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Cited by 604Cardiovascular Function and Risk FactorsCardiac Imaging and DiagnosticsCardiac pacing and defibrillation studies

Twist Mechanics of the Left Ventricle

Open access
Sengupta, Partho P., Tajik, A. Jamil, Chandrasekaran, Krishnaswamy, Khandheria, Bijoy K.·2008·JACC: Cardiovascular Imaging
DOI 10.1016/j.jcmg.2008.02.006
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Abstract

Left ventricular (LV) twist or torsion represents the mean longitudinal gradient of the net difference in clockwise and counterclockwise rotation of the LV apex and base, as viewed from LV apex. Twist during ejection predominantly deforms the subendocardial fiber matrix, resulting in storage of potential energy. Subsequent recoil of twist deformation is associated with the release of restoring forces, which contributes to LV diastolic relaxation and early diastolic filling. Noninvasive techniques such as magnetic resonance imaging and echocardiography are useful for understanding LV twist dynamics in clinical settings, and data regarding their relative merits and pitfalls are rapidly accumulating. This review is a focused update on the current and evolving applications of LV twist mechanics in clinical cardiology. First, the theoretical framework for understanding the physiological sequence of LV twist during a cardiac cycle is presented. Second, variations in LV twist encountered in different experimental and clinical situations are discussed. Finally, the review presents an algorithm for routine application of LV twist in clinical differentiation of patterns of LV dysfunction encountered in day-to-day practice.

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Registry

Crossref · 10.1016/j.jcmg.2008.02.006

Cites

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  • The helical arrangement of the heart's musculature is a fundamental structural design critical to achieving large ejection fractions.

    “Over the past half-century, it has been argued that this helical arrangement represents a fundamental structural design critical to achieving large ejection fractions (EFs) (1, 3–6).”

    From Recreating the heart's helical structure-function relationship with focused rotary jet spinning (2022) · cites this paper as [1]

    The section on myofiber geometry explains how the left ventricle’s helical fibers generate twist that assists contraction and wall thickening. The section on LV dysfunction also links impaired twist mechanics with declining ejection fraction. These passages support a connection between helical architecture and ejection, but do not establish that it is critical to achieving large ejection fractions. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • In a healthy heart, kinetic energy is stored during contraction in the sarcomeric protein titin and released during relaxation, giving rise to rotational displacements, or ventricular twist.

    “In a healthy heart, kinetic energy is stored during contraction in the sarcomeric protein titin and is subsequently released during relaxation (38), giving rise to rotational displacements, or ventricular twist (1, 38).”

    From Recreating the heart's helical structure-function relationship with focused rotary jet spinning (2022) · cites this paper as [1]

    The 'Link Between Myofiber Geometry and Twist Mechanics' section describes ventricular rotation during contraction and release of stored energy during relaxation. But it identifies that energy as potential energy stored in the deformed subendocardial matrix, not kinetic energy stored in titin; it also describes the release as torsional recoil, rather than the origin of the contraction-phase twist. Page numbers are unavailable in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • The heart's musculature is organized helically, with left ventricular cardiomyocytes transitioning transmurally from a left- to right-handed helix.

    “The heart’s musculature is organized in a helical fashion, with cardiomyocytes in the left ventricle smoothly transitioning transmurally froma left- to right-handed helix (1).”

    From Recreating the heart's helical structure-function relationship with focused rotary jet spinning (2022) · cites this paper as [1]

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Cites

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Research works printed but not linked: 8

  1. [1]1. Lower R. Tractatus de Corde. London, UK: Oxford University Press, 1669.
  2. [19]19. Narula J, Vannan MA, DeMaria AN. Of that Waltz in my heart. J Am Coll Cardiol 2007;49:917-20.
  3. [29]29. Ashikaga H, Criscione JC, Omens JH, Covell JW, Ingels NB Jr. Trans- mural left ventricular mechanics un- derlying torsional recoil during relax- ation. Am J Physiol Heart Circ Physiol 2004;286:H640 -7.
  4. [32]32. Notomi Y, Srinath G, Shiota T, et al. Maturational and adaptive modula- tion of left ventricular torsional bio- mechanics: Doppler tissue imaging observation from infancy to adult- hood. Circulation 2006;113:2534 -41.
  5. [47]47. Weyman AE. The year in echocardi- ography. J Am Coll Cardiol 2007;49: 1212-9.
  6. [49]49. Wang J, Khoury DS, Yue Y, Torre- Amione G, Nagueh SF. Left ventric- ular untwisting rate by speckle track- ing echocardiography. Circulation 2007;116:2580 -6.
  7. [70]70. Young AA, Kramer CM, Ferrari VA, A x e l L , R e i c h e k N . T h r e e - dimensional left ventricular deforma- tion in hypertrophic cardiomyopathy. Circulation 1994;90:854 -67.
  8. [79]79. Zhang J. Myocardial energetics in car- diac hypertrophy. Clin Exp Pharma- col Physiol 2002;29:351-9.

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Authors
Sengupta, P. P., Tajik, A. J., Chandrasekaran, K., & Khandheria, B. K.
Affiliations
Mayo Clinic in Arizona (US)
Corresponding author
Sengupta, Partho P.
ORCID
Venue
JACC: Cardiovascular Imaging
Publisher
Elsevier BV
Published
2008-05
Volume
1
Issue
3
Pages
366-376
ISSN
  • 1876-7591 (ISSN-L)
  • 1936-878X
DOI
10.1016/j.jcmg.2008.02.006
OpenAlex
W1495679923
Cited by
604
References
83
Citations by year
2026: 19 · 2025: 23 · 2024: 42 · 2023: 32 · 2022: 29 · 2021: 34 · 2020: 30 · 2019: 42 · 2018: 36 · 2017: 51 · 2016: 30 · 2015: 37 · 2014: 40 · 2013: 47 · 2012: 45
FWCI
3.33
Type
journal article
Language
en
Open access
Licence
Locations
  • JACC. Cardiovascular imaging (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords
left ventricular torsion, left ventricular mechanics, diastolic relaxation, early diastolic filling, cardiac cycle, left ventricular dysfunction, echocardiography, magnetic resonance imaging
MeSH terms
Algorithms, Animals, Biomechanical Phenomena, Diagnostic Imaging, Elasticity, Humans, Myocardial Contraction, Predictive Value of Tests, Risk Factors, Rotation, Stress, Mechanical, Stroke Volume, Ventricular Function, Left, Ventricular Dysfunction, Left, Torsion, Mechanical

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