Circulation, Vol 83, 962-973, Copyright © 1991 by American Heart Association
KL Yun, MA Niczyporuk, GT Daughters 2d, NB Ingels Jr, EB Stinson, EL Alderman, DE Hansen and DC Miller
BACKGROUND. Contraction of obliquely oriented left ventricular (LV) fibers
results in a twisting motion of the left ventricle. The purpose of this
study was to assess the effects of acute human cardiac allograft rejection
on LV twist pattern and the twist-volume relation. METHODS AND RESULTS.
Tantalum markers were implanted into the LV midwall in 15 transplant
recipients to measure time-varying, three- dimensional chamber twist using
computer-assisted analysis of biplane cinefluoroscopic images. Twist was
defined as the mean longitudinal gradient of circumferential rotation about
the LV long axis. When plotted against normalized percent ejection fraction
(%EF), the resulting twist-normalized %EF relation could be divided into
three phases. In systole, LV twist was linearly related to ejection of
blood. In contrast, diastolic untwist was characterized by early rapid
recoil with little change in LV volume, followed by more gradual untwisting
when the bulk of diastolic filling occurred. During 10 acute rejection
episodes in 10 patients, maximum twist, peak systolic twist rate, and the
slope of the systolic twist-normalized %EF relation did not change. In
contrast, the slope of the early (first 15% of filling) diastolic
twist-normalized %EF relation (M(early-dia)) decreased significantly (-
0.194 +/- 0.062 [prerejection] versus -0.103 +/- 0.054 rad/cm [rejection],
p = 0.0003), resulting in a prolonged tau 1/2 (time required to untwist by
50% [20 +/- 5% versus 28 +/- 5% of diastole], p = 0.0003) and decrease in
percent untwisting at 15% diastolic LV filling (62 +/- 11% versus 36 +/-
13%, p = 0.0003). Therefore, a greater proportion of LV untwisting occurred
later in diastole during rejection, as reflected by an increase in the
slope (M(mid-dia)) of the middle to late (from 15 to 90% filling) diastolic
twist-normalized %EF relation (-0.018 +/- 0.009 versus -0.030 +/- 0.010
rad/cm, p = 0.0015). Peak rate of untwist was not affected. With resolution
of rejection, M(early-dia) and percent untwist during early diastole
returned to baseline levels (p = NS versus baseline). There was also a
trend for M(mid-dia) to return toward prerejection values (p = NS versus
baseline), but this change did not reach statistical significance compared
with rejection values. CONCLUSION. Acute cardiac allograft rejection is
associated with altered diastolic twist mechanics in the absence of any
demonstratable systolic abnormalities. During rejection, myocardial edema
and other factors may result in intrinsic changes of the elastic properties
of the myocardium, thereby leading to modification of recoil forces
responsible for the early, rapid unwinding of the deformed ventricle.
ARTICLES
Alterations in left ventricular diastolic twist mechanics during acute human cardiac allograft rejection
Department of Cardiovascular Surgery, Stanford University School of Medicine, Calif.
This article has been cited by other articles:
 |
|
 |
|
  J. D. Estep, D. J. Shah, S. F. Nagueh, J. J. Mahmarian, G. Torre-Amione, and W. A. Zoghbi The Role of Multimodality Cardiac Imaging in the Transplanted Heart J. Am. Coll. Cardiol. Img., September 1, 2009; 2(9): 1126 - 1140. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Ferferieva, P. Claus, K. Vermeulen, C. Missant, M. Szulik, F. Rademakers, and J. D'hooge Echocardiographic assessment of left ventricular untwist rate: comparison of tissue Doppler and speckle tracking methodologies Eur J Echocardiogr, July 1, 2009; 10(5): 683 - 690. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Alharthi, P. Jiamsripong, A. Calleja, P. P. Sengupta, E. M. McMahon, B. Khandheria, A. J. Tajik, and M. Belohlavek Selective echocardiographic analysis of epicardial and endocardial left ventricular rotational mechanics in an animal model of pericardial adhesions Eur J Echocardiogr, May 1, 2009; 10(3): 357 - 362. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Perry, C. G. De Pasquale, D. P. Chew, and M. X. Joseph Assessment of early diastolic left ventricular function by two-dimensional echocardiographic speckle tracking Eur J Echocardiogr, November 1, 2008; 9(6): 791 - 795. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Takeuchi, W. B. Borden, H. Nakai, T. Nishikage, M. Kokumai, T. Nagakura, S. Otani, and R. M Lang Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy: a study using two-dimensional speckle tracking imaging Eur. Heart J., November 2, 2007; 28(22): 2756 - 2762. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Ashraf, X. K. Li, M. T. Young, A. J. Jensen, J. Pemberton, L. Hui, P. Lysyansky, Z. Friedman, B. Park, and D. J. Sahn Delineation of cardiac twist by a sonographically based 2-dimensional strain analysis method: an in vitro validation study. J. Ultrasound Med., September 1, 2006; 25(9): 1193 - 1198. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. D. Buckberg, M. Castella, M. Gharib, and S. Saleh Structure/function interface with sequential shortening of basal and apical components of the myocardial band Eur. J. Cardiothorac. Surg., April 1, 2006; 29(Suppl_1): S75 - S97. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D. Buckberg, M. Castella, M. Gharib, and S. Saleh Active myocyte shortening during the 'isovolumetric relaxation' phase of diastole is responsible for ventricular suction; 'systolic ventricular filling' Eur. J. Cardiothorac. Surg., April 1, 2006; 29(Suppl_1): S98 - S106. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Castella, G. D. Buckberg, and S. Saleh Diastolic dysfunction in stunned myocardium: a state of abnormal excitation-contraction coupling that is limited by Na+-H+ exchange inhibition Eur. J. Cardiothorac. Surg., April 1, 2006; 29(Suppl_1): S107 - S114. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Helle-Valle, J. Crosby, T. Edvardsen, E. Lyseggen, B. H. Amundsen, H.-J. Smith, B. D. Rosen, J. A.C. Lima, H. Torp, H. Ihlen, et al. New Noninvasive Method for Assessment of Left Ventricular Rotation: Speckle Tracking Echocardiography Circulation, November 15, 2005; 112(20): 3149 - 3156. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Notomi, R. M. Setser, T. Shiota, M. G. Martin-Miklovic, J. A. Weaver, Z. B. Popovic, H. Yamada, N. L. Greenberg, R. D. White, and J. D. Thomas Assessment of Left Ventricular Torsional Deformation by Doppler Tissue Imaging: Validation Study With Tagged Magnetic Resonance Imaging Circulation, March 8, 2005; 111(9): 1141 - 1147. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Ashikaga, J. C. Criscione, J. H. Omens, J. W. Covell, and N. B. Ingels Jr. Transmural left ventricular mechanics underlying torsional recoil during relaxation Am J Physiol Heart Circ Physiol, February 1, 2004; 286(2): H640 - H647. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. Hees, J. L. Fleg, S.-J. Dong, and E. P. Shapiro MRI and echocardiographic assessment of the diastolic dysfunction of normal aging: altered LV pressure decline or load? Am J Physiol Heart Circ Physiol, February 1, 2004; 286(2): H782 - H788. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. A. Tibayan, D. T. M. Lai, T. A. Timek, P. Dagum, D. Liang, G. T. Daughters, N. B. Ingels, and D. C. Miller Alterations in left ventricular torsion in tachycardia-induced dilated cardiomyopathy J. Thorac. Cardiovasc. Surg., July 1, 2002; 124(1): 43 - 49. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.-J. Dong, P. S. Hees, C. O. Siu, J. L. Weiss, and E. P. Shapiro MRI assessment of LV relaxation by untwisting rate: a new isovolumic phase measure of tau Am J Physiol Heart Circ Physiol, November 1, 2001; 281(5): H2002 - H2009. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. M. Spotnitz Macro design, structure, and mechanics of the left ventricle J. Thorac. Cardiovasc. Surg., May 1, 2000; 119(5): 1053 - 1077. [Full Text] [PDF]
|
|
|
|
|
|
E Nagel, M Stuber, B Burkhard, S.E Fischer, M.B Scheidegger, P Boesiger, and O.M Hess Cardiac rotation and relaxation in patients with aortic valve stenosis Eur. Heart J., April 1, 2000; 21(7): 582 - 589. [Abstract] [PDF]
|
|
|
|
|
|
R. E. Henson, S. K. Song, J. S. Pastorek, J. J. H. Ackerman, and C. H. Lorenz Left ventricular torsion is equal in mice and humans Am J Physiol Heart Circ Physiol, April 1, 2000; 278(4): H1117 - H1123. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. C. Moore, C. H. Lugo-Olivieri, E. R. McVeigh, and E. A. Zerhouni Three-dimensional Systolic Strain Patterns in the Normal Human Left Ventricle: Characterization with Tagged MR Imaging Radiology, February 1, 2000; 214(2): 453 - 466. [Abstract] [Full Text]
|
|
|
|
|
|
M. Stuber, M. B. Scheidegger, S. E. Fischer, E. Nagel, F. Steinemann, O. M. Hess, and P. Boesiger Alterations in the Local Myocardial Motion Pattern in Patients Suffering From Pressure Overload Due to Aortic Stenosis Circulation, July 27, 1999; 100(4): 361 - 368. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Gibbons Kroeker, J. V. Tyberg, and R. Beyar Effects of Ischemia on Left Ventricular Apex Rotation : An Experimental Study in Anesthetized Dogs Circulation, December 15, 1995; 92(12): 3539 - 3548. [Abstract] [Full Text]
|
|
|
|
|
|
A. DeAnda Jr, M. Komeda, S. D. Nikolic, G. T. Daughters II, N. B. Ingels, and D. C. Miller Left Ventricular Function, Twist, and Recoil After Mitral Valve Replacement Circulation, November 1, 1995; 92(9): 458 - 466. [Abstract] [Full Text]
|
|
|
|
|
|
C. A. G. Kroeker, J. V. Tyberg, and R. Beyar Effects of Load Manipulations, Heart Rate, and Contractility on Left Ventricular Apical Rotation : An Experimental Study in Anesthetized Dogs Circulation, July 1, 1995; 92(1): 130 - 141. [Abstract] [Full Text]
|
|