Left ventricular rotation: a neglected aspect of the cardiac cycle

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...

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Bibliographic Details
Published in:Intensive care medicine 2011-01, Vol.37 (1), p.156-163
Main Authors: Bloechlinger, Stefan, Grander, Wilhelm, Bryner, Juerg, Dünser, Martin W.
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthesiology
Biological and medical sciences
Biomechanical Phenomena
Coronary vessels
Critical Care Medicine
Electrocardiogram
Electrocardiography
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Emergency Medicine
Heart
Heart - physiology
Heart beat
Heart Diseases - physiopathology
Humans
Intensive
Intensive care
Intensive care medicine
Medical research
Medical sciences
Medicine
Medicine & Public Health
Medicine, Experimental
Myocardial Contraction
Pain Medicine
Pediatrics
Physiological and Technical Notes
Pneumology/Respiratory System
Rotation
Ventricular Function, Left
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Summary: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.
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-010-2053-8