be designed and upgraded, clinicians must have a high index of suspicion for this rare complication.     

斑点追踪显像评价左室旋转运动的研究进展

心动周期中心尖及心底沿左室长轴向不同方向旋转,引起心脏扭曲或扭转运动。心肌纤维的螺旋状排列是联系心脏旋转运动解剖学与生理学机制的基础。斑点追踪显像可检测心脏扭转运动,对预测及治疗心肌功能障碍提供有价值的信息,是评价心脏旋转运动的新超声心动图技术。     

二维斑点追踪技术评价心肌梗死患者冠脉 内支架术后左室扭转功能变化

目的 探讨斑点追踪成像技术（STI）在心肌梗死患者冠脉内支架置入术（PCI）疗效评估中的应用价值.方法 选取2011年3月至2013年5月在昆明医科大学第二附属医院心内科接受PCI治疗的心肌梗死患者30例为病例组,正常对照组35例,对正常对照组及接受PCI治疗的患者在术前,术后1周、1个月、3个月、6个月时进行常规超声心动图检查和斑点追踪成像技术分析,测量左室舒张末期内径（LVDd）、左室舒张末期容积（LVESV）、左室收缩末期容积（LVEDV）,以及左室基底段和心尖段收缩期整体旋转角度峰值（Prot-base、Prot-apex）,并计算左心室扭转角度峰值（Ptw）,比较分析各参数在PCI手术前后的变化,结合分析左室扭转功能的改变.结果 与正常对照组比较,病例组PCI治疗前LVDd、LVESV、LVEDV较对照组扩大,LVEF[（43.74±9.47）％比（58.38±4.37）％]较对照组降低,差异均有统计学意义（P均＜0.05）;与PCI治疗前比较,PCI术后1周、1个月LVDd、LVESV、LVEDV及LVEF都没有明显改变,差异无统计学意义（P均＞0.05）;PCI治疗后3个月、6个月时LVDd、LVESV、LVEDV比PCI治疗前有一定缩小,LVEF[（49.33± 11.06）％比（43.74±9.47）％、（53.74±8.06）％比（43.74±9.47）％]增高,差异均有统计学意义（P均＜0.05）.病例组术前Prot base[（-4.57 ±2.16）°比（-8.18±2.67）°]、Prot apex [（5.17±2.25）°比（9.38±2.72）°]、Ptw[（9.74±3.61）°比（17.56±3.41）°]均显著低于正常对照组（P＜0.05）;病例组术后1周Prot base、Prot apex、Ptw均较术前无明显改善（P＞0.05）.病例组术后1、3、6个月Prot base[（-5.84±2.03）°比（-4.57±2.16）°、（-6.68±2.45）°比（-4.57±2.16）°、（-7.56±2.41）°比（-4.57±2.16）°]、Prot apex [（6.58±2.86）°比（5.17±2.25）°、（7.04±3.12）°比（5.17±2.25）°、（8.75±2.63）°比（5.17±2.25）°]、Ptw [（12.42±4.77）°比（9.74±3.61）°、（13.72±     

Effect of age and gender on left ventricular rotation and twist in a large group of normal adults — A multicenter study

Background

The newly developed 2-dimensional speckle tracking imaging (2D-STI) allows assessment of left ventricular (LV) rotation and twist. The aims of the present study are to establish normal values and to examine the effect of aging and gender on these parameters.

Methods

We studied 228 healthy subjects (109 males, mean age 44 ± 15 years, ranged 18–78 years). LV longitudinal and circumferential strain, rotation and twist were assessed by 2D-STI at basal, middle and apical levels of parasternal short-axis and apical 2-, 4- and 3-chamber views.

Results

The mean global LV longitudinal and circumferential strains were − 20.4 ± 3.4% and − 22.9 ± 3.1%, respectively. Of the 2,736 segments analyzed, 110 (8%) and 128 (9.4%) segments did not have optimal images for the assessment of basal and apical rotation. The basal rotation (− 9.6 ± 2.5°) was significantly lower than apical rotation (11.2 ± 4.3°, p < 0.0001) with a mean LV twist of 20.5 ± 4.5°. The longitudinal strain decreased with aging, which was accompanied by significant augmentations in circumferential strain, LV rotation and twist. There was no gender difference for rotational and twist measurements which had acceptable inter and intra-observer variabilities.

Conclusions

Evaluation of LV rotation and twist are feasible with 2D-STI. Older age rather than gender seems to augment global LV rotation and twist. This may be the compensatory mechanism as a result of aging-related decline in subendocardial function. These data can serve as the references for further evaluation of pathological myocardial motions in various cardiovascular diseases.     

Study of Left Ventricular Rotation and Torsion in the Acute Phase of ST-Elevation Myocardial Infarction by Speckle Tracking Echocardiography

Background: The mechanics of the complex left ventricular (LV) myocardial fiber architecture may accurately be assessed by speckle tracking echocardiography (STE). The role of STE to assess LV mechanical dysfunction in the setting of ST segment elevation myocardial infarction (AMI) is still poorly studied. Patients and Methods: 29 consecutive patients (55 ± 13 years) presenting with AMI underwent STE within 72 hours of admission. Reperfusion was achieved with thrombolysis in 15 patients and with primary percutaneous coronary intervention in 14. LV rotational and torsion data were registered during peak systole. Standard Doppler data included LV ejection fraction (EF), mitral inflow deceleration time (DT), and conventional E/A ratio. E/E' ratio (mitral inflow E velocity/tissue Doppler E velocity) was calculated as a marker of LV filling pressure. Twelve subjects with clinically indicated but negative dobutamine stress echocardiogram served as Controls. Results: Peak systolic torsion was not only significantly lower in AMI compared with Controls (13.3 ± 7.6 vs. 21.8 ± 6.1; P < 0.01), it was also lower in subjects with LVEF <40% (5.0 ± 2.9) compared with those who had LVEF >40% (10.6 ± 6.6; P < 0.02). Torsion had a modest but significantly positive linear relation (R = 0.6; P < 0.05) with DT, not with E/E' or LVEF. Conclusion: LV systolic torsion is decreased in AMI and more markedly decreased in patients with LVEF <40%. The most significant linear relationship between DT and torsion may possibly indicate that the LV mechanical dysfunction is also associated with altered filling dynamics. (Echocardiography 2010;27:45-49)     

The Effects of Serum Potassium and Magnesium Levels in a Patient with Gitelman's Syndrome on the Timing of Ventricular Wall Motion and the Pattern of Ventricular Strain and Torsion

Gitelman's syndrome is a primary renal tubular hypokalemic metabolic alkalosis. Hypokalemia and hypomagnesemia can cause cardiac tissue excitability and conduction. Global ventricular mechanical function is directly related to the contractile properties of cardiac myocytes, which are largely dependent on the flow of ions such as potassium and magnesium. Here, we show that increased levels of potassium, in addition to magnesium, in a patient with Gitelman's syndrome significantly impacts the timing of ventricular wall motion and the pattern of ventricular strain and torsion. Two‐dimensional speckle tracking echocardiography was used for evaluation of the hypokalemic–hypomagnesemic period (first day) and third day after potassium chloride and magnesium replacement therapy. The transthoracic echocardiography showed that the percent ejection fraction was similar in hypokalemic–hypomagnesemic (63%) and normokalemic–normomagnesemic (after potassium and magnesium therapy, 67%) hearts. However, decreased left ventricular apical 4‐chamber peak systolic longitudinal strain, left ventricle global peak systolic strain, and global torsion values increased after potassium chloride and magnesium replacement therapy.     

Left ventricular solid body rotation in non‐compaction cardiomyopathy: A potential new objective and quantitative functional diagnostic criterion?

BACKGROUND: Left ventricular (LV) twist originates from the interaction between myocardial fibre helices that are formed during the formation of compact myocardium in the final stages of the development of myocardial architecture. Since non-compaction cardiomyopathy (NCCM) is probably caused by intrauterine arrest of this final stage, it may be anticipated that LV twist characteristics are altered in NCCM patients, beyond that seen in patients with impaired LV function and normal compaction. AIMS: The purpose of this study was to assess LV twist characteristics in NCCM patients compared to patients with non-ischaemic dilated cardiomyopathy (DCM) and normal subjects. METHODS AND RESULTS: The study population consisted of 10 patients with NCCM, 10 patients with DCM, and 10 healthy controls. LV twist was determined by speckle tracking echocardiography. In all controls and DCM patients, rotation was clockwise at the basal level and counterclockwise at the apical level. In contrast, in all NCCM patients the LV base and apex rotated in the same direction. CONCLUSIONS: These findings suggest that 'LV solid body rotation', with near absent LV twist, may be a new sensitive and specific, objective and quantitative, functional diagnostic criterion for NCCM.     

The effect of supine rotation on left ventricular dimensions in man: A study using radio-opaque epicardial markers

It has been reported that patient rotation into the left lateral decubitus position (30° rao) produces significant changes in the regression equations used for left ventricular volume determination and that normal values for echocardiographic left ventricular dimensions obtained from supine patients differ from those obtained after rotation. The purpose of this study was to establish whether patient rotation is associated with changes in left ventricular size and systolic function. The distances between left ventricular epicardial markers attached at the time of cardiac surgery were measured using biplane cineradiography in 14 patients in order to determine left ventricular dimensions before and after rotation. Supine epicardial left ventricular dimensions were not significantly different from those obtained with the patient rotated 30° rao. These results suggest that reported changes in invasive and noninvasive measurements of left ventricular function associated with patient rotation are not primarily due to changes in left ventricular size.     

Assessment of regional rotation patterns improves the understanding of the systolic and diastolic left ventricular function: an echocardiographic speckle-tracking study in healthy individuals

Aim: To elucidate the complexity of left ventricular motion throughoutthe cardiac cycle, we studied regional rotation in detail. Methods and Results: Regional rotation in six subdivisions of the circumference atthree levels was studied by using speckle-tracking echocardiographyin 40 healthy subjects. At the basal level the inferoseptalsegments rotated significantly more clockwise during systolethan the opposing anterolateral segments. At the papillary levelthe inferoseptal segments differed significantly from the anterolateralsegments, where the inferoseptal segments rotated clockwiseand the anterolateral segments rotated counter-clockwise. Theapical level showed significant difference in regional rotationonly at aortic valve opening. In early systole, untwist beforethe main systolic twist was seen at the basal and apical levels;however, the duration of the basal untwist was much longer thanthat of the apical. The diastolic phases of rotation at thebasal and apical levels matched the different filling phases. Conclusion: Large regional differences in rotation are present at the basaland papillary levels in healthy subjects. The diastolic untwistmatches the phases of both the E-wave and A-wave and seems tobe related with intraventricular pressure differences, indicatingthat untwist plays an important role in the filling of the ventricle.     

二维超声斑点追踪显像技术对正常人左室旋转和扭转运动的评价

目的:应用二维超声斑点追踪显像技术探讨正常人左室旋转(LVrot)和左室扭转(LVtw)运动特征。方法:入选健康成人志愿者58例,取胸骨旁左室心尖和心底短轴观对LVrot进行定量分析,获LVrot及LVtw角度随心动周期变化曲线,记录心底部与心尖部LVrot角度峰值和LVtw角度峰值及达峰时间。结果:正常人扭转运动主要表现为心底部顺时针旋转和心尖部逆时针旋转,心脏整体表现为心动周期内逆时针方向为主的扭转运动。心尖部和心底部旋转角度达峰时间差异无统计学意义(P>0.05)。扭转角度于收缩末期达峰值。结论:应用二维超声斑点追踪显像技术可无创性评价正常人LVrot和LVtw运动特征。左室心底部及心尖部旋转角度、达峰时间可做为评价左室运动同步性指标之一。