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.