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New approach to assess left ventricular torsion by the torsion index

Session Poster session 4

Speaker Valentina Faga

Event : EuroEcho 2017

  • Topic : other
  • Sub-topic : Other
  • Session type : Poster Session

Authors : V Faga (Valencia,ES), V Mora Llabata (Valencia,ES), I Roldan Torres (Valencia,ES), D Romero (Buenos Aires,AR), N Ugalde Gallegos (Buenos Aires,AR), M Rodriguez Israel (Buenos Aires,AR), A Sauri Ortiz (Valencia,ES), E Romero Dorta (Valencia,ES), M Salim Martinez (Valencia,ES), JA Lowenstein (Buenos Aires,AR)

V Faga1 , V Mora Llabata1 , I Roldan Torres1 , D Romero2 , N Ugalde Gallegos2 , M Rodriguez Israel2 , A Sauri Ortiz1 , E Romero Dorta1 , M Salim Martinez1 , JA Lowenstein2 , 1Hospital Dr. Peset - Valencia - Spain , 2 Investigaciones medicas de Buenos Aires, Servicio de cardiodiagnóstico - Buenos Aires - Argentina ,


European Heart Journal Supplements ( 2017 ) 18 ( Supplement 3 ), iii296

Background. Current clinical practice and scientific literature often fail to highlight the differences between ventricular twist and torsion, being the two parameters used as synonymous. Moreover, conventional torsion does not take into account left ventricle (LV) longitudinal shortening. 

Purpose. The aim of the study was to analyze several parameters used to assess LV rotational mechanics, to provide normal range values in healthy population, and to suggest a new parameter that combines rotational mechanics with longitudinal shortening. 

Methods. LV rotational parameters were determined in 90 healthy volunteers using speckle-tracking echocardiography, along with mitral annulus plane systolic excursion (MAPSE) and basal-apex distance (B-A). The first ones were obtained from LV basal and apical transverse planes, while MAPSE and B-A were obtained from apical 4 chambers view. Twist was calculated as the sum of apical and basal rotation (º). Torsion was obtained dividing twist by B-A (º/cm). We suggest the use of the Torsion Index (twist/MAPSE, º/cm) as a new parameter that allows for a more realistic assessment of LV torsion, since it includes a parameter of longitudinal shortening such as the MAPSE.

Results. Mean age 50,3 ± 11,1 years. No significative differences were observed in twist, torsion and torsion index analyzing by gender. MAPSE was greater in men.  Subjects with age >55 years showed higher values of both LV torsion and torsion index, mostly reflected in the latter one, with no age differences in the remaining parameters (see table). Intra and interobserver variability was good, being the intraclass correlation coefficients >0.75. 

Conclusions. Twist and conventional torsion do not take into account any dynamic parameter of LV shortening. Torsion index includes the MAPSE, that allows for a more physiological and sensitive assessment of LV rotational mechanics since both longitudinal and transversal movements are considered at once.

LVEF (%) MAPSE Twist Torsion Torsion index
Total (n=90) 66,6±5,5 1,4±0,1 20,3±7,6 2,5±1,0 14,2±5,3
Men (n=52) 66,4±5,4 1,4±0,1 20,7±7,9 2,4±1,0 14,0±5,4
Women (n=38) 66,9±5,7 1,3±0,1 19,6±7,1 2,6±1,0 14,5±5,2
p 0,68 0,01 0,51 0,39 0,67
≤ 55 years (n=59) 65,7±5,3 1,4±0,1 19,4±7,9 2,3±1,0 13,1±5,0
> 55 years (n=31) 68,4±5,7 1,3±0,1 21,9±6,6 2,8±0,9 16,5±5,2
p 0,03 0,001 0,14 0,05 0,003
LVEF: Left ventricle ejection fraction; MAPSE: Mitral annulus plane systolic excursion.

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