The impact of isometric handgrip testing on left ventricular twist mechanics

Key points Left ventricular twist (LVT) results from rotation of the LV apex and base in opposite directions. Although LVT is altered in various cardiac diseases, physiological factors that affect LVT remain incompletely understood. In an experimental model involving healthy humans, isometric handgrip testing (IHGT) was performed to produce a clinically relevant form of LV afterload increase. The impact of IHGT on LV twist mechanics was assessed using speckle-tracking echocardiography. IHGT produced significant increase in systemic blood pressure and acute reduction in LV stroke volume. In this setting, LV apical rotation and LVT significantly decreased. Impairment of LV twist mechanics may in part underlie the LV dysfunction that can occur in the clinical context of acute increase in afterload. Abstract Left ventricular (LV) rotation occurs due to contraction of obliquely oriented myocardial fibres. Left ventricular twist (LVT) results from rotation of the apex and base in opposite directions. Although LVT is altered in various cardiac diseases, physiological factors that affect LVT remain incompletely understood. Isometric handgrip testing (IHGT), a well-established laboratory-based technique to increase LV afterload, was performed for 3 min at 40% maximum force generation in healthy human subjects (n= 18, mean age 29.7 +/- 2.7 years). Speckle-tracking echocardiography was used to measure LV volumes, LV apical and basal rotation, peak systolic LVT and peak early diastolic untwisting rate (UTR) at rest and at peak IHGT. IHGT led to significant increase in systemic blood pressure (systolic, 120.6 +/- 9.7 vs. 155.6 +/- 14.5 mmHg, P < 0.001; diastolic, 67.5 +/- 6.4 vs. 94.1 +/- 21.1 mmHg, P < 0.001) and LV end-systolic volume (44.2 +/- 7.8 vs. 50.5 +/- 10.8 ml, P= 0.005), as well as a significant increase in heart rate (62.8 +/- 11.7 vs. 84.7 +/- 13.8 beats min-1; P < 0.001). IHGT produced a significant acute reduction in LV stroke volume (63.9 +/- 12.0 vs. 49.4 +/- 7.8 ml, P < 0.001). In this setting, there was a significant decrease in peak systolic apical rotation (11.9 +/- 3.0 vs. 8.6 +/- 2.2 deg, P < 0.001) and a resultant 25% decrease in peak systolic LVT (16.6 +/- 2.8 vs. 12.5 +/- 2.8 deg, P < 0.001). The magnitude of peak early diastolic UTR did not change (-114.5 +/- 26.4 vs. -110.6 +/- 39.8 deg s-1, P= 0.71). Peak systolic apical rotation and LVT decrease during IHGT in healthy humans. This impairment of LV twist mechanics may in part underlie the LV dysfunction that can occur in the clinical context of acute increase in afterload.