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Left ventricular rotation: a neglected aspect of the cardiac cycle

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Abstract

Purpose

To describe the mechanics and possible clinical importance of left ventricular (LV) rotation, exemplify techniques to quantify LV rotation and illustrate the temporal relationship of cardiac pressures, electrocardiogram and LV rotation.

Materials and methods

Review of the literature combined with selected examples of echocardiographic measurements.

Results

Rotation of the left ventricle around its longitudinal axis is an important but thus far neglected aspect of the cardiac cycle. LV rotation during systole maximizes intracavitary pressures, increases stroke volume, and minimizes myocardial oxygen demand. Shearing and restoring forces accumulated during systolic twisting are released during early diastole and result in diastolic LV untwisting or recoil promoting early LV filling. LV twist and untwist are disturbed in a number of cardiac diseases and can be influenced by several therapeutic interventions by altering preload, afterload, contractility, heart rate, and/or sympathetic tone.

Conclusions

The concept of LV twisting and untwisting closely linking LV systolic and diastolic function may carry potential diagnostic and therapeutic importance for the management of critically ill patients. Future clinical studies need to address the feasibility of assessing LV twist and untwist as well as the relevance of its therapeutic modulation in critically ill patients.

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Conflict of interest

No author has a conflict of interest in regards of methods, techniques, or drugs discussed in this manuscript.

Author information

Authors and Affiliations

  1. Department of Intensive Care Medicine, University Hospital Bern, Inselspital, Freiburgstrasse, 3010, Bern, Switzerland

    Stefan Bloechlinger & Martin W. Dünser

  2. Department of Internal Medicine, Community Hospital Hall in Tirol, Hall in Tirol, Austria

    Wilhelm Grander

  3. Binzmuehlestrasse, Zurich, Switzerland

    Juerg Bryner

Authors
  1. Stefan Bloechlinger
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  2. Wilhelm Grander
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  3. Juerg Bryner
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  4. Martin W. Dünser
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Corresponding author

Correspondence to Stefan Bloechlinger.

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Video 1.

Torsion is shown as a function of circumferential strain in a color-coded three-dimensional image of the left ventricle. Torsion is calculated as the difference in rotation between the apex and the base. Note the opposite rotation of the base and apex coded as brown-beige-yellow at the base and blue-turquoise at the apex, respectively. Note that for technical reasons three-dimensional echocardiography currently allows for a maximum frame rate of 19.1 frames per second only (AVI 2040 kb)

Video 2.

Three-dimensional speckle tracking demonstrating radial strain of the subepicardial and subendocardial layers: the inferior segment shows the largest counterclockwise torsion (viewed from the base). Note that for technical reasons, three-dimensional echocardiography currently allows for a maximum frame rate of 19.1 frames per second only (AVI 2158 kb)

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Bloechlinger, S., Grander, W., Bryner, J. et al. Left ventricular rotation: a neglected aspect of the cardiac cycle. Intensive Care Med 37, 156–163 (2011). https://doi.org/10.1007/s00134-010-2053-8

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  • DOI: https://doi.org/10.1007/s00134-010-2053-8

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