Time to twist: marker of systolic dysfunction in Africans with hypertension

Aims Speckle-tracking echocardiography (STE) has emerged as a quantitative technique to assess left ventricular (LV) function via twist mechanics. Hypertension-associated changes in LV twist have not been previously evaluated in African patients with LV systolic dysfunction. This study evaluates LV twist dynamics in hypertensive patients with a low ejection fraction (EF). Methods and results Forty-one hypertensive patients with EF <45% and normal coronary angiography (HTLEF group) were compared with 41 control subjects using STE. Peak apical rotation (AR) and isochronous basal rotation (BR) were measured, as was net twist (maximal value of simultaneous AR−BR). Rigid body rotation (RBR) was defined as AR and BR occurring in the same direction. Of 41 HTLEF patients, 28 (68%) had normal twist pattern, whereas 13 (32%) exhibited RBR; 11 of those 13 exhibited clockwise rotation. AR (1.89° ± 0.99 vs. 7.15° ± 2.26; P < 0.0001), BR (1.44° ± 0.78 vs. −3.75° ± 1.61; P < 0.0001), and net twist (3.3° ± 1.17 vs. 10.9° ± 2.7; P < 0.0001) were lower in HTLEF patients. The subgroup with clockwise RBR showed greater LV dysfunction (EF: 27.9 ± 5.8 vs. 35 ± 7.5%; P = 0.005) and more spherical LV geometry in both diastole and systole ( P = 0.0009 and P = 0.0002, respectively) compared with those who had a normal pattern of twist. In the HTLEF subgroup with normal twist pattern, AR ( r = 0.57; P = 0.002) and net twist ( r = 0.57; P = 0.002) correlated with EF. Conclusions LV twist in patients with hypertension and EF <45% is diminished. Apical rotation and net twist are good correlates for EF in hypertensive patients with EF <45%.