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Ventricular rotation and the rotation axis: a new concept in cardiac function
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The twisting motion of the left ventricle (LV), with clockwise rotation at the base and counter clockwise rotation at the apex during systole, is a vital part of LV function. Even though LV rotation has been studied for decades, the rotation pattern has not been described in detail. By the introduction of speckle tracking echocardiography measuring rotation has become easy of access. However, the axis around which the LV rotates has never before been assessed. The aims of this thesis were to describe the rotation pattern of the LV in detail (study I), to assess RV apical rotation (study II), develop a method to assess the rotation axis (study III) and finally to study the effect of regional ischemia to the rotation pattern of the LV (study IV).

Methods: Healthy humans were examined in study I-III and the final study populations were 40 (60±14 years), 14 (62±11 years) and 39 (57±16 years) subjects, respectively. In study IV six young pigs (32-40kg) were studied. Standard echocardiographic examinations were performed. In study IV the images were recorded before and 4 minutes after occlusion of left anterior descending coronary artery (LAD). Rotation was measured in short axis images by using a speckle tracking software. By development of custom software, the rotation axis of the LV was calculated at different levels in every image frame throughout the cardiac cycle.

Results: Study I showed significant difference in rotation between basal and apical rotations, as well as significant differences between segments at basal and mid ventricular levels. The rotation pattern of the LV was associated with different phases of the cardiac cycle. Study II found significant difference in rotation between the LV and the RV. RV rotation was heterogeneous and bi-directional, creating a ´tightening belt action´ to reduce it circumference. Study III indicated that the new method could assess the rotation axis of the LV. The motion of the rotation axes in healthy humans displayed a physiological and consistent pattern. Study IV found a significant difference in the rotation pattern, between baseline and after LAD occlusion, by measuring the rotation axes, but not by conventional measurements of rotation. AV-plane displacement and wall motion score (WMS) were also significantly changed after inducing regional ischemia.

Conclusion: There are normally large regional differences in LV rotation, which can be associated anatomy, activation pattern and cardiac phases, indicating its importance to LV function. In difference to the LV, the RV did not show any functional rotation. However, its heterogeneous circumferential motion could still be of importance to RV function and may in part be the result of ventricular interaction. The rotation axis of the LV can now be assessed by development of a new method, which gives a unique view of the rotation pattern. The quality measurements and results in healthy humans indicate that it has a potential clinical implication in identifying pathological rotation. This was supported by the experimental study showing that the rotation axis was more sensitive than traditional measurements of rotation and as sensitive as AV-plane displacement and WMS in detecting regional myocardial dysfunction.

Place, publisher, year, edition, pages
Umeå: Umeå university , 2010. , 57 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1378
Keyword [en]
Left ventricular function, right ventricular function, rotation, twist, rotation axis, transition plane, ischemia, speckle tracking echocardiography
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:umu:diva-37187ISBN: 978-91-7459-096-8 (print)OAI: oai:DiVA.org:umu-37187DiVA: diva2:358269
Public defence
2010-11-12, Sal B, Unod t 9, NUS, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2010-10-23 Created: 2010-10-21 Last updated: 2010-10-26Bibliographically approved
List of papers
1. Assessment of regional rotation patterns improves the understanding of the systolic and diastolic left ventricular function: an echocardiographic speckle-tracking study in healthy individuals
Open this publication in new window or tab >>Assessment of regional rotation patterns improves the understanding of the systolic and diastolic left ventricular function: an echocardiographic speckle-tracking study in healthy individuals
2009 (English)In: European Journal of Echocardiography, ISSN 1525-2167, E-ISSN 1532-2114, no 10, 56-61 p.Article in journal (Refereed) Published
Abstract [en]

AIM To elucidate the complexity of left ventricular motion throughout the cardiac cycle, we studied regional rotation in detail. METHODS AND RESULTS: Regional rotation in six subdivisions of the circumference at three levels was studied by using speckle-tracking echocardiography in 40 healthy subjects. At the basal level the inferoseptal segments rotated significantly more clockwise during systole than the opposing anterolateral segments. At the papillary level the inferoseptal segments differed significantly from the anterolateral segments, where the inferoseptal segments rotated clockwise and the anterolateral segments rotated counter-clockwise. The apical level showed significant difference in regional rotation only at aortic valve opening. In early systole, untwist before the main systolic twist was seen at the basal and apical levels; however, the duration of the basal untwist was much longer than that of the apical. The diastolic phases of rotation at the basal and apical levels matched the different filling phases. CONCLUSION: Large regional differences in rotation are present at the basal and papillary levels in healthy subjects. The diastolic untwist matches the phases of both the E-wave and A-wave and seems to be related with intraventricular pressure differences, indicating that untwist plays an important role in the filling of the ventricle.

Keyword
Regional rotation; Left ventricular systolic function; Left ventricular diastolic function; Speckle-tracking echocardiography; Diastolic suction; Healthy humans
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-37183 (URN)10.1093/ejechocard/jen141 (DOI)18490292 (PubMedID)
Available from: 2010-10-21 Created: 2010-10-21 Last updated: 2017-12-12Bibliographically approved
2. Apical circumferential motion of the right and the left ventricles in healthy subjects described with speckle tracking
Open this publication in new window or tab >>Apical circumferential motion of the right and the left ventricles in healthy subjects described with speckle tracking
2008 (English)In: Journal of the American Society of Echocardiography, ISSN 0894-7317, E-ISSN 1097-6795, Vol. 21, no 12, 1326-1330 p.Article in journal (Refereed) Published
Abstract [en]

Background

The aim of this study was to determine whether right ventricular (RV) apical rotation could be of importance in RV function and compare this with left ventricular (LV) apical rotation.

Methods

Short-axis images at the apical level of both ventricles were simultaneously recorded in 14 healthy subjects (mean age, 62 ± 11 years).

Results

There was a significant difference in mean rotation between the two ventricles in the time interval between 50% of ejection and aortic valve closure (P < .05). At aortic valve closure, LV rotation was 10.9 ± 4.8° counterclockwise, and RV rotation was 1.1 ± 5.8° clockwise. The anterior and inferior parts of the right ventricle rotated in opposite directions toward the septum. The septal segments of both ventricles rotated inferiorly, thus likely reducing interventricular stress.

Conclusion

This study showed clear differences in apical rotation between the two ventricles. Whereas the left ventricle displayed uniform rotation, the right ventricle showed heterogeneous rotation, resulting overall in almost no rotation but in a “tightening belt” motion.

Keyword
Right ventricular function, Left ventricular function, Apical rotation, Speckle tracking, Ventricular interaction
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-37184 (URN)10.1016/j.echo.2008.09.014 (DOI)19041576 (PubMedID)
Available from: 2010-10-21 Created: 2010-10-21 Last updated: 2017-12-12Bibliographically approved
3. The rotation axis of the left ventricle: a new concept derived from ultrasound data in healthy individuals
Open this publication in new window or tab >>The rotation axis of the left ventricle: a new concept derived from ultrasound data in healthy individuals
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: The axis around which the left ventricle (LV) rotates has never previously been described. The aim was to develop a method to calculate the spatial motion of the rotation axis throughout the cardiac cycle.

Method: By constructing a model of the LV, based on dimensions and rotation values at the basal, mid ventricular and apical levels, a rotation axis could be calculated at each level in 39 healthy subjects. The transition plane, defined as the level without rotation, where basal and apical rotation meet was also calculated.

Results: The rotation axis was not congruent to the longitudinal axis of the LV at any time point. A significant and specific mean direction for each of the rotation axes for the majority of the tested time points displayed a physiological pattern.

Conclusion: This new method introduces a new concept in cardiac function and provides further insight into the complexity of LV mechanics.

National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-37185 (URN)
Available from: 2010-10-21 Created: 2010-10-21 Last updated: 2010-10-26Bibliographically approved
4. The effect of acute myocardial ischemia on the rotation axis of the left ventricle
Open this publication in new window or tab >>The effect of acute myocardial ischemia on the rotation axis of the left ventricle
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: We have developed a method to assess the axis around which the left ventricle (LV) rotates. The aim was to assess the effect of acute regional ischemia on the otation axis.

Method: Mid‐LAD occlusion was induced in six anesthetised pigs and echocardiographic images were recorded at baseline and after LAD occlusion. The rotation axis was calculated at three different levels of the LV throughout the cardiac cycle. Results: The direction of the rotation axis was significantly changed (p<0.01) after LAD occlusion, being directed towards the ischemic area. AV‐plane displacement was significantly reduced (p<0.05) during ischemia. No significant difference in twist or otation amplitudes was found.

Conclusion: This new method of assessing rotational function seems as sensitive as AV‐plane displacement and superior to traditional rotation and twist parameters in detecting dysfunction in acute ischemic myocardium. The rotation axis method has the advantage of potentially identifying areas with dysfunction.

National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-37186 (URN)
Available from: 2010-10-21 Created: 2010-10-21 Last updated: 2010-10-26Bibliographically approved

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