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reduction or even loss of LV twist was observed in making?European Heart Journal (2016) 37, 1196–1207
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sional speckle tracking echocardiography: technical aspects and clinical
Case Examples: (Fig2) applicationsResearch Reports in Clinical Cardiology 2016,7: 147—158
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Echo evaluation from a control nondiabetic non-hy- 6. Rubler S, Dlugash J, Yuceoglu YZ, Kumral T, Branwood AW, Grishman A.
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Am J Cardiol. 1972;30:595–602.
ratio, Deceleration time, E/e’ ratio and apical counter
clockwise and basal clockwise rotation. Normal val- 7. Seferović PM, Paulus WJ. Clinical diabetic cardiomyopathy: a twofaced dis-
ues for LV rotation and net twist angle in a recent ease with restrictive and dilated phenotypes. Eur Heart J. 2015;36:1718–
1727–1727a–c.
study of a large group of healthy volunteers reported
a mean value of peak LV twist angle as 7.7 ± 3.5° 8. Lang, R.M., Bierig, M., Devereux, R.B., Flachskampf, F.A., Foster, E., Pel-
likka, P.A. et al. Recommendations for chamber quantification: a report
B. EarlyDiabetes without LV hypertrophy. Note the from the American Society of Echocardiography’s Guidelines and Standards
attenuation of E wave or early filling wave, prolon- Committee and the Chamber Quantification Writing Group, developed in
gation of the deceleration time and accentuation conjunction with the European Association of Echocardiography, a branch
of A wave or atrial filling velocities. There is also of the European Society of Cardiology. J Am SocEchocardiogr. 2005; 18:
1440–1463
alteration of E/e’ ratio. Note less prominent initial
clockwise twist, higher peak twist, delayed time 9. Galderisi M. Diastolic dysfunction and diabetic cardiomyopathy: evaluation
to peak and lower untwisting during early diastole by Doppler echocardiography. J Am Coll Cardiol 2006; 48:1548.
in this patient, compared with the normal subject. 10. Bouchard A, Sanz N, Botvinick EH, et al. Noninvasive assessment of
C. Advanced Diabetes and Left ventricular hypertro- cardiomyopathy in normotensive diabetic patients between 20 and 50
years old. Am J Med 1989; 87:160.
phy and normal Ejection fraction. Note the Pseudo
normalization with normal E/A ratio, Deceleration 11. Pérez JE, McGill JB, Santiago JV, et al. Abnormal myocardial acoustic prop-
erties in diabetic patients and their correlation with the severity of disease.
time and abnormal E/e’. Note the relatively preserved J Am Coll Cardiol 1992; 19:1154.
LV twist mechanics, although LV twisting and un-
twisting velocities, are both attenuated and delayed. 12. MenhelKinno, Alfonso H. Waller and Julius M. Gardin. Approach-
es-to-echocardiographic-assessment-of-left-ventricular-mass. What does
D. Diabetic Cardiomyopathy and reduced Ejection the echocardiography add? Expert analysis. American College of Cardi-
Fraction: Note the abnormally increased E/A ratio, de- ology 2016 Feb 3
creased deceleration time and E/e’. There is marked 13. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac
reduction in amplitude of apical counter clockwise chamber quantification by echocardiography in adults: an update from
and basal clockwise rotation. the American Society of Echocardiography and the European Association
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Evaluation of all diabetic patients with echocardiog- hypertension. Ann Intern Med 1991;114:345-52.
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leads to detection of early and preventable changes. graphic measurement of left ventricular mass: comparison with magnetic
Thus, the treatment approaches may be changed resonance imaging and two-dimensional echocardiographic determinations
in these conditions to include the cardio protective in man. Int J Card Imaging 2000;16:347-57.
drugs, for an example DPP4 inhibitors and statins. 16. Mor-Avi V, Sugeng L, Weinert L, et al. Fast measurement of left ventricular
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