Abstract 302: Disturbances of Left Ventricular Twist Are the Earliest Marker of Myocardial Disease in Hypertensive Heart Disease
Background: Previous work proposing an augmentation of LV twist and untwist in early disease is at odds with the contribution of untwist to LV filling. We sought whether abnormal myocardial twist mechanics was associated with diastolic dysfunction in pts with hypertensive response to exercise (HRE; men ≥ 220/105mmHg, women ≥ 190/105 mmHg), a pre-hypertensive condition.
Methods: A complete resting echocardiogram was performed in 94 asymptomatic individuals with HRE (54±9y, 40 women). Mitral annular diastolic velocity (E′) was determined by tissue Doppler imaging. LV torsion (the instantaneous net difference of apical and basal rotation) and twist/untwist velocity were analyzed using 2-D speckle tracking.
Results: LV ejection fraction was 65±6% and BP was 134±16/80±11mmHg. Subjects were divided into those with diastolic dysfunction (DD; E′<7cm/s, n=45), normal diastolic function with reduced (<15 degree) torsion (n=23) and increased torsion (n=26). These groups did not differ in age, gender, body mass index, BP, LV mass or EF. However, Individuals with reduced torsion had larger LA volume (p=0.04) and LA volume index (p=0.02) than those with preserved torsion. All twisting and untwisting parameters were significantly lower in subjects with reduced torsion (Table⇓). In a linear regression model, peak systolic twisting velocity (PSTV; β=−0.21, p=0.04), LV mass index (â=0.43, p<0.001) and mean Em (â=−0.28, p=0.008) were significant predictors of LA volume index.
Conclusion: Impaired torsion, twisting and untwisting velocity are associated with increased LA volume. Impaired E′ and torsion may both be manifestations of early myocardial disease in HRE.