title: Left ventricular twisting modifications in patients with left ventricular concentric hypertrophy at increasing after-load conditions.
abstract: OBJECTIVE
  Left ventricular hypertrophy (LVH) develops as a result of several clinical conditions, such as intensive training, hypertension, aortic valve stenosis. Aim of this study was to analyze the left ventricular twist (LVT) modifications in LVH patients with increasing after-load conditions.
  
  
  METHODS
  A total of 131 patients were enrolled: 17 healthy sedentary people (Hg), without concentric LVH; 45 water polo players (ATg); 22 patients with hypertensive cardiopathy (HPg); 47 patients with different degrees of aortic stenosis (ASg); all patients had concentric LVH, ejection fraction (EF) >54%, and were age-matched. The left ventricular end-systolic wall stress (LV-ESWS) was used as index of after-load.
  
  
  RESULTS
  Left ventricular twist value showed a progressive increase from ATg to ASg, according to increasing after-load. Longitudinal left ventricular function by tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) was reduced in HPg and ASg. There was a negative correlation between LVT and longitudinal systolic function at TDI and STE (r = -0.4; P < 0.001; -0.23; P < 0.05). E/A ratio was lower in HPg and ASg than ATg and Hg. LVT was linearly related to LV-ESWS (r = 0.36; P < 0.01), E/A ratio (r = -0.59; P < 0.001), E/E' ratio (r = 0.43; P < 0.001), age (r = 0.5; P < 0.001), relative wall thickness (RWT) (r = 0.38; P < 0.01), heart rate (HR) (r = 0.3; P < 0.05), maximum (G. max), and mean transvalvular gradient (G. mean) in ASg (r = 0.37; P < 0.01, r = 0.4; P < 0.01). RWT, E/A ratio, and HR were independent predictor of LVT (β = 0.23; P = 0.007; -0.44; P = 0.001; 0.17; P = 0.049). Only in ASg, G. mean was independent predictor of LVT (β = 0.44; P = 0.01).
  
  
  CONCLUSIONS
  Left ventricular twist showed a linear trend at increasing after-load values to compensate the reduction in systolic longitudinal function in pathological LVH patients.
authors.affiliation: Division of Cardiology, University of Siena, Siena, Italy.
authors.forename: Amato
authors.initials: A
authors.lastname: Santoro
authors.forename: Federico
authors.initials: F
authors.lastname: Alvino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Antonelli
authors.forename: Valerio
authors.initials: V
authors.lastname: Zacà
authors.forename: Susanna
authors.initials: S
authors.lastname: Benincasa
authors.forename: Stefano
authors.initials: S
authors.lastname: Lunghetti
authors.forename: Sergio
authors.initials: S
authors.lastname: Mondillo
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D059267:Cardiomegaly, Exercise-Induced; D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods*; D015444:Exercise / Q000502:physiology; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007090:Image Interpretation, Computer-Assisted; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012016:Reference Values; D018570:Risk Assessment; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: strain; ventricular hypertrophy; ventricular twisting