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Updated: Jun 7, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Left ventricular rotational mechanics in patients with coronary artery disease: differences in subendocardial and
Matteo Bertini1, Victoria Delgado, Gaetano Nucifora
1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Insights
Subendocardial left ventricular (LV) twist is reduced in ST-elevation myocardial infarction (STEMI) and chronic heart failure (HF). Subepicardial LV twist is impaired only in chronic HF and large STEMI, indicating differential layer involvement in coronary artery disease.
Area of Science:
- Cardiology
- Cardiac Imaging
- Myocardial Mechanics
Background:
- Subendocardial and subepicardial myocardial fibers have distinct orientations and differential susceptibility to coronary artery disease (CAD).
- Understanding the distinct functional impact on these layers is crucial for assessing left ventricular (LV) function in CAD patients.
Purpose of the Study:
- To investigate and compare the alterations in subendocardial and subepicardial LV twist in patients with varying stages of coronary artery disease.
- To differentiate the impact of ST-elevation myocardial infarction (STEMI) and chronic ischemic heart failure (HF) on myocardial layers.
Main Methods:
- Utilized real-time three-dimensional echocardiography for LV volumes and function assessment in 214 participants.
- Employed two-dimensional speckle tracking echocardiography to differentiate and analyze subendocardial and subepicardial LV twist.
- Stratified patients into groups: STEMI (small vs. large), chronic HF, and normal controls.
Main Results:
- Peak subendocardial LV twist was significantly reduced in STEMI and further impaired in chronic HF patients compared to controls.
- Peak subepicardial LV twist was preserved in STEMI but significantly reduced in chronic HF.
- Subepicardial LV twist was notably lower in large STEMI compared to small STEMI, suggesting a size-dependent effect.
Conclusions:
- Subendocardial LV twist is compromised in both STEMI and chronic ischemic heart failure.
- Subepicardial LV twist is selectively impaired in chronic ischemic heart failure and large STEMI.
- These findings highlight the differential vulnerability of LV myocardial layers to ischemic injury.
Objective:
Subendocardial and subepicardial layers have opposite orientation of the myofibres and they are differently affected by coronary artery disease. This study investigated the differences in subendocardial and subepicardial left ventricular (LV) twist in patients with coronary artery disease.
Methods:
214 patients were included in the study: 60 with first ST elevation myocardial infarction (STEMI), 111 with chronic ischaemic heart failure (HF) and 43 normal subjects. Real-time three-dimensional echocardiography provided LV volumes and function. Two-dimensional speckle tracking echocardiography differentiating the subendocardial and subepicardial layers was used for the assessment of LV twist. Patients with STEMI were divided into two groups (small and large STEMI).
Results:
Compared with normal subjects, peak subendocardial LV twist was significantly impaired in patients with STEMI (11.2 ± 6.0° vs 15.3 ± 2.7°, p<0.001). In patients with chronic HF, peak subendocardial LV twist was even more impaired (4.6 ± 3.4°, p<0.001 vs normal subjects and patients with STEMI). Conversely, peak subepicardial LV twist was not statistically different between normal subjects and patients with STEMI (8.9 ± 1.9° vs 8.4 ± 4.4°, p=0.98), whereas it was significantly impaired in patients with chronic HF (2.6 ± 2.5°, p<0.001 vs normal subjects and patients with STEMI). Peak subendocardial LV twist was not statistically different between large and small STEMI, whereas peak subepicardial LV twist was significantly lower in large STEMI than in small STEMI (7.1 ± 4.8° vs 9.6 ± 3.6°, p=0.025).
Conclusions:
Subendocardial LV twist is reduced in patients with STEMI and chronic ischaemic HF whereas subepicardial LV twist is reduced only in chronic ischaemic HF. When STEMI are divided into large and small infarctions, it becomes evident that subepicardial LV twist is only reduced in large infarctions.
