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(Circulation. 2006;113:2477-2479.)
© 2006 American Heart Association, Inc.

Editorial

New Untwist on Diastole

What Goes Around Comes Back

Elyse Foster, MD; Katy E. Lease, MD

From the Departments of Medicine and Cardiology (E.F., K.E.L.), University of California, San Francisco.

Correspondence to Elyse Foster, MD, University of California, San Francisco, Moffitt 314A, Box 0214, 505 Parnassus Ave, San Francisco, CA 941943-0214. E-mail foster@medicine.ucsf.edu

Key Words: Editorials • cardiomyopathy • diastole • echocardiography • exercise

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Diastolic dysfunction contributes significantly to the clinical syndrome of congestive heart failure in the settings of both preserved and impaired left ventricular (LV) systolic function.^1,2 Over the past 20 years, the clinical diagnosis of diastolic dysfunction has been based largely on echocardiographic Doppler parameters of LV filling.³ The most important limitation of these parameters is their dependence on loading conditions. New practical and comprehensive methods of evaluating diastolic function are critically needed not only for diagnosis but also for testing emerging new therapies.

Article p 2524

Recent work has elucidated both intracellular and extracellular mechanisms that contribute to diastolic dysfunction, and some progress has been made in finding new treatments for diastolic heart failure. Additional research has evaluated the contribution of LV architecture and its role in maintaining the normal contraction sequence that optimizes mechanical efficiency. The importance of systolic twist and the subsequent recoil that leads to diastolic untwisting was examined in the article by Notomi et al⁴ using tissue Doppler techniques in both normal subjects and patients with hypertrophic cardiomyopathy, at rest and during exercise.

	The Left Ventricle Viewed as a Double Helix That Twists and Untwists

 
Leonardo DaVinci⁵ in the 16th century and Rushmore⁶ in the 1950s described the rotational motion of the left ventricle.⁷ In 1970, McDonald⁷ reported a study in which he placed radiopaque markers on the epicardium of patients undergoing closed mitral valvuloplasty. He demonstrated that the pre-ejection phase was characterized by descent of the base and a counterclockwise rotation of the epicardial surface of the left ventricle with a thrust of the apex toward the . . . [Full Text of this Article]

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