Effects of Postischemic Regional Left Ventricular Diastolic Wall Motion Abnormalities or Delayed Relaxation Following Coronary Vasospasm on Global Diastolic Function

Abstract

bnormalities of left ventricular (LV) filling and relaxation are sensitive early signs of myocardial ischemia in acute experiments involving animals and humans. [1][2][3][4] It is reasonable to assume that good quantitative analysis methods should detect differences between ischemic and non-ischemic myocardium very accurately. A number of non-invasive indexes of diastolic function have been proposed by the analysis of M-mode echocardiograms, Doppler LV filling velocity patterns, and radionuclide ventriculograms. [5][6][7] Diastolic function as assessed with these indexes is frequently abnormal, even in patients with ischemic heart disease in whom systolic function is maintained within normal ranges. [5][6][7] Indeed, the beginning of the regional LV outward wall motion in the isovolumic relaxation phase is delayed in the coronary involved region. 5,6 Because the impaired region is confined to the underperfused area of the involved coronary arteries, and ischemic damage may not necessarily result in impaired global LV diastolic function; the measure of the LV regional diastolic function may provide a more sensitive estimate of the coronary involved region than the measure Circulation Journal Vol.69, April 2005 of global LV function. 8,9 Color kinesis (CK; Philips Medical Systems, Andover, MA, USA) has been recently developed to facilitate the echocardiographic evaluation of regional wall motion. 10,11 Recently, we have found using this method, that impaired or stunned regional diastolic function with delayed outward wall motion persisted beyond recovery of ischemia commonly in patients with coronary vasospasm. [12][13][14] This diastolic dysfunction is specifically caused by postischemic damage because it is completely recovered. The present study was designed to determine how the global diastolic function was affected by impaired regional LV wall motion or diastolic asynchrony following coronary vasospasm in patients with single or multivessel coronary vasospasm. Methods Study PatientsConsecutive 18 patients (11 men and 7 women with a mean age of 62±9 years; range: 37-77 years) with variant angina having a recent history of repetitive angina, coronary vasospasm induced by intracoronary injection of acetylcholine during coronary arteriography, good echocardiographic image quality and adequate tracking by CK but without any types of arrhythmias or conduction disturbance, were subjected to the present study. Patients with a significant (>75% luminal diameter) organic coronary stenosis or apparent systolic regional LV dysfunction were Background Regional left ventricular (LV) diastolic wall motion abnormalities detected by color kinesis (CK), an echocardiographic technique, may be a more sensitive measure to postischemic damage following coronary spasm than parameters of global diastolic function. Methods and ResultsRegional LV diastolic wall motion was evaluated by using CK in 18 patients with variant angina on the day following coronary spasm, which was induced by intracoronary acetylcholine. Fractional regiona...

Evaluation of left ventricular diastolic function using color kinesis

“…[13][14][15] In the present study, the mean CK-DI value for six LV segments in the normal subjects (30 ± 18 years) was 70.6%. This result indicated that approximately 70% of the maximum LV expansion Comparison between septal and free wall CK-DI in the four study groups.…”

“…16 The CK-diastolic index (CK-DI) was defi ned as the degree of LV segmental expansion during the fi rst 30% of diastole, expressed as a percentage. [13][14][15] The mean CK-DI, septal CK-DI, and free wall CK-DI were calculated from the average CK-DI of all segments, septal segments (asp, sp, inf), and free wall segments (ant, lat, pst), respectively. For each subject, data obtained from three diastolic CK images were averaged.…”

“…They reported that ischemia may be diagnosed by detecting diastolic stunning, a phenomenon wherein regional LV delayed relaxation or diastolic asynchrony persists for a few weeks after an ischemic event and subsequent recovery from LV contraction abnormalities in patients with coronary vasospasm. [13][14][15] Thus, diastolic CK images have been demonstrated to be promising in the assessment of LV diastolic function. The aim of this study was to determine the feasibility and usefulness of diastolic CK images with ICK software to objectively assess global and regional LV diastolic function.…”

Detection of Diastolic Abnormality by Dyssynchrony Imaging Correlation With Coronary Artery Disease in Patients Presenting With Visibly Normal Wall Motion

“…[3][4][5][6][7][8][9][10] It is frequently observed in patients with CAD presenting with LV asynergy. [23][24][25] Earlier studies have demonstrated the presence of abnormal diastolic function in patients with CAD without evidence of systolic wall motion abnormalities by radionuclide angiography or digitized cineangiography.…”

“…Both clinical [3][4][5] and animal studies [6][7][8][9][10] have demonstrated that PSS is related to myocardial ischemia.…”