Age-related changes in left ventricular twist assessed by two-dimensional speckle-tracking imaging

The aim of this study was to determine the normal value of left ventricular (LV) twist, and to examine the effects of aging on LV twist by newly developed 2-dimensional ultrasound speckle-tracking imaging. We acquired basal and apical LV short-axis second harmonic images in 118 healthy volunteers. Using commercially available 2-dimensional strain software, time-domain speckle tracking was performed, and mean value of LV rotation obtained at each plane. LV twist was defined as apical rotation relative to the base. Adequate data were obtained in 113 volunteers. During systole, the LV performs a wringing motion with a counterclockwise rotation at the apex and a clockwise rotation at the base. The mean value of peak twist was 7.7 +/- 3.5 degrees. Immediately after end systole, rapid untwisting develops. Different LV twist profiles are noted according to age. Peak LV twist was significantly higher, and the rate of LV untwisting significantly reduced and delayed, with advancing age. LV twist can be measured noninvasively by 2-dimensional ultrasound speckle-tracking imaging. The observed reduced and delayed diastolic untwisting with aging may contribute toward the tendency of diastolic dysfunction. This novel method allows the detailed study of diastolic function in various cardiovascular diseases.