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Figure 4 LV Twist in Health and Disease

Rotation of the left ventricular (LV) apex, the LV base, and the net LV twist angle (shown in red, green, and black colors, respectively) are assessed by speckle-tracking echocardiography in a normal subject (A), a patient with dilated cardiomyopathy with systolic heart failure (B), a patient with cardiac amyloidosis presenting as heart failure with normal ejection fraction (diastolic heart failure) (C), and a patient with constrictive pericarditis (D). Net ventricular twist is negative in dilated cardiomyopathy because of complete reversal of the LV apex rotation (B). In contrast, a patient with amyloid cardiomyopathy shows relatively preserved magnitude of net LV twist angle. In a normal subject, the onset of untwisting occurs just before the aortic valve closure (AVC) (A); however, in the patient with amyloid cardiomyopathy, the onset of untwisting is delayed after AVC (C). The patient with constrictive pericarditis (D) shows reduced magnitude of net ventricular twist and marked delay in the onset of untwisting. Phases 1 through 4 are defined in the Figure 3 legend.