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World J Cardiol. Aug 26, 2015; 7(8): 476-482
Published online Aug 26, 2015. doi: 10.4330/wjc.v7.i8.476
Role of left ventricular twist mechanics in cardiomyopathies, dance of the helices
Floris Kauer, Marcel Leonard Geleijnse, Bastiaan Martijn van Dalen
Floris Kauer, Marcel Leonard Geleijnse, Bastiaan Martijn van Dalen, Erasmus University Medical Center Rotterdam, The Thoraxcenter, ’s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
Author contributions: Kauer F has written a major part of the first version of the review and he created the figures; After that, further drafting and editing was mainly done by Geleijnse ML and van Dalen BM.
Conflict-of-interest statement: None of the authors has received fees for serving as a speaker, or has a position [such as consultant and/or an advisory board member]. None of the authors has received research funding. None of the authors owns stocks and/or shares in medical organization(s). None of the authors owns patent.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bastiaan Martijn van Dalen, MD, PhD, Erasmus University Medical Center Rotterdam, The Thoraxcenter, ’s Gravendijkwal 230, Room BA 302, 3015 CE Rotterdam, The Netherlands. b.m.vandalen@erasmusmc.nl
Telephone: +31-10-4633533 Fax: +31-10-4635498
Received: November 29, 2014
Peer-review started: December 1, 2014
First decision: December 26, 2014
Revised: February 9, 2015
Accepted: June 15, 2015
Article in press: June 16, 2015
Published online: August 26, 2015
Processing time: 270 Days and 17.9 Hours
Abstract

Left ventricular twist is an essential part of left ventricular function. Nevertheless, knowledge is limited in “the cardiology community” as it comes to twist mechanics. Fortunately the development of speckle tracking echocardiography, allowing accurate, reproducible and rapid bedside assessment of left ventricular twist, has boosted the interest in this important mechanical aspect of left ventricular deformation. Although the fundamental physiological role of left ventricular twist is undisputable, the clinical relevance of assessment of left ventricular twist in cardiomyopathies still needs to be established. The fact remains; analysis of left ventricular twist mechanics has already provided substantial pathophysiological understanding on a comprehensive variety of cardiomyopathies. It has become clear that increased left ventricular twist in for example hypertrophic cardiomyopathy may be an early sign of subendocardial (microvascular) dysfunction. Furthermore, decreased left ventricular twist may be caused by left ventricular dilatation or an extensive myocardial scar. Finally, the detection of left ventricular rigid body rotation in noncompaction cardiomyopathy may provide an indispensible method to objectively confirm this difficult diagnosis. All this endorses the value of left ventricular twist in the field of cardiomyopathies and may further encourage the implementation of left ventricular twist parameters in the “diagnostic toolbox” for cardiomyopathies.

Keywords: Left ventricular mechanics; Left ventricular twist; Cardiomyopathy

Core tip: Left ventricular twist is an essential part of left ventricular function. Nevertheless, knowledge is limited in “the cardiology community” as it comes to twist mechanics. It has become clear that increased left ventricular twist in for example hypertrophic cardiomyopathy may be an early sign of subendocardial (microvascular) dysfunction. Furthermore, decreased left ventricular twist may be caused by left ventricular dilatation or an extensive myocardial scar. Finally, the detection of left ventricular rigid body rotation in noncompaction cardiomyopathy may provide an indispensible method to objectively confirm this difficult diagnosis. All this endorses the value of left ventricular twist in the field of cardiomyopathies and may further encourage the implementation of left ventricular twist parameters in the “diagnostic toolbox” for cardiomyopathies.