Torsional adaptations in the left ventricle post-myocardial infarction

Tanmay Mukherjee, Emilio E Mendiola, Reza Avazmohammadi
Texas A&M University


Abstract

Myocardial infarction (MI) induces cardiomyocyte death and subsequent scar formation, triggering functional adaptations of the left ventricle (LV). LV torsion during contraction, resulting from the helical arrangement of myofibers in the myocardium, is a vital part of normal systolic function. LV torsion can be measured regionally and complements conventional indices used to characterize LV systolic function. We hypothesize that region-specific LV torsion can provide added prognostic value to LV functional indices such as ejection fraction (LVEF). MI was induced in rats by ligating the left anterior descending artery. Rats were evaluated at 2 weeks post-MI (n=3) and 4 weeks post-MI (n=3). Control rats received sham surgery (n=3). An in-house short-axis speckle tracking echocardiography framework was used to calculate regional myocardial wall rotations at basal, mid-wall, and apical slices. Regional peak torsion was then calculated relative to basal and midwall slices. A progressive decrease in LVEF indicated impaired systolic function, with the lowest values at week 4. A significant drop in all the regional torsions (midwall and apical relative to basal and apical relative to midwall) was noted post-MI. Interestingly, while the reduction in LVEF was insignificant, a significant drop in torsion was evident in week 2 and statistically maintained in week 4 for regional torsions relative to the basal slice. The reduction in torsion can be attributed to the presence of a non-contractile scar and geometric and architectural changes in the LV. While reduced LVEF is a crucial indicator of LV systolic dysfunction, assessing regional kinematic changes such as torsion may provide mechanistic insights into LV remodeling and add prognostic value to global indices of LV function in MI.