Assessment of age-related changes in left ventricular twist by 3-dimensional speckle-tracking echocardiography

The purpose of this study was to determine the normal value of left ventricular (LV) twist in 3-dimensional (3D) geometry and to study the effects of aging on 3D LV twist by sophisticated newly developed 3D speckle-tracking echocardiographic techniques.

Recent developments in miniaturized ultrasound arrays have provided us with high-quality 3D echocardiographic data. Speckle tracking based on 3D images is robust to out-of-plane motion error, whereas 2-dimensional speckle tracking is inherently unable to analyze 3D cardiac motion and may lead to measurement inaccuracies. Three-dimensional LV volumetric images were acquired from 124 healthy volunteers (aged 21-82 years) and were analyzed by a recent speckle-tracking method. Left ventricular twist was analyzed as apical rotation relative to the base in the 3D coordinates. The measured parameters in this study were peak apical rotation, peak basal rotation, peak LV twist, normalized peak LV twist, and peak untwist velocity.

As seen from the apex, the normal LV maintains a wringing systolic displacement with an initial counterclockwise rotation followed by a clockwise rotation in the LV basal plane and a counterclockwise rotation in the LV apical plane. In general, the apical and basal twist increases during the aging process, leading to an increased LV twist value. The mean peak twist ± SD in young participants (21-35 years) was 11.73° ± 2.67°, whereas the value for older participants (>65 years) was 18.57° ± 3.08° (P < .001).

Three-dimensional speckle-tracking echocardiography can be an effective noninvasive method for assessing 3D LV twist. Age-related differences in the 3D LV twist may be the result of the age-related changes in the endocardial myofibers.