Defining Left Ventricular Apex-to-Base Twist Mechanics Computed From High-Resolution 3D Echocardiography. Validation Against Sonomicrometry

Muhammad Ashraf, Andriy Myronenko, Thuan Nguyen, Akio Inage, Wayne Smith, Robert I. Lowe, Karl Thiele, Carol A. Gibbons Kroeker, John V. Tyberg, Jeffrey F. Smallhorn, David J. Sahn, Xubo Song

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Objectives: To compute left ventricular (LV) twist from 3-dimensional (3D) echocardiography. Background: LV twist is a sensitive index of cardiac performance. Conventional 2-dimensional based methods of computing LV twist are cumbersome and subject to errors. Methods: We studied 10 adult open-chest pigs. The pre-load to the heart was altered by temporary controlled occlusion of the inferior vena cava, and myocardial ischemia was produced by ligating the left anterior descending coronary artery. Full-volume 3D loops were reconstructed by stitching of pyramidal volumes acquired from 7 consecutive heart beats with electrocardiography gating on a Philips IE33 system (Philips Medical Systems, Andover, Massachusetts) at baseline and other steady states. Polar coordinate data of the 3D images were entered into an envelope detection program implemented in MatLab (The MathWorks, Inc., Natick, Massachusetts), and speckle motion was tracked using nonrigid image registration with spline-based transformation parameterization. The 3D displacement field was obtained, and rotation at apical and basal planes was computed. LV twist was derived as the net difference of apical and basal rotation. Sonomicrometry data of cardiac motion were also acquired from crystals anchored to epicardium in apical and basal planes at all states. Results: The 3D dense tracking slightly overestimated the LV twist, but detected changes in LV twist at different states and showed good correlation (r = 0.89) when compared with sonomicrometry-derived twist at all steady states. In open chest pigs, peak cardiac twist was increased with reduction of pre-load from inferior vena cava occlusion from 6.25° ± 1.65° to 9.45° ± 1.95°. With myocardial ischemia from left anterior descending coronary artery ligation, twist was decreased to 4.90° ± 0.85° (r = 0.8759). Conclusions: Despite lower spatiotemporal resolution of 3D echocardiography, LV twist and torsion can be computed accurately.

Original languageEnglish (US)
Pages (from-to)227-234
Number of pages8
JournalJACC: Cardiovascular Imaging
Issue number3
StatePublished - Mar 2010


  • 3-dimensional echocardiography
  • left ventricular twist
  • myocardial ischemia
  • validation study

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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