Left Ventricular Twist and Ventricular–Arterial
Coupling in Hypertensive Patients
- Author(s)
- Hong-Won Shin; Hyungseop Kim; Jeong-Eun Lee; In-Cheol Kim; Hyuck-Jun Yoon; Hyoung-Seob Park; Yun-Kyeong Cho; Chang-Wook Nam; Seung-Ho Hur; Yoon-Nyun Kim; Kwon-Bae Kim
- Keimyung Author(s)
- Kim, Hyung Seop; Kim, In Cheol; Yoon, Hyuck Jun; Park, Hyoung Seob; Cho, Yun Kyeong; Nam, Chang Wook; Hur, Seung Ho; Kim, Yoon Nyun; Kim, Kwon Bae
- Department
- Dept. of Internal Medicine (내과학)
- Journal Title
- Echocardiography
- Issued Date
- 2014
- Volume
- 31
- Issue
- 10
- Abstract
- Background: Left ventricular (LV) twist is usually influenced by LV hypertrophy resulting from hyp erten-
sion or vascular stiffness. Vascular stiffness would increase arterial elastance (Ea), whereas LV end-systolic
stiffness (Ees) could be influenced by LV hyp ertrophy. Therefore, in hypertensive patients, we assessed
the extent to which ventricular–arterial coupling (VAC; Ea/Ees) affects LV twist, which may be a com-
pensatory mechanism for systolic dysfunction. Methods: Hypertensive patients (n = 128) and healthy
controls (n = 40) underwent conven tional and speckle tracking echocardiography including LV twist.
Ea and Ees were estimated noninvasiv ely by echocardiography. Patients were divided into 3 tertiles
according to the twist angle. Univariate and mul tivariate regression analyses were perf ormed to test the
influence of VAC on twist. Results: Patients in the lowest LV twist tertile had larger LV end-systolic vol-
ume, lower ejection fraction, lesser mid-wall fractional shortening (MWFS), and higher LV mass index
(LVMI), compared to those with the highest tertile. They showed the lower septal tissue Doppler veloc-
ity, and global longitudinal and circumferential strain. With regard to VAC, Ea was simi lar among 3
groups, but Ees was significantly decreased in patient with lower tertile, resulting in increased VAC
(1.1 0.2 vs. 0.9 0.1 vs. 0.7 0.1, P < 0.001). While LV twist showed significant correlations with
Ees, MWFS, and LVMI, VAC (b = 14.92, P < 0.001) was most associated with twist in a multivariate
analysis. Conclusions: LV twist was significantly associated with VAC in acco rdance with LV function; LV
twist and VAC decreased progressively as LV systolic function deteriorated, while being enhanced dur-
ing the well-compensated phase. (Echocardiography 2014;31:1274–1282)
Key words: ventricular–arterial coupling, stiffness, elastance, echocardiography
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