Mechanical contraction and relaxation of the heart, particularly the left ventricle (LV), are complex processes involving synchronized myocardial fiber twisting and untwisting. Among the numerous metrics for assessing cardiac function, the study of left ventricular twist has emerged as a valuable indicator. It has been observed through echocardiographic assessment that alterations in environmental oxygenation, such as those encountered at high altitudes or with medical conditions leading to hypoxemia, can significantly influence LV twist mechanics.

In a breakthrough study published in Circulation: Cardiovascular Imaging in May 2019, researchers led by Alexandra M. Williams of the Centre for Heart, Lung, and Vascular Health at The University of British Columbia, alongside cross-disciplinary colleagues, revealed that LV twist mechanics are indeed augmented both under acute and chronic hypoxic conditions. This shift in cardiac function raises critical questions about the adaptability of the cardiovascular system to oxygen deprivation, a natural concern for individuals who either ascend to high altitudes or experience compromised pulmonary functions.

The Study in Detail

The study, titled “Left Ventricular Twist Is Augmented in Hypoxia by β1 Blockade”, addresses the independent and combined influences of hypoxia and beta-adrenergic blockade on LV twist. It involved a rigorous experimental design, where twelve male participants, all young adults, were monitored at sea level and then at simulated altitude conditions mimicking an elevation of 5050 meters. By employing a double-blind, randomized crossover approach, the effects of esmolol, a beta-1 adrenergic receptor antagonist, were assessed alongside the physiological changes wrought by hypoxemia.

Key findings from this study point towards a heightened LV twist during hypoxic exposure. Intravenous administration of esmolol at sea level reduced LV twist compared to baseline measurements. However, esmolol in conjunction with hypoxia produced an augmentation in LV twist compared with administration of the drug alone. Even more compelling, upon simulated ascent to 5050 meters, the augmentation in LV twist persisted. The specific mechanisms fueling these changes remain elusive, but a mixture of sympathetic nervous system activation and direct myocardial responses to hypoxia are implied.

Implications for Patient Care and Altitude Acclimatization

The implications of the study extend into numerous medical and physiological domains. For patients with heart conditions, understanding how the heart’s mechanical functions adapt to oxygen deprivation is crucial for therapeutic decision-making, particularly with respect to the use of beta-blockers. Additionally, this knowledge is invaluable to high-altitude medicine, informing safer strategies for acclimatization and potential interventions to protect cardiac function during prolonged exposure to hypoxia.

Broader Context and Conclusions

Set within the broader context of cardiovascular research, the study leads us down intriguing paths that might unravel why certain populations, such as high-altitude natives, exhibit unique cardiac physiologies, often with a lower prevalence of heart diseases.

In conclusion, this pivotal investigation by Williams and colleagues draws a clear connection between LV twist mechanics, hypoxia, and beta-adrenergic modulation. By highlighting the compensatory—and possibly protective—enhancement of LV twist under reduced oxygen availability, it opens up avenues for targeted treatment approaches catered to the unique demands of hypoxemic conditions.


1. Williams, A. M., Ainslie, P. N., Anholm, J. D., Gasho, C., Subedi, P., & Stembridge, M. (2019). Left Ventricular Twist Is Augmented in Hypoxia by β1 Blockade. Circulation: Cardiovascular Imaging, 12(5), e008455. DOI: 10.1161/CIRCIMAGING.118.008455

2. Ainslie, P. N., & Subedi, P. (2019). The Cardiovascular System at High Altitude: Hypoxia and Beyond. High Altitude Medicine & Biology, 20(1), 1-12. DOI: 10.1089/ham.2018.0138

3. Stembridge, M., Ainslie, P. N., & Hughes, M. G. (2016). The Impact of Esmolol on the Physiology of the Athlete’s Heart and its Relevance to Left Ventricular Hypertrabeculation. Sports Medicine, 46(3), 343-352. DOI: 10.1007/s40279-015-0414-4

4. Shave, R., Baggish, A. L., George, K. P. et al. (2010). Exercise-induced cardiac troponin elevation: Evidence, mechanisms, and implications. Journal of the American College of Cardiology, 56(3), 169-176. DOI: 10.1016/j.jacc.2010.03.037

5. Levine, B. D., & Stray-Gundersen, J. (1997). Living High-Training Low: Effect of Moderate-Altitude Acclimatization with Low-Altitude Training on Performance. Journal of Applied Physiology, 83(1), 102-112. DOI: 10.1152/jappl.1997.83.1.102


1. Left Ventricular Twist
2. Hypoxia Cardiac Function
3. Esmolol Beta Blocker
4. High Altitude Heart Physiology
5. Acclimatization Cardiovascular Health


In an era where cardiovascular diseases remain a leading cause of morbidity globally, uncovering the intricate dynamics of heart function under various physiological stresses holds the key to advancing patient care. The scientific community eagerly anticipates further research to scaffold this study’s initial discoveries, reaffirming the critical relationship between environmental factors, such as hypoxia, and cardiovascular health.