Influence of the pattern of hypertrophy on left ventricular twist in hypertrophic cardiomyopathy.
OBJECTIVE
Left ventricular (LV) twist has an important role in LV function. The influence of the pattern of LV hypertrophy on LV twist in hypertrophic cardiomyopathy (HCM) patients is unknown. This study sought to assess LV twist in a large group of HCM patients according to the pattern of LV hypertrophy.


METHODS
The final study population consisted of 43 patients with HCM (mean age 43 (15) years, 31 men) and a typical sigmoidal (n = 16) or reverse septal curvature (n = 27) and 43 age-matched and gender-matched healthy control subjects. LV peak systolic rotation (Rot(max)), LV peak systolic twist (Twist(max)) and untwisting at 5%, 10% and 15% of diastole were determined by speckle tracking echocardiography (STE).


RESULTS
Compared to control subjects, HCM patients had increased basal Rot(max) (-5.5 degrees (2.3 degrees ) vs -3.4 degrees (1.7 degrees ), p<0.001) and comparable apical Rot(max) (7.3 degrees (3.1 degrees ) vs 7.0 degrees (2.2 degrees ), p = NS), resulting in increased Twist(max) (12.4 degrees (4.0 degrees ) vs 9.9 degrees (2.7 degrees ), p<0.01). Untwisting at 5%, 10% and 15% of diastole was decreased in HCM patients (all p<0.05). There was a striking difference in apical Rot(max )(9.4 degrees (2.8 degrees ) vs 6.0 degrees (2.6 degrees ), p<0.01) and Twist(max) (15.3 degrees (3.2 degrees ) vs 10.6 degrees (3.3 degrees ), p<0.01) between HCM patients with a sigmoidal and reverse septal curvature.


CONCLUSIONS
STE may provide novel non-invasive indices to assess LV function in patients with HCM. Apical Rot(max) and Twist(max) in HCM patients are dependent on the pattern of LV hypertrophy.
van Dalen
B M
BM
Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands. b.m.vandalen@erasmusmc.nl
Kauer
F
F
Soliman
O I I
OI
Vletter
W B
WB
Michels
M
M
ten Cate
F J
FJ
Geleijnse
M L
ML
D000328:Adult; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012399:Rotation; D013599:Systole; D014102:Torsion Abnormality / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D014463:Ultrasonography; D016277:Ventricular Function, Left