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Comparative Study
. 2012 Jun 25:10:26.
doi: 10.1186/1476-7120-10-26.

Left ventricular twist is load-dependent as shown in a large animal model with controlled cardiac load

Roman A'roch  1 , Ulf Gustafsson, Jan Poelaert, Göran Johansson, Michael Haney
Affiliations
Comparative Study

Left ventricular twist is load-dependent as shown in a large animal model with controlled cardiac load

Roman A'roch et al. Cardiovasc Ultrasound. .

Abstract

Background: Left ventricular rotation and twist can be assessed noninvasively by speckle tracking echocardiography. We sought to characterize the effects of acute load change and change in inotropic state on rotation parameters as a measure of left ventricular (LV) contractility.

Methods: Seven anesthetised juvenile pigs were studied, using direct measurement of left ventricular pressure and volume and simultaneous transthoracic echocardiography. Transient inflation of an inferior vena cava balloon (IVCB) catheter produced controlled load reduction. First and last beats in the sequence of eight were analysed with speckle tracking (STE) during the load alteration and analysed for change in rotation/twist during controlled load alteration at same contractile status. Two pharmacological inotropic interventions were also included to examine the same hypothesis in additionally conditions of increased and decreased myocardial contractility in each animal. Paired comparisons were made for different load states using the Wilcoxon's Signed Rank test.

Results: The inferior vena cava balloon occlusion (IVCBO) load change compared for first to last beat resulted in LV twist increase (11.67° ±2.65° vs. 16.17° ±3.56° respectively, p < 0.004) during the load alteration and under adrenaline stimulation LV twist increase 12.56° ±5.1° vs. 16.57° ±4.6° (p < 0.013), and though increased, didn't reach significance in negative inotropic condition. Untwisting rate increased significantly at baseline from -41.7°/s ±41.6°/s vs.-122.6°/s ±55.8°/s (P < 0.039) and under adrenaline stimulation untwisting rate increased (-55.3°/s ±3.8°/s vs.-111.4°/s ±24.0°/s (p < 0.05), but did not systematically changed in negative inotropic condition.

Conclusions: Peak systolic LV twist and peak early diastolic untwisting rate are load dependent. Differences in LV load should be included in the interpretation when serial measures of twist are compared.

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Figures

Figure 1
Figure 1
Representative vena cava occlusion sequence is demonstrated in pressure-volume diagrams with the first and last beats in the sequence shown to demonstrate the loading conditions, first at baseline, then as well as during experimentally (pharmacologically) manipulated inotropic conditions, positive inotropic condition (adrenaline) and negative inotropic condition (beta blockade).
Figure 2
Figure 2
LV twist changes for the first and last beat in a sequence of eight consecutive beats in a vena cava occlusion manoeuvre were analysed by speckle tracking imaging. Left ventricular twist increased significantly in control group and in positive inotropic condition. There was a trend to increase but no significance was reached in negative inotropic condition. Both individual and grouped values are presented. CTRL = control group, ADR = adrenaline group, BB = beta-blockade group. # = p < 0.05 using Wilcoxons Signed Rank test vs. first beat.
Figure 3
Figure 3
Representative images of counterclockwise apical rotation for the first and last beat in a vena cava occlusion sequence by speckle tracking imaging. Rotation in individual segments and mean values are presented. Maximal apical rotation (arrow) increased from 5.8 to 6.2°.
See this image and copyright information in PMC

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