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Lee, Kim, Kim, Jang, Bae, Kang, Lee, and Jung: Age-Related Changes in Left Ventricular Torsion as Assessed by 2-Dimensional Ultrasound Speckle Tracking Imaging
Original Article

Korean Circulation J 2008;38(10):529-535.

Published online: 20 January 2008

DOI: https://doi.org/10.4070/kcj.2008.38.10.529

Age-Related Changes in Left Ventricular Torsion as Assessed by 2-Dimensional Ultrasound Speckle Tracking Imaging

Hyun Jik Lee, MD, Bong Soo Kim, MD, Jae Hoon Kim, MD, Hee Sang Jang, MD, Byung Seok Bae, MD, Hyun Jae Kang, MD, Bong Ryeol Lee, MD, Byung Chun Jung, MD

Department of Cardiology, Fatima General Hospital, Daegu, Korea

Correspondence: Byung Chun Jung, MD, Department of Cardiology, Fatima General Hospital, 302-1 Sinam-dong, Dong-gu, Daegu 701-600, Korea Tel: 82-53-940-7214, 7459, Fax: 82-53-954-7417 E-mail: Augustjbc@yahoo.co.kr

Received 26 May 2008       Revised 11 July 2008       Accepted 17 July 2008

Copyright © 2008 The Korean Society of Cardiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives

The newly developed 2-dimensional ultrasound speckle tracking imaging (2D-STI) has enabled researchers to assess the changes of left ventricular (LV) rotation and torsion. The aims of the present study are to establish normal values and to examine the effect of advancing age on left ventricular torsion.

Subjects and Methods

We enrolled 182 healthy persons in this study. After examined the standard clinical echocardiographic parameters, we obtained the degree of the LV rotation at the basal and apical levels of the short axis view with using a customized software program EchoPAC, GE.

Results

Among the 182 healthy subjects, 109 healthy subjects were finally included (49 males and 60 females) due to the failure of obtaining reliable rotational patterns (feasibility: 59.8%). The basal and apical peak LV rotations during systole were 8.14±3.55 degrees and 8.48±3.70 degrees, respectively. The basal peak LV rotation and peak LV torsion had a tendency to increase with aging (r=0.277, p=0.004 and r=0.253, p=0.008, respectively). All the values of the basal LV rotation during systole tended to increase with aging. The apical LV rotation had no relationship with aging throughout the entire cardiac cycle.

Conclusion

2D-STI was a feasible methodology to measure the LV rotation. The peak LV torsion during systole shows statistically significant augmentation with advancing age, and this is mainly due to the increased basal LV rotation.

Keywords: Age factors, Echocardiography, Doppler, Left ventricle, Torsion

References

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Fig. 1.
Left ventricular rotation (A), torsion (B), rotational velocity (C), and torsional velocity (D)profile curves are presented. ∗Means significant correlation with aging by univariate regression analysis, which has been presented on Table 2. All data are plotted as function of time normalized to one cardiac cycle (RR interval). Positive Y-axis values indicate counterclockwise rotation, and negative Y-axis values clockwise rotation. LV rotation: left ventricular rotation, LV torsion: left ventricular torsion.
kcj-38-529f1.tif
Fig. 2.
Correlations between age and basal peak LV rotation (A), apical peak LV rotation (B)and peak LV torsion (C) are presented. The basal peak LV rotation and peak LV torsion have a meaningful tendency to increase with aging (r=0.277, p=0.004 and r=0.253, p=0.008, respectively). The apcial peak LV rotation has no relationship with aging (r=0.092, p=0.340). LV rotation: left ventricular rotation, LV torsion: left ventricular torsion.
kcj-38-529f2.tif
Table 1.
Demographic and echocardiographic parameters of the different age groups
Parameters 1st quartile (n=27) 2nd quartile (n=28) 3rd quartile (n=26) 4th quartile (n=28) p
Age (years) 35.1±8.7 51.4±3.2 60.3±2.8 72.7±5.2 0.00
Male (%) 15 (55.5) 11 (39.3) 11 (42.3) 12 (42.9) NS
BMI (Kg/m2) 24.2±3.0 24.7±3.2 24.7±3.0 23.2±2.5 NS
EF (%) 64.3±6.3 64.7±4.4 65.6±4.3 64.6±6.5 NS
RR interval (ms) 749±127 859±154 844±147 862±158 0.016
E velocity (cm/s) 80.1±18.1 76.5±17.3 75.5±23.7 69.3±18.7 NS
A velocity (cm/s) 67.5±15.3 75.3±20.2 82.4±21.4 89.2±16.6 0.00
DT (ms) 187±34 226±37 218±58 238±48 0.001
IVRT (ms) 76±9 80±12 81±13 83±12 NS
E/A ratio 1.3±0.4 1.1±0.4 0.9±0.2 0.8±0.2 0.00
Sm (cm/s) 8.7±1.8 8.1±1.3 8.5±1.8 8.1±1.7 NS
E/E' ratio 8.8±2.7 11.5±4.1 11.8±3.7 12.6±4.4 0.002

All values of the quartiles were tested by ANOVA, but the frequency of gender was tested with Chi-square tests.?BMI: body mass index, EF: ejection fraction, DT: deceleration time, IVRT: isovolumic relaxation time, Sm: tissue Doppler imaging of the septal mitral annulus, NS: not significant, RR: R wave to the next R wave in the electrocardiogram, ANOVA: analysis of variance

Table 2.
The Left ventricular rotation and torsion parameters in different age groups and according to aging
Parameters 1st quartile 2nd quartile 3rd quartile 4th quartile ANOVA Regression on age
(n=27) (n=28) (n=26) (n=28) p r p
Basal pLV rotation (degree) –7.1±3.9∗ –8.2±3.8 –7.9±3.0 –9.3±3.2∗ NS 0.277 0.004†
Apical pLV rotation (degree) 7.8±3.0 9.5±4.0 7.8±3.6 8.8±3.9 NS 0.092 0.340
pLV trorsion (degree) 14.9±6.2∗ 17.6±4.6 15.6±5.1 18.1±4.4∗ 0.05 0.253 0.008†
Basal LV rotation values according to the percentile time of the cardiac cycle (RR interval)
5% of RR interval 0.36±0.97 0.26±1.18 0.26±0.98 –0.64±1.45 0.005 0.315 0.001†
10% of RR interval 0.53±1.72 0.29±2.01 0.30±1.78 –1.08±1.24 0.002 0.352 0.000†
15% of RR interval 0.53±2.11 –0.39±2.56 –0.01±2.31 –2.02±1.83 0.000 0.404 0.000†
20% of RR interval –0.43±2.23 –2.17±3.06 –1.13±2.76 –3.26±2.55 0.001 0.369 0.000†
25% of RR interval –2.13±2.54 –3.98±3.03 –3.12±3.13 –4.69±2.76 0.009 0.324 0.001†
30% of RR interval –3.89±3.08 –5.47±3.14 –4.94±3.22 –6.34±2.74 0.03 0.305 0.001†
35% of RR interval –5.25±3.36 –6.46±3.48 –6.70±3.02 –7.79±2.95 0.04 0.335 0.000†
40% of RR interval –6.17±3.50 –6.84±3.81 –7.31±2.95 –8.28±3.28 NS 0.285 0.003†
45% of RR interval –6.47±3.89 –6.56±3.88 –6.15±2.77 –7.81±3.82 NS 0.170 0.076
50% of RR interval –6.06±4.01 –5.68±3.81 –5.20±2.42 –6.82±3.99 NS 0.110 0.257
55% of RR interval –5.46±4.03 –4.48±3.78 –3.71±2.61 –5.51±3.91 NS 0.041 0.668
60% of RR interval –4.51±3.61 –3.36±3.47 –2.69±2.42 –4.24±3.93 NS 0.012 0.897
65% of RR interval –3.74±3.09 –2.79±2.87 –2.01±2.69 –3.49±3.82 NS 0.013 0.895
70% of RR interval –3.34±2.76 –2.49±2.28 –2.06±3.47 –3.03±3.20 NS 0.026 0.780
75% of RR interval –3.13±2.25 –2.32±2.14 –1.73±2.97 –3.03±3.20 NS 0.038 0.693
80% of RR interval –2.89±1.97 –2.37±1.99 –1.83±2.62 –2.87±2.87 NS 0.039 0.687
85% of RR interval –2.72±1.86 –2.32±1.81 –2.12±2.43 –2.93±2.76 NS 0.009 0.925
90% of RR interval –2.29±1.64 –1.95±1.80 –2.01±1.98 –2.73±2.35 NS 0.038 0.696
95% of RR interval –1.14±1.12 –0.86±1.56 –1.19±1.19 –1.67±1.40 NS 0.111 0.253
100% of RR interval –0.06±0.33 –0.03±0.20 –0.02±0.05 –0.04±0.24 NS 0.001 0.991

∗ Means a significant difference on post-Hoc analysis after ANOVA testing,

† Means a significant difference on univariate regression analysis for age. ANOVA: analysis of variance, NS: not significant, pLV rotation: peak left ventricular rotation, pLV torsion: peak left ventricular torsion

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