Left Ventricle Twist/Torsion Evaluation 6 Months after Rheumatic Aortic Valve Replacement using 2D Speckle Tracking Echocardiography

Objective: This study aimed to assess the rotation and torsion in the endocardial, epicardial, and global myocardium using two-dimensional speckle tracking imaging(2D-STI) in patients with rheumatic heart disease who underwent aortic valve replacement (AVR). Methods: This study included 42 AVR patients [(23 F/19 M, aged (62.7±11.2) years] and 25 normal control [(16 F/9 M, aged (63.3±10.5) years]. 2D-STI was performed in five consecutive heart beats, and data were stored for offline analysis using Q-Lab. The peak systolic rotation of the endocardial, epicardial, and global myocardium in the left ventricular basal and apical walls were measured using 2D-STI. The torsion and twisting angles of the sub-endocardial, sub-epicardial, and global myocardium were calculated. Results: Rotation at the left ventricular basal level of the study group was not significantly reduced compared with that in the normal control group. However, at the apical level, rotation was significantly reduced (p=0.03, 0.003, 0.004). The torsion angle of the study group was significantly reduced compared with that of the normal control group (p=0.006, 0.003, 0.003). Furthermore, patients with different left ventricular ejection function after AVR showed differences in torsion of the endocardial, epicardial, and global myocardium. Conclusions: The systolic rotation and twist of the subendocardial, sub-epicardial, and global myocardium in the left ventricle were reduced, whereas those at the basal level remained unchanged. After AVR, old patients have an almost complete recovery of left ventricular rotational motion at the basal level. 2D-STI is a useful non-invasive tool for evaluation of the left ventricular regional function.