Dissociation between left ventricular untwisting and filling. Accentuation by catecholamines.

Abstract

BACKGROUND Efficient early diastolic filling is essential for normal cardiac function. Diastolic suction, as evidenced by a decreasing left ventricular pressure during early filling, could result from restoring forces (the release of potential energy stored during systolic deformation) dependent on myofilament relaxation. Although these restoring forces have been envisioned within individual myofibers, recent studies suggest that gross fiber rearrangement involving the connective tissue network occurs easy in diastole. This may lead to the release of potential energy stored during systole and suction-aided filling. METHODS AND RESULTS To establish precisely the timing and extent of restoration of the systolic torsional deformation of the left ventricle with respect to early filling at baseline and with enhanced relaxation, we studied untwisting during control conditions and with catecholamine stimulation. Using noninvasive and nondestructive magnetic resonance tagging, torsional deformation of the left ventricle was measured at 20-msec intervals in 10 open-chest, atrially paced dogs, starting at aortic valve closure. Eight equiangular tags intersected the epicardium and endocardium in three short-axis imaging planes (base, mid, and apex). From the intersection points, epicardial and endocardial circumferential chord and arc lengths were measured and angular twist of mid and apical levels with respect to the base (maximal torsion and its reversal, untwisting) was calculated. Echo-Doppler provided timing of aortic valve closure and of mitral valve opening. Zero torsion was defined at end diastole. Torsion at the apical level reversed rapidly between its maximum and the time immediately after mitral valve opening: from 7.0 +/- 5.8 degrees to 3.2 +/- 5.4 degrees and 12.0 +/- 8.5 degrees to 6.9 +/- 7.8 degrees (mean +/- SD, both p less than 0.01) at the epicardium and endocardium, respectively. During the same period, no significant circumferential segment length changes occurred. As expected, after mitral valve opening, filling resulted in significant circumferential segment lengthening, whereas further reversal of torsion was small and nonsignificant. During dobutamine infusion, torsion at end systole was greater and reversal during isovolumic relaxation was much more rapid and greater in extent (p less than 0.01). Torsion reversed from 11.5 +/- 4.3 degrees to 5.7 +/- 4.8 degrees and 17.4 +/- 6.4 degrees to 6.9 +/- 7.7 degrees at epicardium and endocardium. CONCLUSIONS Untwisting occurs principally during isovolumic relaxation before filling and is markedly enhanced in speed and magnitude by catecholamines. This partial return of the left ventricle to its preejection configuration before mitral valve opening could represent an important mechanism for the release of potential energy stored in elastic elements during the systolic deformation. These myocardial restoring forces would be markedly enhanced by physiological changes consequent to catecholamines such as during exercise, offsetting the concomitant shortening of the filling period.

Assessment of Left Ventricular Torsional Deformation by Doppler Tissue Imaging

“…The method used in this study was optimized for assessment of systolic function and early diastole. These advantages of the DTI method may facilitate assessment of LV torsional dynamics, including the relationship between systolic torsion and diastolic suction 7,16,32 (based on the cylinder model of Ingels et al 6 or the Torrent-Guasp model: creation of a suction force by contraction of a ventricular myocardial band 36 ) and may give insight into tissue 7,18,19 and molecular [21][22][23] aspects of ventricular mechanics. Diastole is a very complex process that cannot be separated from the preceding systole.…”

Echocardiographic evaluation of diastolic heart failure

“…Subsequent elastic recoil of twist deformation during isovolumic relaxation releases restoring forces, contributing to LV relaxation and early diastolic filling 149 , 150 . LV torsion is a function of LV contractility and varies linearly with EF 151 , while diastolic untwisting contributes to LV filling through suction generation 152 , 153 . Pertinent to the study of diastolic function is the dynamics of LV untwisting that commences in late systole but mostly occurs during the isovolumetric relaxation and is largely completed at the time of mitral valve opening 152 .…”

“…LV torsion is a function of LV contractility and varies linearly with EF 151 , while diastolic untwisting contributes to LV filling through suction generation 152 , 153 . Pertinent to the study of diastolic function is the dynamics of LV untwisting that commences in late systole but mostly occurs during the isovolumetric relaxation and is largely completed at the time of mitral valve opening 152 . The rate of untwisting correlates with τ, is independent of left atrial pressure 154 and was observed to remain constant during volume loading.…”

Functional Recovery of Subepicardial Myocardial Tissue in Transmural Myocardial Infarction After Successful Reperfusion

“…Axes are radial (R) using the direction perpendicular to wall; fiber (F), tangent to surface and parallel to local fiber direction at either epicardium or endocardium; and cross-fiber (X), tangent to surface and perpendicular to F. M 1270 3 40 56 ASA, ACEI 7 49/M 8300 3 60 3 40 36 ASA, BB, ACEI 8 59/F 4847 0 100 3* 40 46 ACEI, ASA 9 55/F 952 3 50 58 ASA, ACEI 10 70/M 7260 3 80 3 40 43 ASA, BB 11 74/M 3165 2 95 2 30 47 ASA 12 59/M 2950 3 90 3 20 10 and to calculate the normal and shear strains of the myocardium. 11 A 3D deformation analysis of the myocardium can be performed with the use of perpendicular short-and long-axis images. 12 The LV myocardium was thus divided into 32 small cuboids encompassing the entire LV except for the apex (Figure 1).…”