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Left ventricular twist in clinically stable heart transplantation recipients: a speckle tracking echocardiography study
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2013 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, no 1, 357-361 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIM: Cavity twist is an integral part of LV function and its pattern in transplanted hearts is not well known. This study aimed at exploring LV twist in clinically stable heart transplant (HT) recipients with no evidence for rejection.

METHODS: We studied 32 HT patients (54±24months after HT), 34 other cardiac surgery (CS) patients and compared them with 35 health controls using speckle tracking echocardiography, measuring peak twist angle, time-to-peak twist, and untwist rate.

RESULTS: LV twist angle was smaller in the HT group (6.2±3.3°) in comparison with the CS group and controls (13.2±3.5° and 13.1±4.5°, respectively; p<0.0001 for all) and untwist rate was reduced (HT group: -74±30°/s; CS group: -118±43°/s; controls: -116±39°/s; p<0.0001 for all). Time-to-peak twist was not different between groups. Time after HT was the main independent predictor of both LV twist angle and untwist rate (β=0.8, p<0.0001).

CONCLUSION: Though clinically stable, LV twist dynamics are significantly impaired in HT recipients, even in comparison with patients who underwent other cardiac surgery.

Place, publisher, year, edition, pages
Elsevier, 2013. Vol. 168, no 1, 357-361 p.
Keyword [en]
LV function, torsion, heart transplantation, echocardiography, speckle tracking
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-63833DOI: 10.1016/j.ijcard.2012.09.042ISI: 000325409800068PubMedID: 23031285OAI: oai:DiVA.org:umu-63833DiVA: diva2:584019
Available from: 2013-01-08 Created: 2013-01-08 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Mechanical and histological disturbances in advanced heart failure and cardiac transplantation
Open this publication in new window or tab >>Mechanical and histological disturbances in advanced heart failure and cardiac transplantation
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general purpose of this thesis is to establish capability and accuracy of speckle tracking echocardiography (STE) in assessing left atrial (LA), left ventricular (LV) and right ventricular (RV) function and their correlation with myocardial fibrosis, filling pressure and clinical outcomes in advanced heart failure (HF) patients before and after heart transplantation (HT).

I demonstrated that HT recipients had impaired LV twist dynamics in the form of reduced rotation twist angle and untwist rate but time to peak twist was not different from the age matched controls and other cardiac surgical patients.

With a longitudinal study conducted on patients with refractory HF, the best prognostic power has been shown by RV strain analysis. Among the indexes of LV function, the LV ejection fraction (LVEF) demonstrated the lowest diagnostic accuracy; instead LV global circumferential strain (GCS) showed a better sensitivity and specificity than LV global longitudinal strain (GLS).

When analyzing the relationship between different severity of myocardial fibrosis and LV cavity function, the strongest function parameter that correlated with severity of myocardial fibrosis was GLS. In contrast, none of diastolic LV function or even measures of exercise capacity correlated with myocardial fibrosis.

In patients with end-stage HF, global peak atrial longitudinal strain (PALS), an index of atrial reservoir function was dependent by pulmonary capillary wedge pressure (PCWP) and LV fibrosis, but not influenced by LV systolic function. Results from this study confirm previous evidence of correlation between impaired global PALS and increased PCWP.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2016. 99 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1862
Keyword
Advanced heart failure, heart transplantation, speckle tracking echocardiography, left ventricular function, right ventricular function, left ventricular fibrosis, left ventricular filling pressure, atrial strain
National Category
Cardiac and Cardiovascular Systems
Research subject
Cariology
Identifiers
urn:nbn:se:umu:diva-127295 (URN)978-91-7601-609-1 (ISBN)
Public defence
2016-11-30, E04, Målpunkt R-1, Norrlands Universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2016-11-09 Created: 2016-11-05 Last updated: 2016-11-21Bibliographically approved

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