Left ventricular rotational mechanics in patients with coronary artery disease: differences in subendocardial and subepicardial layers

ObjectiveSubendocardial and subepicardial layers have opposite orientation of the myofibres and they are differently affected by coronary artery disease. This study investigated the differences in subendocardial and subepicardial left ventricular (LV) twist in patients with coronary artery disease.Methods214 patients were included in the study: 60 with first ST elevation myocardial infarction (STEMI), 111 with chronic ischaemic heart failure (HF) and 43 normal subjects. Real-time three-dimensional echocardiography provided LV volumes and function. Two-dimensional speckle tracking echocardiography differentiating the subendocardial and subepicardial layers was used for the assessment of LV twist. Patients with STEMI were divided into two groups (small and large STEMI).ResultsCompared with normal subjects, peak subendocardial LV twist was significantly impaired in patients with STEMI (11.2±6.0° vs 15.3±2.7°, p