Changes in left ventricular wall motion after coronary artery bypass surgery: signal or noise?

Jeppson, G M; Clayton, Paul D.; Blair, T J; Liddle, Harold V.; Jensen, Robert L.; Klausner, Steven C.

doi:10.1161/01.cir.64.5.945

Cited by 21 publications

(8 citation statements)

References 26 publications

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“…Similar to our findings, stent revascularization of chronic total coronary occlusion has been shown to increase wall thickening in dysfunctional segments, but decrease wall thickening in remote segments, with no net change in ejection fraction [24]. Also, ventriculography has been used to report improved regional wall motion in hypokinetic segments but also simultaneous deterioration in wall motion in initially normokinetic segments [25]. Our findings of simultaneous improvement and deterioration of regional function in segments of different baseline functional status seems reasonable considering the lack of change in LVEF in our population.…”

Section: Discussionsupporting

confidence: 82%

Chronic non-transmural infarction has a delayed recovery of function following revascularization

Cain

Johnsson

Palmer

et al. 2010

BMC Cardiovasc Disord

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BackgroundThe time course of regional functional recovery following revascularization with regards to the presence or absence of infarction is poorly known. We studied the effect of the presence of chronic non-transmural infarction on the time course of recovery of myocardial perfusion and function after elective revascularization.MethodsEighteen patients (mean age 69, range 52-84, 17 men) prospectively underwent cine magnetic resonance imaging (MRI), delayed contrast enhanced MRI and rest/stress 99m-Tc-tetrofosmin single photon emission computed tomography (SPECT) before, one and six months after elective coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).ResultsDysfunctional myocardial segments (n = 337/864, 39%) were classified according to the presence (n = 164) or absence (n = 173) of infarction. Infarct transmurality in dysfunctional segments was largely non-transmural (transmurality = 31 ± 22%). Quantitative stress perfusion and wall thickening increased at one month in dysfunctional segments without infarction (p < 0.001), with no further improvement at six months. Despite improvements in stress perfusion at one month (p < 0.001), non-transmural infarction displayed a slower and lesser improvement in wall thickening at one (p < 0.05) and six months (p < 0.001).ConclusionsDysfunctional segments without infarction represent repetitively stunned or hibernating myocardium, and these segments improved both perfusion and function within one month after revascularization with no improvement thereafter. Although dysfunctional segments with non-transmural infarction improved in perfusion at one month, functional recovery was mostly seen between one and six months, possibly reflecting a more severe ischemic burden. These findings may be of value in the clinical assessment of regional functional recovery in the time period after revascularization.

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Section: Discussionsupporting

confidence: 82%

Chronic non-transmural infarction has a delayed recovery of function following revascularization

Cain

Johnsson

Palmer

et al. 2010

BMC Cardiovasc Disord

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“…It is not valid, however, to assume from our data that regions displaying hypokinesis are infarcted, since hypokinesis sometimes develops in normally perfused myocardium adjacent to areas of ischemia.11 It should be noted that simply scoring wall motion by defining hypokinesis or akinesis as "present" if motion falls below an arbitrary threshold limits interpretation of the data and decreases accuracy because variability in the measurement could push a value across a threshold in the absence of real abnormality or hide a significant change because it fails to cross the threshold. 49 As suggested by Shepertycki et al,15 appreciation of abnormal motion may be enhanced by displaying the patient's motion against the predicted normal motion. This can be easily performed by the centerline method by altering the length of the patient's motion chords to equal the normal mean motion of that chord and displaying the chords together with the patient's enddiastolic and end-systolic contours ( figure 7).…”

Section: Discussionmentioning

confidence: 99%

Advantages and applications of the centerline method for characterizing regional ventricular function.

Sheehan¹,

Bolson²,

Dodge³

et al. 1986

Circulation

577

179

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We sought to identify theoretical advantages and applications of the centerline method for quantitative assessment of regional ventricular function. Motion was measured along 100 chords constructed perpendicular to a centerline drawn midway between the end-diastolic and end-systolic contours, and normalized for heart size. Abnormality was expressed in units of standard deviations from the mean motion in a normal reference population to indicate both the severity and significance of the wall motion abnormality. The mean abnormality averaged over 100 chords correlated highly with the area ejection fraction (r = .97). The centerline method uses a "sliding window" to measure motion where it is abnormal, because assessment of wall motion in predefined regions of the ventricular contour underestimates abnormality. From the 100 data points, the extent (% of contour) of regional abnormalities can also be determined. The

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“…Realignment decreased variability significantly at only 3 chords at the apex in the study-to-study comparison, even though it had the greatest variability in rotational angle. This suggests that variability in cardi- 27 Jeppson et al27 discussed the problem of regression toward the mean, the tendency for improvement to appear on follow-up study due to statistical unlikelihood that the same sample will show severe abnormality more than once. We avoid this problem by comparing motion in the most abnormally contracting region in the first study with motion in the most abnormally contracting region in the second study, keeping the length of the region constant.…”

Section: Discussionmentioning

confidence: 99%

Variability in the measurement of regional left ventricular wall motion from contrast angiograms.

Sheehan¹,

Stewart²,

Dodge³

et al. 1983

Circulation

139

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Four types of variability affecting quantification of regional wall motion from contrast left ventriculograms (LVgrams) were studied. These included beat-to-beat variability in 24 LVgrams, intraobserver and interobserver variability in 20 LVgrams, and study-to-study variability in serial LVgrams of 21 patients with stable coronary artery disease. Motion was measured at 100 equidistant chords perpendicular to a center line drawn midway between the end-diastolic and end-systolic contours and normalized for heart size. Variability was computed as the absolute difference between observations. Beat-to-beat, intraobserver, and interobserver variability at the 100 chords were similar, averaging 14%, 14%, and 17%, respectively, of the mean motion in 64 patients with normal ventriculograms. Study-to-study variability was significantly higher, averaging 30% of mean normal motion, but was reduced when regional motion was calculated as the mean motion of chords within a region of interest. Variability peaked at the apex. Realignment to correct for cardiac rotation significantly increased variability. Investigators whose methods of wall motion analysis rely on identification of the apex as a landmark should be aware of this source of potential variability and error. Circulation 68, No. 3, 550-559, 1983. IT HAS LONG BEEN KNOWN that coronary artery stenosis results in abnormal regional left ventricular wall motion. ' Early studies in which wall motion was gauged subjectively were hampered by large interobserver variability that resulted in poor reproducibility of results.2-More recently, quantitative methods of measuring regional wall motion have been developed. With these methods, wall motion abnormalities in patients with coronary artery and valvular disease have been measured and related to the site and severity of coronary disease, to the amount of fibrosis in infarcted myocardium, and to the development of congestive heart failure.5'-' The reproducibility or variability in motion measurements by the various quantitative methods, however, has not yet been determined. Knowledge of variability is necessary to gauge the significance of measured abnormalities in wall motion and of changes observed in serial studies performed to assess progression of disease or response to a therapeutic intervention. Therefore, our study was performed to determine

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Changes in left ventricular wall motion after coronary artery bypass surgery: signal or noise?

Cited by 21 publications

References 26 publications

Chronic non-transmural infarction has a delayed recovery of function following revascularization

Chronic non-transmural infarction has a delayed recovery of function following revascularization

Advantages and applications of the centerline method for characterizing regional ventricular function.

Variability in the measurement of regional left ventricular wall motion from contrast angiograms.

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