Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure

Aims: To examine myocardial deformation and rotation in patients with heart failure, and elucidate the underlying mechanisms that account for normal ejection fraction (EF) in patients with diastolic heart failure (DHF). Methods and results: Fifty consecutive patients presenting with congestive heart failure (age: 58 ± 16 years) underwent simultaneous right heart catheterization and transthoracic echocardiography. Left ventricular (LV) volumes, mass, EF, meridional, and circumferential wall stress were measured in addition to haemodynamic measurements. 2-D speckle tracking was applied to measure longitudinal, radial, and circumferential strain and twist. Twist was reduced only in patients with systolic heart failure (SHF: 5 ± 2°, DHF: 13 ± 6°, control: 14 ± 5°, P < 0.001). Circumferential strain was not different between DHF (-15 ± 5%) and control groups (-20 ± 3%, P > 0.05), though it was significantly lower in patients with SHF (-7 ± 3%, P < 0.05). Importantly, longitudinal (DHF:-12%, SHF: -4%, control: -19%, P < 0.001) and radial (DHF: 28 ± 9%, SHF: 14 ± 8%, control: 47 ± 7%, P < 0.001) strains were significantly lower in both heart failure groups than in controls, and were depressed to a larger extent in SHF patients than in those with DHF (both P < 0.05). Conclusion: LV longitudinal and radial strains are reduced, but circumferential deformation and twist are normal in DHF patients. On the other hand, in patients with SHF, longitudinal, radial, and circumferential deformation, and twist are all reduced. Multivariable regression analysis suggests that preserved LV twist and circumferential strain may contribute to normal EF in patients with DHF.