J Cardiovasc Ultrasound.  2009 Mar;17(1):2-9. 10.4250/jcu.2009.17.1.2.

Clinical Significance of Left Ventricular Torsional Parameters during Supine Bicycle Cardiopulmonary Exercise Echocardiography

• Choo SR
• Chung WJ
• Jang YW
• Bong JM
• Shin MS
• Koh KK
• Ahn TH
• Choi IS
• Shin EK

• KMID: 1473759
• DOI: http://doi.org/10.4250/jcu.2009.17.1.2

Abstract

BACKGROUND
Left ventricular (LV) torsion plays an important role in both LV systolic and diastolic function. Notwithstanding the fact that speckle tracking imaging echocardiography (STI) is a validated method to measure LV torsion, few data regarding the clinical significance of LV torsional parameters using STI on exercise capacity during exercise echocardiography were reported.
METHODS
Fifty four participants completed the supine bicycle cardiopulmonary exercise echocardiography under a symptom-limited protocol. LV torsion was defined as the net difference between LV peak apical rotation, and basal rotation divided by LV diastolic longitudinal length. LV basal, and apical short-axis rotations at each stage were analyzed by STI.
RESULTS
LV torsion measurement was feasible in 43/54 (80%) at peak exercise. The LV torsions were increased during exercise, and even until the recovery. Peak twisting, and untwisting velocities were significantly increased during exercise, but were decreased at recovery. As expected, baseline torsion was positively correlated with LV ejection fraction and baseline apical peak untwisting velocity has correlation with E/E' (r=0.50, p<0.01 and r=0.30, p<0.05, respectively). Interestingly, apical peak twisting velocity at peak exercise was significantly correlated with maximal O2 consumption and VO2 interval change (r=0.50, p<0.01 and r=0.33, p<0.05, respectively).
CONCLUSION
It was feasible to measure LV torsion by STI at every step during exercise echocardiography, although the feasibility was relatively low at peak exercise. LV torsional parameters during exercise showed significant relations with exercise capacity as well as LV systolic and diastolic functions.

Keyword

Torsion; Left ventricular functions; Exercise; Echocardiography

MeSH Terms

Echocardiography
Track and Field
Ventricular Function, Left

Figure

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  Fig. 1 Basal rotation during exercise and recovery phase. The white arrowheads represent each peak values. At baseline (A), 75 W exercise (B), peak exercise (C) and recovery (D), each basal rotation represents negative value (clockwise rotation) and increases during exercise and even till the recovery phase.

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  Fig. 2 Apical rotation during exercise and recovery phase. The white arrowheads represent each peak values. At baseline (A), 75 W exercise (B), peak exercise (C) and recovery (D), each apical rotation represents positive value (counterclockwise rotation) and increases during exercise and even till the recovery phase.

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  Fig. 3 Basal peak twisting and untwisting velocities during exercise and recovery phase. The white arrowheads represent each peak twisting velocities and yellow arrowheads represent each peak untwisting velocities. At baseline (A), 75 W exercise (B), peak exercise (C) and recovery (D), both twisting and untwisting velocity were increased during exercise and decreased at recovery phase.

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  Fig. 4 Apical peak twisting and untwisting velocity during exercise and recovery phase. The white arrowheads represent each peak twisting velocities and yellow arrowheads represent each peak untwisting velocities. At baseline (A), 75 W exercise (B), peak exercise (C) and recovery (D), both twisting and untwisting velocity were increased during exercise and decreased at recovery phase.

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  Fig. 5 The correlation between torsional parameters at baseline and left ventricular functional parameters. There were positive correlations between torsion at baseline and left ventricular ejection fraction (r=0.50, p=0.001) (A). Apical peak untwisting velocity at baseline showed positive correlation with E/E' (r=0.30, p<0.05) (B).

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  Fig. 6 LV torsion (A), apical peak twisting velocity (B) and apical peak untwisting velocity (C) during exercise echocardiography. LV torsion increases during exercise and recovery. However, apical peak twisting velocity increases during exercise and decreases at recovery phase and also absolute value of apical peak untwisting velocity increases during exercise and decreases at recovery phase.

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  Fig. 7 The correlation between maximal O2 consumption and apical peak twisting velocity at peak exercise. Maximal O2 consumption (MVO2, mL/min/kg) correlated with apical peak twisting velocity at peak exercise (r=0.5, p<0.001).

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  Fig. 8 The Feasibility of left ventricular torsion. Measurements of left ventricular torsion were feasible in 51/54 (94%) at baseline, 49/54 (90%) at 75 W exercise, 43/54 (80%) at peak exercise and 52/54 (96%) at recovery, respectively.

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