Left ventricular rotation: a neglected aspect of the cardiac cycle
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To describe the mechanics and possible clinical importance of left ventricular (LV) rotation, exemplify techniques to quantify LV rotation and illustrate the temporal relationship of cardiac pressures, electrocardiogram and LV rotation.
Materials and methods
Review of the literature combined with selected examples of echocardiographic measurements.
Rotation of the left ventricle around its longitudinal axis is an important but thus far neglected aspect of the cardiac cycle. LV rotation during systole maximizes intracavitary pressures, increases stroke volume, and minimizes myocardial oxygen demand. Shearing and restoring forces accumulated during systolic twisting are released during early diastole and result in diastolic LV untwisting or recoil promoting early LV filling. LV twist and untwist are disturbed in a number of cardiac diseases and can be influenced by several therapeutic interventions by altering preload, afterload, contractility, heart rate, and/or sympathetic tone.
The concept of LV twisting and untwisting closely linking LV systolic and diastolic function may carry potential diagnostic and therapeutic importance for the management of critically ill patients. Future clinical studies need to address the feasibility of assessing LV twist and untwist as well as the relevance of its therapeutic modulation in critically ill patients.
KeywordsLeft ventricular twist Untwist Torsion Recoil Systolic function Diastolic function Critically ill patients
Conflict of interest
No author has a conflict of interest in regards of methods, techniques, or drugs discussed in this manuscript.
- 5.Gustafsson U, Lindqvist P, Mörner S, Waldenström A (2009) Assessment of regional rotation patterns improves the understanding of the systolic and diastolic left ventricular function: an echocardiographic speckle-tracking study in healthy individuals. Eur J Echocardiogr 10:56–61CrossRefPubMedGoogle Scholar
- 8.Sengupta PP, Khandheria BK, Korinek J, Jahangir A, Yoshifuku S, Milosevic I, Belolavek M (2007) Left ventricular isovolumic flow sequence during sinus and paced rhythms: new insights from use of high-resolution Doppler and ultrasonic digital particle imaging velocimetry. J Am Coll Cardiol 49:899–908CrossRefPubMedGoogle Scholar
- 10.Notomi Y, Popovic ZB, Yamada H, Wallick DW, Martin MG, Oryszak SJ, Shiota T, Greenberg NL, Thomas JD (2008) Ventricular untwisting: a temporal link between left ventricular relaxation and suction. Am J Physiol Heart Circ Physiol 294:H505–H513. doi: 10.1152/ajpheart.00975.2007 CrossRefPubMedGoogle Scholar
- 16.Zocalo Y, Bia D, Armentano RL, Arias L, Lopez C, Etchart C, Guevara E (2007) Assessment of training-dependent changes in the left ventricle torsion dynamics of professional soccer players using speckle tracking echocardiography. Conf Proc IEEE Eng Med Biol Soc 1:2709–2712Google Scholar
- 17.Sengupta PP, Krishnamoorthy VK, Korinek J, Narula J, Vannan MA, Lester SJ, Tajik JA, Seward JB, Khandheria BK, Belohlavek M (2007) Left ventricular form and function revisited: applied translational science to cardiovascular ultrasound imaging. J Am Soc Echocardiogr 20:539–551CrossRefPubMedGoogle Scholar
- 22.Dong SJ, Hees PS, Huang WM, Buffer SA, Weiss JL, Shapiro EP (1999) Independent effects of preload, afterload and contractility on left ventricular torsion. Am J Physiol Heart Circ Physiol 277:1053–1060Google Scholar
- 28.Akagawa E, Murata K, Tanaka N, Yamada H, Miura T, Kunichika H, Wada Y, Hadano Y, Tanaka T, Nose Y, Yasumoto K, Kono M, Matsuzaki M (2007) Augmentation of left ventricular apical endocardial rotation with inotropic stimulation contributes to increased left ventricular torsion and radial strain in normal subjects—quantitative assessment utilizing a novel automated tissue tracking technique. Circ J 71:661–668CrossRefPubMedGoogle Scholar