title: Left ventricular torsion and circumferential strain responses to exercise in patients with ischemic coronary artery disease.
abstract: LV torsion during exercise in patients with coronary artery disease (CAD) is not well known. Circumferential strain (CS) and left ventricular (LV) torsion (Tor) have not been evaluated during ischemia in these patients. We aimed to assess the effect of ischemia during exercise echocardiography (ExE) on CS and Tor. We studied a group of 73 patients with true positive ExE results (Ischemic group: ischemia plus an abnormal coronary angiogram) and a matched control group of 66 patients with negative ExE and either normal coronary angiography or low post-test probability of CAD. Basal rotation (Rot) and apical rotation and basal and apical CS were studied by speckle tracking at rest and exercise. Apical CS and apical and basal Rot values were similar between groups at rest, except basal CS which was already worse in the ischemic group. At exercise, all rotational and CS parameters were impaired in the ischemic in comparison with the control group (basal CS: -18 ± 5 vs. -25 ± 7 %, p < 0.001; apical CS: -31 ± 11 vs. - 43 ± 9 %, p < 0.001; time to basal CS: 52 ± 6 vs. 48 ± 7 %, p = 0.001; time to apical CS: 55 ± 7 vs. 49 ± 6 %, p < 0.001; basal rotation: -0.7 ± 6.5° vs. -6.2 ± 8.5°, p < 0.001; LV twist 13.0 ± 10.4° vs.19.7 ± 11.5°, p < 0.001; LV-Tor 1.9 ± 1.6°/cm vs. 2.8 ± 1.7˚/cm, p = 0.001) with the exception of apical rotation which was similar (12.3 ± 7.4° vs. 13.4 ± 7.7°, p = NS). Basal and apical CS and basal rotation impair during exercise-induced ischemia. LV-Tor decreases with ischemia due to worsening of basal rotation, whereas apical rotation does not impair, suggesting the existence of an apical compensatory mechanism.
authors.affiliation: Department of Cardiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigacion Biomedica de A Coruña (INIBIC) and Universidad de A Coruña, As Xubias, 84, 15006, A Coruña, Spain. pete@canalejo.org.
authors.forename: Jesus
authors.initials: J
authors.lastname: Peteiro
authors.affiliation: Department of Cardiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigacion Biomedica de A Coruña (INIBIC) and Universidad de A Coruña, As Xubias, 84, 15006, A Coruña, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bouzas-Mosquera
authors.affiliation: Department of Information Technology, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigacion Biomedica de A Coruña (INIBIC) and Universidad de A Coruña, A Coruña, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Broullon
authors.affiliation: Department of Cardiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigacion Biomedica de A Coruña (INIBIC) and Universidad de A Coruña, As Xubias, 84, 15006, A Coruña, Spain.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sanchez-Fernandez
authors.affiliation: Department of Cardiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigacion Biomedica de A Coruña (INIBIC) and Universidad de A Coruña, As Xubias, 84, 15006, A Coruña, Spain.
authors.forename: Cayetana
authors.initials: C
authors.lastname: Barbeito
authors.affiliation: Department of Cardiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigacion Biomedica de A Coruña (INIBIC) and Universidad de A Coruña, As Xubias, 84, 15006, A Coruña, Spain.
authors.forename: Lucia
authors.initials: L
authors.lastname: Perez-Cebey
authors.affiliation: Department of Cardiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigacion Biomedica de A Coruña (INIBIC) and Universidad de A Coruña, As Xubias, 84, 15006, A Coruña, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Martinez
authors.affiliation: Department of Cardiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigacion Biomedica de A Coruña (INIBIC) and Universidad de A Coruña, As Xubias, 84, 15006, A Coruña, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Vazquez-Rodriguez
mesh_terms: D000222:Adaptation, Physiological; D000368:Aged; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D025401:Echocardiography, Stress / Q000379:methods*; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D013314:Stress, Mechanical; D054159:Torsion, Mechanical; D016277:Ventricular Function, Left
keywords: Circumferential strain; Exercise echocardiography; Ischemia; Left ventricular torsion