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Left ventricular torsional hysteresis in patients with hypertension: a global parameter for diastolic function
Journal of Cardiovascular Magnetic Resonance volume 15, Article number: O28 (2013)
Torsion is an important determinant of left ventricular (LV) systolic and diastolic function. We hypothesized that the area within the torsion volume loop, called the torsional hysteresis (TH), may be an important parameter of diastolic function (DD).
60 resistant hypertension (HTN) patients, 40 healthy controls were studied using cardiac MRI with tissue tagging. Volumetric and torsional parameters were evaluated.
HTN patients demonstrated concentric remodeling. All HTN patients had preserved ejection fraction (>55%) and normalized peak ejection rate was significantly greater in HTN vs. controls. HTN patients had significantly decreased MRI-measured early filling rate, E/A ratio (1.33±1.13 vs. 2.19±1.07, P<0.0001) and early diastolic mitral annulus velocity normalized to LV length (66.23±20.65 vs. 85.67±29.96 %, P<0.001) vs. controls. Furthermore, the normalized TH was significantly greater in HTN compared controls (0.11± 0.07 vs. 0.079±0.045, P<0.001) (Figure 1). LV normalized TH best correlated with E/A ratio (r=-0.23, P=0.025) but not with LVmass/volume. Mean normalized TH plus 1 standard deviation and mean E/A ratio minus 1 standard deviation of controls were used as cutoffs to identify DD in HTN respectively. Both cutoffs identified ~50% HTN patients with DD (27 by normalized TH, 28 by E/A ratio), among which 13 patients were identified with DD by both cutoffs, as shown in Figure 2.
TH as measured by area within torsion volume loops was significantly increased in hypertensive concentric remodeling with associated DD. TH took into account not only active and passive recoil processes of the LV diastolic phase but also the systolic phase and represents a heretofore new assessment of diastolic function.
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Schiros, C., Desai, R.V., Venkatesh, B.A. et al. Left ventricular torsional hysteresis in patients with hypertension: a global parameter for diastolic function. J Cardiovasc Magn Reson 15, O28 (2013). https://doi.org/10.1186/1532-429X-15-S1-O28
- Diastolic Function
- Resistant Hypertension
- Mitral Annulus
- Preserve Ejection Fraction
- Ejection Rate