Left ventricular twisting modifications in patients with left ventricular concentric hypertrophy at increasing after-load conditions

Aims Left ventricular hypertrophy (LVH) develops as result of several clinical conditions such as intensive training, hypertension, aortic valve stenosis. Aim of the study was to analyze the left ventricular twist (LVT) in LVH patients with increasing after-load conditions. Methods: 131 patients were enrolled: 17 healthy sedentary people (Hg), without concentric LVH; 37 waterpolo players (ATg); 30 patients with hypertensive cardiopathy (HPg); 47 patients with different degrees of aortic stenosis (ASg); all patients had concentric LVH and ejection fraction (EF) >54%. Results: LVT value showed a progressive increase from ATg to ASg, according to increasing afterload. Longitudinal left ventricular function by Tissue Doppler imaging (TDI) and Speckle Tracking echocardiography (STE) was reduced in HPg and ASg. There was a negative correlation between LVT and longitudinal systolic function at TDI and STE (r=-0.4; p<0.001; -0.35; p<0.01; 0.23; p<0.05). E/A ratio was lower in HPg and ASg than ATg and Hg. LVT was linearly related to E/A ratio (r=-0.59; p<0.001), to E/E' ratio (r=0.43; p<0.001), to maximum (G.max) and mean transvalvular gradient (G.mean) in ASg (r=0.37; p<0.01, r=0.4; p<0.01). Relative wall thickness (RWT), E/A ratio and HR were independent predictor of LVT (beta=0.23; p=0.007; -0.44; p=0.001; 0.17; p=0.049). Only in ASg, G.mean was independent predictor of LVT (beta=0.44; p=0.01). LVT resulted independent predictor of diastolic function evaluated by E/A ratio (beta= -0.469; p= 0.041). Conclusion: LVT could be a determinant of diastolic function in LVH patients. It showed a linear trend at increasing afterload values to compensate the reduction of systolic longitudinal function in pathological LVH.