Speckle tracking echocardiography derived 2-dimensional myocardial strain predicts left ventricular function and mass regression in aortic stenosis patients undergoing aortic valve replacement

  • Adam Staron
  • Manish Bansal
  • Piyush Kalakoti
  • Ayumi Nakabo
  • Zbigniew Gasior
  • Piotr Pysz
  • Krystian Wita
  • Marek Jasinski
  • Partho P. Sengupta
Original Paper


Regression of left ventricular (LV) mass in severe aortic stenosis (AS) following aortic valve replacement (AVR) reduces the potential risk of sudden death and congestive heart failure associated with LV hypertrophy. We investigated whether abnormalities of resting LV deformation in severe AS can predict the lack of regression of LV mass following AVR. Two-dimensional speckle tracking echocardiography (STE) was performed in a total of 100 subjects including 60 consecutive patients with severe AS having normal LV ejection fraction (EF > 50 %) and 40 controls. STE was performed preoperatively and at 4 months following AVR, including longitudinal strain assessed from the apical 4-chamber and 2-chamber views and the circumferential and rotational mechanics measured from the apical short axis view. In comparison with controls, the patients with AS showed a significantly lower LV longitudinal (p < 0.001) and circumferential strain (p < 0.05) and higher apical rotation (p < 0.001). Following AVR, a significant improvement was seen in both strains (p < 0.001 for each respectively), however, apical rotation remained unchanged (p = 0.14). On multivariate analysis, baseline LV mass (odds ratio 1.02; p = 0.011), left atrial volume (odds ratio 0.81; p = 0.048) and circumferential strain (odds ratio 0.84; p = 0.02) independently predicted LV mass regression (>10 %) following AVR. In conclusion, STE can quantify the burden of myocardial dysfunction in patients with severe AS despite the presence of normal LV ejection fraction. Furthermore, resting abnormalities in circumferential strain at LV apex is related with a hemodynamic milieu associated with the lack of LV mass regression during short-term follow up after AVR.


Speckle tracking echocardiography Aortic valve replacement Left ventricular mass Aortic stenosis 


Conflict of interest



  1. 1.
    Maganti K, Rigolin VH, Sarano ME, Bonow RO (2010) Valvular heart disease: diagnosis and management. Mayo Clin Proc 85(5):483–500PubMedCrossRefGoogle Scholar
  2. 2.
    Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M (2006) Burden of valvular heart diseases: a population-based study. Lancet 368(9540):1005–1011PubMedCrossRefGoogle Scholar
  3. 3.
    Orsinelli DA, Aurigemma GP, Battista S, Krendel S, Gaasch WH (1993) Left ventricular hypertrophy and mortality after aortic valve replacement for aortic stenosis. A high risk subgroup identified by preoperative relative wall thickness. J Am Coll Cardiol 22(6):1679–1683PubMedCrossRefGoogle Scholar
  4. 4.
    Casale PN, Devereux RB, Milner M, Zullo G, Harshfield GA, Pickering TG, Laragh JH (1986) Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men. Ann Intern Med 105(2):173–178PubMedGoogle Scholar
  5. 5.
    Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP (1990) Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 322(22):1561–1566PubMedCrossRefGoogle Scholar
  6. 6.
    Ghali JK, Liao Y, Simmons B, Castaner A, Cao G, Cooper RS (1992) The prognostic role of left ventricular hypertrophy in patients with or without coronary artery disease. Ann Intern Med 117(10):831–836PubMedGoogle Scholar
  7. 7.
    Kannel WB, Schatzkin A (1985) Sudden death: lessons from subsets in population studies. J Am Coll Cardiol 5(6 Suppl):141B–149BPubMedCrossRefGoogle Scholar
  8. 8.
    Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH (1991) Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 114(5):345–352PubMedGoogle Scholar
  9. 9.
    Cosgrove DM, Lytle BW, Gill CC, Golding LA, Stewart RW, Loop FD, Williams GW (1985) In vivo hemodynamic comparison of porcine and pericardial valves. J Thorac Cardiovasc Surg 89(3):358–368PubMedGoogle Scholar
  10. 10.
    David TE, Armstrong S, Sun Z (1992) Clinical and hemodynamic assessment of the Hancock II bioprosthesis. Ann Thorac Surg 54(4):661–667 (discussion 667–668)Google Scholar
  11. 11.
    Kurnik PB, Innerfield M, Wachspress JD, Eldredge WJ, Waxman HL (1990) Left ventricular mass regression after aortic valve replacement measured by ultrafast computed tomography. Am Heart J 120(4):919–927PubMedCrossRefGoogle Scholar
  12. 12.
    Henry WL, Bonow RO, Borer JS, Kent KM, Ware JH, Redwood DR, Itscoitz SB, McIntosh CL, Morrow AG, Epstein SE (1980) Evaluation of aortic valve replacement in patients with valvular aortic stenosis. Circulation 61(4):814–825PubMedCrossRefGoogle Scholar
  13. 13.
    Giannini C, Petronio AS, Talini E, De Carlo M, Guarracino F, Grazia M, Donne D, Nardi C, Conte L, Barletta V, Marzilli M, Di Bello V (2011) Early and late improvement of global and regional left ventricular function after transcatheter aortic valve implantation in patients with severe aortic stenosis: an echocardiographic study. Am J Cardiovasc Dis 1(3):264–273PubMedGoogle Scholar
  14. 14.
    Lindqvist P, Bajraktari G, Molle R, Palmerini E, Holmgren A, Mondillo S, Henein MY (2010) Valve replacement for aortic stenosis normalizes subendocardial function in patients with normal ejection fraction. Eur J Echocardiogr 11(7):608–613PubMedCrossRefGoogle Scholar
  15. 15.
    Rost C, Korder S, Wasmeier G, Wu M, Klinghammer L, Flachskampf FA, Daniel WG, Voigt JU (2010) Sequential changes in myocardial function after valve replacement for aortic stenosis by speckle tracking echocardiography. Eur J Echocardiogr 11(7):584–589PubMedCrossRefGoogle Scholar
  16. 16.
    Delgado V, Tops LF, van Bommel RJ, van der Kley F, Marsan NA, Klautz RJ, Versteegh MI, Holman ER, Schalij MJ, Bax JJ (2009) Strain analysis in patients with severe aortic stenosis and preserved left ventricular ejection fraction undergoing surgical valve replacement. Eur Heart J 30(24):3037–3047PubMedCrossRefGoogle Scholar
  17. 17.
    He GW, Grunkemeier GL, Gately HL, Furnary AP, Starr A (1995) Up to thirty-year survival after aortic valve replacement in the small aortic root. Ann Thorac Surg 59(5):1056–1062PubMedCrossRefGoogle Scholar
  18. 18.
    Lund O, Pilegaard HK, Magnussen K, Knudsen MA, Nielsen TT, Albrechtsen OK (1990) Long-term prosthesis-related and sudden cardiac-related complications after valve replacement for aortic stenosis. Ann Thorac Surg 50(3):396–406PubMedCrossRefGoogle Scholar
  19. 19.
    Lytle BW, Cosgrove DM, Taylor PC, Goormastic M, Stewart RW, Golding LA, Gill CC, Loop FD (1989) Primary isolated aortic valve replacement. Early and late results. J Thorac Cardiovasc Surg 97(5):675–694PubMedGoogle Scholar
  20. 20.
    Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM, Shah PM, Shanewise JS, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 48(3):e1–e148Google Scholar
  21. 21.
    Dinh W, Nickl W, Smettan J, Kramer F, Krahn T, Scheffold T, Barroso MC, Brinkmann H, Koehler T, Lankisch M, Futh R (2010) Reduced global longitudinal strain in association to increased left ventricular mass in patients with aortic valve stenosis and normal ejection fraction: a hybrid study combining echocardiography and magnetic resonance imaging. Cardiovasc Ultrasound 8:29PubMedCrossRefGoogle Scholar
  22. 22.
    Zito C, Salvia J, Cusma-Piccione M, Antonini-Canterin F, Lentini S, Oreto G, Di Bella G, Montericcio V, Carerj S (2011) Prognostic significance of valvuloarterial impedance and left ventricular longitudinal function in asymptomatic severe aortic stenosis involving three-cuspid valves. Am J Cardiol 108(10):1463–1469PubMedCrossRefGoogle Scholar
  23. 23.
    Meimoun P, Elmkies F, Benali T, Boulanger J, Zemir H, Clerc J, Luycx-Bore A (2011) Assessment of left ventricular twist mechanics by two-dimensional strain in severe aortic stenosis with preserved ejection fraction. Ann Cardiol Angeiol (Paris) 60(5):259–266CrossRefGoogle Scholar
  24. 24.
    Carasso S, Cohen O, Mutlak D, Adler Z, Lessick J, Aronson D, Reisner SA, Rakowski H, Bolotin G, Agmon Y (2011) Relation of myocardial mechanics in severe aortic stenosis to left ventricular ejection fraction and response to aortic valve replacement. Am J Cardiol 107(7):1052–1057PubMedCrossRefGoogle Scholar
  25. 25.
    Poulsen SH, Sogaard P, Nielsen-Kudsk JE, Egeblad H (2007) Recovery of left ventricular systolic longitudinal strain after valve replacement in aortic stenosis and relation to natriuretic peptides. J Am Soc Echocardiogr 20(7):877–884PubMedCrossRefGoogle Scholar
  26. 26.
    Blessberger H, Binder T (2010) Two dimensional speckle tracking echocardiography: clinical applications. Heart 96(24):2032–2040PubMedCrossRefGoogle Scholar
  27. 27.
    Blessberger H, Binder T (2010) NON-invasive imaging: two dimensional speckle tracking echocardiography: basic principles. Heart 96(9):716–722PubMedCrossRefGoogle Scholar
  28. 28.
    Miyazaki S, Daimon M, Miyazaki T, Onishi Y, Koiso Y, Nishizaki Y, Ichikawa R, Chiang SJ, Makinae H, Suzuki H, Daida H (2011) Global longitudinal strain in relation to the severity of aortic stenosis: a two-dimensional speckle-tracking study. Echocardiography 28(7):703–708PubMedCrossRefGoogle Scholar
  29. 29.
    Hyodo E, Arai K, Koczo A, Shimada YJ, Fujimoto K, Di Tullio MR, Homma S, Gillam LD, Hahn RT (2012) Alteration in subendocardial and subepicardial myocardial strain in patients with aortic valve stenosis: an early marker of left ventricular dysfunction? J Am Soc Echocardiogr 25(2):153–159PubMedCrossRefGoogle Scholar
  30. 30.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463PubMedCrossRefGoogle Scholar
  31. 31.
    Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA (2002) Recommendations for quantification of doppler echocardiography: a report from the doppler quantification task force of the nomenclature and standards committee of the American Society of Echocardiography. J Am Soc Echocardiogr 15(2):167–184PubMedCrossRefGoogle Scholar
  32. 32.
    Sanderson JE, Wang M, Yu CM (2004) Tissue doppler imaging for predicting outcome in patients with cardiovascular disease. Curr Opin Cardiol 19(5):458–463PubMedCrossRefGoogle Scholar
  33. 33.
    Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quinones M (2009) Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 22(1):1–23 (quiz 101–102)Google Scholar
  34. 34.
    Christakis GT, Joyner CD, Morgan CD, Fremes SE, Buth KJ, Sever JY, Rao V, Panagiotopoulos KP, Murphy PM, Goldman BS (1996) Left ventricular mass regression early after aortic valve replacement. Ann Thorac Surg 62(4):1084–1089PubMedCrossRefGoogle Scholar
  35. 35.
    Marcus ML, Doty DB, Hiratzka LF, Wright CB, Eastham CL (1982) Decreased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries. N Engl J Med 307(22):1362–1366PubMedCrossRefGoogle Scholar
  36. 36.
    Rajappan K, Rimoldi OE, Dutka DP, Ariff B, Pennell DJ, Sheridan DJ, Camici PG (2002) Mechanisms of coronary microcirculatory dysfunction in patients with aortic stenosis and angiographically normal coronary arteries. Circulation 105(4):470–476PubMedCrossRefGoogle Scholar
  37. 37.
    Carabello BA (2002) Clinical practice. Aortic stenosis. N Engl J Med 346(9):677–682PubMedCrossRefGoogle Scholar
  38. 38.
    Carabello BA, Green LH, Grossman W, Cohn LH, Koster JK, Collins JJ Jr (1980) Hemodynamic determinants of prognosis of aortic valve replacement in critical aortic stenosis and advanced congestive heart failure. Circulation 62(1):42–48PubMedCrossRefGoogle Scholar
  39. 39.
    Carabello BA (2002) Ventricular function in aortic stenosis: how low can you go? J Am Coll Cardiol 39(8):1364–1365PubMedCrossRefGoogle Scholar
  40. 40.
    Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, Galderisi M, Marwick T, Nagueh SF, Sengupta PP, Sicari R, Smiseth OA, Smulevitz B, Takeuchi M, Thomas JD, Vannan M, Voigt JU, Zamorano JL (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr 24(3):277–313PubMedCrossRefGoogle Scholar
  41. 41.
    Geyer H, Caracciolo G, Abe H, Wilansky S, Carerj S, Gentile F, Nesser HJ, Khandheria B, Narula J, Sengupta PP (2010) Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr 23(4):351–369 (quiz 453–355)Google Scholar
  42. 42.
    Ng AC, Delgado V, Bertini M, Antoni ML, van Bommel RJ, van Rijnsoever EP, van der Kley F, Ewe SH, Witkowski T, Auger D, Nucifora G, Schuijf JD, Poldermans D, Leung DY, Schalij MJ, Bax JJ (2011) Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction: a two-dimensional speckle tracking analysis. Eur Heart J 32(12):1542–1550PubMedCrossRefGoogle Scholar
  43. 43.
    Lafitte S, Perlant M, Reant P, Serri K, Douard H, DeMaria A, Roudaut R (2009) Impact of impaired myocardial deformations on exercise tolerance and prognosis in patients with asymptomatic aortic stenosis. Eur J Echocardiogr 10(3):414–419PubMedCrossRefGoogle Scholar
  44. 44.
    Popescu BA, Calin A, Beladan CC, Muraru D, Rosca M, Deleanu D, Lancellotti P, Antonini-Canterin F, Nicolosi GL, Ginghina C (2010) Left ventricular torsional dynamics in aortic stenosis: relationship between left ventricular untwisting and filling pressures. A two-dimensional speckle tracking study. Eur J Echocardiogr 11(5):406–413PubMedCrossRefGoogle Scholar
  45. 45.
    Yingchoncharoen T, Gibby C, Rodriguez LL, Grimm RA, Marwick TH (2012) Association of myocardial deformation with outcome in asymptomatic aortic stenosis with normal ejection 819 fraction. Circ Cardiovasc Imaging 5(6):719–725Google Scholar
  46. 46.
    Sutton M, Plappert T, Spiegel A, Raichlen J, Douglas P, Reichek N, Edmunds L (1987) Early postoperative changes in left ventricular chamber size, architecture, and function in aortic stenosis and aortic regurgitation and their relation to intraoperative changes in afterload: a prospective two-dimensional echocardiographic study. Circulation 76(1):77–89PubMedCrossRefGoogle Scholar
  47. 47.
    Taniguchi K, Takahashi T, Toda K, Matsue H, Shudo Y, Shintani H, Mitsuno M, Sawa Y (2007) Left ventricular mass: impact on left ventricular contractile function and its reversibility in patients undergoing aortic valve replacement. Eur J Cardiothorac Surg 32(4):588–595PubMedCrossRefGoogle Scholar
  48. 48.
    Panidis IP, Kotler MN, Ren JF, Mintz GS, Ross J, Kalman P (1984) Development and regression of left ventricular hypertrophy. J Am Coll Cardiol 3(5):1309–1320PubMedCrossRefGoogle Scholar
  49. 49.
    Lund O, Erlandsen M (2000) Changes in left ventricular function and mass during serial investigations after valve replacement for aortic stenosis. J Heart Valve Dis 9(4):583–593PubMedGoogle Scholar
  50. 50.
    Biederman RW, Doyle M, Yamrozik J, Williams RB, Rathi VK, Vido D, Caruppannan K, Osman N, Bress V, Rayarao G, Biederman CM, Mankad S, Magovern JA, Reichek N (2005) Physiologic compensation is supranormal in compensated aortic stenosis: does it return to normal after aortic valve replacement or is it blunted by coexistent coronary artery disease? An intramyocardial magnetic resonance imaging study. Circulation 112(9 Suppl):I429–I436PubMedGoogle Scholar
  51. 51.
    Monrad ES, Hess OM, Murakami T, Nonogi H, Corin WJ, Krayenbuehl HP (1988) Time course of regression of left ventricular hypertrophy after aortic valve replacement. Circulation 77(6):1345–1355PubMedCrossRefGoogle Scholar
  52. 52.
    Tasca G, Brunelli F, Cirillo M, DallaTomba M, Mhagna Z, Troise G, Quaini E (2005) Impact of valve prosthesis-patient mismatch on left ventricular mass regression following aortic valve replacement. Ann Thorac Surg 79(2):505–510PubMedCrossRefGoogle Scholar
  53. 53.
    Tasca G, Brunelli F, Cirillo M, Dalla Tomba M, Mhagna Z, Troise G, Quaini E (2005) Impact of the improvement of valve area achieved with aortic valve replacement on the regression of left ventricular hypertrophy in patients with pure aortic stenosis. Ann Thorac Surg79(4):1291–1296 (discussion 1296)Google Scholar
  54. 54.
    Mhagna Z, Tasca G, Brunelli F, Cirillo M, Amaducci A, DallaTomba M, Troise G (2006) Effect of the increase in valve area after aortic valve replacement with a 19-mm aortic valve prosthesis on left ventricular mass regression in patients with pure aortic stenosis. J Cardiovasc Med (Hagerstown) 7(5):351–355CrossRefGoogle Scholar
  55. 55.
    Ali A, Patel A, Ali Z, Abu-Omar Y, Saeed A, Athanasiou T, Pepper J (2011) Enhanced left ventricular mass regression after aortic valve replacement in patients with aortic stenosis is associated with improved long-term survival. J Thorac Cardiovasc Surg 142(2):285–291PubMedCrossRefGoogle Scholar
  56. 56.
    Maselli D, Pizio R, Bruno LP, Di Bella I, De Gasperis C (1999) Left ventricular mass reduction after aortic valve replacement: homografts, stentless and stented valves. Ann Thorac Surg 67(4):966–971PubMedCrossRefGoogle Scholar
  57. 57.
    Gaudino M, Glieca F, Luciani N, Cellini C, Morelli M, Girola F, Guarini G, Possati G (2004) Left ventricular mass regression after aortic valve replacement for aortic stenosis: time course and determinants. J Heart Valve Dis 13(Suppl 1):S55–S58PubMedGoogle Scholar
  58. 58.
    Hanayama N, Christakis GT, Mallidi HR, Rao V, Cohen G, Goldman BS, Fremes SE, Morgan CD, Joyner CD (2005) Determinants of incomplete left ventricular mass regression following aortic valve replacement for aortic stenosis. J Card Surg 20(4):307–313PubMedCrossRefGoogle Scholar
  59. 59.
    Kuhl HP, Franke A, Puschmann D, Schondube FA, Hoffmann R, Hanrath P (2002) Regression of left ventricular mass one year after aortic valve replacement for pure severe aortic stenosis. Am J Cardiol 89(4):408–413PubMedCrossRefGoogle Scholar
  60. 60.
    Kearney LG, Lu K, Ord M, Patel SK, Profitis K, Matalanis G, Burrell LM, Srivastava PM (2012) Global longitudinal strain is a strong independent predictor of all-cause mortality in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging 13(10):827–833PubMedCrossRefGoogle Scholar
  61. 61.
    Levy F, Debry N, Labescat AL, Meimoun P, Malaquin D, Marechaux S, Rusinaru D, Jeu A, Ennezat PV, Castel AL, Tribouilloy C (2012) Echocardiographic prediction of postoperative atrial fibrillation after aortic valve replacement for aortic stenosis: a two-dimensional speckle tracking left ventricular longitudinal strain multicentre pilot study. Arch Cardiovasc Dis 105(10):499–506PubMedCrossRefGoogle Scholar
  62. 62.
    Bauer F, Mghaieth F, Dervaux N, Donal E, Derumeaux G, Cribier A, Bessou JP (2008) Preoperative tissue doppler imaging differentiates beneficial from detrimental left ventricular hypertrophy in patients with surgical aortic stenosis. A postoperative morbidity study. Heart 94(11):1440–1445PubMedCrossRefGoogle Scholar
  63. 63.
    Chan J, Hanekom L, Wong C, Leano R, Cho GY, Marwick TH (2006) Differentiation of subendocardial and transmural infarction using two-dimensional strain rate imaging to assess short-axis and long-axis myocardial function. J Am Coll Cardiol 48(10):2026–2033PubMedCrossRefGoogle Scholar
  64. 64.
    Kansal MM, Panse PM, Abe H, Caracciolo G, Wilansky S, Tajik AJ, Khandheria BK, Sengupta PP (2012) Relationship of contrast-enhanced magnetic resonance imaging-derived intramural scar distribution and speckle tracking echocardiography-derived left ventricular two-dimensional strains. Eur Heart J Cardiovasc Imaging 13(2):152–158PubMedCrossRefGoogle Scholar
  65. 65.
    Del Rizzo DF, Abdoh A, Cartier P, Doty D, Westaby S (1999) Factors affecting left ventricular mass regression after aortic valve replacement with stentless valves. Semin Thorac Cardiovasc Surg 11(4 Suppl 1):114–120PubMedGoogle Scholar
  66. 66.
    Meester GT, Brower RW, Hugenholtz PG (1982) Regression of left ventricular wall mass index after coronary artery bypass surgery (CBS) in a group of patients with stable angina pectoris. Eur Heart J 3(Suppl A):155–160PubMedCrossRefGoogle Scholar
  67. 67.
    Opdahl A, Helle-Valle T, Remme EW, Vartdal T, Pettersen E, Lunde K, Edvardsen T, Smiseth OA (2008) Apical rotation by speckle tracking echocardiography: a simplified bedside index of left ventricular twist. J Am Soc Echocardiogr 21(10):1121–1128PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Adam Staron
    • 1
    • 5
  • Manish Bansal
    • 2
  • Piyush Kalakoti
    • 2
  • Ayumi Nakabo
    • 2
  • Zbigniew Gasior
    • 1
    • 5
  • Piotr Pysz
    • 1
    • 5
  • Krystian Wita
    • 4
    • 5
  • Marek Jasinski
    • 3
    • 5
  • Partho P. Sengupta
    • 2
  1. 1.2nd Cardiology DepartmentMedical University of SilesiaKatowicePoland
  2. 2.Zena and Michael A. Wiener Cardiovascular InstituteThe Mount Sinai Medical CenterNew YorkUSA
  3. 3.2nd Cardiac Surgery DepartmentMedical University of SilesiaKatowicePoland
  4. 4.1st Cardiology DepartmentMedical University of SilesiaKatowicePoland
  5. 5.Cardiology DepartmentEuromedic Medical CenterKatowicePoland

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