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Twist Mechanics of the Left Ventricle
Open accessAbstract
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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“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]
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“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).”
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“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).”
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Metadata
- Authors
- Sengupta, P. P., Tajik, A. J., Chandrasekaran, K., & Khandheria, B. K.
- Affiliations
- Mayo Clinic in Arizona (US)
- Corresponding author
- Sengupta, Partho P.
- Venue
- JACC: Cardiovascular Imaging
- Publisher
- Elsevier BV
- Published
- 2008-05
- Volume
- 1
- Issue
- 3
- Pages
- 366-376
- ISSN
- 1876-7591 (ISSN-L)
- 1936-878X
- 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
- bronze
- doi.org
- 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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