Left ventricular torsional dynamics post exercise for LV diastolic function assessment.

AIMS: 2D speckle tracking echocardiography allows for assessment of left ventricular (LV) torsional deformation as a composite function of the radial, longitudinal and circumferential fibres. We test the hypothesis that post-exercise LV torsional dynamics are more sensitive markers for myocardial dysfunction than resting measures, and better predictors for exercise capacity compared to post-exercise LV diastolic filling pressure (E/e'). METHODS: We studied 88 patients referred for stress echocardiogram. Treadmill exercise was performed using Bruce protocol, and echo images were acquired using GE Vivid 7. LV rotational dynamics were analysed by speckle tracking method using the GE ECHOPAC software. Tertiles were defined according to exercise capacity measured by the achieved metabolic equivalents (METS) adjusted for age and gender. Comparison was made between LV torsional dynamics and E/e' to correlate with METS to predict exercise capacity. RESULTS: Mean age of the study population was 58 years, 48% females. Patients with systolic dysfunction or evidence of ischaemia were excluded from the analysis. No significant correlation was found between METS and LV torsion measures at rest. There was statistically significant correlation between METS and post-exercise LV torsion (r=0.34, p=0.001), twist velocity increase (r=0.27, p=0.01), and incremental change in torsion (r=0.22, p<0.05). In addition, a correlation was also shown between post-exercise E/e' and METS (r=-0.33, p=0.002). CONCLUSION: Post-exercise LV torsional dynamics correlate with exercise capacity and may be a useful tool for assessing LV myocardial function in subjects with normal LVEF.

Intracoronary optical coherence tomography for the assessment of in-stent restenosis.

Optical coherence tomography (OCT) is a novel imaging modality in interventional cardiology. With its clear image quality, it has attracted considerable attention as a tool to accurately evaluate atherosclerosis and coronary stents in vivo. It has a 10-fold higher resolution compared to intravascular ultrasound and utilises near-infrared light that requires temporary blood clearance during image acquisition. We present a case of in-stent restenosis in a patient five years after percutaneous intervention. Optical coherence tomography clearly showed the mechanism behind the stent failure and helped appropriately plan the subsequent repeat intervention. The technology heralds an exciting advance in the invasive assessment of the coronary arteries that will improve our understanding of heart disease into the future.