Background:
Left ventricular systolic function assessment is the cornerstone of an echocardiographic examination. LV ejection fraction LVEF is the most commonly employed. It results from the combined action of basal and apical rotation, longitudinal and circumferential contraction and radial thickening. However, LVEF has many limitations; some of them related to the definition itself and others to imaging techniques (1, 2).
The characteristic double helical structure of myocardial fibers results in systolic rotation of the base and apex of the LV in opposite directions along its longitudinal axis, and the algebraic subtraction of this rotation causes LV twist. Due to this muscular movement, the base of the LV moves towards the apex, producing a longitudinal LV shortening (3). Therefore, systolic ventricular contraction results from the combined and simultaneous action of twisting and shortening of LV (Myocardial torsion) which is a fundamental component of cardiac function (4, 5).
Speckle tracking echocardiography (6) (STE) is a useful echocardiographic tool for evaluating myocardial function, due its high spatial and temporal resolution, good intra and interobserver reproducibility (7) , being independent of the insonation angle (8) and it is not affected by translational movements of the heart. It also employed in assessing the torsion mechanics including twist and untwist which has emerged as novel reliable quantitative parameters for the assessment of LV function. Twist and rotational parameters may contribute useful comprehensive information beyond the conventional indices of LV function. (9) Our aim in this study is to assess the effect of Sacubitril/Valsartan on the myocardial mechanics of the left ventricle in HFrEF patients.