Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


The helical ventricular myocardial band of Torrent-Guasp is a new concept, which provides strong grounds for reconciliation of some important aspects in cardiovascular medicine. Oblique fiber orientation provides left ventricular rotation, which in addition to radial thickening and longitudinal shortening, is predicted as an essential component of the effective left ventricular pumping. Left ventricular rotation can be measured in clinical practice noninvasively using echocardiography and this provides new opportunities for the assessment of different aspects of left ventricular mechanical function.

About the Authors

E. N. Pavlyukova
Research Institute of Cardiology, Siberian Branch of Russian Academy of Medical Sciences
Russian Federation
Kievskaya ul. 111A, Tomsk, 634012 Russia

D. A. Kuzhel
Krasnoyarsk Territory Hospital №2, Krasnoyarsk State Medical University named after Prof. V.F Voyno-Yasenetsky
Russian Federation

Karla Marxa ul. 43, Krasnoyarsk, 660097 Russia

Partizana Zheleznyaka ul. 1, Krasnoyarsk, 660022 Russia

G. V. Matyushin
Krasnoyarsk State Medical University named after Prof. V.F Voyno-Yasenetsky
Russian Federation
Partizana Zheleznyaka ul. 1, Krasnoyarsk, 660022 Russia

E. A. Savchenko
Krasnoyarsk State Medical University named after Prof. V.F Voyno-Yasenetsky
Russian Federation
Partizana Zheleznyaka ul. 1, Krasnoyarsk, 660022 Russia

S. A. Filippova
Krasnoyarsk Territory Hospital №20
Russian Federation
Instrumentalnaya ul. 12, Krasnoyarsk, 660014 Russia


1. Lower R. Tractatus de Corde. London, UK: Oxford University Press; 1669.

2. Kardel T. Steno on muscles: introduction, texts, translations. Trans Am Phylos Soc 1994;84(1):58-75.

3. Beladan C.C., Calin A., Rosca M., et al. Left ventricular twist dynamics: principles and applications. Heart 2014;100:731-40.

4. Kocica M.J., Corno A.F., Corno, et al. The helical ventricular myocardial band: global, three-dimensional, functional architecture of the ventricular myocardium. European J Car-Thor Sur 2006:295;s21-s40.

5. Pettigrew J.B. On the arrangement of the muscular fibres in the ventricles of the vertebrate heart, with physiological remarks. Phylos Trans 1864;154:445-500.

6. Greenbaum R.A., Ho S.Y., Gibson D.G., et al. Left ventricular fibre architecture in man. Br Heart J 1981;45:248-63.

7. Streeter D.D. Gross morphology and fiber geometry of the heart. In: Berne RM, Sperelakis N, editors. Handbook of physiology: section 2. The heart (American Physiology Society), vol. 1. Baltimore: Williams and Wilkins; 1979: 61-112.

8. Torrent-Guasp F., Ballester M., Buckberg G.D., et al. Spatial orientation of the ventricular muscle band: physiologic contribution and surgical implications. J Thorac Cardiovasc Surg 2001;122:389-92.

9. Song J-K. How Does the Left Ventricle Work? Ventricular Rotation as a New Index of Cardiac Performance. Korean Circ J 2009;39:347-351.

10. Nakatani S. Left Ventricular Rotation and Twist: Why Should We Learn? J Cardiovasc Ultrasound 2011;19(1):1-6.

11. Sengupta P.P., Khandheria B.K., Korinek J., et al. Apex-to-base dispersion in regional timing of left ventricular shortening and lengthening. J Am Coll Cardiol 2006;47:163-72.

12. Sengupta P.P., Tajik A.J., Chandrasekaran K., Khandheria B.K. Twist Mechanics of the Left Ventricle. J Am Coll Cardiol Img 2008;1:366-76.

13. Partridge J.B., Smerup M.H., Petersen S.E., et al. Linking left ventricular function and mural architecture: what does the clinician need to know? Heart 2014;100:1289-98.

14. Beyar R., Sideman S. Left ventricular mechanics related to the local distribution of oxygen demand throughout the wall. Circ Res 1986;58:664-77.

15. Esch B.T., Warburton D.E. Left ventricular torsion and recoil: implications for exercise performance and cardiovascular disease. J Appl Physiol 2009; 106(2):362-9.

16. Kim W.J., Lee B.H., Kim Y.J., et al. Apical rotation assessed by speckle-tracking echocardiography as an index of global left ventricular contractility. Circ Cardiovasc Imaging 2009;2:123-31.

17. Notomi Y., Martin-Miklovic M.G., Oryszak SJ, et al. Enhanced ventricular untwisting during exercise: a mechanistic manifestation of elastic recoil described by Doppler tissue imaging. Circulation 2006;113:2524-33.

18. Helmes M., Lim C.C., Liao R., et al. Titin determines the Frank-Starling relation in early diastole. J Gen Physiol 2003; 121(2):97-110.

19. Notomi Y., Popovic Z.B., Yamada H., et al. Ventricular untwisting: a temporal link between left ventricular relaxation and suction. Am J Physiol Heart Circ Physiol 2008;294:H505-13.

20. Van Dalen B.M., Soliman O.I.I., Kauer F., et al. Alterations in Left Ventricular Untwisting With Ageing. Circ J 2010;74:101-8.

21. Notomi Y., Srinath G., Shiota T., et al. Maturational and adaptive modulation of left ventricular torsional biomechanics: Doppler tissue imaging observation from infancy to adulthood. Circulation 2006;113:2534-41.

22. Takeuchi M., Nakai H., Kokumai M., et al. Age-related changes in left ventricular twist assessed by two-dimensional speckle-tracking imaging. J Am Soc Echocardiogr 2006;19:1077-84.

23. Notomi Y., Srinath G., Shiota T., et al. Maturational and adaptive modulation of left ventricular torsional biomechanics: Doppler tissue imaging observation from infancy to adulthood. Circulation 2006;113:2534-41.

24. Zocalo Y., Bia D., Armentano R.L., et al. Assessment of training-dependent changes in the left ventricle torsion dynamics of professional soccer players using speckle-tracking echocardiography. Conf Proc IEEE Eng Med Biol Soc 2007;1:2709-12.

25. Hansen D.E., Daughters G.T., Alderman E.L., et al. Effect of volume loading, pressure loading, and inotropic stimulation on left ventricular torsion in humans. Circulation 1991;83:1315-26.

26. Dong S.J., Hees P.S., Huang W.M., et al. Independent effects of preload, afterload, and contractility on left ventricular torsion. Am J Physiol 1999;277:H1053-60.

27. Buchalter M.B., Weiss J.L., Rogers W.J., et al. Noninvasive quantification of left ventricular rotational deformation in normal humans using magnetic resonance imaging myocardial tagging. Circulation 1990;81:1236-44.

28. Helle-Valle T., Crosby J., Edvardsen T., et al. New noninvasive method for assessment of left ventricular rotation: speckle tracking echocardiography. Circulation 2005;112:3149-56.

29. Park C.M., March K., Williams S., et al. Feasibility and Reproducibility of Left Ventricular Rotation by Speckle Tracking Echocardiography in Elderly individuals and Impact of Different Software. PLOS ONE 2013;8(9):75-98.

30. Owan T.E., Hodge D.O., Herges R.M., et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 2006;355:251-9.

31. Pacileo G., Baldini L., Limongelli G., et al. Prolonged left ventricular twist in cardiomyopathies: a potential link between systolic and diastolic dysfunction. European Journal of Echocardiography 2011;12:841-849.

32. Zhang J. Myocardial energetics in cardiac hypertrophy. Clin Exp Pharmacol Physiol 2002;29:351-9.

33. Park S.J., Miyazaki C., Bruce C.J., et al. Left ventricular torsion by two-dimensional speckle tracking echocardiography in patients with diastolic dysfunction and normal ejection fraction. J Am Soc Echocardiogr 2008;21:1129-37.

34. Ahmed M.I., Desai R.V., Gaddam K.K., et al. Relation of Torsion and Myocardial Strains to Left Ventricular Ejection Fraction in Hypertension. JACC Cardiovasc Imaging 2012;5(3): 273-281.

35. Park S.J., Miyazaki C., Bruce C.J., et al. Left ventricular torsion by two-dimensional speckle tracking echocardiography in patients with diastolic dysfunction and normal ejection fraction. J Am Soc Echocardiogr 2008;21:1129-37.

36. Takeuchi M., Borden W.B., Nakai H., et al. Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy: a study using two-dimensional speckle tracking imaging. Eur Heart J 2007;28:2756-62.

37. Cameli M., Lisi M., Righini F.M., et al. Left ventricular remodeling and torsion dynamics in hypertensive patients. Int J Cardiovasc Imaging 2013;29(1):79-86.

38. Qin C., David Meggo-Quiroz L., Nanda N.C., et al. Early Effect of Essential Hypertension on the Left Ventricular Twist-Displacement Loop by Two-Dimensional Ultrasound Speckle Tracking Imaging. Echocardiography 2013;5:12456.

39. Wang J., Fang F., Yip G.W., et al. Quantification of left ventricular performance in different heart failure phenotypes by comprehensive ergometry stress echocardiography. Int J Cardiol 2013;169(4):311-5.

40. Soullier C., Obert P., Doucende G., et al. Exercise Response in Hypertrophic Cardiomyopathy: Blunted Left Ventricular Deformational and Twisting Reserve With Altered Systolic-Diastolic Coupling. Cardiovasc Imaging 2012;5:324-332.

41. Zhou W., Benharash Р., Ho Y., et a. Left ventricular twist and untwist rate provide reliable measures of ventricular function in myocardial ischemia and a wide range of hemodynamic states. Physiol Rep 2013;1(5):1-11.

42. Park S.M., Hong S.J., Ahn C.M., et al. Different impacts of acute myocardial infarction on left ventricular apical and basal rotation. Eur Heart J Cardiovasc Imaging 2012;13(6):483-9.

43. Kroeker C.A., Tyberg J.V., Beyar R. Effects of ischemia on left ventricular apex rotation. An experimental study in anesthetized dogs. Circulation 1995;92:3539-48.

44. Joyce E., Leong D.P., Hoogslag G.E., et al. Left ventricular twist during dobutamine stress echocardiography after acute myocardial infarction: association with reverse remodeling. Int J Cardiovasc Imaging 2013;19.

45. Kusunose K., Zhang Y., Mazgalev T.N., et al. Left ventricular strain distribution in healthy dogs and in dogs with tachycardia induced dilated cardiomyopathy. Cardiovascular Ultrasound 2013,11:43.

46. MornoşC., Ruşinaru D., Manolis A.J., et al. The Value of a New Speckle Tracking Index Including Left Ventricular Global Longitudinal Strain and Torsion in Patients with Dilated Cardiomyopathy. Hellenic J Cardiol 2011; 52: 299-306.

47. Karaahmet T., Gürel E., Tigen K., et al. The effect of myocardial fibrosis on left ventricular torsion and twist in patients with non-ischemic dilated cardiomyopathy. Cardiol J 2013;20(3):276-86.

48. Setser R.M., Kasper J.M., Lieber M.L., et al. Persistent abnormal left ventricular systolic torsion in dilated cardiomyopathy after partial left ventriculectomy. J Thorac Cardiovasc Surg 2003;126:48-55.

49. Setser R.M., Smedira N.G., Lieber M.L., et al. Left ventricular torsional mechanics after left ventricular reconstruction surgery for ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2007;134:888-96.

50. Pavlyukova EN, Kuzhel DA, Matyushin GV, et al. Myocardial deformation and complete left bundle branch block. Ration Pharmacother Cardiol 2012; 8 (6): 814-20. Russian (Павлюкова Е.Н., Кужель Д.А., Матюшин Г.В. и соавт. Деформация миокарда и полная блокада левой ножки пучка Гиса. Рациональная Фармакотерапия в Кардиологии 2012;8(6):814-20).

51. Bertini M., Marsan N.A., Delgado V., et al. Effects of cardiac resynchronization therapy on left ventricular twist. J Am Coll Cardiol 2009;54:1317-25.

52. van Dalen B.M., Caliskan K., Soliman O.I., et al: Left ventricular solid body rotation in non-compaction cardiomyopathy: a potential new objective and quantitative functional diagnostic criterion? Eur J Heart Fail 2008, 10(11):1088-93

53. Badran H.M., Faheem N., Ibrahim W.A., et al. Systolic function reserve using two-dimensional strain imaging in hypertrophic cardiomyopathy: comparison with essential hypertension. `J Am Soc Echocardiogr 2013;26(12):1397-406.

54. Carasso S., Yang H., Woo A., et al. Systolic myocardial mechanics in hypertrophic cardiomyopathy: novel concepts and implications for clinical status. J Am Soc Echocardiogr 2008;8.

55. Ni X-D., Huang J., Hu Y-P., et al. Assessment of the Rotation Motion at the Papillary Muscle Short-Axis Plane with Normal Subjects by Two-Dimensional Speckle Tracking Imaging: A Basic Clinical Study. PLOS ONE 2013;8(12):83-71.

56. Tigen K., Sunbul M., Karaahmet T., et al. Left Ventricular and Atrial Functions in Hypertrophic Cardiomyopathy Patients with Very High LVOT Gradient: A Speckle Tracking Echocardiographic Study. Echocardiography 2013;17:12482.

57. Carasso S., Woo A., Yang H., et al. Myocardial mechanics explains the time course of benefit for septal ethanol ablation for hypertrophic cardiomyopathy. J Am Soc Echocardiogr 2008.

58. Moravsky G.., Bruchal-Garbicz B., Jamorski M., et al. Myocardial mechanical remodeling after septal myectomy for severe obstructive hypertrophic cardiomyopathy. J Am Soc Echocardiogr 2013;26(8):893-900.

59. Sengupta P.P., Krishnamoorthy V.K., Abhayaratna W., et al. Disparate patterns of left ventricular mechanics differentiate constrictive pericarditis from restrictive cardiomyopathy. J Am Coll Cardiol Img 2008;1:29-38.

60. Phillips A.A. Cote A.T., Bredin S.S.D., Warburton D.E.R. Heart disease and left ventricular rotation – a systematic review and quantitative summary. Cardiovascular Disorders 2012;12:46.

61. Nagel E., Stuber M., Burkhard B., et al. Cardiac rotation and relaxation in patients with aortic valve stenosis. Eur Heart J 2000;21:582-9.

62. Biederman R.W., Doyle M., Yamrozik J., et al. Physiologic compensation is supranormal in compensated aortic stenosis: does it return to normal after aortic valve replacement or is it blunted by coexistent coronary artery disease? An intramyocardial magnetic resonance imaging study. Circulation 2005;112:I429-36.

63. Zhuang Y., Yong Y.H., Yao J., et al. Left Ventricular Rotation and Torsion in Patients with Perimembranous Ventricular Septal Defect. Echocardiography 2013;19:12374.

64. Xie M., Zhang W., Cheng T.O., et al. Left ventricular torsion abnormalities in patients after the arterial switch operation for transposition of the great arteries with intact ventricular septum. Int J Cardiol 2013;168(5):4631-7.

65. Haber I., Metaxas D.N., Geva T., Axel L. Three-dimensional systolic kinematics of the right ventricle. Am J Physiol Heart Circ Physiol 2005;289: H1826-33.

66. Menting M.E., Eindhoven J.A., van den Bosch A.E., et al. Abnormal left ventricular rotation and twist in adult patients with corrected tetralogy of Fallot. Eur Heart J Cardiovasc Imaging 2013:28.


For citation:

Pavlyukova E.N., Kuzhel D.A., Matyushin G.V., Savchenko E.A., Filippova S.A. LEFT VENTRICULAR ROTATION, TWIST AND UNTWIST: PHYSIOLOGICAL ROLE AND CLINICAL RELEVANCE. Rational Pharmacotherapy in Cardiology. 2015;11(1):68-78. (In Russ.)

Views: 819

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)