Abstract 14205: Left Ventricular Untorsion Rate Evaluated by a Three-dimensional Speckle Tracking Echocardiography is a Novel Echo Index of Relaxation in Patients With Hypertension and Preserved Ejection Fraction
Introduction: Early relaxation of left ventricle (LV) is characterized by rapid torsional recoil of LV. Predominant epicardial stretch along myofibers during isovolumic relaxation (IVR) appears to drive global torsional recoil to aid early diastolic filling.
Hypothesis: We sought to evaluate whether untorsion rate by 3-dimensional speckle tracking echocardiography (3D-STE) could serve as a feasible index of diastolic function in hypertension (HTN) and hypertensive heart failure (HHF).
Methods: We measured LV torsion, strain rate during IVR (SR-IVR) and the tangent from peak of torsion to point 40 msec after mitral valve opening on time-torsion curve as untorsion rate at 3 myocardial layers in controls (n=55, age, 67±10), HTN (n=111, age 69±11) and HHF with preserved ejection fraction (EF) (HFpEF, n=32, age 79±12) by 3D-STE with 60-80vps. Significant valvular disease, prior cardiac surgery, coronary artery disease, irregular rhythm and diabetes mellitus were excluded. Torsion was defined as difference between apical and basal rotation divided by long axis length for every instant in time. We estimated pulmonary capillary wedge pressure (PCWP) by the following 10.8 - 12.4 x log (left atrial active emptying function / minimum volume) as reported previously.
Results: There was no difference in LVEF and global torsion among 3 groups (LVEF: control: 67±6, HTN: 68±8, HFpEF: 64±9%; Torsion: 1.4±0.2, 1.5±0.3, 1.3±0.3°/cm). LV untorsion rate decreased in HTN and further decreased at 3 layers in HFpEF (endocardium: control: -7.4±3.0, HTN: -5.9±2.0*, HFpEF: -5.2±1.8* °/cm/sec, *p<0.05 vs control, mid-wall: -4.4±1.7, -3.8±1.3, -3.2±1.2*+ °/cm/sec, +p<0.05 vs HTN, epicardium: -2.3±1.4, -2.1±1.3, -1.5±0.9* °/cm/sec) associated with reduced longitudinal SR-IVR (epicardium: 0.33±0.22, 0.30±0.17, 0.22±0.16*s-1) and increased E/e’ and PCWP (E/e’: 9±3, 12±4*, 17±8*+, PCWP: 7±3, 8±5, 15±5*+mmHg).
Conclusions: LV untorsion rate assessed by 3D-STE was decreased in HTN and further decreased in HFpEF despite no difference in LVEF among control, HTN and HFpEF. LV untorsion rate during early diastolic phase assessed by 3D-STE appears to be a novel and valuable parameter in identifying diastolic dysfunction in hypertensive patients.
Author Disclosures: M. Kawasaki: None. R. Tanaka: None. T. Yoshizane: None. S. Minatoguchi: None. H. Miwa: None. K. Ono: None. M. Nagaya: None. S. Horio: None. T. Noda: None. H. Ohashi: None. S. Watanabe: None. S. Minatoguchi: None.
- © 2016 by American Heart Association, Inc.