The role of initial left ventricle systolic rotation in the twist and untwist modulation in unstable angina and myocardial infarction

Objective: to evaluate the role of initial systolic rotation (ISR) of left ventricle (LV) in twist and untwist modulation in unstable angina (UA) and myocardial infarction (MI). Material and methods: 145 patients were examined and divided into three groups, the first of which included 30 patients with UA, the second - 62 patients with anterior MI, the third - 53 patients with inferior MI. Transthoracic echocardiography was performed in all patients with the use of Affiniti 70 (Philips, Netherlands) with aCMQ (automatic cardiac movement quantitative analysis) software. The maximal systolic peaks of segmental longitudinal and circular strain and global longitudinal and circular strain (GLS and GCS), systolic and diastolic rotation, twist and untwist of the left ventricle were assessed. The evaluation of basal and apical ISR based on curves of basal and apical LV rotation. Results: the twist and untwist of LV is predominantly influenced by the magnitude of circular strain of LV apical segments. A positive wave of basal ISR was obtained with higher frequency (44.1%) than a negative wave (31.7%) (P < 0.05). The presence of ISR of left ventricle basal segments is associated with greater basal systolic rotation and lesser LV twist (hereinafter: M ± SD, minimal - maximal values) (-3.0 ± 2.0 °, -8.4-1.2 ° and 7.5 ± 3.5 °, -1.0-16.4 °, respectively) than in the absence of the ISR wave (-4.5 ± 1.9 °, -12.1-0.1 °, P < 0.0001 and 9.1 ± 4.1 °, 0.5-21.5 °, P < 0.05, respectively). In all patients GLS values were significantly lower in the presence of basal ISR than in absence of it (-12.1 ± 3.4%, -18.2--3.0% and -10.7 ± 3,5%, -17.2--2.8%, respectively, P < 0.05). Significant GCS/GLS ratio decrease was obtained in the presence of ISR in comparison with its absence (1.71 ± 0.46, 0.67-3.70 and 1.92 ± 0.59, 0.96-4.10, respectively, P < 0.05). In UA and MI, a decrease in the systolic circular strain magnitude of basal segments <20% (modulus) in the presence of a basal ISR wave is combined with a decrease of the twisting index <1.0 °/cm (P < 0.05). In UA and MI, a decrease in the systolic circular strain magnitude of basal segments <20% (modulus) in the presence of a basal ISR wave is combined with a decrease in the untwisting index <0.35 °/cm (P < 0.05). Conclusions: the occurrence of basal ISR wave is higher in inferior MI than in anterior MI (P < 0.05). The presence of basal ISR wave is associated with lower values of LV twist in patients with UA and MI (P < 0.05), and modulate the effect of LV basal segment circular contraction on the value of the twisting and untwisting indices.

speckle tracking echocardiography, myocardial strain, initial systolic rotation, twist, untwist, left ventricle, coronary heart disease

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