Circulation Research, Vol 62, 941-952, Copyright © 1988 by American Heart Association

ARTICLES

Torsional deformation of the left ventricular midwall in human hearts with intramyocardial markers: regional heterogeneity and sensitivity to the inotropic effects of abrupt rate changes

DE Hansen, GT Daughters 2d, EL Alderman, NB Ingels Jr and DC Miller
Division of Cardiology, Stanford University School of Medicine, California.

The spiral orientation of left ventricular (LV) fibers suggests that twisting about the ventricular long axis of the apex with respect to the base, i.e., torsional deformation, may be characteristic of LV contraction. To demonstrate this twisting motion, 10 orthotopic human cardiac allograft recipients were studied with biplane cineradiography of tantalum helices implanted within the LV midwall at 12 specific sites. Counterclockwise twisting about the LV long axis (as reviewed from apex to base) accompanied ventricular ejection in all patients. Torsional deformation angles, measured relative to a reference minor axis at the base, were substantially smaller in the anteroapical wall, as compared with counterparts in the apical third of the inferior and lateral walls (anterior = 13.3 +/- 6.0 degrees, inferior = 18.7 +/- 6.3 degrees, and lateral = 23.4 +/- 10.7 degrees). Torsional angles at the midventricular level were roughly half as much and exhibited similar regional variabilities (anterior = 7.6 +/- 3.3 degrees, inferior = 9.0 +/- 3.3 degrees, lateral = 10.7 +/- 5.2 degrees, and septal = 8.8 +/- 3.8 degrees). Comparison of control beats and the initial beat after abrupt cessation of rapid atrial pacing (126 +/- 10 beats/min) with return to the control heart rate (96 +/- 9 beats/min) permitted the mild positive inotropic effect of tachycardia to be assessed at similar levels of ventricular load. Torsional deformation of the anteroapical and inferoapical sites increased significantly (p less than 0.05) over control values to 15.6 +/- 7.5 degrees and 21.2 +/- 5.5 degrees, respectively. In contrast, torsional deformation of the lateral wall was essentially unchanged. These data provide direct evidence for torsional deformation of the left ventricle in humans, demonstrate that torsion of the LV chamber is nonuniform, and suggest a dependence of LV torsion upon contractile strength that is attenuated in the lateral wall.

This article has been cited by other articles:

				I. K. Russel, M. J.W. Gotte, J. G. Bronzwaer, P. Knaapen, W. J. Paulus, and A. C. van Rossum Left ventricular torsion an expanding role in the analysis of myocardial dysfunction. J. Am. Coll. Cardiol. Img., May 1, 2009; 2(5): 648 - 655. [Abstract] [Full Text] [PDF]

				P. P. Sengupta, A. J. Tajik, K. Chandrasekaran, and B. K. Khandheria Twist mechanics of the left ventricle principles and application. J. Am. Coll. Cardiol. Img., May 1, 2008; 1(3): 366 - 376. [Abstract] [Full Text] [PDF]

				M. Ashraf, X. K. Li, M. T. Young, A. J. Jensen, J. Pemberton, L. Hui, P. Lysyansky, Z. Friedman, B. Park, and D. J. Sahn Delineation of cardiac twist by a sonographically based 2-dimensional strain analysis method: an in vitro validation study. J. Ultrasound Med., September 1, 2006; 25(9): 1193 - 1198. [Abstract] [Full Text] [PDF]

				G. D. Buckberg, M. Castella, M. Gharib, and S. Saleh Structure/function interface with sequential shortening of basal and apical components of the myocardial band Eur. J. Cardiothorac. Surg., April 1, 2006; 29(Suppl_1): S75 - S97. [Abstract] [Full Text] [PDF]

				T. Helle-Valle, J. Crosby, T. Edvardsen, E. Lyseggen, B. H. Amundsen, H.-J. Smith, B. D. Rosen, J. A.C. Lima, H. Torp, H. Ihlen, et al. New Noninvasive Method for Assessment of Left Ventricular Rotation: Speckle Tracking Echocardiography Circulation, November 15, 2005; 112(20): 3149 - 3156. [Abstract] [Full Text] [PDF]

				M. Takemoto, H. Yoshimura, Y. Ohba, Y. Matsumoto, U. Yamamoto, M. Mohri, H. Yamamoto, and H. Origuchi Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract improves left ventricular dilation and clinical status in patients without structural heart disease J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1259 - 1265. [Abstract] [Full Text] [PDF]

				E. Fuchs, M. F. Muller, H. Oswald, H. Thony, P. Mohacsi, and O. M. Hess Cardiac rotation and relaxation in patients with chronic heart failure Eur J Heart Fail, October 1, 2004; 6(6): 715 - 722. [Abstract] [Full Text] [PDF]

				C. G. Fonseca, H. C. Oxenham, B. R. Cowan, C. J. Occleshaw, and A. A. Young Aging alters patterns of regional nonuniformity in LV strain relaxation: a 3-D MR tissue tagging study Am J Physiol Heart Circ Physiol, July 11, 2003; 285(2): H621 - H630. [Abstract] [Full Text] [PDF]

				J. J. W. Sandstede, T. Johnson, K. Harre, M. Beer, S. Hofmann, T. Pabst, W. Kenn, W. Voelker, S. Neubauer, and D. Hahn Cardiac Systolic Rotation and Contraction Before and After Valve Replacement for Aortic Stenosis: A Myocardial Tagging Study Using MR Imaging Am. J. Roentgenol., April 1, 2002; 178(4): 953 - 958. [Abstract] [Full Text] [PDF]

				J. Garot, O. Pascal, B. Diebold, G. Derumeaux, B. L. Gerber, J.-L. Dubois-Rande, J. A. C. Lima, and P. Gueret Alterations of systolic left ventricular twist after acute myocardial infarction Am J Physiol Heart Circ Physiol, January 1, 2002; 282(1): H357 - H362. [Abstract] [Full Text] [PDF]

				J. Bogaert and F. E. Rademakers Regional nonuniformity of normal adult human left ventricle Am J Physiol Heart Circ Physiol, February 1, 2001; 280(2): H610 - H620. [Abstract] [Full Text] [PDF]

				S. P. Bell, L. Nyland, M. D. Tischler, M. McNabb, H. Granzier, and M. M. LeWinter Alterations in the Determinants of Diastolic Suction During Pacing Tachycardia Circ. Res., August 4, 2000; 87(3): 235 - 240. [Abstract] [Full Text] [PDF]

				E Nagel, M Stuber, B Burkhard, S.E Fischer, M.B Scheidegger, P Boesiger, and O.M Hess Cardiac rotation and relaxation in patients with aortic valve stenosis Eur. Heart J., April 1, 2000; 21(7): 582 - 589. [Abstract] [PDF]

				J. Garot, D. A. Bluemke, N. F. Osman, C. E. Rochitte, E. R. McVeigh, E. A. Zerhouni, J. L. Prince, and J. A. C. Lima Fast Determination of Regional Myocardial Strain Fields From Tagged Cardiac Images Using Harmonic Phase MRI Circulation, March 7, 2000; 101(9): 981 - 988. [Abstract] [Full Text] [PDF]

				C. C. Moore, C. H. Lugo-Olivieri, E. R. McVeigh, and E. A. Zerhouni Three-dimensional Systolic Strain Patterns in the Normal Human Left Ventricle: Characterization with Tagged MR Imaging Radiology, February 1, 2000; 214(2): 453 - 466. [Abstract] [Full Text]

				M. T. Donofrio, B. J. Clark, C. Ramaciotti, M. L. Jacobs, K. E. Fellows, P. M. Weinberg, and M. A. Fogel Regional wall motion and strain of transplanted hearts in pediatric patients using magnetic resonance tagging Am J Physiol Regulatory Integrative Comp Physiol, November 1, 1999; 277(5): R1481 - R1487. [Abstract] [Full Text] [PDF]

				J. Garot, G.A. Derumeaux, J.L. Monin, A.M. Duval-Moulin, M. Simon, D. Pascal, A. Castaigne, J.L. Dubois-Rande, B. Diebold, and P. Gueret Quantitative systolic and diastolic transmyocardial velocity gradients assessed by M-mode colour Doppler tissue imaging as reliable indicators of regional left ventricular function after acute myocardial infarction Eur. Heart J., April 2, 1999; 20(8): 593 - 603. [Abstract] [PDF]

				M. A. Fogel, P. M. Weinberg, K. B. Gupta, J. Rychik, A. Hubbard, E. A. Hoffman, and J. Haselgrove Mechanics of the Single Left Ventricle : A Study in Ventricular-Ventricular Interaction II Circulation, July 28, 1998; 98(4): 330 - 338. [Abstract] [Full Text] [PDF]

				J. H. Gorman III, K. B. Gupta, J. T. Streicher, R. C. Gorman, B. M. Jackson, M. B. Ratcliffe, D. K. Bogen, and L. H. Edmunds Jr. Dynamic Three-Dimensional Imaging of the Mitral Valve and Left Ventricle by Rapid Sonomicrometry Array Localization J. Thorac. Cardiovasc. Surg., September 1, 1996; 112(3): 712 - 726. [Abstract] [Full Text]

				C. A. Gibbons Kroeker, J. V. Tyberg, and R. Beyar Effects of Ischemia on Left Ventricular Apex Rotation : An Experimental Study in Anesthetized Dogs Circulation, December 15, 1995; 92(12): 3539 - 3548. [Abstract] [Full Text]

				M. A. Fogel, P. M. Weinberg, K. E. Fellows, and E. A. Hoffman A Study in Ventricular–Ventricular Interaction : Single Right Ventricles Compared With Systemic Right Ventricles in a Dual-Chamber Circulation Circulation, July 15, 1995; 92(2): 219 - 230. [Abstract] [Full Text]

				C. A. G. Kroeker, J. V. Tyberg, and R. Beyar Effects of Load Manipulations, Heart Rate, and Contractility on Left Ventricular Apical Rotation : An Experimental Study in Anesthetized Dogs Circulation, July 1, 1995; 92(1): 130 - 141. [Abstract] [Full Text]