Premium
Speckle‐tracking analysis based on 2D echocardiography does not reliably measure left ventricular torsion
Author(s) -
Parisi Valentina,
Losi Maria Angela,
Contaldi Carla,
Chiacchio Elena,
Pastore Fabio,
Scatteia Alessandra,
Giamundo Alessandra,
Nardo Carlo di,
Lombardi Raffaella,
Betocchi Sandro
Publication year - 2013
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12002
Subject(s) - medicine , twist , speckle tracking echocardiography , short axis , cardiology , long axis , ejection fraction , geometry , heart failure , mathematics
Summary Purpose Worldwide left ventricular ( LV ) twist is measured by 2 D speckle tracking acquiring apical short axis at a LV level where papillary muscles are no longer visible; however, we hypothesized that this methodological recommendation is not enough accurate to obtain a reliable measurement of apical rotation. Methods We measured twist and untwist rate in 30 healthy subjects by following the earlier method. By 3 D echocardiography, we identified two LV apex levels: (i) 3 D A pex, defined as the last apical slice at which LV cavity was visible; (ii) 2 D A pex, defined as the level where diameters are equal to those of apical LV short axis used for twist analysis in the same subject. The ratio between the distance of 2 D A pex and 3 D A pex from LV base was calculated and expressed as percentage (2 D A pex/3 D A pex). Results 2D A pex/3 D A pex was strongly related to the magnitude of twist and untwisting rate ( r = 0·82, P <0·001; r = −0·46, P = 0·015, respectively). The only determinant of twist was 2 D A pex/3 D A pex ( r 2 = 0·68; r = 0·82; F ratio: 52·6, P <0·001); whereas untwisting rate was influenced by 2 D A pex/3 D A pex and age ( r 2 = 0·42; r = 0·65; F ratio: 7·7; P = 0·003 for 2 D A pex/3 D A pex; and P = 0·011 for age). Conclusions Left ventricular apical level acquisition, even when recorded in a standard manner, determines variability of twist mechanics measurements. Thus, current anatomical markers used to identify LV apex for twist analysis are not reliable and need different standardization. 3D echocardiography may help in such standardization.