P1023Left ventricular rotation and twist assessed by three-dimensional speckle tracking echocardiography: the importance of apical-cap inclusion


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Abstract

Backround and Purpose: left ventricular(LV) twist is a main aspect of ejection. It is the difference between apex and basal rotation and it can be assessed by speckle-tracking echocardiography(STE). Recent studies highlighted that twist can be underestimated by 2D-echocardiography due to the lack of a real apex. In this experience we evaluated a series of healthy subjects and patients to assess the feasibility of twist assessment by means of 3D-STE.Methods: full-volume acquisition was performed in 14 healthy subjects (CNT),28 patients with normal ejection fraction(EF)>50% (Group A) and 19 patients with EF<40% (Group B). Rotation was assessed at basal, medium, apical level and at the true apical-cap (Rbas, Rmed, Rapi, RAA respectively). LV twist was calculated as recommended by considering the apex at the apical level (TwAp) as well as at the apical-cap (TwAA). Regional twist between apical and apical-cap was also computed (RegTw).Results:rotation was progressively higher from base to apical-cap (p<0,0001) with a significantly difference between apical and apical-cap (5,86±3,9° vs 9,85±7,6°;p<0,0001). The difference was constant in all Groups (Figure, p<0,01). As a result TwAp was significantly lower than TwAA in the overall population (8,12±5,06° vs 11,76±8,13°; p<0,0001) and in the subgroups (CNT:8,83±2,69° vs 12,72±4,60°;Group A:10,31±5,65° vs 15,11±9,18°;Group B:4,37±3,09° vs 6,11±5,18°;p<0,01 for all). RegTw that represents the twist underestimation when the apical-cap is not considered was 4,27±4,53° for CNT, 5,21±7,89° for Group A and 2,01±2,63° for Group B.Conclusions: LV twist can be assessed by 3D-STE with values often higher than previously observed with 2D technique probably due to recognition and inclusion of the true apical-cap which appears to contribute significantly to LV twist.

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